A guest column by Jack Mills, Executive Director of the National Network of Sector Partners (NNSP), an initiative of the Insight Center for Community Economic Development.
NNSP released a brief last week that provides important lessons for health care providers and direct-care workers. From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) reports on the experience of dozens of health care organizations and manufacturing companies.
These employers have found that investments in lower-wage workers directly benefit their bottom lines while their workers move up to better jobs. The brief documents the benefits for employers and provides lessons to help other employers follow suit.
Companies highlighted in the brief include the Visiting Nurse Association of Eastern Massachusetts (VNAEM), which employs 160 people at its home care agency and two assisted living facilities for low- and moderate-income seniors and individuals with disabilities.
Aides Should Get the Pay and Respect They Deserve
As VNAEM CEO Linda Cornell points out, aides are low on the organization’s wage ladder, but they are “the people who have the most responsibility in our organization for the direct hands-on care that our patients and residents receive.” Their performance on the job consequently has a huge effect on service quality and customer satisfaction.
VNAEM’s goal is for every patient and resident to be treated as you would want your loved ones treated, and its ultimate goal is to have everyone in the association recognize and embrace direct-care workers as equal members of the care team. Their approach was that certified aides and nurses’ aides should receive high-quality training, and the pay and respect that they deserve.
Funding from the Commonwealth Corporation’s Extended Care Career Ladder Initiative (ECCLI) supported VNAEM’s early work toward its goals with B&F Consulting in 2004-2005. Over the next two years, VNAEM teamed up with other health care employers and a nonprofit workforce organization, called Employment Resources, Inc. (ERI), to form a collective recruitment and training program for entry-level aides.
Ms. Cornell and her staff had long felt that the standard training required for certified aides and nurses’ aides was too rudimentary to ensure the quality of care that the association wanted to be known for. “In the industry,” she says, “the training did not match what we need…. It was just a bare minimum, no real hands-on training.”
Industry-Focused Workforce Development
Fortunately, ERI was working on an approach to the broader, industry-wide change that Ms. Cornell had in mind. With an ECCLI grant, ERI designed a program specifically tailored for employers who — collectively — hired lots of aides every year. Since so many participated, the program could recruit widely, train large numbers of people, greatly improve the kind of training each candidate received, and yet keep the cost per worker low for each employer.
How the Program Worked
- The program took place at the participating companies’ facilities, so trainees received an immediate, firsthand experience of the working environment.
- A one-on-one assessment of each worker and assessments of supervisors’ and managers’ needs were performed at the outset.
- The employers paid 100 percent of their employees’ salaries while they were being trained.
- The training included various kinds of adult basic education and English as a Second Language, depending on the needs.
- The program paid for transportation and child care when needed.
- Employees who completed each stage of the curriculum got an immediate boost in wages.
- Wages rose from $10 to as much as $16 per hour for completing the full regimen.
- Graduates have become equal members of care teams.
- Several graduates have become Team Leaders and several others have become nurses.
The program also involved and trained supervisors and managers at every level to:
- ensure that the companies know how to get the best results from the newly trained workers;
- get every level to buy into culture change regarding how important all of the workers are at every level; and
- understand how they can better lead.
Given that the need for well-trained employees is common across the health sector, it was logical for ERI to reach out to a number of health care organizations in the region to form a program together. All of the employers worked together to design the training. ERI was at the “center of the wheel” in implementing the design. It brought together other organizations to deliver the services that employers and workers needed.
So-called “sector initiatives” like this one have been shown, in rigorous independent evaluations (pdf), to yield higher earnings and steadier work for participants with low incomes who also face multiple barriers. VNAEM and other employers that participate in sector initiatives receive major benefits too, as documented in other studies and as the brief describes in detail.
Funding for From Hidden Costs to High Returns: Unlocking the Potential of the Lower-Wage Workforce (pdf) was generously provided by the Hitachi Foundation.














