elevating our future workforce

ELEVATING OUR FUTURE WORKFORCE

Minnesota Health & Housing Alliance March District Meeting

MEMBERS REPORT BIGGEST CHALLENGES IN 2006-07

• Financial

• Workforce

• Regulatory

• Transformation

Source: 2007 MHHA Member Value Survey

MEMBERS REPORT BIGGEST CHALLENGES IN 2006-07

• Staffing Issues

(especially RN and CNA)

• Recruiting Well-trained Staff

• Retaining Staff

(limited wages and benefits)

Source: 2007 MHHA Member Value Survey

NUMBER OF VACANT FTE POSITIONS IN CARE CENTERS

0.91 1.07

2.53

0.30

4.81

0

1

2

3

4

5

RN LPN C.N.A. Total Total

Source: Long Term Care Imperative 2007 Legislative Survey

ESTIMATED VACANT FTE POSITIONS IN CARE CENTERS

0200400600800

1,0001,2001,4001,6001,8002,000

R.N. L.P.N. C.N.A. DietaryAide

Total

2004 2005 2006

Source: Long Term Care Imperative 2007 Legislative Survey

Source: Minnesota State Demographic Center

PROJECTED POPULATION & WORKFORCE GROWTH

Projected Growth in Workforce

2005-2025

Projected Growth in the Population Age 60 and Over

HEALTHCARE JOBS LEAD MINNESOTA’S FUTURE NEEDS

-10,000 0 10,000 20,000 30,000 40,000 50,000

Agriculture, Forestry, Fishing & Hunting

Utilities

Mining

Manufacturing

Real Estate and Rental and Leasing

Public Administration

Arts, Entertainment, and Recreation

Management of Companies and Enterprises

Wholesale Trade

Information

Finance and Insurance

Other Services, Ex. Public Admin

Construction

Accommodation and Food Services

Educational Services

Retail Trade

Administrative and Waste Services

Professional and Technical Services

Health Care and Social Assistance

Source: DEED, Employment Projections

MINNESOTA HEALTHCARE CAREER TRENDS HISTORY

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Manufacturing Healthcare

PROJECTED GROWTH FOR TOP 15 HEALTHCARE OCCUPATIONS

Source: MN Dept of Employment and Economic Development

0 5,000 10,000 15,000 20,000 25,000 30,000

Registered Nurses

Home Health Aides

Nursing Aides, Orderlies, and Attendants

Licensed Practical and Licensed Vocational Nurses

Medical Assistants

Dental Assistants

Medical and Health Services Managers

Medical and Clinical Laboratory Technicians

Pharmacy Technicians

Healthcare Support Workers, All Other

Pharmacists

Medical Records and Health Information Technicians

Radiologic Technologists and Technicians

Medical and Clinical Laboratory Technologists

Dental Hygienists

Net Job Growth

Replacement Openings

AGING SERVICES

97% 95% 91%

3% 5% 9%

0%

20%

40%

60%

80%

100%

1988 1995 2001

Families Agencies Minnesota Health & Housing Alliance – February 23, 2006Source: Minnesota Department of Human Services

WHO PROVIDES CARE TO OLDER MINNESOTANS

1% drop in family caregiving = $30M in public funds.

13.611.5

9.8

0

3

6

9

12

15

2005 2015 2025

Ratio of women 20-55 to people 85 and over

Minnesota Health & Housing Alliance – February 23, 2005Source: Minnesota State Demographer

RATIO OF CAREGIVERS TO OLDER ADULTS DROPPING

MINNESOTA BOSTS HIGH WORKFORCE PARTICIPATION

NURSING SHORTAGE ONLY EXPECTED TO WORSEN

Current Licensure Average Age

41

42

43

44

45

46

47

RN 44.1 44.7 45.1 45.6 46.0

LPN 42.7 43.5 44.3 44.9 45.1

FY 1998 FY 2000 FY 2002 FY 2004 FY 2006

Source: Minnesota Board of Nursing

A NURSING WORKFORCE APPROACHING RETIREMENT

46

45

NURSING PROGRAMS GROW BUT DEMAND REMAINS HIGH

The Minnesota State Colleges and University System (MNSCU) trains 78% of the state’s new nursing graduates

32 colleges and universities on 53 campuses in 46 communities

MNSCU MISSION TO SUPPORT COMMUNITY NEEDS

Between 2001 and 2005: 74% increasein nursing graduates!

LPNs by 77%RNs by 69%Master’s prepared nurses by 150%

AVERAGE HOURLY RN WAGES HOSPITALS vs CARE CENTERS

$34.80$33.40$31.41

$29.61$27.85

$23.31$22.66$22.58$21.56$20.55$18

$23

$28

$33

$38

2001 2002 2003 2004 2005

Hospital Nursing Home

Source: MN Health Care Cost Information System, Long Term Care Imperative Compensation Survey

Gap=$7.30

Gap=$11.49

Wage Gap Increased 57% in Five Years

AVERAGE HOURLY LPN WAGESHOSPITALS vs. CARE CENTERS

$18.24$17.75

$16.84

$16.29$15.85

$16.60$16.45$16.36$15.65

$15.08

$14

$16

$18

$20

2001 2002 2003 2004 2005

Hospital Nursing Home

Source: MN Health Care Cost Information System, Long Term Care Imperative Compensation Survey

Gap=$1.64Gap = $0.77

Wage Gap Increased 113% in Five Years

AVERAGE HOURLY CNA WAGESHOSPITALS vs. CARE CENTERS

$14.66$14.02

$13.27$12.83

$12.27

$11.19$11.22$11.10$10.83$10.45$10

$11

$12

$13

$14

$15

2001 2002 2003 2004 2005

Hospital Nursing Home

Source: MN Health Care Cost Information System, Long Term Care Imperative Compensation Survey

Gap=$1.82

Gap=$3.47

Wage Gap Increased 91% in Five Years

PERCENT OF CARE CENTERS IN FINANCIAL CRISIS

Source: Imperative Nursing Facility Survey Prepared by LarsonAllen

Legend=<25%

=26%-35%=35%-45%=>45%

East Central 19.4%

Metro 18.6%

Northeast 50.0%

Northwest 35.3%

Southeast 39.2%Southwest 30.0%

West Central 34.6%

(Operating Margin of -5% or worse)

30% of Facilities are in Crisis, 4% Higher

than Last Year

ALMOST 23,000 JOBS AT RISK DUE TO FINANCIAL CRISIS

Jobs at Risk: 5,854

Beds: 13,684

Jobs at Risk: 3,227

Beds: 2,806

Jobs at Risk: 2,387

Beds: 3,000

Jobs at Risk: 2,814

Beds: 4,078 Jobs at Risk: 5,007

Beds: 5,554

Jobs at Risk: 1,311

Beds: 1,615

Jobs at Risk: 2,142

Beds: 4,801

THE INTEREST IS THERE!

• Healthcare careers are the No. 1 choice for students leaving high school (not college-bound), and the third-highest path for those college-bound

• 28% of current Minnesota high school students express interest in health occupations

www.minnesotahosa.org

INNOVATION IS OCCURING

• Share the many changes in Care Centers

• “Culture Change” helps bring focus to our core work and emphasize relationships

• New relationships with and strategies for informal caregivers, volunteers (HCAM) and other non-traditional labor pools is vital

INNOVATION IS OCCURING

• Technology with the potential to revolutionize our missions

• Pioneering design is transforming the spaces we live and work

• Aging Services Careers – new job descriptions, responsibilities, training models, and opportunities for respect

AGING SERVICESWORKFORCE INNOVATION:

MHHA Workforce Solutions Council Drives Association Response

TALENT

WORKFORCE SOLUTIONS COUNCIL

• Advance MHHA’s strategic initiative to “elevate the older adult services workforce of the future”

– Focus on strategies for recruiting and inspiring talent in the field

– Focus on retention strategies and best/promising practices in job satisfaction

– Coordinate efforts with parallel initiatives

CREATING SOLUTIONS

CREATING SOLUTIONS

• Career Exposure and Recruitment

MHHA will explore the promotion of the many careers in older adult services to traditional and prospective employee audiences through a series of outreach initiatives and partnerships

CREATING SOLUTIONS

• Member Skill Building for Talent Retention

MHHA will explore ways to maximize member knowledge through education, issue briefs and launch of an e-community clearinghouse focused on targeted workforce initiatives having the greatest impacts in the field

CREATING SOLUTIONS

• Launch of a New Employee Model

MHHA will lead the creation and expansion of a new older adult services employee in Minnesota, facilitating development of provider knowledge, curriculum design, articulation and instructor agreements with higher education partners

CREATING SOLUTIONS

• Replication of New Training Models

Breaking out of the bottleneck found in traditional higher education avenues, MHHA will explore alternative models for the training of key employee groups, with an emphasis in the field of nursing

CREATING SOLUTIONS

• Career Exposure and Recruitment

• Member Skill Building for Talent Retention

• Launch of a New Employee Model

• Replication of New Training Models

A NEW EMPLOYEE MODEL

CHALLENGES

• Identifying best/ promising practices in the field and emerging care delivery models

• Providing standardization and recognition while allowing for customization

• Developing new curriculum and articulation agreements with higher education

• Identifying resources to lead efforts

HEALTH SUPPORT SPECIALIST (HSS)

• A pathway for organizations to move towards a “universal” worker model

• Designed around a household model with self-lead teams

HEALTH SUPPORT SPECIALIST (HSS)

• Entry-level training program for new frontline workers, taking into account the knowledge and training of existing staff

• Theoretical instruction (386 hrs) combined with on-the-job learning (2500 hrs)

• Customized to unique mission or other training curriculum for each organization

A CLEAR CURRICULUM AND CAREER LADDER

Employment and mentoring with a qualified journey worker from day one

Entry Level

Health Support Specialist

ADVANCING THROUGH THE STEPS

• Medical Terminology

• Dietary Services

(National Serv-Saf Certification)

• Environmental Services

(OSHA 10-hour industry card)

ADVANCING THROUGH THE STEPS

• CPR and First Aid Certificate

• Advanced Dementia Care Certificate

(Alzheimer’s Association)

• Culture Change Certificate

• Certified Nursing Assistant (CNA)

(Facility, Technical or Community College)

ADVANCING THROUGH THE STEPS

• Rehabilitative Aid

(Facility Certificate)

• Certified Medication Aid

(Technical or Community College)

Health Support Specialist Apprentices

Advanced Health Support Specialist

ADVANCING TO “JOURNEY WORKER”

• Completion of all career ladder steps

(Including on the job learning hours)

• Completion of all facility requirements

(Set by each organization)

• Registered Apprenticeship Certificate through Program Sponsor (MHHA)

“The Registered Apprentice program has helped me to broaden my knowledge base to be able to serve our residents better.”

Jennifer Steinkuhler

Health Support Specialist

Brewster Place, KA

HEALTH SUPPORT SPECIALIST (HSS)

HEALTH SUPPORT SPECIALIST (HSS)

• Kansas Registered Apprenticeship program

• Development of curriculum, online distance education, funding sources

• Grant awarded Jan. 1, 2007 to replicate

• Recognized by US Department of Labor

US DEPT. OF LABORU.S. Department of Labor Employment and Training Administration Office of Apprenticeship (OA) Washington, D.C. 20210

Subject: Additional RAIS Code and Occupational Title for Health Support Specialist Occupation Code: 200

Symbols: DSNIP/FJH

Distribution: A-541 Headquarters A-544 All Field Tech A-547 SD+RD+SAC+; Lab.Com

Action: Immediate

PURPOSE: To inform the Office of Apprenticeship (OA), staff of an addition to the Registered Apprenticeship Information System (RAIS) for the coding and recording of a new occupational title for an existing occupation:

Health Support Specialist Existing Title: Home Health Aide O*NET-SOC Code: 31-1011.00 RAIS Code: 1086AA Training Term: 2,500 – 5,000 hrs. Type of Training: Hybrid

The letters “AA” have been added as an extension of the RAIS Code 1086 to identify applications utilizing the new occupational title. The O*NET-SOC Code will remain the same. BACKGROUND: Apprenticeship Program Consultant Michele Boschetto from the Kansas State Apprenticeship Council submitted this occupation. The Health Support Specialist has been recognized to meet Health Care Industry demands for highly-skilled and highly-trained workers. Since the two occupations are similar except for application within the Health Care Industry, O*NET determined it did not qualify for its own separate O*NET-SOC Code. Therefore, OA is awarding a separate RAIS Code extension that would allow for distinction and application by industry. ACTION: Effective immediately, all OA/BAT staff should implement data entry for the “Health Support Specialist” classification into RAIS under Code 1086AA. New program standards and revisions to existing program standards may include incorporation of either occupational title and should utilize the appropriate RAIS Code.

HEALTH SUPPORT SPECIALIST (HSS)

FUNDING SOURCES

• MHHA Foundation

• CBJTG grant through Kansas

• Workforce Investment Act (WIA)

• Pell grants

• Veterans assistance

• Minnesota Scholarship Programs

• Other special funding projects

Patricia Williams began her career in dietary services 13 years ago.

HEALTH SUPPORT SPECIALIST (HSS)

HEALTH SUPPORT SPECIALIST (HSS)

“Brewster Place encouraged me to go into the program to become more involved with resident care.

HEALTH SUPPORT SPECIALIST (HSS)

“It gave me the will to continue my education – put the learning bug in me.”

HEALTH SUPPORT SPECIALIST (HSS)

“I plan to work toward an LPN degree next. I look forward to coming in each day.”

Patricia WilliamsHealth Support SpecialistBrewster Place, KA

THE BENEFITS

• Reduces barriers to employment through provider-based classroom instruction

• Increases loyalty, self-esteem, wages, college credits, and incentive to remain in aging services

MHHA ACTIVITY

• Applying to the Department of Labor Registered Apprenticeship Unit to be the sponsoring organization in Minnesota

• Initiating education and partnership building with provider organizations and higher education stakeholders

• Application for grant funds to further develop, launch and sustain program

Tiara Weber has graduated from the program and is now a Health Support Specialist. She is pictured with therapy dog Sissy.

HEALTH SUPPORT SPECIALIST (HSS)

HEALTH SUPPORT SPECIALIST (HSS)

HEALTH SUPPORT SPECIALIST (HSS)

NEW TRAINING MODELS

“Long-Term Care Connection”

A Customized LTC LPN Program Developed by

Good Shepherd Community

CHALLENGES

• Shortage of licensed and qualified staff• Increasing nurse retirements• Competition with hospital wages• 24/7 staffing schedules (holidays/weekends)• Lack of graduates with LTC focus• Required nurse/resident ratios• Financial costs of training• Lack of evening programs

EDUCATION BARRIERS

• Lack of clinical space

• Lack of qualified faculty

• Lack of classroom space

• Lack of resources to start-up and maintain

GOOD SHEPHERD REALITY

• High use of pool staff

• High staff turnover

• Few recruitment options for LPNs

• Limited career ladder opportunities

• Long waiting lists for traditional students

• No options for non-traditional students

• Funding — but no where to spend it

LTC LPN PROGRAM

In 2001, Good Shepherd Community launched a customized LPN program in partnership with St. Cloud Technical College

LTC LPN PROGRAM

• Facility served as primary clinical site and also created classroom and lab space

• Evening classes and accelerated learning methodology incorporated

LTC LPN PROGRAM

• St. Cloud Technical College provided customized curriculum

• Nursing Facility Scholarship Program funding was utilized

• Results: Increased staff retention, creation of career ladders, increased LPN pool in region, increased quality of care, improved staff morale, loyalty

LTC LPN PROGRAM

• Enrollment now available to 25 long-term care settings in Central Minnesota

• Three classes – over 60 caregivers – have received their LPN degrees to date

• Classes provided a focus on the LTC LPN and increase number of available staff in the region

MHHA ACTIVITY

The MHHA Board of Directors authorized staff to proceed with planning for expansion and replication of the LTC LPN program developed by Good Shepherd Community and St. Cloud College

REPLICATION

• Identify communities with need, promise

• Identify providers with potential classroom and lab space

• Secure funding for necessary investments

• Coordinate with MNSCU for curriculum, adoption of adjunct instructors/faculty

• Disseminate best practices from Good Shepherd experience i.e. scheduling, etc.

FOR FURTHER INFORMATION

Adam SuomalaManager of Member Relations

asuomala@mhha.com

651-603-3530