LTSS Center researchers surveyed graduates of a LeadingAge California program designed to address critical shortages in the clinical workforce. Here’s what they found.
For the past three years, LeadingAge California has been working to address critical shortages in the clinical workforce by actively recruiting, training, and providing employment opportunities for new certified nursing assistants (CNA) and home health aides (HHA) across California.
The Gateway-In Project© began on July 1, 2022, and ended on June 30, 2025. It was funded by a $25 million grant awarded to LeadingAge California by the California Department of Health Care Access and Information. Researchers at the LeadingAge LTSS Center @UMass Boston evaluated the initiative in two phases and created two infographics summarizing their findings.
The Gateway-In Project© helped participants join the clinical workforce by:
- Paying tuition and fees for education and training.
- Providing wraparound support, including childcare, transportation, food, and related training costs. This support was designed to reduce the barriers many prospective students faced.
- Helping graduates pass their state certification exams and find jobs.
- Offering retention bonuses to graduates who were employed for one, six, and 12 months.
Phase One Evaluation
The LTSS Center distributed an online survey to 1,180 students who graduated from The Gateway-In Project© during its first year. The survey aimed to evaluate the program’s success by gathering data on Year 1 students’ employment status at the one-year mark and their perspectives on working as CNAs or HHAs.
Key Findings: Key findings from the Phase One survey include the following:
- Completion: Most students completed a CNA training program. Most are currently employed as CNAs, and nearly two-thirds work full-time.
- Satisfaction: Employed graduates reported high levels of satisfaction with their jobs.
- Preparation: Graduates reported that their training prepared them for their roles, and almost all said they would recommend the program to family members or friends.
- Career advancement: Most graduates planned to advance in their careers, with the majority aiming to pursue a nursing degree.
Findings from the Phase-One survey are featured in this infographic.
Phase Two Evaluation
The second phase of the evaluation involved surveying a sample of students who enrolled in The Gateway-In Project© during its second year. Students completed online surveys at three different points:
- Baseline: 412 students completed a survey before their training began. This survey provided researchers with baseline statistics.
- One month: 155 graduates completed a survey one month after completing the training.
- One year: 78 graduates completed a survey approximately one year after training, while they were working.
Key Findings: Key findings from the Phase Two survey include the following:
- Employment rates: The percentage of Year 2 graduates employed as CNAs and/or HHAs increased at each follow-up point, reaching nearly 90% at the one-year mark. Most survey respondents worked as CNAs/HHAs in skilled nursing settings and were employees of the organization, rather than agency staff.
- Income: Annual household incomes for graduates increased slightly but significantly from baseline to the one-month post-training follow-up, although perceived income adequacy remained unchanged.
- Job Satisfaction: Like Year 1 graduates, Year 2 graduates reported high job satisfaction, with over 75% expressing satisfaction with their jobs one year after completing training. Graduates said they were most satisfied with learning new skills and taking on challenging tasks. However, fewer than half of the graduates said they were satisfied with their wages or salary.
- Career Plans: A much higher percentage of graduates saw their CNA/HHA role as a stepping stone at both the one-month and one-year follow-ups, compared to baseline.
- Program Satisfaction: Year 2 students reported high satisfaction with The Gateway-In Project©.
- Wraparound Supports: The three most common wraparound supports used by students were reimbursement for education-related costs, food, and transportation.
Findings from the survey are featured in this infographic.
Conclusions
Findings from both phases of the LTSS Center evaluation show that The Gateway-In Project© effectively trained and supported the employment of new CNAs/HHAs, especially by engaging and assisting individuals who might not have been able to afford such training.
Notably, most graduates saw the CNA/HHA role as a stepping stone to higher-level jobs in aging services. Both groups of graduates reported high job satisfaction; the primary reason for lower job satisfaction was dissatisfaction with benefits and wages.
“Training initiatives like The Gateway-In Project© can introduce new CNAs and HHAs to the aging services field, especially those who may not be able to afford CNA/HHA training,” says Natasha Bryant, senior director of workforce research & development at the LTSS Center. “In addition, it is nice to see that involvement in The Gateway-In Project© seems to spark interest in similar higher-level and higher-paid positions in aging services.”
Despite this interest in higher-level positions, however, retaining these graduates in the aging sector may be difficult if starting wages are low and benefits are insufficient, adds Verena Cimarolli, vice president of applied research and partnerships at the LTSS Center.
“This shows us again that we have a lot more work ahead of us to improve working conditions and the well-being of direct care professionals,” says Cimarolli.