New York SNF Organization Combats Workforce Crisis Expanding CNA, LPN, Home Health Aide Training

Students are paid for the time they spend training and getting hands-on experience in Loretto facilities.

As the largest regional long-term care provider in their area, the Loretto, a nonprofit organization of skilled nursing, memory care, and assisted living facilities that has served the central New York community for almost 100 years, has felt the pressure of the current workforce crisis.

Now, the Loretto is taking matters into its own hands. By expanding its paid training program, the organization is creating a pipeline of talent for its facilities and introducing individuals to career pathways within healthcare.

HealthLeaders spoke with Loretto's chief marketing and engagement officer, Julie Sheedy, and chief people officer, Nancy Williams about how the organization has approached the workforce crisis, its training program, and how other nursing home providers can implement similar programs.

The following transcript has been edited for brevity and clarity.

HealthLeaders: How has the program alleviated the strain of the workforce crisis on the organization and its facilities?

Julie Sheedy: With the shortage, hospitals are trying to hang on to the staff that they have. We have made a significant commitment to training programs and are the only provider in this area that provides both certified nurse aide (CNA) and home health aide trainings. We also have the first federally recognized and approved licensed practical nurse (LPN) apprentice program in New York state.

That speaks to the commitment that Loretto has made to grow our own, and we've had success with that, which has perpetuated our expansion into Cuba County.

HL: When did the organization decide to try and find its own solution to the workforce crisis?

Sheedy: We've had the program in the Syracuse area and Onondaga County for several years based on a successful model called Health Train, to try to provide healthcare career pathways. We established our own certified nurse aide training program in Syracuse, and we now train on average, over 100 individuals a year through that program.

Loretto was asked to step in and assume responsibility for a large skilled nursing facility in Auburn, New York in Cayuga County, which is a very different market and very hard to recruit in. It's a much more rural community and it's surrounded by a lot of farmland, so it's even more difficult to find qualified individuals in that market.

As we continue to assess the challenges we're facing with staffing, we recognize the value of our training program here and started to take steps to do that which starts with building a plan and getting state approval.

We also needed to make sure we had the space available to train and educators available, so we also had some changes in that facility which freed up space that was repurposed into a classroom which was a benefit as well.

We have a class running every month and that's where the 100 average comes from, and then we just had our first inaugural class graduate in Auburn, with six individuals.

We've got a little bit of a slower roll there in Auburn. We have one educator, and we also have to meet mandatory state requirements for a teacher-to-student ratio.

HL: Are the students completing the program with the promise of employment after?

Nancy Williams: Students go through the five-week program, and they get great hands-on experience through it. It takes them through to the preparation for sitting for the New York state examination. Once they've successfully completed that exam, they're able to work and function as certified nursing assistants and they're able to have full employment at Loretto, along with benefits.

The intent is to provide a great level of support to them through the program. There's also the benefit of it being an earn-as-you-learn program, so there's that support that comes along with it as well.

Then at the end of the educational experience, they're working as CNAs within our facilities.

Sheedy: Loretto is paying them to be trained so they become an official employee of Loretto when they're accepted into the class. They're paid a wage while they're in that class.

HL: What does the training consist of as far as modules?

Williams: The first couple of weeks is classroom learning and training, and then they have clinical training that occurs in the Loretto units. They're with our staff and residents gaining hands-on experience and honing the skills that they've learned over those first few weeks as they get started.

Then as they get to the tail-end of the program, it includes comprehensive reviews of their skills that they've learned and different types of mock testing to prepare them for the state CNA exam that they'll be sitting for.

We've been doing this for a long time at our Syracuse site, so with the expansion to the Auburn site and Cuba County, we have this successful template to draw from. They mirror one another and take a comprehensive approach to prepare the students to be successful when they sit for their exam and then when they're taking care of our community members thereafter.

HL: How important is it for organizations to make the effort to address the workforce crisis as they wait for more to be done at the state or federal levels?

Williams: We know from the success that we've had with the investment of our career paths for our employees that it's important for us to be growing our own, especially in the face of the nursing and healthcare staffing shortage.

The pandemic added many layers of complexity to that and we're going to continue to face the impacts of the staffing shortage as we move toward the future.

It will be great as other things come into play to provide support for us as an organization and for healthcare in general, but we find it to be very important for us to be proactive and investing in the careers and the learning and development of our employees, and we know that this is important to them, both professionally and personally.

Sheedy: Loretto has several successful partnerships in this community. We've been talking to our community college recently about how to support them in growing some nontraditional career pathways through their programs.

One of the challenges that this industry faces is the lack of available educators, so the more that we can do collaboratively to share resources and offer opportunities to our community, the better. We're trying to do that all the time by working with different organizations.

HL: What are some steps other organizations should take to implement similar training programs?

Sheedy: For peers and leaders, a place to start is to understand what the regulations are in your state.

When we wanted to expand into Auburn, we put together a plan and put it in front of our State Department of Health to get approval. Learn about the regulatory requirements for being an educational provider versus a healthcare provider.

You also need to understand what resources are available to you, either within your organization or your community, to find qualified educators that meet the requirements. There are specific requirements to offer this type of training in the post-acute market. Also look at that model of paying a wage while they're training because that is an incentive for the population that we're recruiting.

For many of these individuals, this is their first exposure to healthcare. They might have had a family member or a loved one in healthcare, but now they're looking at a professional path into employment and career development.

Williams: We have a union environment here within our organization, so make sure to work collaboratively with your union representatives and ensure that they have a say and that you're including all the stakeholders that need to be involved in the process.

Sheedy: You should also have a student profile criterion for who should be in these training programs. Part of the key to success is that these individuals are prepared to be in a learning environment and that they can meet the criteria to be in the program, to commit to the class and the hours, have transportation, and other things to ensure their success.