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February 2011

Jobs? They’re out there. Really.

A nurse’s aide spends time with an Isabella Geriatric Center resident. This Washington Heights nursing home is a member of the Southern New York Association, and will receive more well-trained employees through the New York Alliance for Careers in Health Care. Photo by Mike Fitelson.
Old age and disease aren’t ruled by economic cycles—so even as service, manufacturing, and construction jobs disappeared in the recession—more than 20,000 health care jobs were created in the City during the past two years. For those already working in the sector, jobs are changing as hospitals, health centers, and nursing homes adapt to health care reform, new technologies, a tough economy, and an aging population.

“Now is a crucial time to train, retrain, and redeploy the City’s health care workforce to provide care that keeps people healthier and out of the emergency room” says Patricia Jenny, program director for community development and the environment at The Trust.

The Trust has launched the New York Alliance for Careers in Health Care (NYACH), a project that, for the first time, starts with employers analyzing their labor force needs, instead of starting with training programs that usually look for employers willing to work with them. NYACH will work first with trade associations of hospitals, community health centers, and nursing homes. These groups will then bring together their members to focus on articulating their workforce requirements to training organizations and schools.

While the Alliance is groundbreaking in scope, it is also the logical next step in work that started ten years ago. In 2001, City funders concerned about the lack of workforce development infrastructure formed the New York City Workforce Development Fund, housed at The Trust, to do joint grantmaking. Three years later, it started the Workforce Innovation Fund with the City’s Department of Small Business Services to create partnerships of training providers and employers in specific sectors.

In addition to The Trust grants below, money for the project is being provided by the New York City Workforce Development Fund and the National Fund for Workforce Solutions.

  • Community Health Care Association of New York State, $150,000
  • Eugenio Maria de Hostos Community College, $196,000
  • Greater New York Hospital Foundation, $100,000
  • Southern New York Association, $110,000
  • Workforce Development Corporation, $150,000

Len McNally, program director, health and people with special needs, and Pat Jenny, program director, community development and the environment.

An Interview with Trust Program Directors Pat Jenny and Len McNally

NYCT: Why the New York Alliance for Careers in Health Care (NYACH), and why now?
Pat Jenny: There is an urgent need to find where the jobs are for disadvantaged people after a recession that has hit low-skilled workers the hardest.

The Trust has invested millions of dollars in safety-net grants to help poor New Yorkers through difficult times, but we also wanted to focus on a longer-term solution to poverty. We knew that meant helping people find good jobs; the health care industry provides a wealth of opportunities. It’s the one industry that is massive, fairly recession-proof, has many steps on a variety of career ladders, including some that have minimal requirements—and probably most important—workers with the right skills are in demand.

Len McNally: With health care reform, shortages of primary care doctors and nurses, changing medical technologies, and the need to cut costs, providing better health care to New Yorkers rests heavily on a workforce that can rise to these challenges.

NYCT: What is the impact of health care reform on health workers?
LM: The federal government is moving toward more primary and preventive care and away from expensive, unnecessary hospital care. We are often providing costly and inappropriate care in emergency rooms to the 1.5 million uninsured New Yorkers. It’s not coordinated, it’s not comprehensive, and it’s not continuous.

There is $19 billion in federal money set aside for the expansion of community health centers to provide primary care to millions of poor and uninsured. We will see a doubling of the centers’ capacity around the country in the next 5 to10 years, and that’s thousands of new jobs.

NYCT: Where was the idea for NYACH conceived?
PJ: Last January, I was at a meeting of human resource professionals in health care organized by the Obama administration, and was inspired by the Baltimore Alliance for Careers in Health Care. I came back on the train thinking, ‘This would be a good idea for New York.’ As an institution, The Trust is a leader in health care grantmaking in the City, and we are also a leader on workforce issues—so let’s put them together. Len agreed. We spent the next ten months interviewing employers, health care providers, and workforce development experts.

NYCT: What sets this project apart?
PJ: We knew that we needed to start with employers, and help them communicate what they need in tomorrow’s workforce. Getting employers involved and invested from the beginning was challenging, but we were in a good position to work with them through their trade associations.

LM: We were also thinking big—our goal is to change how the entire City’s health care workforce is trained. We needed to make sure that we were addressing the different labor needs of the three major health providers—hospitals, community health centers, and nursing homes.

NYCT: What was The Trust’s involvement in developing a sector approach to workforce development?
PJ: The City and training providers were behind the curve on providing employment services in the late ’90s. Private funders, including The Trust, got together in 2001 to deal with the fact that a city of eight million people didn’t have a good system of programs for someone trying to find a job.

By 2004, the City was ready to work with us. Together we created a sector initiative in biotechnology and health care, eventually starting One Stop Centers in transportation, health care, and manufacturing that have already trained and placed hundreds of workers.

NYCT: How will the grants you made in December 2010 change the City’s workforce programs?
PJ: This entire project will be shepherded by a new NYACH coordinator at the City’s nonprofit Workforce Development Corporation. He or she will make sure that everyone involved in the Alliance is communicating and moving the project forward. We will support the coordinator’s salary for two years; after that, we expect the City or other private funders to support the position. We also expect that the positions we are funding at health care trade associations will be made permanent and paid for by the associations.

LM: The coordinator is important because we found in our interviews with 50 health care executives that there has been stunningly poor communication between trainers and employers. The coordinator will make sure that changes.

NYCT: What are your hopes for this project?
LM: We hope it makes health care better. For instance, community health centers are perpetually in need of doctors. Could nurse practitioners and physician’s assistants give some of the care doctors provide? If the answer is ‘possibly,’ then we will work with the educators to create a curriculum that gives them the skills they need. That doesn’t exist now.

I also hope that when schools recruit students they can tell them, ‘we have a placement service that can guarantee every single one of you a job in primary care if you graduate from this program.’

These women are training to be certified nurse’s aides at Hostos Community College in the Bronx.

Launching Careers in Caring

“I like old people,” says Dionne Layne Morales, a 42-year-old mother who babysits and tutors children in her Bronx home. While training to be a certified nurse’s aide at a local retirement home, she met two women who were 101 and 102. “It was an honor to take care of those ladies, to bath them and comb their hair. It was an honor.”

Ms. Morales studied at Hostos Community College, which she chose because the 8-week program offered classes that worked with her busy schedule and had a payment plan. “I could go to class and then pick up the boys at school, and then I would do my homework while they did theirs.”

After she passes the first certification test, she will enroll in the next—certifying nurse’s aides to take blood and administer electrocardiogram tests, a requirement for most hospitals. “I will do that for about six months and then continue my training to be a licensed practical nurse or registered nurse.”

A Trust grant of$110,000 to Hostos will help expand its certification classes and help make them an option for people on public assistance who have little work experience. While Ms. Morales was able to pay for and complete the course on her own, others need help getting a foothold on their careers. Our grant will fund the recruitment and tutoring of 152 high school graduates or GED recipients who need remedial education to pass the certificate programs. BronxWorks, a long-time community service provider, will help Hostos find the best candidates for the program.

“We’re trying to get people with very limited skills into something that could be a basic building block while they think about their next steps,” says Carlos Molina, dean for special projects at Hostos. All of the students recruited will qualify for financial aid; their textbooks, classes, and MetroCards will be paid for through grants from The Trust and other funders.

Ms. Morales continued: “My teacher in the program was great because she was a working registered nurse, and she taught us a lot of extra things about biology and physiology, so that if we want to advance past being an aide, we will be really, really prepared.”

Redeploying Veterans in Nursing Homes

For veterans returning from their final tour of duty, homecoming isn’t always as sweet as they imagined on the battlefields of Iraq and Afghanistan. Finding a job, tough for anyone in this economy, is especially hard for veterans who have only a high school degree and may not have experience suited to civilian jobs. Vets with experience as field medics need additional training and certification. With a $110,000 grant to the Southern New York Association, a trade group of 66 nursing homes, the Association will begin a program to recruit and provide job training for returning vets.

Effie Batis, director of operations for the Association, takes pride in not only building a strong workforce to fill thousands of nursing home jobs, but also in helping people in challenging circumstances fill these positions. “We started working seven years ago with women living in shelters who had fled domestic abuse. With our help, these women persevered, taking nursing classes by day while living in a homeless shelter at night,” says Ms. Batis. “After the success of that program, our passion became to help others change their lives, become self-sufficient, and enter the health care field.”

She continued: “We feel that people who have worked in the military are used to giving 100 percent, which is what it takes to succeed in this field. However, there are challenges for returning veterans—there might have been things that held them back from going to college on their own, learning disabilities or a dislike of traditional school environments—and so you need to address these.”

The program is designed to help vets with a range of skill levels and match them with jobs. Veterans with disabilities that impair mobility may pursue certification as lab technicians or enter the growing field of health care information technology. “It often helps to expose people to the work environment before they are in training,” says Batis. “If working with the elderly is something the returning vets enjoy, it will motivate them to succeed in what are very rigorous and demanding educational programs. Part of our success is finding where people are economically, educationally, and emotionally and steering them on a path where they will succeed.”

Not all residents at Isabella Geriatric Center are old or there for the long-haul. This certified nurse’s aide is helping a young man hurt in an accident get ready to go home. Photo by Mike Fitelson.

Helping Patients Stay Healthier

When people can’t afford to see a doctor, they often end up doing nothing until their problems becomes urgent. Expensive emergency visits—that could have been avoided with preventive and primary care—are creating financial strains on hospitals and nursing homes, especially those that care for the poor. The Greater New York Hospital Association (GNYHA), a trade group for voluntary and public hospitals and nursing homes, is helping its members with changes brought about by federal and state health reform. Federal reform in particular will increase funding for primary care and cut reimbursement for preventable hospital readmissions. “There will be less money available for us to do what we need to do, so we need to help people stay healthier,” says Tim Johnson, executive director of the GNYHA Foundation.

“It’s not enough to just care for patients while they’re in the hospital. Health care workers today must be more proactive and provide more follow-up care to patients—calling them to make sure they’ve taken their medicines, or have seen the recommended specialist—so they don’t end up back in the emergency room,” continued Mr. Johnson.  

With a Trust grant of $100,000, the GNYHA Foundation is forming the Center for Health Workforce Advancement to help its members recruit, train, and retain a strong workforce.

Through the Center and the New York Alliance for Careers in Health Care, the GNYHA Foundation will work with Trust-grantee Hostos Community College to help shape a curriculum that prepares students for these jobs. Mr. Johnson continues: “I think that patients are willing to take on more responsibility for managing chronic conditions, but they need the education, and health care professionals could be better educated and trained to provide this help to patients.”

Preparing for a Growth Spurt in Primary Care

Community health centers provide millions of New Yorkers with affordable primary, dental, and mental health care. According to Maggie Brennan, chief operating officer of the Community Health Care Association of New York State, “Community health centers are bipartisan favorites because they provide high quality and cost-effective care to people who are fairly sick and underserved—it’s a good model that now has an additional $19 billion in federal dollars set aside to help expand existing centers and to set up new ones.”
A $150,000 grant to the Association, which supports 32 City community health centers, will help it staff the doubling of capacity of community health care providers over the next 5 to 10 years.

The grant will support two new health care workforce experts. “This funding could not have come at a better time,” continued Ms. Brennan. “We had been talking workforce development for five years, but now we can hire staff to take it on full time.”

The new team will develop an internship program and work more closely with the State’s Medical Society and medical schools in the City to create pipelines of doctors and nurses who want to be a part of community health care, which pays less than private practice or hospitals. It will also work with local colleges to bring their degree programs in line with the new health center job requirements, with a focus on jobs needed to bring health centers up to “medical-home” standards—meaning more patient navigators to manage each patient’s care.

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