Long Term CareLong Term CareProfessional caregivers in long-term care settings often face flat organizational structures that offer limited career advancement. Promoting advancement opportunities could allow workers to take on advanced caregiving roles, become mentors for newer workers, serve as part of effective integrated care teams and perform supervised health maintenance tasks. Direct care professionals in particular need access to career ladders — formal processes that outline how employees may advance to higher salaries and levels of responsibility. On-the-job training through apprenticeship programs offer another way for professional caregivers to demonstrate the aptitude to advance professionally.
Career advancement and career ladders allow direct care workers to take on advanced roles on care teams and become specialists in dementia care, chronic condition management, behavioral health, and medication and pain management. Federal and state policymakers could work with providers to create meaningful career lattices through competency-based job descriptions and work with educational institutions to create training programs.
The California Legislature in 2024 approved SB 895, which requires the Office of the Chancellor for the California Community Colleges to pilot 15 nursing bachelor degree programs throughout the state. Lawmakers hope the opportunities can help the state address a decade-long shortage of licensed nurses, while breaking down a barrier of entry, and helping to diversify the workforce. The effectiveness of the programs will be evaluated on or before July 1, 2032.
While many states have explored registered apprenticeships to enhance career pathways for certified nursing assistants (CNAs), California’s CNA Upskilling Program allows existing CNAs to progress through different educational tiers and receive wage increases as they progress. The model was developed by the Quality Care Health Foundation, an educational foundation affiliated with the California Association of Health Facilities, and NAHCA: The CNA Association. It incorporates four tiers that rely on educational modules for peer preceptorship, restorative nursing, dementia care, behavioral health, and geriatric care specialist.
Legislation in the District of Columbia establishes a new credential for direct care workers to replace the home health aide and certified nursing assistant certifications. It seeks to eliminate barriers to certified apprenticeship programs for direct care workers and lower the age requirement for direct care workers to 16 years of age. It also allows those certified in Maryland or Virginia to practice in D.C. and establishes a minimum wage for direct support services. Forest Hills, a retirement community in C., introduced the first CNA career ladder apprenticeship program in 2022 to encourage retention through support, training and connections. The program is a competency-based pathway model that includes tiers for dementia and behavioral health, end-of-life care and leadership.
Maryland established the Pathway to Nursing Pilot Program in the Higher Education Commission and created a Maryland Pathway to Nursing Advisory Committee to assist the secretary of higher education in the development and implementation of the program. Goals of the program include alleviating the shortage of nursing professionals by increasing graduation and licensure rates of licensed practical nursing and registered nursing students in the state; facilitating student applications for financial resources that provide tuition assistance, loan repayment and support for other educational costs; and providing program participants with financial assistance to cover the cost of computers, textbooks and other supplies as well as wraparound support services that provide assistance with transportation, child care, elder care and other living expenses that pose a barrier to students successfully completing educational requirements.
Maryland also revised its certification and licensure requirements for certified nursing assistants and geriatric nursing assistants; required applicants for certification as a certified nursing assistant to complete a nursing assistant competency evaluation; and authorized an approved acute care nursing assistant training program to request a waiver of certain federal requirements.
Two academic entities in Oklahoma are working to address a nursing shortage with an agreement that paves the way for licensed practical nurses (LPN) who have completed career tech practical nursing programs to advance to a two-year state college nursing program that leads to a registered nurse (RN) license. The Oklahoma State Regents for Higher Education and the Oklahoma Department of Career and Technology Education in 2024 established nursing program advancement guidelines that help graduates pursue nursing careers.
The Florida Health Care Association (FHCA) in 2024 awarded $69,500 in scholarships to allow 29 long-term care employees from across the state to advance their careers in health care. The awards included four $5,000 scholarships to allow caregivers to advance their careers, 12 career climb scholarships for long term care employees and 13 nursing home Administrators in Training (AIT) scholarships. FHCA in 2024 also agreed to collaborate with the Florida Assisted Living Association to try to strengthen the long-term care workforce and improve the coordination of high-quality care. The two groups said they would work together to educate consumers, policymakers and other stakeholders about the important role of both skilled nursing and assisted living providers in the continuum of long-term care for older adults and their families.
LeadingAge Minnesota and Care Providers of Minnesota in 2024 announced a collaboration to help boost knowledge of career pathways for long-term care workers. The collaboration includes an online resource, com, meant to help prospective workers pursue a variety of career opportunities. The website offers an in-depth look at six distinct career pathways in long-term care:
Social services and life enrichment
Therapy and rehabilitation
Housekeeping and maintenance
Direct care and nursing
Culinary and hospitality
Administration and operations support
LeadingAge Virginia used Civil Monetary Penalty funds to develop an advanced CNA curriculum in conjunction with the Virginia Board of Nursing, Blue Ridge Community College and Sunnyside Retirement Communities. Twenty-two scholarships were provided to eligible certified nurse aides working in certified nursing homes to complete the course. An Advanced Certified Nurse Aide (ACNA) is a CNA who has received further education by successfully completing an approved course and a competency evaluation.
Florida provided a path for CNAs to become Qualified Medication Aides in nursing homes. RNs are allowed to delegate a QMA to dispense medications to nursing home patients. This will address workforce shortages by freeing up RNs to provide care in other ways and add career paths for CNAs.
Hawaii created a “glidepath” earn-and-learn cross-sector collaboration that allows working individuals to maintain their jobs while advancing health education credentials.
Washington reduced barriers to those seeking a home care aide certification by allowing remote testing, expanding testing sites, allowing tests to be administered at the location people are trained, and exploring travel stipends.
Wisconsin launched the Certified Direct Care Professional (CDCP) program in July 2023 to train 10,000 direct care workers in collaboration with the University of Wisconsin-Green Bay. The CDCP program is a free online and asynchronous training with 14 competencies that prepares workers for positions in various home and community-based settings (HCBS). After completing the program, CDCPs may complete microcredentials to increase their knowledge and skill in specific areas of care, including dementia care, trauma-informed care, supporting youth and children with special health care needs, and more. The Wisconsin Department of Health Services is also collaborating with technical colleges to develop a Certified Nursing Assistant (CNA) ladder program for CDCPs.