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California’s skilled nursing facilities faced a major challenge starting in spring 2018. State-required staffing ratios were changing. To meet the new state requirements, facilities needed more certified nursing assistants (CNAs).
To help meet the new requirements, the governor issued a critical proposal calling for the Employment Training Panel (ETP) to award $2.5 million to reimburse skilled nursing facilities and other training providers for the cost of providing CNA training. ETP is a major funding source for workplace training and one that California community colleges rely upon in helping employers they work with cover the costs of upskilling current employees, or, in the case of the CNA training program, provide training for new employees. (Read more about ETP in our blog entry Supporting the Demand Side: ETP Subcontracting as a Strategy to Expand Workforce Training for Employers.)
A number of community colleges already held contracts with ETP, so they were in position to deliver a rapid response through their Contract Education units to help solve the CNA shortage. The California Community Colleges Contract Education Collaborative, a group comprised of the colleges’ Contract Education practitioners, responded to the governor’s critical proposal.
Contract Education units at community colleges help businesses and industries in California stay competitive, within the U.S. and globally, by creating and delivering customized training programs for their employees and/or helping them secure funding that covers a portion of their training costs.
The new state rules required skilled nursing facilities in California to meet a new standard of patient care starting in July 2018. Instead of the 3.2 nursing hours per patient day, facilities had to increase the amount of time staff is engaged with direct patient care to 3.5 nursing hours per patient day. And, the requirement specified at least 2.4 of the 3.5 hours must be provided by certified nursing assistants (CNAs). CNAs work under registered nurses or licensed vocational nurses and provide basic care to patients, helping them to eat, bathe and do other activities they cannot do on their own.
In some cases, facilities already had training programs in place, but needed help with the training costs. Windsor Chico Care Center in Chico, California, was one of them, having launched its CNA training program in 2015.
“It was kind of a financial hardship for us,” John Crowley, administrator at the Chico facility, said about implementing the program. “It was difficult to kind of take on the cost of the program, but the long-term benefits were certainly worth it.”
Crowley’s program qualified for ETP funding after extensive collaboration between community college Contract Education practitioners to pool existing resources and work with ETP to come up with a solution that created more CNA jobs to help skilled nursing facilities across the state.
Developing a Solution
Getting to the point of being able to reimburse skilled nursing facilities for training newly hired employees to become CNAs was no easy feat. It took the work of Contract Education units at six California community colleges and the involvement of the state’s Employment Training Panel to put the pieces in place, said Annie Rafferty, director of contract education, training and development at Butte College, The Training Place.
How could this existing pool of state funding be used to help address the CNA shortage? That’s the question the collaborative asked as its members worked together to develop a solution. They consulted industry experts, held a workshop to share information with skilled nursing facilities and gain deeper insight into their needs, attended conferences and worked directly with employers.
The solution involved a lengthy process by which the colleges worked together to modify each college’s ETP contract to include a clause that allowed employers to be reimbursed for training that led to CNA job creation.The participating colleges pooled their ETP funding to see how much money they could dedicate to reimbursing employers who trained newly hired employees to be CNAs. They compiled a list of facilities eligible for this performance-based funding, based on a number of factors, including which facilities had certified instructors and an approved program; a CNA turnover rate of 20% or less for the previous year; met the minimum hourly wage requirement and met the 90-day retention requirement.
While employers are reimbursed a portion of their training costs, not all of the costs associated with the training are offset.
“The employer is investing a significant amount of money in the training, in partnership with us because the CNA is being paid their wages during training,” Butte College’s Rafferty explained, adding that companies are reimbursed for costs related to delivering training, not employee wages.
Higher CNA retention rates, larger pool of applicants
Since the inception of the CNA training program in 2018, there have been 210 trainees across the state through programs that partner with Butte, Chaffey, College of the Sequoias, El Camino, Kern and San Bernardino colleges.
That includes trainees at the Windsor Chico Care Center, where 95% of CNA trainees passed the training and went on to become certified, as well as met the 90-day ETP retention requirement, thanks to the addition of an extra week of training, Rafferty said. The center has received ETP funding for seven cohorts of students, giving the facility $4,000 per trainee, which covers virtually all of its training costs.
“They’re able to provide more training and reduce the cost of training and focus more on retention efforts with the newly hired CNAs,” Rafferty said.
Crowley, Windsor Chico Care Center’s administrator, said the funding has allowed his facility to really open up the training to a larger pool of applicants who otherwise could not afford to go through training without being paid. There typically are 60 applicants for 15 training slots. Would-be CNAs train at the Windsor facility and are placed there or at one of two other sister facilities in the area.
“[The cost] is a huge hardship,” he said of CNA training programs in general. “One is coming up with two grand. Some of these students are in their twenties. A lot of them had been working kind of entry-level or minimum-wage jobs. They don’t have two grand.”
The CNA program that has helped Crowley’s facility and others like his is another example of how the California Community Colleges Contract Education Collaborative has been able to help build up California’s workforce by providing rapid-response resources that address worker shortages in the state.
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