Continuing Education Grants to Help Solve Staffing Needs.

The Commonwealth of Virginia has a reputation for harsh treatment of criminals, but on February 6, the lower house of the state legislature overwhelmingly passed a bill to soften the existing ban on nursing home employment of individuals convicted of domestic violence. The bill's author described the measure as a response to the industry's shrinking pool of job applicants. In effect, the legislature's proposed solution is to hire more (hopefully) rehabilitated felons. The Virginia legislature's approach was neither requested nor desired by nursing homes.

Deborah Cloud, vice-president of communications for the American Association of Homes and Services for the Aging (AAHSA), acknowledges that adequate staffing of nursing homes and long-term care facilities has become "a concern of crisis proportion for our members." As she explains, the problem is not limited to a shortage of trained and certified staff or the aging of the nursing profession. Competition among providers for limited certified staff is driving costs.

Judy Perez, AAHSA spokesperson on medical issues, believes that the origins of the staffing crisis are more than a decade old, but people have been focusing on the issue only for the last year. "Frontline staff who deliver care have been tearing their hair out," she said in an interview, while the problem "has barely caught the attention of public policymakers."

Part of Washington's blindness is that policymakers are torn between conflicting goals. On the one hand, the demand to ensure safe and secure care drives members of Congress and Health Care Financing Administration (HCFA) administrators to insist that the most highly trained and skilled professionals take charge of even the most routine tasks. One consumer laughingly pointed out that a disabled elderly relative living in a family member's home can be fed by a preadolescent child but cannot be assisted at nursing home meals by anyone who isn't at least a CNA. As a result, nurses and CNAs in nursing homes must often spend hours performing routine work rather than providing the specialized services for which they are qualified.

On the other hand, legislators are driven to keep the costs of care low. Failing reimbursement levels mean that there are fewer resources available to pay for the increasingly skilled staff levels. Nursing homes are trapped between a demand for them to bid for more members of the diminishing pool of well-trained staff and the demand to be more efficient and spend less money.

Raising pay and benefit levels can be part of the solution: Nursing homes shouldn't be outbid for skilled employees by entry-level food service and retail jobs. More important, however, is providers' willingness to provide continuing education opportunities. This means finding both the time and the money to ensure that current employees can increase their skills and their value to the residents and management.

Presbyterian Homes in Camp Hill, Pennsylvania, has taken the unusual step of overhauling its staff compensation system to replace wage increases based on tenure with wage increases based on increased skills and knowledge. The result is that newly hired staff become more interested in remaining in the nursing home field because their incomes will increase as they develop long-term-care-related specialties.

Department of Education funds can be used to support continuing education activities, but recent changes complicate access to the money. Congressional Republicans, with the tacit support of the Clinton administration, transferred control of most federal education grants to the state departments of education. In other words, to tap into the millions of federal dollars available for continuing education for employees, long-term care facilities must apply to their state governments rather than the U.S. Department of Education.

The Tech-Prep Education grants included in the Carl D. Perkins Vocational and Applied Technology Education Act of 1998 are a good example of the "new approach" to state-administered federal funds. Under this program, each state and territory receives approximately $2 million per year. The states then use the money to award planning and demonstration grants to communities where local education agencies have established links with sites where high school students and graduates can receive training. The demonstrations must lead to a two-year degree or training certificate, such as a nursing assistant certification. For this reason, a spokesperson for the U.S. Department of Education believes that nursing homes that enter into an agreement with community colleges are good candidates to apply to state departments of education for the Tech-Prep grants.

Nursing homes located near Indian reservations could make use of thc Indian Vocational Education Program (IVEP), another provision of the Perkins Education Act. In 2002, tribal organizations will compete for grants valued between $250,000 and $500,000 each that will be used to provide technical and vocational education for Native Americans. Practical nursing and other health careers are specifically identified as desired projects for these grants. Nursing homes or state long-term care associations can ally with a tribal government to submit an application to fund training for careers in the industry.

Nursing homes that hire immigrant staff could benefit from a third federal program: Adult Education Basic Grants to States. These grants, totaling more than $416 million in the past year, are specifically designed to provide English literacy to adults and out-of-school youth. The applicants are required to be community-based organizations, nonprofit institutions or institutions of higher education. Even libraries and local volunteer groups can apply to state departments of education for the funds. The benefit to nursing homes is that workplace literacy and English language improvement services are identified as particularly desirable grant-funded programs. A joint application with a local educational or literacy promotion program can result in a long-term care facility providing free instruction in English as a new language to foreign-born hires.

U.S. Department of Education officials who provided information on these programs were initially surprised to learn that nursing homes had a potential need for such continuing education. Thanks to the "new federalism" approach to federal programs, the work of these Washington administrators is largely limited to administering the transfer of the money to the state and tribal governments. They are not involved in making certain that grants are used to address our country's most urgent continuing education issues. National and state nursing home associations, and individual providers, now have the responsibility to inform state departments of education of their worthiness as potential applicants for these funds.