By Kate Ruder, Kaiser Health News
GRAND JUNCTION — During her 12-hour night shift, Brianna Shelton helps residents of BeeHive Homes Assisted Living with going to the bathroom. Many of them suffer from dementia and some cannot get out of bed on their own. Only a few can remember her name, but it doesn’t matter to her.
“They’re somebody’s mother, somebody’s grandmother, somebody’s great-grandmother,” Shelton said. “I want to take care of them like I would take care of my family.”
Shelton trained as a health care aide through an apprenticeship program designed to meet the growing need for healthcare workers in rural western Colorado. Here, far from Denver’s bustling urban corridor, labor shortages are growing as baby boomers retire, young people move away from these older communities, and demand for health care at home and in institutions is increasing.
Rural areas often have a higher proportion of residents aged 65 or older than urban areas. And more rural areas have relatively fewer direct care workers, such as health care aides, to help people with disabilities than less rural areas, according to a recent study in the journal Health Affairs.
In addition to increasing the number of direct caregivers, Colorado’s apprenticeship program provides opportunities to improve the earning capacity of residents who live at or below the poverty line, who have lost their jobs during the pandemic of COVID-19, or who are unemployed or underemployed. They train to become personal health care aides, who assist patients with daily tasks such as bathing or housekeeping, or certified health care aides, who can provide direct health care, such as checking blood pressure.
Apprentices take training classes at the Western Colorado Area Health Education Center in Grand Junction, and the center pays students who live in more rural areas to take classes at the Technical College of the Rockies in Delta County. Apprentices receive on-the-job training with one of 58 local employers – an assisted living facility, for example – and are required to work there for a year. Each apprentice has an employer mentor. AHEC Western Colorado staff members also provide mentoring, and the center has a life coach.
“We really want students to get into health care, get jobs, and keep those jobs,” said Georgia Hoaglund, executive director of Western Colorado AHEC, which has 210 active learners and was supported by a $2 million grant. dollars from the US Department of Labor. in 2021.
Some apprentices are recent high school graduates. Others are single mothers or veterans. They often have educational or economic barriers to employment. Hoaglund and his team of 10 buy apprentice uniforms so they can start new jobs with the right uniforms; otherwise, they might not be able to pay them. Staff members pay for gas for apprentices if they cannot afford to refuel to get to work. They talk to apprentices on the phone every month, sometimes every week.
Although the apprenticeship program gives these workers a good start, the jobs can be stressful, and burnout and low wages are the norm. Career advancement is another barrier, Hoaglund said, due to the logistics or cost of higher education. Hoaglund, who calls the families of his staff and some of the apprentices his children, dreams of offering more advanced training – in nursing, for example – with scholarships.
Apprenticeship is perhaps best known as a workforce training tool among electricians, plumbers, carpenters and other tradespeople. But they’re also seen as a way to build a needed pipeline of direct-care health care workers, said Robyn Stone, senior vice president of research at LeadingAge, an association of nonprofit providers of aging services.
“Traditionally, healthcare employers hired people after they completed a training program,” said Susan Chapman, a registered nurse and professor at the University of California, San Francisco School of Nursing. “Now we ask the employer to participate in this training and pay the person during his training.”
The pandemic has exacerbated shortages of direct care workers, which could encourage employers to invest in apprenticeship programs, Chapman and Stone said. Federal investment could also help, and a Biden administration initiative to improve the quality of retirement homes includes $35 million in grants to address labor shortages in rural areas.
Shelton had never worked in healthcare before moving to Fruita, a small town about 20 miles northwest of Grand Junction and surrounded by red sandstone towers. She left Fresno, California a year ago to care for an uncle with multiple sclerosis. She and her 16-year-old daughter live in a trailer on her uncle’s property, where Blackie, her rescue Labrador retriever, roams with the chickens and cats.
Blackie also sometimes accompanies Shelton to BeeHive to visit residents. Shelton said it was more than a job for her and she was grateful to the apprenticeship program for helping her get there. “It opened a door for me,” Shelton said.
Shelton works three 12-hour shifts a week, in addition to caring for her uncle and daughter. Still, she says, she struggles to have enough money for gas, bills and food and has taken out small loans to make ends meet.
She is not alone. Health care aides are often underpaid and undervalued, said Chapman, who found significantly higher rates of poverty among such workers than among the general population.
According to a study by nonprofit policy group PHI, direct care workers nationwide earn an average of $13.56 an hour, and these low wages make it difficult to recruit and retain workers, leading to new shortages and instability.
In an effort to keep workers in the state, Colorado raised the minimum wage for certified health care aides and nursing assistants to $15 an hour this year with money from the American Rescue Plan Act. And the Colorado Department of Health Care Policy and Funding’s 2023-24 budget request includes an increase to $15.75. Similar efforts to raise salaries are underway in 18 other states, including New York, Florida and Texas, according to a recent article by the National Governors Association.
Another way to keep apprentices in their jobs and encourage career and salary growth is to provide specialized training opportunities in dementia care, medication management or behavioral health. “What apprenticeship provides is career mobility and advancement,” Stone said.
To practice in Colorado, new certified practical nurses undergo classroom training, complete clinical rotations, and pass a certification exam consisting of a written test and a skills test. Hoaglund said testing requirements can be stressful for students. Shelton, 43, passed the written exam but must retake the skills test to obtain a certified nursing assistant license.
Hoaglund’s program started in 2019, but it really took off with the 2021 federal grant. Since then, 16 people have completed the program and received pay raises or promotions. Twice as many people left without finishing. Grand Junction’s largest hospital, Intermountain Healthcare-St. Mary’s Medical Center, recruits program workers.
Hoaglund said every person who enters the healthcare field is a win.
Brandon Henry, 23, was a student at University Colorado Mesa in Grand Junction and worked at PetSmart before joining the apprenticeship program in 2019. After enrolling, he trained and worked as a certified practical nurse during the worst of the pandemic. As an apprentice, he says, he learned the importance of having grace while caring for patients.
He returned for more training at Western Colorado AHEC to obtain a license that allows him to dispense drugs at accredited facilities, such as assisted living centers. He now works at Intermountain Healthcare-St. Mary’s Medical Center, where he completed hospital-based wound care and physiotherapy training courses. This winter, he will graduate from Colorado Mesa with a Bachelor of Science in Nursing.
“At the hospital, I found more opportunities for pay raises and job growth,” Henry said.
Kaiser Health News is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the Kaiser Family Foundation’s three major operating programs. KFF is an endowed non-profit organization providing information on health issues to the nation.
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