By Geralyn Magan
Direct care professionals need career advancement pathways to help them expand their skills, grow their paychecks, and take on increased responsibility, says Natasha Bryant.
How can providers of aging services recruit and retain direct care professionals like certified nursing assistants (CNA), home health aides (HHA), and home care and personal care aides?
Natasha Bryant, senior director of workforce research and development at the LeadingAge LTSS Center @UMass Boston, answered that question during a September webinar sponsored by the Council of State Governments.
Her advice? One solution is to offer direct care professionals more opportunities for career advancement.
During her presentation, Bryant maintained that the lack of meaningful career advancement opportunities for direct care professionals is one of the most critical impediments to attracting more people to the aging services field and giving them a reason to stay. Access to a variety of career advancement pathways is necessary for direct care professionals to expand their skills, grow their paychecks, and take on increased responsibility, she said.
HOW CAN DIRECT CARE PROFESSIONALS ADVANCE IN AGING SERVICES?
Direct care professionals can follow a formal path—called a career ladder—to earn a degree or certification so they can take on a new role or title. For example, a personal care aide may become a CNA or HHA, then move on to become a licensed practical nurse, and then study to become a registered nurse (RN).
Career ladders work well for many direct care professionals, but not all aides want to pursue this path. That’s where career lattices come in, said Bryant.
“Not all staff want to advance up a career ladder, but this doesn’t mean they don’t want to grow in their profession,” she said. “They deserve the chance to develop expertise, try new things, and develop new skills.”
To meet this need, providers of aging services can create internal training processes to help direct care professionals increase their expertise in a given role while remaining direct care professionals, said Bryant. For example, direct care professionals could become condition-specific specialists in such areas as dementia care, chronic condition management, behavioral health, or medication and pain management. They could then earn badges or micro-credentials that recognize their new skills, she said.
Employers can promote career lattices by developing competency-based job descriptions for advanced roles and partnering with educational institutions to create programs to train direct care professionals to fill those roles. In addition, Bryant emphasized, providers must be willing to pay a higher wage to compensate these caregivers for their advanced training and new responsibilities.
ARE ANY PROVIDERS OFFERING CAREER LATTICES THAT WORK?
Bryant shared several examples of programs offering direct care professionals the opportunity to take on advanced roles and enhanced positions:
Massachusetts Supportive Home Care Aide: Home care aides working in this program specialize in caring for individuals with mental health conditions, Alzheimer’s disease, or other forms of dementia. The aides receive an additional 12 hours of training and advanced support from supervisors who also receive extra training. The aides are integrated into care teams through quarterly team meetings during which they share their observations of a client’s condition and receive further training.
Trinity Health Senior Communities: This program deployed 12 CNAs as transition specialists who supported patients as they moved from the hospital to Trinity’s rehabilitation setting and then back home. The aides were trained to understand and report changes in chronic conditions and communicate with family caregivers, patients, and care team members. The CNAs earned $3 more per hour than other CNAs, which added $5,000 to their annual income. A program evaluation found that the program led to lower hospital readmission rates and greater satisfaction among rehabilitation patients.
Homestead STEPS Program: This program increased the starting wage of home care aides to $16 an hour and developed a three-tiered training program that covered basic home care, substance use and mental health, and medical skills. After completing each tier, aides received a new title, more responsibility, and a 50-cent-per-hour raise. The program evaluation documented improved retention and job satisfaction among aides and reduced emergency room visits for patients.
WHAT OTHER STRATEGIES CAN HELP DIRECT CARE PROFESSIONALS SUCCEED?
Providers can use several strategies to help direct care professionals gain the experience and skills they need to be successful. Bryant shared these two strategies:
Peer Mentorship: A peer mentorship model trains experienced direct care professionals in coaching and problem-solving. These peer mentors support direct care professionals who are new to the field, helping them transition into direct care work and navigate the challenges of professional caregiving.
“We find that a lot of turnover in aging services occurs during the first three months on the job,” said Bryant. “Peer mentors can support and guide new hires during this critical time. Some studies have shown that peer mentorship programs increase retention rates among those receiving peer mentoring support.”
Team-Based Care: Direct care professionals know their care recipients well and are in a good position to provide members of the care recipient’s care team with important information about a care recipient and their medical condition. Integrating homecare aides and nursing assistants into team-based care allows aides to work with members of the care team—including physicians, nurses, and other clinicians—as they support an older adult. Aides can be trained to observe the care recipient, document the person’s health status and the care they’re receiving, and communicate effectively with other care team members, said Bryant.
“Building career lattices and ladders for direct care professionals can help improve recruitment and retention as well as care delivery and outcomes,” concluded Bryant. “Success of these efforts depends on effective training and supervision, aides having the authorization to perform specialized or advanced tasks, formal structures to facilitate communication between aides and clinical partners, and sustainable funding to cover the training costs and increased compensation.”