Can We Upgrade Low-Skill, Low-Wage Occupations? The Case of Apprenticeships in the Long-Term Care Occupations

Abstract

AbstractThe best prospect for improving job quality and compensation in low-wage jobs is by increasing worker productivity. This study investigates the prospects of registered apprenticeship training for raising productivity in the long-term care (LTC) industry, a high-demand, low-wage field that principally employs female caretakers. Case studies of five LTC registered apprenticeship programs and analysis of administrative data suggest that apprenticeship training improved productivity, client satisfaction, pay, and career advancement opportunities. It is less clear whether cost savings were sufficient to offset low Medicare and Medicaid reimbursement rates or remain sustainable without federal, state, or private support.KEYWORDS: apprenticeshiplong-term careworkersskillscompetencieson-the-job trainingrelated instructioncertified nursing assistantshome health aideshealth support specialistsdirect support specialistsUS Department of Labor Notes1. The occupations include licensed practical nurses, nurses' aides, home health aides, and personal and home care aides. Using the projections from Lacey and Wright (Citation2009) and dividing by the projected number of employed women, the authors calculate that about 7 percent of women's total employment will be in the four LTC worker occupations.2. Title 29, Part 29 of the Code of Federal Regulations, which outlines requirements for the Registered Apprenticeship program, requires "a progressively increasing schedule of wages to be paid to the apprentice consistent with the skill acquired."3. At the time of the launch of the initiative, OA was named the Office of Apprenticeship Training, Employer, and Labor Services (OATELS).4. A recent survey of registered apprenticeship sponsors found that 72 percent of employers of apprentices pay for training. Most training that is not covered by employers is paid for with Workforce Investment Act funds or private sources (Lerman, Eyster, and Chambers Citation2009, 32).5. A "registered apprenticeship program" is one in which employers, groups of employers, and unions design, organize, manage, and finance on-the-job training and related training instruction under the standards developed by and registered with OA or a state apprenticeship agency.6. Locations in Boise and Idaho Falls, Idaho, were visited for this study.7. Home Care Associates is currently not operating its registered apprenticeship program due to a lack of funds, although it currently employs past apprentices and is interested in restarting the program.8. One possible reason why partnerships with One-Stop Career Centers are rare may be a result of the low wage rates in LTC occupations, as a principal Workforce Investment Act performance measure is wage growth. We owe this insight to an anonymous reviewer.9. Almost all sites supplied their own calculated turnover rates, but because the best employees were often selected for the apprenticeship it is not possible to directly attribute turnover reductions to the program or to the individual apprentices.