Sustaining and Retaining the Home Care Workforce: An Innovative Employer-led Model

Sustaining and Retaining the Home Care Workforce: An Innovative Employer-led Model Michelle Zadrozny, LMSW Creating Transformational Workplaces Director of Workforce Development BrightStar Care Central TX

Our Community Austin has the nation's fastest growing population of pre-seniors, ages 55 to 64, with a 110% increase from 2000 to 2010. Sharon Jayson USAToday 08/02/2013 8% of the population in Travis County is 65+, as of 2013. CAN Community Dashboard 8% of individuals 65+ are living in poverty in Travis County, as of 2009. American Community Survey 8.7% of the population in Travis County are individuals with disabilities, as of 2011. Texas Workforce Investment Council

The Challenge: Supporting the Direct Care Workforce

Who Are Direct Service Workers? Approximately 800,000 in the USexpected to pass 1 million by 2018 Primarily minority women Have a high school education or less Live with economic insecurity Average age 57+

Current Realities Low Income, Low Skilled Workforce High Risk/Incidence of Diabetes and other preventable health conditions Lack of access to health care and medical insurance No certification or career path for Personal Care Attendants Up to 100% turnover for employers

Common Issues Meeting Basic Needs- Food, Shelter, Housing Banking/budgeting/financial management Poor health and nutrition Mental health and substance abuse issues Domestic violence English as a second language Low literacy Childcare needs Caring for their own family who is elderly/ disabled

Direct Service Workforce Home Health Aides and Personal Care Aides are projected to be the 3 rd and 4 th fastest-growing U.S. occupations between 2008 and 2018 SOURCES: US Department of Labor, PHI Quality Care through Quality Jobs

Aspire: Partnership for Employee Excellence (Piloted with HAND a non-profit home care provider serving Austin / Central TX)

Aspire: A Workforce Support Model Improve client care Reduce turnover and absenteeism Improve workers skills and productivity Develop career opportunities and growth Improve quality of life for attendants and their families

Aspire: A Workforce Support Model Received the Innovative Program of the Year Award from Leading Age Texas in 2015

Aspire Program Components Recruitment' &'RetenCon' Employee' Assistance' Program'(EAP)' Aspire' Workforce' Development' Professional' Skill'' Development' Leadership' Development'&' Personal' Growth'

Employee Assistance Program (EAP) Holistic Health and Wellness Approach 6 Dimensions of Wellness Physical, Spiritual, Emotional, Psychological, Social, Financial

Aspire EAP Individual Counseling and Case management Counseling referrals through Capital Area Counseling* Food Pantry* Financial education classes* Health & wellness education* Health & wellness counseling Resource fairs and pay day appreciation events Access to community resources for improved financial stability & quality of life Job Performance Coaching *Services offered in Spanish

Aspire Professional Development Monthly Paid Trainings offered One hour of Personal Care Attendant Skills Training One hour of Personal Growth and Wellness Community Resource Fair according to Theme* English language classes* Leadership development opportunities Assistance with accessing educational resources and opportunities* Career coaching *Services offered in Spanish

Outcomes 2013-15 EAP utilization 12% (national rate is 4%) Over 60+ are now banked &/or have moved to direct deposit Enrollments in ACA 40+ English at Work model with financial component developed 70+ trained on health and wellness, nutrition, self care and attendant skills Attendant survey/research with University of Texas in progress *based on workforce of 300 Personal Care Attendants at HAND

How did we do it? Capacity-Building: Internships Social Work MSW first year and Final Field (Administration and Leadership Track) University of Texas School of Social Work Texas State University Development & Communications St. Edward s University EAP Counseling St Edward s University-- LPC Practicum University of Texas School of Nursing Masters of Public Health Nursing Nurse Specialists/Interdisciplinary Teams RN to BSN

Recruiting and Hiring

Recruiting and Hiring In 2013-14, we connected with 4+ area training providers to recruit recent CNA graduates Current Reality most training providers report a 65% placement rate, mostly due to lack of preparation for job demands, lack of professionalism/ soft skills pressing life challenges resulting from generational poverty Structured Recruiting and Hiring process would provide: Consistent hiring for core competencies and work culture Manager coaching and training for home care service industry

Training and Skill Development

Training and Skill Development In 2014, we provided 4 training events, reaching 1/3 of the workforce. 2015 trainings will occur monthly. Skills Training topics include: Clients Rights, Abuse, and Neglect Working with Clients with Long Term Disabilities and Life-limiting Illness Basic Home Safety and Risk Management Alzheimer s and Dementia Care Professional Boundary Setting

Training and Skill Development Personal Growth Training topics include: Diabetes Prevention and Risk Management Wheels 101: Tips and Tools to Finance a Car Health Insurance Q &A / Open Enrollment Grief and Loss: Coping with the Death of a Client or Loved One Do One Thing Different: How to Jump Start a Life Change April 1 st Day at the Capital: Advocating for Higher Attendant Wages

Case Management and Counseling Capital Area Counseling University of Texas School of Social Work Interns Texas State University MSW Interns St Edwards University LPC Practicum

Case Management and Counseling Consistently assist 12% of our workforce through the Employee Assistance Program, with issues related to Family stress Transportation issues Housing instability Food insecurity We also provide counseling sessions for issues impacting an attendant s ability to stay focused and present on the job

Financial Literacy

Financial Literacy In 2013-14, we opened 67 new bank accounts (including 18 new direct deposits), saving up to $25,480 collectively!* We have increased bank account access by roughly 70% since the program started. *Calculations are based on savings from check cashing over projected lifetime earnings (United Way for Greater Austin Financial Stability Partnership www.uwatx.org) )

Primary Care and Medical Access

Primary Care and Medical Access Provided biweekly Pay Day Outreach events Engaging 30-60 attendants Connecting attendants with community services: The Supplemental Nutrition Assistance Program (SNAP) Giving out 46 free flu shots and health screenings (2014) Provide health insurance outreach during open enrollment periods for ACA Increasing access to medical insurance and local assistance programs (reaching 25% of workforce in 2014)

Physical Health & Wellness

Looking to the Future: Developing the Pipeline Recruitment' &'RetenCon' Employee' Assistance' Program'(EAP)' Aspire' Workforce' Development' Professional' Skill'' Development' Leadership' Development'&' Personal' Growth'

Current Realities Austin TX 2 nd fast growing suburban poverty rate in the US #1 fastest growing rate of preseniors (55-64) in the US In the past 10 years Elderly population has grown at TWICE the national rate Poverty among elderly residents has grown 42%

Direct Service Workforce By 2018, the Direct Service Sector will be the 2nd Largest U.S. Occupational Group (behind only retail in total employment). The Direct Service sector includes retirement communities, assisted living, rehab centers, personal assistants, hospitals and home care services. At 4.3 million, the direct-care workforce will be larger than: Teachers from kindergarten through high school (3.9 million) All law enforcement and public safety workers (3.7 million) Fast food and counter workers (3.7 million) SOURCES: US Department of Labor, PHI Quality Care through Quality Jobs

Direct Service Workforce Home Health Aides and Personal Care Aides are projected to be the 3 rd and 4 th fastest-growing U.S. occupations between 2008 and 2018. SOURCES: US Department of Labor, PHI Quality Care through Quality Jobs

Changing Skill Demands High-Skill Occupations Workers with analytical ability, problem solving, and creativity. Automation Traditional Middle-Skill Occupations Workers who perform routine tasks that are procedural and repetitive Low-Skill Occupations Service oriented, manual labor, security Source: The Vanishing Middle: Job Polarization and Workers Response to the Decline in Middle-Skill Jobs, Didem Tüzemen and Jonathan Willis, Kansas City Federal Reserve Bank, 2013. CHANGING'SKILL' DEMANDS' ALIGNING&TALENT& PIPELINES& EXAMPLES&

Changing Skill Demands Percent of U.S. Workforce by Occupation Skill Level 26% 59% 15% HighJSkill'OccupaCons' TradiConal'MiddleJSkill'OccupaCons' LowJSkill'OccupaCons' 37% 45% 18% Source: The Vanishing Middle: Job Polarization and Workers Response to the Decline in Middle-Skill Jobs, Didem Tüzemen and Jonathan Willis, Kansas City Federal Reserve Bank, 2013. CHANGING'SKILL' DEMANDS' ALIGNING&TALENT& PIPELINES& EXAMPLES&

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& I. &&&Educa=on & & & && II. &&Workforce&Development & && III. &Economic&Development & &Industry&Clusters& CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent Development Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& Designs'by'

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& I. &&&Educa=on&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&? && II. &&Workforce&Development & && III. &Economic&Development & &Industry&Clusters& CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

A'BeOer'State'System' Talent Sector'Strategies'Coming'of'Age:'' Development Pipelines EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& Aligning&Educa=on,&Workforce&&&Economic&Development& I. &&&Educa=on & & & &Train&&&Pray& II. &&Workforce&Development & && III. &Economic&Development & && CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& I. &&&Educa=on & & & &Career&Pathways& II. &&Workforce&Development & && III. &Economic&Development & && CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Regional'EducaCon'&'Training'Systems' Talent Development Pipelines PREPARING&MORE&STUDENTS&AND&ADULTS&FOR&SUCCESS&IN&THE&WORKFORCE& Aligning&Educa=on,&Workforce&&&Economic&Development& THE&EDUCATION&&&TRAINING&SYSTEM& Career & technical education (diploma & certificate) Community & technical college (diploma & certificate) Designs'by'

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& High&Quality&Career&Pathways&Systems& 1. Linked'and'aligned'programs'that& have&wellsconnected&educa=on,& training&and&support&services& informed&by&employer&needs;&& 2. MulCple'entry'points,'or'onJramps' including&for&those&with&limited& educa=on,&english,&skills,&and&work& experiences,&(i.e.,&bridge&programs).& Career'Pathway'Systems' Career & technical education (diploma & certificate) Community & technical college (diploma & certificate) 3. MulCple'exit'points'at&successively& higher&levels&of&family&suppor=ng& employment&and&aligned&with& subsequent&entry&points.& Source: Shared Vision, Strong Systems: Alliance for Quality Career Pathways, Framework Version 1.0. Center for Law and Social Policy, June 2014. CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& I. &&&Educa=on & & & && II. &&Workforce&Development & &Sector&Partnerships& III. &Economic&Development & && Career' EducaCon' Career & Pathways' Pathways' technical education (diploma & certificate) Community & technical college (diploma & certificate) CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent Development Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& Designs'by'

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALIGNING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& High&Quality&Sector&Partnerships:& Are&employer&driven;& Are&convened&by&a&credible&third&party;& Act&as&a&coordina=ng&body&across&mul=ple&educa=on,&workforce& development,&economic&development&and&other&programs;& Create&highly&customized&responses&to&industry&and&jobseeker& needs;&and& Cross&geopoli=cal&boundaries&to&focus&on&regional&labor&markets.& CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent'Development'Pipelines' Pipelines Aligning&Educa=on,&Workforce&&&Economic&Development& ALINGING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& Sector&Partnerships&are&Different&from:& A&local&workforce&investment&board& A&regional&or&city&economic&development&board& A&Chamber&of&Commerce& An&industry&associa=on& A&community&college&advisory&board& CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Talent'Development'Pipelines' Pipelines ALINGING&EDUCATION,&WORKFORCE&&&ECONOMIC&DEVELOPMENT& Aligning&Educa=on,&Workforce&&&Economic&Development& CHANGING&SKILL& DEMANDS& ALIGNING'TALENT' PIPELINES' EXAMPLES&

Career' EducaCon' Career & Pathways' Pathways' technical education (diploma & certificate) Community & technical college (diploma & certificate) Designs'by'

Central Texas Home Care Coalition Initiated in 2014 15 local home care agencies Strategic Priority areas: Training Retention and Work Supports Wages and Advocacy

Central Texas Home Care Coalition Potential membership-160 agencies in Austin alone! Shared support services for members Collaborative training program (skills and wellness) Regional sector training and recruitment Scaling up of EAP best practices for counseling and support

Central Texas Home Care Coalition Sharing Resources EAP Walk in Clinic Resource Fairs Staffing and Recruiting Monthly Training Events Presence at TAHC&H

Central Texas Home Care Coalition Our goals are: 1. To work together to strengthen and expand our local industry s workforce to the benefit of regional employers, clients and the workers themselves. 2. To efficiently leverage a range of resources to improve both the quality of care delivered as well as the business results of our participating employers. 3. To improve the skills, productivity and retention of local Personal Care Attendant workforce while also improving workers career opportunities and quality of life.

Expected Outcomes Employers gain access to more work-ready applicants Collaborative hiring and recruitment strategies Better, more targeted training less expensively More training that is accessible, job relevant and market valuable Workers/Job Seekers gain better access to employee-centered, coalition-aligned hiring employers Workers receive better support for themselves and their families

CHANGING&SKILL& DEMANDS& ALIGNING&TALENT& PIPELINES& EXAMPLES'

Healthcare Industry Challenges: 1.Surging Demand for Healthcare Services: Growing at double the rate of other industry sectors in the State; 2.Rapid Facility Expansion: Major hospital facility expansion during the last 3 years; 3.Difficulty Filling Positions: Hospitals faced difficulty filling many of the same critical high demand occupations; 4.Too Many Requests to Partner/Help: Employers were asked to serve on multiple councils, committees, job fairs, etc. Also having multiple regions and staff contacting them about hiring needs. CHANGING&SKILL& DEMANDS& ALIGNING&TALENT& PIPELINES& EXAMPLES'

Three Workforce Investment Boards Formed one joint subcommittee Seven Industry Partners: (Hospital'and'Ambulatory'Systems)' &Initial group was too broad & included all of healthcare Began By Examining Critical Occupations Across The Industry: (From 145 occupations to 4) Nursing (ADN, RN, BSN) Laboratory Technologist (Medical Scientists) Medical Laboratory Technicians Surgical Technicians Partnership Grew to Include: &Eight Educational Programs (Colleges & Universities) Four Economic Development Entities Two Professional Associations CHANGING&SKILL& DEMANDS& ALIGNING&TALENT& PIPELINES& EXAMPLES'

Benefits of Partnership: Surprise that the problems employers were facing were universal, and that the solutions were better found and implemented as a group Pooled resources and expertise, including the use of crosscompany Subject Matter Experts Single point of contact for industry with the education and workforce system Five new education and training pathways to direct employment in skilled, high-wage jobs Ac=vity& Total&Planned& Total&Actual& %&of&goal& Entered&Training& 80& 149& 186%& Completed&Training& 69& 72& 104%& Earned&Cer=ficate&or& Industry&Creden=al& 67& 72& 107%& CHANGING&SKILL& DEMANDS& ALIGNING&TALENT& PIPELINES& EXAMPLES'

Key&Lessons&Learned& IndustryJDriven:'It&was&essen=al&that&the&goals&and&objec=ves&were&iden=fied& by&employers,&rather&than&by&workforce&development&or&higher&educa=on& Project'Manager:'Essen=al&to&have&SOMEONE&in&charge,&who&is&able&to&drive&mee=ng& agendas&and&hold&partners&or&workgroups&accountable&to&commitments.& InJPerson'MeeCngs:'Face&to&face&partnership&mee=ngs&were&impera=ve.& Streamlined'and'Coordinated'Policies'Across'the'Regions:'Prevents&employers& from&having&to&deal&with&different&public&programs,&bureaucra=c&regions,&and&several& public&en==es&repeatedly&approaching&them&for&duplica=ve&partnerships&and&programs.& Input'of'Industry'Professionals:'Subject&maher&experts&provided&firsthand& experience&about&skills&sets&and&quali=es&required&for&specific&jobs.& Clearly'Defined'Roles'and'ExpectaCons:'Partners&needed&clear&responsibili=es&and& accountability& CHANGING&SKILL& DEMANDS& ALIGNING&TALENT& PIPELINES& EXAMPLES'

Join Us! Website www.transformationalworkplace.com Twitter @CenTXHomeCare Central TX Home Care Coalition meetings occur monthly you can contact Michelle to get on the list serve

THANK YOU! Michelle Zadrozny, LMSW Michelle.zadrozny@gmail.com 512-799-9348 Creating Transformational Workplaces www.transformationalworkplace.com Director of Workforce Development BrightStar Care Austin/Central TX http://www.brightstarcare.com/austin