1. Lessons Learned Forum Tuesday, February 20, 2007 AARP Office, Lansing
Paraprofessional Healthcare Institute (PHI)
Home Health Aide
Apprenticeship Pilot in Michigan
Lessons Learned Forum
Tuesday, February 20, 2007
AARP Office, Lansing

2. PHI MI HHA Apprentice Pilot
Lessons Learned Forum Agenda Tuesday, February 20, 2007  9 a.m. - Noon
Welcome, Introductions and Overview of Morning
DoL Health Care Apprenticeship Program Developments
PHI’s Home Health Aide Pilot Project
A Picture of Each Michigan Agency’s Program
What the Apprenticeship Means for Apprentices
BREAK
Lessons Learned and How Public Supports Can Help
Discussion and Next Steps for Michigan and Beyond
PHI MI HHA Apprentice Pilot

3. PHI MI HHA Apprentice Pilot
Welcome to Our Guests!
Our Goals for Today:
To share what we’ve learned about expanding training for direct care workers in home health care
To explain why robust and consistent public support across the State is so important
To explore how we can work together to expand quality training and apprenticeships in home health care
PHI MI HHA Apprentice Pilot

4. DoL Health Care Apprenticeship Program Developments
Dave Jackson presenting
PHI MI HHA Apprentice Pilot

5. PHI’s HHA Apprenticeship Project – Summer, 2005
The Home Health Aide Apprenticeship, a new apprenticeable occupation, is piloted under a grant from the federal Dept. of Labor’s federal High Growth Initiative
Builds on experience with Good Samaritan System’s CNA Model
Pilots running in Philadelphia, Indiana, and Michigan
Goal of having 75 apprentices in program in each state
PHI MI HHA Apprentice Pilot

6. PHI’s HHA Apprenticeship Project Goals
Improve home health aide (HHA) retention
Increase HHA job satisfaction
Improve consumer satisfaction
Increase provider agencies’ reputation
Enhance workforce system partners’ collaboration
PHI MI HHA Apprentice Pilot

7. Why Will Agencies Host a Home Care Aide (HHA) Apprenticeship?
To offer HHAs a nationally recognized credential issued by U.S. Dept. of Labor which…
Enhances their skills
Creates an identified standard for employers and consumers
To enhance initial and ongoing training offerings and build on current training resources
To highlight home care needs and value to the state and national workforce systems
To leverage workforce training funds
PHI MI HHA Apprentice Pilot

8. Creating a Person-Centered Workplace Culture
HHAs are treated as valued employees:
They gain an internal and external career ladder
They receive wage increases as they improve competencies
Peer Mentors support and help retain them by:
Coaching Aides in problem solving
Supporting Aides in delivering quality care
Mentoring Aides in person-centered relationship skills
Training increases self-esteem and skills, and enhances others’ perception of HHAs
PHI MI HHA Apprentice Pilot

9. HHA Model – Entry-Level Training Certification
After initial (minimum 16-hours) training, HHA begins work
Experienced HHAs’ competencies are assessed to custom design training plan
HHA completes 75 to 150 hours of entry-level instruction including PHI communications and problem-solving
HHA expands competency by up to 400 hours of on-the-job learning supported by Peer Mentor and supervisor
With successful evaluation, apprentice is issued a DoL credential, pay raise, and moves on to specializations
HHA can test for Medicare home health aide certification (Already certified HHAs may enroll in program as well)
PHI MI HHA Apprentice Pilot

10. Home Health Aide Specializations
Apprentices, with their agencies, select 2 specialties
HHAs receive up to 40 classroom hours and 4 months on-the-job learning
Current specialties in Michigan are:
Peer Mentor
Dementia care
Hospice and palliative care
Geriatric (added to meet need of Michigan agency)
Other specialties may be added by an employer
Upon completing each specialty, HHAs receive pay raise and DoL credential
PHI MI HHA Apprentice Pilot

11. PHI’s Support for Pilot Agencies
Assistance with Program Design
“All-Agency” meetings
Tools, guides, questionnaires
Recruitment Strategies and Tools
PHI guides and reference materials
Skill assessment processes
On-the-Job Peer Mentoring Program
PHI’s 3-day Peer Mentoring Program
Curriculum for instructors, PHI program design guides
Peer Mentor Booster sessions
Consulting support
PHI MI HHA Apprentice Pilot

12. PHI’s Support for Pilot Agencies, continued…
Training and Competency Assessment
Training manuals for Entry-Level, Dementia, Hospice
Sessions in Dementia care and other topics
Competency assessment checklist
Outcome measurement
Common measures
Maximizing funding resources
Identified available funding and support
$3, stipend to each participating agency
PHI MI HHA Apprentice Pilot

13. Three Pilot Sites in Michigan
Harbor Home Healthcare
Petoskey and Traverse City, MI
Private duty home health agency
Heritage Community
Kalamazoo, MI
Independent & assisted living homes
Lutheran Home Care & Hospice of Hope
Frankenmuth, MI
Private duty home health and hospice agency
PHI MI HHA Apprentice Pilot

14. What the Apprenticeship Means for Apprentices
I think anyone who has the desire should have the opportunity. I’m very much appreciative…for the program.
…the program will enable me to be the best I can be.
…I love my job, work, the clients I care for, and am eager to learn more…
Apprentice Applicant Forms – Harbor Home Healthcare
PHI MI HHA Apprentice Pilot

15. Lessons Learned – Agencies’ Capacities Were Strained
Despite their Commitment, Launching Efforts Can Be Challenging for Small Organizations
Agencies are short of financial and staff resources with which to undertake project and the Pilot required much more time than they anticipated
Administrative demands and new programs were difficult for busy staff to add to their responsibilities
Facilities are often inadequate for on-site training
PHI MI HHA Apprentice Pilot

16. Lessons Learned – Staffing Issues Create a Multiple Challenges
Staff turnover – program managers, trainers, apprentices – strains the programs
It is not easy to find and keep instructors that practice adult learner-centered training
Having staff off work for training strains work schedules
PHI MI HHA Apprentice Pilot

17. Lessons Learned – Home Health Staffing has Unique Challenges
Home Health Aides’ schedules are usually:
Part-time
Assembled from varying assignments and hours to meet client needs
Subject to abrupt changes
Limited in opportunities to use the range of skills taught in apprenticeship – though all skills may be required by different assignments over time
These conditions add to the difficulties agencies face when hosting program
PHI MI HHA Apprentice Pilot

18. Lessons Learned – Integrating Program into Operations
Engaging staff to ensure the success of the Peer Mentoring program while the apprenticeship was also being launched was difficult
Programs tended to be seen as the projects of the 1 or 2 staff who were championing them and not ‘owned’ widely by operations staff
Unexpected dips (or surges) in business stress scheduling and disrupt agencies’ ability to maintain apprentice training and involvement
PHI MI HHA Apprentice Pilot

19. Lessons Learned – Handling Administrative Demands
Tracking to ensure that apprentices receive on-the-job learning hours, particularly in the specialties, can be cumbersome
Ongoing evaluation of the quality of training and the supervision of apprentices and mentors is important to program outcomes, but strains overloaded staff
Agencies’ capacity for data collection and analysis varies greatly and affects planning capacity
PHI MI HHA Apprentice Pilot

20. Lessons Learned – Introducing a New Credential
Long Term Care Industry relies on CNA certificates as the portable credential for direct care workers
Not being able to sit for the exam discouraged participation in the HHA apprenticeship
Because all instructors were registered CNA trainers, the State agreed to approve graduates taking exam – with documentation from agencies
Home health is likely to come under increasing regulation, highlighting the need for a portable credential: Apprenticeship sets a high standard
PHI MI HHA Apprentice Pilot

21. Lessons Learned – Returns on Investment
High up-front costs without early savings can stress agencies. It may take longer to achieve expected results:
New employee and long-term staff turnover
Supervisor satisfaction and time for strategic planning
Improved client feedback
Improved employee satisfaction and evaluation outcomes
Improved attendance and punctuality, reduced call-ins
Reduction in reportable incidents, health and safety concerns
Eased scheduling difficulties due to: fewer attendance concerns, aides working with broad range of clients, staff engaged in scheduling
Enhanced marketing
Increased employee contribution to continuous improvement
PHI MI HHA Apprentice Pilot

22. Lessons Learned – Creative Strategies Needed to Succeed
Building relationships with local workforce agencies and other community resources eased the challenges greatly
E-learning may be a key strategy for providing more flexible and accessible training
Having locally available magnet training programs was an enormous advantage for Harbor
Conducting training – at least partially – on workers’ own time was necessary to meet the financial challenges
Beginning the program with incumbent workers allowed one agency to ease into the apprenticeship program
PHI MI HHA Apprentice Pilot

23. Lessons Learned – Agencies are Committed to Vision & Values
Agencies undertook the Pilot Program knowing that it would strain their resources
They’ve made adaptations and revised approaches to persist with the programs despite the difficulties
They’ve worked very hard to support their apprentices and express their belief in them
They’ve greatly enjoyed the positive outcomes for the apprentices
PHI MI HHA Apprentice Pilot

24. Lessons Learned – Apprentices Value the Program Greatly
It increases apprentices’ self-esteem as well as their skills – they feel valued by their agencies
It builds mutual support among them as they go through the program together
It is also has engaged their families in valuing their work and personal growth. It has improved family’s commitment to the agency and apprentices’ success.
Apprentices are eager to continue learning!
PHI MI HHA Apprentice Pilot

25. Lessons Learned – Technical Assistance is Key to Success
Although PHI had numerous written guides and training resources, a step-by-step manual would have been a much more effective tool for the agencies (but that’s what pilots are for!!)
All-Agency meetings to discuss program design allowed for good discussion and learning, and…
Agencies would have benefited from one-on-one consulting for detailed planning and budgeting, and monthly visits to review program progress and address challenges
PHI MI HHA Apprentice Pilot

26. Lessons Learned – Public Supports are Crucial to Success
Harbor Home Healthcare utilized wage supports and subsidized public training to make their apprenticeship possible, and anticipates ongoing support
A non-profit organization (CSN) in the Traverse Bay area provides low-cost, high quality entry-level health care magnet training in partnership with the local MI! Works! Agency
CSN’s 50-hour health careers pre-training program provided a valuable ‘pre-screen’ for potential new hires
PHI MI HHA Apprentice Pilot

27. Lessons Learned – Public Supports are Crucial to Success
Heritage has received a grant from its local United Way to pursue e-learning options
Heritage and Lutheran fully funded their initial programs and provided training on paid time
Home health agencies want to expand training – but they are strained to do it without financial and technical support
PHI MI HHA Apprentice Pilot

28. Lessons Learned – A Consortium Approach Could Enhance Success
Regional consortia of employers:
Can pool resources and needs to offer more cost-effective programming
Have more clout with public and private workforce development institutions to organize customized training that meets their needs
Can create the administrative infrastructure for more effective program management
- See Jackson Area Manufacturers’ Association model
PHI MI HHA Apprentice Pilot

29. Next Steps for Michigan and Beyond
What are the implications of our discussion?
What can we do to support best practices in home health in the future?
PHI MI HHA Apprentice Pilot

30. Thanks! For More Information –
PHI Staff in Michigan:
Maureen Sheahan - PHI Michigan Practice Specialist ;
Hollis Turnham, PHI Michigan State Director ;
Chris Curtin, PHI Consultant, CSN ,
US Dept. of Labor, Michigan:
Dave Jackson, Apprenticeship Representative ,
PHI MI HHA Apprentice Pilot

31. Thanks! For More Information –
Harbor Home Healthcare, Petoskey & Traverse City:
Marcia Peterson – Nursing Manager
(231) ;
Heritage Community of Kalamazoo
Jill Hess, Vice President, Organizational Development
(269) ;
Lutheran Homes of Michigan, Frankenmuth
Lynn Zuellig, Director of Service Integration
(989) ;
Lynn Maurer, Director, Lutheran Home Care and Hospice of Hope
(989) ;
PHI MI HHA Apprentice Pilot