ABSTRACT: Cooperative Home Care Associates (CHCA) has been an industry pioneer in developing a comprehensive and integrated model for direct-care worker recruitment, training, and retention. The model encompasses four primary elements: 1) targeted recruitment, 2) comprehensive assessment, 3) enhanced entry-level training, and 4) guaranteed employment as well as post-employment support services. (February 2010)
In 2009, CHCA employed over 1,600 direct-care workers. CHCA developed its integrated model for providing high-quality training to individuals interested in working as home health aides--and ensuring their employment in full-time jobs--in conjunction with PHI, a national nonprofit that supports quality care through improving the quality of direct-care jobs.
CHCA primarily relies on referrals from its 1,600 direct-care workers to recruit individuals into its training program. In 2009, 77 percent of the agency’s training participants were referred by an employee. Other referral sources include government or nonprofit organizations such as Union Settlement, New York City’s Workforce1 Career Centers, and the New York City Human Resources Administration. The agency encourages referrals from employees by providing employees with a $50 bonus if a participant they refer graduates from the training program and remains employed for at least six months.
"Our current employees are a tremendous resource for referrals," said Lamont Spence, the workforce development director at CHCA. "More than anyone else, they know what direct-care work entails, and what CHCA can provide to a new worker in terms of training and support. The $50 incentive helps, but I don’t believe it is the primary factor that motivates our employees in making a referral," Spence continued. "I sincerely believe it is the CHCA culture of training, supporting, and valuing its employees that makes our employee referral system so strong," Spence concluded.
Assessment and Selection of Trainees.CHCA does not accept large numbers of trainees into its entry-level training program. Instead, recruitment staff utilize an assessment and selection process designed to identify the candidates most likely to succeed as caregivers. Recruitment staff look for people who:
- Have had some formal or informal caregiving experience.
- Show compassion for other human beings.
- Demonstrate a basic ability to set priorities and resolve problems.
Specifically, CHCA assesses applicants to its training program for these traits by completing the following activities:
- Orientation Sessions: By attending a two-hour orientation session (which CHCA case managers conduct three times each week) applicants learn about the requirements of the four-week training program, as well as the responsibilities of the home health aide job.
- Initial Skills Assessment: Applicants still interested in working full-time as a home health aide--and in attending the four-week training program--respond to a brief questionnaire, which serves as a baseline skills assessment tool.
- Interview: CHCA then selects applicants to interview. CHCA has identified "a caring attitude" and "emotional maturity" to be key indicators of long-term job retention, qualities that are best assessed in a personal interview. The interview also provides the opportunity to confirm an applicant’s ability to attend class eight hours each weekday for four weeks.
- Counseling Session: All individuals accepted into the CHCA training program receive a 75-minute pre-training counseling session with a CHCA case manager. Case managers verify the child-care arrangements of participants; identify their long-term and short-term occupational goals; determine their familiarity with mainstream financial institutions and money management; and make appropriate referrals to nonprofit organizations to support participants in resolving potential employment barriers. This includes helping an applicant to resolve any issues that come up through a criminal background check or past drug use that may come to light through personal disclosure or public records.
The employer-based, adult learner-centered entry-level training program at CHCA is a key building block of the agency’s growth and success.
Verniece Jackson, a CHCA home health aide who graduated from the program in November 2009, noted that in addition to learning how to become a good home health aide, the training program at CHCA helped her to become a better person. "It helped me learn to pull back in difficult situations and ask open-ended questions so conversations continue to flow," Jackson said.
Training at CHCA consists of the following components that make it truly "enhanced":
- Duration. CHCA entry-level training is approximately 150 hours, conducted over four weeks at their in-house training facility. This significantly exceeds the 75-hour minimum required by the federal government.
- Learning Environment. Training staff strive to create a safe--but challenging--learning environment for trainees who may have little formal education or work experience.
- Training Method. CHCA trainers use adult learner-centered instructional methods throughout the training program. Active learning techniques--such as role-plays, case studies, and group discussions--make the direct-care job "come alive" in the classroom. Team teaching, often with the assistance of senior aides, also provides a high degree of individualized attention and support.
- Training Content. In addition to teaching clinical skills, entry-level training at CHCA includes additional components that are critical to success on the job. These components include non-clinical skill-building in areas such as team-building, respecting differences, effective communication, and problem solving.
- Support. CHCA provides three months of on-the-job training support through its peer mentoring program, as well as close oversight from supervisors. Also, CHCA provides frequent opportunities to gather for peer exchanges, problem-solving sessions, and additional clinical skills training.
"The Adult Learner-Centered training method--coupled with additional training on problem-solving and communication skills--makes a huge difference in the long-term success of our employees," said Yarleen Anavitate, the service delivery manager at CHCA. "Few individuals entering our training program have the communication skills that the job requires, and equipping our trainees with some practical training in these skills has a significant impact, not only on the job, but in a trainee’s personal life as well," Anavitate continued. "I don’t know how many times an employee has told me that she has successfully used these skills with her children, partner, and other people in her life."
CHCA has implemented the following initiatives to help graduates of the home health aide training program have successful careers at CHCA:
- Peer Mentoring. All new CHCA employees are assigned a peer mentor to support them during their first two months of employment. During this time, new employees receive calls every two weeks from a peer mentor, asking about any challenges that they experienced and then either offering pertinent advice or referrals to other organizational resources. Mentors are also available to all employees when they confront a particularly challenging personal or professional situation.
- Case Management. CHCA provides ongoing case management support to help employees solve problems that can affect their success on the job. These issues could involve housing, childcare, or other issues related to their domestic situation. For example, Santa Glover, an immigrant from the Dominican Republic, could only work for 20 hours a week because of difficulties in securing affordable childcare. She received assistance from a CHCA case manager in securing subsidized services from New York City’s Administration for Children’s Services, which enabled her to work full-time with clients.
- PHI Coaching Supervision. Training in coaching and effective communication are integrated into all aspects of the organization. All CHCA supervisory staff and managers are trained in a coaching style of management called PHI Coaching Supervision. This approach helps supervisory and management staff provide support to direct-care workers, while also holding them accountable. When a supervisor uses coaching skills, she is often able to help her supervisors resolve problems that would otherwise result in disciplinary actions or termination. In addition, CHCA office staff and direct-care workers are trained in the communication skills that are at the core of the PHI Coaching Approach. This ensures that the entire organization shares not only critical skills but also a language and perspective that reinforces the value of respectful relationships between co-workers and between workers and clients.
- Guaranteed Hours. In this program, aides are paid for a minimum of 30 hours a week--guaranteeing a stable income even if they work less than this amount. To participate, employees must have worked at CHCA for three years, must accept all case assignments, and must work every other weekend. Since most CHCA aides work more than 35 hours per week, the agency rarely pays home health aides for hours not worked. [Read more on the Guaranteed Hours Program (pdf)]
The CHCA employer-based training model has been highly successful. In 2009, 77 percent of those who enrolled in the training program earned their certification as both a Personal Care Assistant and Home Health Aide--and obtained employment. Prior to their training, 88 percent of participants reported having been unemployed.
CHCA experienced a 19 percent turnover rate in 2009--which is less than half of the average turnover experienced within New York City’s home care industry. This low turnover rate has been consistent over several years, as shown in the table below:
Job Satisfaction Survey
Additionally, in fall 2008, PHI administered a job satisfaction survey to CHCA office staff and HHAs. Of the respondents, 92 percent were in agreement with the statement "I am very satisfied with my job," and 88 percent indicated that they would like to continue working for CHCA (see table below).
Notably, the survey asked several questions about supervision as a follow up to CHCA’s implementation of the PHI Coaching Approach. When asked about their supervisors, 96 percent agreed with the statement, "My supervisor treats staff with respect."
Finally, in open-ended questions, HHAs noted that CHCA is not just a place to work, it is a community. As one aide noted, "I like working at CHCA because it’s like a family for some of us who don’t have one."
Multiple Transitions. CHCA notes that an employee doesn’t make a single transition into the workplace. Instead, there are a series of small transitions, some predictable, some not. By providing employees with several kinds of support, from case management to mentoring, CHCA helps employees manage the changes in their lives and thereby increases retention.
Supervisory Training. Because the quality of a direct-care worker’s experience is significantly influenced by their interactions with supervisors, CHCA has found that training for supervisory staff in coaching and communication skills is critical. PHI Coaching Supervision, a unique training program that fosters respectful relationships throughout an organization, has been effective in improving the relationships between workers and supervisors at CHCA, and decreased the need for disciplinary actions.
Organization-wide Communication Training. While PHI Coaching Supervision training for CHCA supervisors made an important and measurable difference in several areas of their operations, CHCA also learned that just training supervisors in these skills was insufficient. CHCA learned that if they really wanted to create a highly-functional, respectful, and dynamic organizational culture, these same communication skills needed to be developed and integrated among all staff at the agency. CHCA initiated an organization-wide PHI Coaching Approach to Communication training program that included all non-supervisory staff.
A "Coaching Sustainability Committee" was also established. This committee--which includes representatives from all job functions throughout the agency--helps to ensure that the PHI Coaching Approach is integrated into all aspects of the organizational culture. This committee continues to develop and expand ongoing training initiatives to improve communication within CHCA, as well as with clients and families.
Sponsoring Organization: Cooperative Home Care Associates is a worker-owned home care agency based in the South Bronx (NY).
Setting: CHCA provides home-based eldercare and disability services, primarily to the residents of the New York City boroughs of the Bronx and Manhattan.
Best Practice: An integrated model for providing high-quality training and employment to individuals interested in working as home health aides.
Start Date: CHCA was established in 1985, and has worked to refine and expand this model since its founding. The agency implemented its employer-based training program in 1987, which was subsequently enhanced with the following post-employment supports: guaranteed hours (in 1993), peer mentoring (in 2003), and PHI Coaching Supervision (in 2008).
Costs & Funding: In 2009, the cost of the CHCA home health aide training program totaled $2,400 per participant. These costs were primarily covered using funds from private foundations and government programs.
- Glasser, Ruth, and Jeremy Brecher. We Are the Roots. University of California Center for Cooperatives, 2002.
- Inserra, Anne, Maureen Conway, and John Rodat. The Cooperative Home Care Associates: A Case Study of a Sectoral Employment Development Approach (pdf). Aspen Institute, February 2002.
- PHI. "The Guaranteed Hours Program: Ensuring Stable, Full-Time, Direct-Care Employment." (pdf) Workforce Strategies No. 4, July 2007.
- PHI. "Training Quality Home Care Workers." (pdf) A PHI Technical Series Publication, August 2003.
- PHI. "Recruiting Quality Health Care Paraprofessionals." (pdf) A PHI Technical Series Publication, 2000.
- PHI. Creating a Culture of Retention: A Coaching Approach to Supervision. (pdf) September 2001; Updated November 2008