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BEST PRACTICES: Loomis House

ABSTRACT: Loomis House maintains a multi-level career ladder to encourage CNAs to develop their skills. CNAs are rewarded with wage increases as they advance up the ladder.  (December 2010)

Practice

Outcomes

Lessons

Background

CNA Career Ladder

In 2000, Loomis House, a nonprofit senior living facility in Holyoke, Massachusetts, became the first long-term care facility in the state to start a journey toward culture change. Loomis’s goal, says Lori Todd, the administrator of Loomis House, was to “move out of a medical model [of care] and more toward all-around social wellness.”

Some of the aspects of culture change that have been introduced to the facility in the last 10 years include the use of LEAP training, the creation of a home-like “neighborhood” structure within its residential campus, and the establishment of a career ladder for its staff of certified nursing assistants (CNAs). Over time, the career ladder especially has continued to grow and evolve, and is now one of Loomis House’s most popular and successful culture-change components.

Funding

Loomis’s career ladder began in April 2000. It was initially funded by a grant from the Extended Care Career Ladder Initiative (ECCLI), a state-run program that awarded grants to long-term care facilities to create career advancement programs, with the ultimate goal of improving the recruitment and retention of direct-care workers throughout Massachusetts. The initial ECCLI grant — $25,000 to help spur culture change in general — became a series of grants, spread out over the course of several years.

“When you’re a not-for-profit, investment in your workers is always the best strategy.”

Lori Todd, Administrator

The ECCLI grants have ended, but Todd says that the money is no longer needed; Loomis’s career ladder has proven to be sustainable even without ECCLI’s support. The career ladder is worth the money Loomis spends on it, Todd says: “When you’re a not-for-profit, investment in your workers is always the best strategy.”

Four-Step Ladder

Loomis House’s CNA career ladder has four levels, each of which requires additional training. Loomis House contracts with a local nurse staffing agency to conduct the training sessions; CNAs are paid for the time they spend in training.

Successful completion of the CNA II, CNA III, and CNA IV levels each result in a wage increase. At CNA IV, CNAs are given new responsibilities as peer mentors. The first three levels don’t change CNAs’ job descriptions, says Loomis House Human Resources Specialist Matt Giroux — they are meant to be more like skill-building opportunities, with the reward of wage increases at the end.

The four levels in the career ladder are:

Basic — A CNA reaches this level — which is also known as CNA I — after undergoing a 20-hour general skills training. The skills taught include dealing with difficult people, managing priorities, end-of-life care, and basic communication skills. According to Giroux, all new CNAs undergo this basic training at some point in their first year at Loomis House.
CNA II — This level requires another 20-hour training session: 8 hours of restorative care, and 12 in dementia/Alzheimer’s care. CNAs who complete this level of the career ladder receive a 30-cent increase in their hourly wage.
CNA III — CNAs need to complete 16 hours of training in physical assessment of residents, 8 hours of the PHI Coaching Approach℠ to Communication training, and an internship in order to reach the level of CNA III. The internship requires CNAs to choose another discipline practiced within the Loomis House facility — examples include activities planning, food service, and home care — and spend at least 20 hours interning in that department. CNAs must record the progress of their internship in a journal; at the end of the internship they are required to write a brief paper detailing what they learned as well as how the internship experience will affect their roles as CNAs. Successful completion of this level also results in a 30-cent hourly wage increase.
CNA IV — Completion of the final level of Loomis’s career ladder results in CNAs receiving a new title: peer mentor. The peer mentor training, which lasts 16 hours, is made available to CNAs who have advanced to the CNA III level and “are just a little more polished” than their co-workers, Giroux says. The peer mentors are expected to work with CNAS during their first six months on the job, helping to ease their introduction to Loomis House. Peer mentors receive a 50-cent increase to their hourly wage.

Champions

CNAs also have the option of joining Loomis House’s “Champions of Person-Centered Care” program, a separate career-advancement track. CNAs can choose to become either a Champion of Life Enhancement or a Champion of Food Services; upon achieving the titles, they receive a 30-cent wage increase.

Each path has different requirements:

Life Enhancement Champion — “Life enhancement” is Loomis’s term for activity planning: planning, coordinating, and leading special events for residents. In order to become a Champion of Life Enhancement, CNAs must complete a life-enhancement training as well as Loomis’s person-centered care training. (The person-centered care training takes place in-house and lasts eight hours.) They also have to complete an internship in Loomis’s Life Enhancement department and undergo training in It’s Never Too Late (IN2L), a senior-friendly computer operating system used to access the Internet and run countless other applications, ranging from games such as Jeopardy to a “Historical Quote of the Day” program. As a Life Enhancement Champion, CNAs help run the IN2L program. They also assist the Life Enhancement department in planning activities for residents.
Food Services Champion — CNAs need to successfully complete the person-centered care training, an internship in the food services department, and a separate career ladder designed for Loomis’s food services employees. As Food Service Champions, CNAs are able to assist with kitchen staff if they need a hand, and help to coordinate better meal service throughout the facility.

Outcomes

Quality Jobs. A recent survey of CNAs at Loomis House, tied to the end of the ECCLI grant, found that overall, the culture change efforts at Loomis House have had a clear impact on job quality — and that Loomis House continues to improve as a workplace from year to year. Between 2008 and 2009, CNA turnover decreased by 10 percent, and job satisfaction among CNAs improved from 61 percent to 71 percent.

Workplace Culture. Additionally, the career ladder has improved the overall Loomis House culture in countless intangible ways, Giroux says. The idea that being a CNA is “not just a job” but a potential career is extremely empowering, Giroux says. Indeed, many CNAs take the lessons they learn from advancing up the career ladder and go on to become nurses. The career ladder “motivates CNAs to go further in the field,” Giroux says.

The training sessions themselves have benefits that go beyond simply teaching new skills to CNAs, Giroux adds. They encourage camaraderie among the CNAs by allowing them the opportunity to associate with one another in a non-work setting, outside the walls of Loomis House. Training sessions present the chance to “learn about your co-workers as a person, and to be able to understand them more” on a deeper level, Giroux says. This emphasis on fostering relationships between staff members creates a deeper connection between Loomis House and its CNA staff. Additionally, the fact that Loomis pays for training helps to further “make [CNAs] feel better about us as an employer,” Giroux says.

Culture Change Message. The career ladder has also created a mechanism for Loomis House to deliver its broader culture-change messages to its employees, Todd says. Key culture-change concepts — including person-centered care, communication skills, and developing an appreciation for other employees throughout the facility — are all “infused throughout the career ladder,” Todd continues. Overall, this has strengthened the success of Loomis’ effort to move away from the medical model and implement a culture that supports residents in a more holistic way.

Lessons Learned

Initially, Todd says, it was a “ton of work” to convince CNAs that the career ladder was a good idea. CNAs were threatened by the concept of undergoing extra training; Todd believes that many were intimidated by the “scary” idea of re-entering a classroom setting years after their formal schooling had ended.

Finding the Natural Leaders. But Todd and the rest of the administration at Loomis House learned to overcome that obstacle by identifying what Todd calls “natural leaders” within the organization — in other words, the CNAs whom the rest of the frontline staff looked up to. Loomis’s managers approached those natural leaders and convinced them to embark on the career ladder.

Leaders began to breathe those ideas through the culture of Loomis House.

Soon, those CNAs were reporting back to the rest of the CNA staff, singing the praises of the training and all the new information they had learned — as well as the wage increases they had achieved. Those natural leaders began to “breathe those ideas through the culture” of Loomis House’s staff, Todd said.

Pretty soon, an excitement for the career ladder grew within the CNA staff. Today, CNAs generally have no hesitations about embarking on the career ladder. Indeed, Todd has learned that whenever Loomis House develops a new program, they now look toward these natural leaders to blaze a path for the rest of the employees. “Every time we try a new change, that’s really worked,” she said.

Sponsoring Organization: Loomis House is one of four senior living facilities operated by Loomis Communities, a Massachusetts-based nonprofit organization.

Setting: The Loomis House campus is composed of a home-like, person-centered residential campus as well as 13 assisted-living apartments. Skilled nursing care can be obtained at the on-campus nursing center.

Start Date: Loomis House was founded in 1902 as the Holyoke Home for Aged People. The career ladder for CNAs was launched in April 2000, and has continued to evolve ever since.

Costs & Funding: The career ladder was initially funded by a series of grants from the Extended Care Career Ladder Initiative (ECCLI). Today, Loomis House itself pays for the program; the program’s budget for FY11 is $6,650.

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