Our work is not only focused on supporting home care workers to complete training and educational programs, but it also contributes to the development of the healthcare workforce infrastructure in New York State. Many initiatives have taken place before and during the COVID-19 pandemic and continue to evolve based on the needs of the home care industry.
Ladders to Value: Workforce Investment Organization (WIO)
In April 2018, the New York State’s Department of Health designated 1199SEIU Training and Employment Funds (TEF) and its partners, along with eight other Workforce Investment Organizations (WIOs), to provide training and support initiatives for direct care workers in the long-term care sector. This program was intended to be a three-year, $245 million initiative with the goal of “supporting the critical long-term healthcare workforce infrastructure through retraining, redeployment, and enhancing skillsets.” It was authorized as part of the same Medicaid 1115 waiver, which funded the Delivery Reform Incentive Payment Program (DSRIP), with the approval of the Centers for Medicare & Medicaid in 2014.
The TEF sponsored Ladders to Value WIO was uniquely qualified to lead this important initiative. TEF has a long and established history of maintaining close working relationships with front-line workers, as well as with their Union and employers.
The Ladders to Value WIO—received $55 million in funding with which all participating managed long-term care plans opted to contract with over the life of the initiative. As indicated in the chart below, during its three years of operations, this initiative provided training to more than 44,000 long-term care workers who completed 95,000 trainings in five regions throughout New York State, including downstate—New York City, Hudson Valley and Long Island—and upstate—Central and Western New York.
Ladders to Value WIO Program, Course Completions, March 2021
| Initiative | Y1 Apr 2018-Mar 2019 |
Y2 Apr 2019-Mar 2020 |
Y3 Apr 2020-Mar 2021 |
TOTAL |
|---|---|---|---|---|
| 1. VBP/Chronic Diseases | 32,392 | 30,826 | 7,301 | 70,519 |
| 2. Career Pathways | 5,559 | 5,863 | 2,075 | 13,497 |
| 3. Behavioral Health | 585 | 3,077 | 4,955 | 8,617 |
| 4. Workplace Safety | 894 | 571 | 881 | 2,346 |
| 39,430 | 40,337 | 15,212 | 94,979 |
The Ladders to Value WIO also provided training and other support to employees from more than 650 different long-term care employers, including 439 nursing homes and 219 home health agencies.
As it invested in programs to improve workforce and patient outcomes in healthcare, TEF also put resources in place to evaluate the impact of its programs. Research began in 2019 with the subsequent formation of the Evaluation Committee, an advisory and oversight group that conducted multiple studies in partnership with researchers from the Visiting Nurse Service of New York, The New Jewish Home, Cornell ILR, and TEF’s internal Research and Policy staff.
This research focused on three topics: 1) the impact of WIO training on value-based payment quality measures, 2) the effect of transportation pilots on worker wellbeing and economic security, and 3) the impact of COVID-19 on the direct care workforce. Numerous articles have been published based on this body of research.
COVID Experience and Lessons in Home Care and Nursing Homes
Reinhardt, Joann P.; Emily Franzosa, Wingyun Mak, Orah Burack. (2021). In Their Own Words: The Challenges Experienced by Certified Nursing Assistants and Administrators During the COVID-19 Pandemic. Sage Publications, 41(6). – https://journals.sagepub.com/doi/10.1177/07334648221081124
Pinto, Sanjay, Chenjuan Ma, Faith Wiggins, Sarah Ecker, Michael Obodai, Michael, Madeline Sterling. 2021. “Forgotten Front Line: Understanding the Needs of Unionized Home Health Aides in Downstate New York During the COVID-19 Pandemic.” NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy. 1-9 – https://journals.sagepub.com/doi/abs/10.1177/10482911211058839?journalCode=newa
Pinto, Sanjay; Madeline Sterling, Faith Wiggins, Rebecca Hall, Chenjuan Ma. 2021. “The Impact of Covid-19 on Certified Nursing Assistants in New York City: A Cross-Sectional Study.” Health Services Research. 41-42 – https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13806
Ecker, Sarah; Sanjay Pinto, Madeline Sterling, Faith Wiggins, Chenjuan Ma. 2021. “Working experience of certified nursing assistants in the greater New York City area during the COVID-19 pandemic: Results from a survey study.” Geriatric Nursing. Vol. 42: 1556-1561 – https://www.sciencedirect.com/science/article/pii/S0197457221003268
Mak, Wingyun; Emily Franzosa, James J. Peters, Orah Burack, Joann Reinhardt. 2021. “Research Needed on Microlearning as a Training Strategy for CNAs in Skilled Nursing Facilities.” Letter to the Editor in JAMDA. 1-2 – https://www.jamda.com/article/S1525-8610(21)00673-3/fulltext
Franzosa, Emily; Wingyun Mak, Orah Burack, Alene Hokenstad, Faith Wiggins, Kenneth Boockvar, Joann Reinhardt. 2022. “Perspectives of Certified Nursing Assistants and Administrators on Staffing the Nursing Home frontline during the COVID-19 pandemic.” Health Services Research. 1-9 – https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13954
Home Care Workers Transportation Pilot
Pinto, Sanjay; K.C. Wagner, Russell Weaver, Zoe West. 2021. “A High Road for Home Care: Program Assessment of the Healthcare Workers Rising Transportation Pilot.” Worker Institute of Cornell ILR Report – https://www.ilr.cornell.edu/sites/default/files-d8/2021-09/CORNELL_2021HealthCareWorkersRising_FINAL%20DRAFT.pdf
Value Based Care Training Impact
Fong, Mei-Chia; David Russell, Carlin Brickner, Oude Gao, Sandi Vito, Margaret McDonald. 2022. “Medicaid long-term care workforce training intervention and value-based payment metrics.” Health Services Research. 57(2): 340-350 – https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.13930
Russell, David; Mei-Chia Fong, Oude Gao, Dan Lowenstein, Marian Haas, Faith Wiggins, Carlin Brickner, Emily Franzosa. 2022. “Formative Evaluation of a Workforce Investment Organization to Provide Scaled Training for Home Health Aides Serving Managed Long-Term Care Plan Clients in New York State” Journal of Applied Gerontology – https://journals.sagepub.com/doi/abs/10.1177/07334648221084182