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Rural Colorado is trying to fill health worker gaps with apprenticeships

By Kate Ruder, Kaiser Health News

GRAND JUNCTION – During her 12-hour overnight shift, Brianna Shelton helps residents at BeeHive Homes Assisted Living go to the bathroom. Many of them have dementia, and some cannot get out of bed on their own. Only a few can remember her name, but that doesn’t matter to her.

“They’re somebody’s mother, somebody’s grandmother, somebody’s great-grandmother,” Shelton said. “I want to take care of them like I would take care of my family.”

Shelton trained to be a personal care assistant through an apprenticeship program designed to meet the growing need for health care workers in rural western Colorado. Here, far from Denver’s bustling urban corridor, worker shortages are increasing as baby boomers retire, young people move away from these older communities, and the demand for health care in homes and facilities rises.

Rural areas often have higher proportions of residents who are 65 or older than urban areas. And the most rural regions have relatively fewer direct caregivers, such as personal caregivers, to help people with disabilities than less rural regions do, according to a recent study in the journal Health Affairs.

In addition to increasing the number of direct caregivers, the Colorado Apprenticeship Program provides opportunities to improve earning power for residents who live at or below the poverty line, who have lost their jobs during the COVID-19 pandemic, or who are unemployed or underemployed. They train to become personal care aides, who help patients with daily tasks such as bathing or housekeeping, or certified nursing assistants, who can provide direct health care, such as checking blood pressure.

Apprentices take training classes at Western Colorado Area Health Education Center in Grand Junction, and the center pays for students who live in more rural areas to attend classes at Technical College of the Rockies in Delta County. The apprentices receive on-the-job training at one of 58 local employers – an assisted living facility, for example – and they must work there for one year. Each apprentice has an employer mentor. Staff members at Western Colorado AHEC also provide mentoring, plus the center has a life coach on hand.

“We really just want students to get into health care, get a job and keep that job,” said Georgia Hoaglund, executive director of Western Colorado AHEC, which has 210 active apprentices and was supported by a $2 million grant from the U.S. Department of Labor . in 2021.

Some apprentices are recent high school graduates. Others are single mothers or veterans. They often have educational or economic barriers to employment. Hoaglund and her staff of 10 buy the apprentices scrubs so they can start new jobs with the right uniforms; otherwise they may not be able to afford it. Staff members pay for apprentices’ gas if they can’t afford to fill up their tanks to drive to work. They talk to apprentices on the phone monthly, sometimes weekly.

Although the apprenticeship program gives these workers a good start, the work can be stressful, and burnout and low pay are the norm. Career advancement is another obstacle, Hoaglund said, because of the logistics or cost of higher education. Hoaglund, who calls her staff family and some of the apprentices her children, dreams of offering more advanced training — for example, in nursing — with scholarship money.

Apprenticeships are perhaps better known as a workforce training tool among electricians, plumbers, carpenters and other trades. But they’re also seen as a way to build a needed pipeline of direct care health workers, said Robyn Stone, senior vice president for research at LeadingAge, an association of nonprofit providers of aging services.

“Traditionally, health care employers hired people after they completed a training program,” says Susan Chapman, a registered nurse and a professor in the school of nursing at the University of California-San Francisco. “Now we ask the employer to participate in that training and pay the person while they are training.”

The pandemic has exacerbated shortages of direct care workers, which could encourage employers to invest in apprenticeship programs, both Chapman and Stone said. Federal investment can also help, and a Biden administration initiative to improve the quality of nursing homes includes $35 million in grants to address workforce shortages in rural areas.

Brandon Henry was a student working at a pet store in Grand Junction, Colorado, before joining the Western Colorado Area Health Education Center's apprenticeship program to become a certified nursing assistant.  He expects to graduate from Colorado Mesa University and become a registered nurse.  (Photo by Kate Ruder/KHN)
Brandon Henry was a student who worked at a pet store in Grand Junction before joining the Western Colorado Area Health Education Center’s apprenticeship program to become a certified nursing assistant. He expects to graduate from Colorado Mesa University and become a registered nurse. (Photo by Kate Ruder/Kaiser Health news)

Shelton had never worked in health care before moving to Fruita, a small town about 12 miles northwest of Grand Junction surrounded by red sandstone towers. She left Fresno, California a year ago to care for an uncle who has multiple sclerosis. She and her 16-year-old daughter live in a trailer home on her uncle’s lot, where Blackie, her rescue Labrador retriever, roams around with the chickens and cats.

Blackie also sometimes accompanies Shelton to BeeHive to hang out with the residents. Shelton said that this is more than a job to her and that she is grateful for the apprenticeship program that helped her get there. “It opened a door for me,” Shelton said.

Shelton works three 12-hour shifts a week in addition to caring for her uncle and daughter. Still, she said, she struggles to have enough money for gas, bills and food and has taken out small loans to make ends meet.

She is not alone. Personal care aides are often underpaid and undervalued, said Chapman, who found significantly higher poverty rates among these workers than among the general population.

Direct caregivers nationwide earn an average of $13.56 an hour, according to a study by the nonprofit policy group PHI, and these low wages make recruiting and retaining workers difficult, leading to further shortages and instability.

In an effort to keep workers in the state, Colorado raised the minimum wage for personal care assistants and certified nursing assistants to $15 an hour this year with money from the USA Rescue Plan Act. And the Colorado Department of Health Care Policy and Financing’s 2023-24 budget request includes a bump to $15.75. Similar efforts to raise wages are underway in 18 other states, including New York, Florida and Texas, according to a recent paper from the National Governors Association.

Another way to keep apprentices employed, and encourage career and salary growth, is to provide opportunities for specialized training in dementia care, medication management or behavioral health. “What apprenticeships offer is career mobility and advancement,” Stone said.

To practice in Colorado, new certified nursing assistants complete classroom training, do clinical rotations, and pass a certification exam that consists of a written test and a skills test. Hoaglund said the testing requirements can be stressful for students. Shelton, 43, passed the written exam but must retake the proficiency test to be licensed as a certified nursing assistant.

Hoaglund’s program started in 2019, but it really took off with the 2021 federal grant. Since then, 16 people have completed the program and received raises or promotions. Twice as many people left without finishing. The largest hospital in Grand Junction, Intermountain Healthcare-St. Mary’s Medical Center, recruits workers from the program.

Hoaglund said every person who enters the health care field is a victory.

Brandon Henry, 23, was a student at Colorado Mesa University in Grand Junction and worked at PetSmart before joining the apprenticeship program in 2019. After enlisting, he trained and worked as a certified nursing assistant through the worst of the pandemic. As an apprentice, he said, he learned the importance of having compassion while caring for patients.

He went back for more training at Western Colorado AHEC to earn a license that would allow him to dispense medicine in accredited facilities, such as assisted living centers. He now works at Intermountain Healthcare-St. Mary’s Medical Center, where he took training classes in wound care and physical therapy offered at the hospital. This winter, he will graduate from Colorado Mesa with a Bachelor of Science in nursing.

“At the hospital, I found more opportunities for salary increases and job growth,” Henry said.

Kaiser Health News is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operating programs at the Kaiser Family Foundation. KFF is an endowed nonprofit organization that provides information on health issues to the country.

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