Existing law establishes the Caregiver Training Initiative to develop and implement proposals designed to recruit, train, and retain health care providers such as certified nurse assistants, certified nurses, registered nurses, licensed vocational nurses, and other types of nursing and direct-care staff. Under the initiative, contracts are required to be awarded to regional collaborative programs selected through a competitive request for proposals process. Existing law requires the Employment Development Department, in consultation with the State Department of Social Services, to administer regional collaborative program selection and funding and specifies various duties of the Employment Development Department.

Existing law establishes the Caregiver Training Initiative to develop and implement proposals designed to recruit, train, and retain health care providers such as certified nurse assistants, certified nurses, registered nurses, licensed vocational nurses, and other types of nursing and direct-care staff. Under the initiative, contracts are required to be awarded to regional collaborative programs selected through a competitive request for proposals process. Existing law requires the Employment Development Department, in consultation with the State Department of Social Services, to administer regional collaborative program selection and funding and specifies various duties of the Employment Development Department.

This bill would require the department to continue to provide support to programs that were funded pursuant to the initiative and that effectively recruited and trained certified nurse assistants.

Date of Hearing: May 3, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1656

Author:(Burke) – As Amended Ver:April 5, 2017

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Employment Training Panel (ETP) to establish a grant award program to fund training programs for certified nurse assistants (CNAs). Specifically, this bill:

1. Requires ETP to establish criteria for awarding grants to applicants with established training programs, and to establish training program standards by July 1, 2018.
2. Appropriates $3 million from the General Fund (GF) to ETP to implement the grant award program.
3. Requires the Employment Development Department (EDD) to provide the panel with appropriate resources to administer the grant award program.

FISCAL EFFECT:

1. One-time appropriation of $3 million GF to ETP to administer the proposed grant program.
2. Minor costs for EDD to provide resources and assistance to ETP, as required by this bill.

COMMENTS:

1. Purpose and Background. According to the author, AB 1656 will allow California and the state’s skilled nursing facilities to attract, train, hire, and retain a qualified CNA workforce. The author notes that a CNA worker shortage has put strain on skilled nursing facilities (SNFs). According to the Office of Statewide Health Planning and Development, an additional 23,000 CNAs will be needed by 2022 to care for California’s aging population.
2. Caregiver Training Initiative (CTI). The program established with this bill would not be the first effort to fund health care worker training and recruitment. California established the CTI in 2000 to address the growing health care worker shortage. The goal was to develop innovate approaches to recruit, train and retain caregivers and healthcare employees and to enhance their earning potential. CTI provided $25 million in state and federal moneys through competitive grants to regional collaborative, and many of those CTI collaborative exceeded their goals for the numbers of caregivers trained.
3. Quality of work. According to surveys and industry reports, there are a number of factors driving the low supply of health care workers and, in particular, the shortage of CNAs. This bill focuses on one such factor, which is limited funding and support for training programs. However, this bill does not address the ongoing issue of the quality of work. As noted in the policy committee analysis, wages for CNAs can be low and working conditions can be quite poor. While improving the quality of this work is beyond the scope of this bill, ideally this bill would go hand-in-hand with an effort to make these jobs more attractive overall.

Analysis Prepared by: Luke Reidenbach / APPR. / (916) 319-2081

Date of Hearing: April 19, 2017

ASSEMBLY COMMITTEE ON LABOR AND EMPLOYMENT

Tony Thurmond, Chair

ABPCA Bill Id:AB 1656 (

Author:Burke) – As Amended Ver:April 5, 2017

SUBJECT: Certified nurse assistant training

SUMMARY: Requires the Employment Training Panel to establish a grant award program to fund training programs for certified nurse assistants by interested and qualified applicants, as specified. It also appropriates funds to implement the program and requires the establishment of criteria for awarding grants and training program standards, as specified. Specifically, this bill:

1. Requires the Employment Training Panel (panel) to establish a grant award program to fund training programs for certified nurse assistants (CNAs by interested and qualified applicants that include skilled nursing facilities and other established training programs.
2. Mandates the panel establish criteria for awarding grants and training program standards, after consulting with representatives from the skilled nursing facility industry and CNAs.
3. Requires that an applicant for a grant award shall do both of the following:
   1. Guarantee employment for a CNA who successfully completes a training program established pursuant to these provisions.
   2. Provide the panel with evidence that the applicant has a successful training program in place and any other information required by the panel to further the purposes of this chapter.
4. Requires the criteria and standards to be adopted on or before July 1, 2018.
5. Appropriates the sum of three million dollars ($3,000,000) from the General Fund to the Employment Training Panel to implement the grant award program described in these provisions.
6. Requires the Employment Development Department to provide the panel with appropriate resources to administer the grant award program.
7. Provides for findings and declarations of the Legislature related to California’s shortage of long term care facility caregivers.

EXISTING LAW:

1. Establishes the Caregiver Training Initiative to develop and implement proposals designed to recruit, train and retain health care providers such as certified nurse assistants, certified nurses, registered nurses, licensed vocational nurses, and other types of nursing and direct-care staff.
2. Requires the Employment Development Department, in consultation with the State Department of Social Services, to administer regional collaborative program selection and funding and specifies various duties of the Employment Development Department.
3. Provides for under the initiative, contracts to be required to be awarded to regional collaborative programs selected through a competitive request for proposals process.

FISCAL EFFECT: Unknown

COMMENTS: The author states, “California’s baby boomers are aging at a rate of 1,100 individuals every day turning 65 – tripling in population by 2030. The California Health Care Foundation estimates that the need for nursing home beds will exceed supply by 2020. Without any new staffing mandates, the Office of Statewide Health Planning and Development estimates that an additional 23,000 certified nursing assistants (CNAs) will be needed by 2022 to care for our state’s aging population.

Our state’s nursing homes are already at a crisis point in recruiting and retaining their nursing workforce let alone being able to address the increased needs of our baby boomers. It is hard to find a skilled nursing facility in the state that does not have a nursing vacancy if not several. We hear stories constantly about facilities that are not able to admit patients because they cannot staff safely without the necessary nursing care staff. Then - if a facility can actually recruit a CNA, LVN or RN for employment, many times soon after their hire these professionals move on to higher paying jobs in hospitals, home care agencies, etc. Also, with the increase in the minimum wage to $15 per hour statewide many of our CNAs will find an equal pay position with a restaurant or retail facility that is not as grueling work - mentally or physically. Most CNAs make very close to the minimum wage, based on what Medi-Cal pays skilled nursing facilities.

With secured funding and programs, AB 1656 will allow the state and our skilled nursing facilities to attract, train, hire and retain a more sustainable and qualified CNA workforce. This bill will serve as an opportunity for people who want to enter the long-term care workforce, provide incentives for CNA applicants and be a solid step in their career ladder.”

Caregiver Training Initiative

In 2000, the Legislature established the Caregiver Training Initiative, to be administered by the Employment Development Department (EDD) and the Department of Social Services (DSS), to develop and implement proposals designed to recruit, train, and retain health care providers such as certified nurse assistants, certified nurses, registered nurses, licensed vocational nurses, and other types of nursing and direct-care staff.

Contracts are awarded to regional collaborative programs selected through a competitive request for proposals process. The Employment Development Department is required, in consultation with the State Department of Social Services, to administer regional collaborative program selection and funding and would specify various duties of the Employment Development Department. An advisory council was established with a designated membership and specified duties for purposes of the initiative.

Skilled Nursing Facilities (SNFs)

Most nursing homes in California are licensed as Skilled Nursing Facilities (SNFs), which is broadly defined as a health facility that provides skilled nursing and supportive care to persons who need this type of care on an extended basis. California SNFs primarily have two-payer sources Medi-Cal, and Medicare. SNFs are struggling to find and retain direct care workers to properly staff facilities, it is in the best interest of the State and SNFs to find a way to grow and retain the CNA workforce.

Report on the Certified Nurse Assistant (CNA) Workforce Shortage and results of the Caregiver Training Initiative^[1]

The proportion of Californians over age 65, 85, and even 95 will increase dramatically over the next two decades. There are not enough caregivers in California to respond to current and future demands from elderly and other populations, and this worker shortage can threaten patient safety and compromise quality of care. To address these urgent workforce issues, the State of California established the statewide Caregiver Training Initiative (CTI) in 2000 to develop innovative approaches to recruit, train and retain caregivers and healthcare employees and also enhance their earning potential, using twelve collaborative programs. The State’s Employment Development Department, under earlier the Health and Human Services Agency and later the Labor and Workforce Development Agency, administered the $25 million federal and state funded program.

The shortage is a result of several trends, including low wages and benefits and competing occupations. Nurse aides, particularly those in nursing homes and home health care, receive lower wages and benefits than service workers and other workers generally. Because so many competing jobs have higher salaries and lower demands, fewer current and future workers are drawn to these jobs... Working conditions can be poor too. Workers are exposed to infections, back injuries, and physical violence from residents. It is not possible to address the critical shortage of caregivers without a strong and meaningful commitment from the state and health care facilities.

The findings show that the Welfare-to-Work participants trained in this program performed just as well as non-WtW caregivers, and even better than other WtW trainees. Other studies have had similar results. This group, however, was more challenging to recruit, and needed more supportive and educational services, including [transportation, childcare] and other prerequisite job-related skills. Continuing health caregiver training partnerships with local WIBs or other training facilities as a long-term investment could not only provide the needed support, but also expand the pool by supplementing educational training…. Most of the CTI collaboratives exceeded their goals for numbers of caregivers trained, but these caregivers need to remain in the healthcare field…. Recent research shows that autonomy, job satisfaction, and group cohesion contribute to job retention among nurses, and that input into care planning and more in-service programs are related to retention of nursing assistants.

Arguments in Support

The California Association for Health Services at Home (CAHSAH) writes in support, “This bill would require the Employment Development Department, in consultation with the State Department of Social Services, to continue to provide funding for the regional collaborative programs that recruit and train certified nurse assistants.

CAHSAH supports the efforts being made to foster “demand-driven skills attainment” for California’s allied health workforce especially given the increasing need for more caregivers as our state’s senior population continues to grow exponentially each year. Home health agencies are experiencing, more hospitals referring patients for home health services and California needs to be ready with a qualified workforce to meet the growing demands of individuals who wish to receive care in their homes.

Ideally, we would also like to see certified home health aides included in the continued funding for these regional workforce programs as the bill does not include that language. Certified home health aide training programs are very limited throughout the state and many counties do not offer these certification programs in their colleges or in the community. California’s Title 22 regulations require home health agencies to utilize certified home health aides.”

LeadingAge California writes that, “Health care providers throughout California have a desperate need to recruit, train, and retain a sustainable and quality workforce. In particular, long-term care facilities are facing the brunt of this workforce shortage. As our aging population is growing at a rapid rate, the available workforce supply has not kept pace. AB 1656 would make available funds to provide training and development of a skilled, well-trained and high quality workforce that care for our state’s most vulnerable residents.”

Previous Related Legislation

AB 2876 (Aroner) Chapter 108, Statues of 2000. This bill was the omnibus social services budget trailer bill which established the Caregiver Training Initiative, among other provisions.

REGISTERED SUPPORT / OPPOSITION:

Support

California Association for Health Services at Home

LeadingAge California

Opposition

None on file

Analysis Prepared by: Taylor Jackson / L. & E. / 916-319-2091

1. Final Process and Outcome Evaluation Report, California Employment Development Department & UCLA School of Public Policy and Social Research https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/CTI-FinalProcessReport2003.pdf ↑