Portland Community College | Portland, Oregon

Leading the design of training for long-term care industry

Photos and story by James Hill

by Chris MooreThe number of older Americans will double in the next 30 years, dramatically increasing the demand for long-term care. Already, there is a chronic shortage of workers in this field, from nursing supervisors to those who provide direct, hands-on care to residents. One of the areas of fastest growth is assisted living, an alternative for people who simply need help with the activities of daily life.Portland Community College and business partners Cedar Sinai Park and Avamere Health Services are working together to improve training and retention of unlicensed care workers in assisted living facilities. The project, called the Assisted Living Facilities Training Consortium (ALFTC), is supported by a one-year grant from the state Workforce Investment Board and substantial in-kind contributions from the partners.Linda Bifano, a registered nurse and consultant for Cedar Sinai Park approached PCC for help."This was something that hadn’t been done in Oregon yet,"says Irene Giustini, director of the college’s Institute for Health Professionals. "We felt there might be an opportunity to get some grant funding and develop it as a demonstration for the entire industry. Avamere Health Services was very interested in joining us and in a short period of time, we had partners, tremendous interest, and financial support."Although Oregon’s assisted living centers are licensed and regulated, the state provides little guidance on the skills or training of direct care workers. Most enter the field with low skill levels or limited English proficiency. Pay is low  $8.17 an hour on the average  and expectations are high. Personal assistants must follow detailed work instructions while interacting effectively with older, physically or mentally impaired adults and their families. Medication assistants must be able to operate medical and laboratory equipment, administer medications and train others.As a result, turnover is high. In Oregon alone, about half of all assisted living direct care workers quit in the first three months. This high turnover rate costs Oregon employers more than $44 million annually. In a recent survey, these workers identified training and education as the most effective way to promote job satisfaction.Determining foundation skillsIn the first phase of the project, the Customized and Workplace Training (CWT) department at PCC developed job profiles for both personal and medication assistants. These profiles include detailed lists of tasks and responsibilities for each job and definitions of foundation skills in nine key areas."Every job requires certain skill levels in math, writing, listening, and so on,"says Paul Wild, CWT department manager. "These skills form the foundation for technical training. We started by profiling each job  not just describing needed technical skills, but also identifying foundation skills. Now we have a tool we can use to determine each employee’s training needs."Those with limited English proficiency will take part in a 30-hour workplace-specific English program. Plus, the Institute is using CWT’s task lists to develop 70 hours of customized technical training for employees. Cedar Sinai Park and Avamere Health Services will then deliver the training in their facilities. CWT is also developing a training management database to track employee mastery of the competencies. Once training programs are in place, the partners will share what they’ve learned with other long-term care providers at the local, state and national levels."Before I went to work for Cedar Sinai Park, I was an independent nurse consultant,"Bifano says. "Everywhere I went, I saw the same problems. It doesn’t make sense to reinvent the wheel at each facility. We need standards and training we can all use."Lower cost, better careAn assisted living facility in Oregon spends about $3,000 to hire and train a direct care worker. Discouraged by low wages and limited advancement opportunities, many workers leave the field after only a few months. The project provides a model for training and career development that will benefit everyone involved:? Employees will be better equipped to do their jobs and less likely to leave in frustration. They will also take the first step on a career path that could lead to better jobs and higher pay.? Employers will see lower costs and improved quality of care.? Residents will have the opportunity to develop longer-term relationships with their caregivers and receive better care."We believe there is a direct correlation between the training of direct care workers and the satisfaction of our residents,"says Linda Nickolisen, regional director of program development for Avamere Health Services’ six assisted living facilities. "When someone comes into a care setting, they’ve already experienced a lot of losses. We want to provide them with a homelike environment and quality care is an important part of that."