Alzheimer’s is more than a mere diagnosis for countless families globally; it marks the beginning of a life-altering journey that exacts a toll on their emotional, mental, and physical well-being. The role of a caregiver is demanding, requiring immense patience and empathy. It often involves witnessing a loved one’s cognitive decline, which can be heart-wrenching.
“There are times … my dad would wake up and knock on my door in the middle of the night and ask me, ‘How is your mom? You have any information about your mom?’ My mom has passed away for many years,” says Qi Zhen Louie, an In-Home Supportive Services (IHSS) provider who has taken CCA’s Alzheimer’s care training.
More than a quarter of the IHSS providers in the program take care of a parent with Alzheimer’s disease and related dementia. Like Qi Zhen, caregivers are often children, or even spouses or close friends, who step into this role out of love and commitment. And, often, they do so without the training necessary to help them adapt to the ever-changing needs of their loved ones.
The Alzheimer’s care training helped Qi Zhen understand the symptoms and stages of the disease. “Now, I am more patient, and it helps with my communication with my dad,” she says. “Before, as soon as he threw a tantrum, I felt very upset …But I learned from (CCA’s) teachers a lot, and also from the sharing of our peers, the students. After the training, I have a lot of positive energy. And I’m able to understand some things that I did not know before.”
(Note to reader: Qi Zhen did this interview with a Cantonese interpreter).
Apprenticeship programs, such as CCA’s Certified Nurse Assistant Registered Apprenticeship Program (CNA RAP), have proven to be a game-changer in preparing much-needed CNAs for the demanding roles they play within skilled nursing facilities. The earn-and-learn model inspires higher levels of performance amongst apprentices, increases productivity, and enhances their problem-solving ability. Because the apprentices become skilled, enculturated, engaged and loyal employees, apprenticeship programs can help reduce staff turnover and improve recruitment.
Since the first cohort of apprentices started their CNA training through CCA’s apprenticeship program earlier this year, 18 have been promoted to a CNA role and are now working at a partner facility. An additional 20 apprentices have completed their training and are either waiting for the results of their CNA certification exam or in the process of scheduling their exam date.
Duane Esquer, Nursing Home Administrator at College Vista Post Acute (a Sun Mar Healthcare facility) in Los Angeles, said, “The benefit of this apprenticeship program for our facility is that we get to increase our staffing so that we’re not struggling with turnover… This program has really had a positive effect on job satisfaction.”
Watch how the CNA Registered Apprenticeship Program has made an impact.
College Vista Post Acute’s parent company, Sun Mar Healthcare, is our inaugural corporate employer to partner with CCA for this apprenticeship program. In 2022, CCA received a $14 million High Road Training Partnership (HRTP) grant from the California Workforce Development Board (CWDB) to add 500 CNAs and 12 LVNs to the skilled nursing facility workforce in three years to help address an industry-wide staffing shortage. In partnership with employers and SEIU Local 2015, the apprenticeship program offers the CNA and LVN training at no cost to participants and guarantees them a job and wage increase when they pass their state exam.
Another employer group Pursue Healthcare also joined the partnership in 2023 and now has a few apprentices working as CNAs, with more are on track to complete classes, pass the state exam, and be promoted to CNA in the coming months. More employers are slated to join in 2024.
There is a clear demand for the training program: the wait list of interested candidates has grown to over 500.
Chrystal Miranda, an apprenticeship program graduate who is now a CNA at College Vista Post Acute, shares her journey: “I don’t think it would have been possible if I did not have this program. I have a daughter at home, so financial stability was always a top priority for me. It was really awesome that they were able to help me out. I didn’t have to worry about one thing or another. I could completely focus on just getting my studying done.”
Watch Chrystal’s story.
All tuition and related expenses are covered so participants do not pay for anything out of their own pockets. They also receive stipends to cover the cost of child care, transportation, and groceries so they can focus on learning in the classroom and practicing their skills during clinicals.
The apprenticeship program offers invaluable hands-on experience, allowing learners to work alongside experienced nursing staff. But the support doesn’t end there. CCA’s CNA program provides one-on-one mentorship to the newly promoted CNAs so they can build the confidence they need to excel in a healthcare setting. Aside from mentorship, the new CNAs also receive retention bonuses throughout their first six months of employment and access to free high-quality training through their SEIU 2015 Education Fund. They can access free continuing education classes, obtain their Restorative Nurse Assistant (RNA) Certificate, get certified in CPR, and many other trainings.
Duane Esquer said all the elements of the apprenticeship program – especially the partnership between the nursing home employers, the union, and CCA – greatly benefit the workers, the facilities and, most importantly, the residents.
“The students who then turn into Certified Nurse Assistants hit the ground running because they’ve had the education, they’ve had the training, they’ve been working directly with our current staff. So it flows very well,” Esquer says. “We’re invested in their success because when they win, we win, and at the end of the day, the residents win the most. They get caring individuals who want to be working in this industry, who want to be a CNA. And we’re so excited to see how this program will grow and continue to succeed and hopefully help other facilities and other companies, and at the end of the day give people opportunities in healthcare that they may have not had before.”
CCA is proud to welcome four new members to our Board of Directors. They represent organizations that champion health equity, social justice, and workforce development. Their expertise in their respective fields, along with their commitment to the well-being of long-term care workers and the individuals they serve, will help guide our work of advancing the caregiving workforce.
Jennifer Schlesinger Vice President, Healthcare Services & Professional Training, Alzheimer’s Los Angeles
Jennifer Schlesinger is the Vice President of Healthcare Services & Professional Training for Alzheimer’s Los Angeles, a nonprofit organization committed to supporting, educating, and empowering local families as they face the everyday challenges of dementia. Jennifer works on state-level advocacy to improve dementia care within healthcare, especially for lower-income older adults. She oversees technical assistance to healthcare systems to improve their dementia capability, professional training, and outreach to healthcare professionals. Jennifer oversees multiple nationally-recognized and award-winning projects including the Dementia Cal MediConnect Project, a project transforming healthcare in the State of California for low-income older adults with dementia, and ALZ Direct Connect®, a care coordination program which connects families dealing with dementia to Alzheimer’s Los Angeles.
Jennifer says, “Caregivers are our backbone. They do the most precious work in our families and communities and yet are often unrecognized and underappreciated. CCA is a vehicle to elevate caregivers and hold them up with the dignity and respect that they deserve.”
Jennifer is a founder of The ReelAbilities Film Festival Los Angeles, which is dedicated to promoting awareness and appreciation of the lives, stories, and artistic expressions of people with disabilities. In her free time, she continues to volunteer as a ReelAbilities steering committee member.
Carmen Roberts Executive Vice President, SEIU 2015
Carmen Roberts is the first from-the-ranks SEIU 2015 member to be elevated to the position of Executive Vice President of the statewide union representing California’s long-term care workers. A longtime member of the union’s Bargaining Committee for Los Angeles County IHSS providers, Carmen has served on the union’s Executive Board for nearly a decade, and became a Regional Vice President for L.A. County in 2017, and most recently became the union’s very first statewide member leader for home care: First Vice President, Home Care Industry.
As Executive Vice President, Carmen draws on all her personal experience as a caregiver to this role. Carmen continues her commitment to building power and bringing structural change to the long-term care industry.
Carmen is looking forward to bringing that dedication to CCA as a board member. “Too many care providers haven’t enough access to the quality, affordable training necessary to provide the best possible care. As a former care provider, I’ll work with CCA to provide increased availability of training. That’s key to ensuring long-term care is recognized as a real career…where young people will say ‘I want to go into long-term care work’ like others choose engineering, medicine, and law,” she says.
Padmini Parthasarathy Principal and Founder, Sāmya Strategies
Padmini Parthasarathy is a social sector leader with a deep understanding of the interconnectedness of health equity and economic, racial, and gender justice. She is committed to cultivating systems and structures that honor those interconnections. In 2021, Padmini founded Sāmya Strategies to more directly channel her passions and expertise toward these efforts.
“I am looking forward to learning more from CCA and my fellow board members about how to ensure quality jobs for direct care workers in California and working together to make that happen!,” she says.
Padmini has a proven record of success in advancing justice, equity, and well-being across philanthropy, the nonprofit sector, and local government. In addition to leading her consulting firm, she serves as the Bay Area Program Officer for Asset Funders Network. Prior to her current roles, she served as strategist for justice, equity, and learning and senior program officer for economic security at the Walter & Elise Haas Fund and as a program director at The California Wellness Foundation overseeing statewide grantmaking to advance the Affordable Care Act and health care reform and promote employment and asset-building opportunities. Before that, Padmini was a program manager for Kaiser Permanente, where she managed its first nationwide Community Health Needs Assessment. She also led an initiative to incorporate asset building and social determinants of health approaches into maternal and child health programs for Contra Costa Health Services.
Zima Creason Executive Director of the California EDGE Coalition
Zima Creason is the Executive Director of the California EDGE Coalition and President of the San Juan Unified Board of Education. At EDGE, her work seeks to address workforce shortages in high-road industries, create pathways to the middle class, and to advance shared prosperity for all Californians. She is committed to stakeholder empowerment and coalition building to establish and sustain thriving communities. Zima has worked in the policy field since 2001 and much of her work has focused on equity as it relates to mental health policy as well as community outreach and engagement. She is dedicated to supporting people to avoid crisis outcomes, social justice, and for all Americans to have access and opportunity to achieve the American Dream regardless of their zip code, culture, ethnicity, socioeconomic status, health/mental health status, gender identification and/or who they love.
Zima is looking forward to making an impact on the long-term care workforce. “As a CCA board member, I am eager to champion the essential caregiver workforce that all Californians rely on. Their dedication not only improves the lives of those they care for but also uplifts the well-being of countless families, many of whom are part of the workforce. Together, we will enhance the value of caregiving and create pathways to economic advancement for this indispensable workforce,” she says.
They join current Board members Jeffrey Phillip Forrest of the Conrad N. Hilton Foundation, Kim Evon of SEIU 2015, Jim Mangia of St. John’s Well Child and Family Center, and Silvia Yee of the Disability Rights Education and Defense Fund.
In 2019, UCSF was awarded a five-year, $3.2 million California Department of Public Health Alzheimer’s Research Award to study the impact of IHSS+ Alzheimer’s training in partnership with the Center for Caregiver Advancement and Alameda Alliance for Health (AAH).
CCA is proud to share the outcomes of our Caregiver Resiliency Teams training program pilot, which we developed through a California Workforce Development Board (CWDB) High Road Training Partnership (HRTP). In just 13 months, we successfully trained over 500 long-term care workers in foundational knowledge on climate change and essential emergency planning and response techniques.
As you can see in this Report, the In-Home Supportive Services (IHSS) providers and nursing home workers who completed the six-week comprehensive course showed substantial gains in skills and knowledge. These caregivers now possess the critical skills to act swiftly and effectively during times of crisis, ensuring that our seniors and people with access and functional needs receive the assistance they need, when they need it most.
We also hosted an Impact Study Briefing to accompany this Report. During the presentation and subsequent panel discussion, we underscored the importance of investing in caregiver workforce training, which plays a pivotal role in building a climate-resilient California.
Our primary goal for the webinar and the Impact Report was to demonstrate, based on the outcomes of our Caregiver Resiliency Teams project, that investing in permanent, compensated training programs aimed at equipping caregivers with emergency preparedness skills can serve as a critical component of California’s response to climate change.
When Felipe Murillo suddenly became his mother’s full-time caregiver, everything seemed like an emergency.
“Initially, after my mom came out of the hospital, I would get scared about everything that would come after that, like when she started coughing,” he said. Felipe’s initial reaction anytime his mother was experiencing anything out of the ordinary was to take her to the emergency room.
But after completing CCA’s 10-week caregiver training program, Felipe can now distinguish between ER and urgent care situations. “… learning about the differences, [I learned that] maybe she doesn’t really need to go to the ER, maybe I could just take her to urgent care,” he said.
A new report from L.A. Care Health Plan shows that CCA’s IHSS+ training program reduces consumer emergency room visits and inpatient utilization. L.A. Care is CCA’s partner in delivering quality, evidence-based training to hundreds of IHSS providers whose consumers are L.A. Care members.
The utilization study, entitled Evaluation of In-Home Support Services (IHSS) Training on Health Care Outcomes and authored by Matthew Pirritano, PhD,says that.. among the consumers whose caregivers participated in the training, “there was a statistically significant decrease in ER utilization over time.” This trend was reported as decreasing prior to the end of the training and subsequently continued to decrease after graduation. Similarly, “inpatient utilization went from relatively flat prior to graduation to decreasing.”
Providing caregivers with high-quality training reduces the need for external medical care in certain situations. Caregiver Jennifer Ballesteros, who completed the multi-week training program, said, “The training is helpful to navigate the medical part of what I do for my mother.”
The material taught in the course may also be linked to the decrease in consumer ER visits and inpatient utilization. As part of the curriculum, students are instructed on how to distinguish between when their consumers need to visit urgent care and when they need emergency care.
The report concluded that “there is a relationship between the training and a change in utilization.” These results are in line with the results of other prior evaluations of similar training programs. “This pre-post design which aggregated results across multiple classes bolsters the argument that the training might be causally related to the changes in utilization.”
The sample population for the study was drawn from cohorts who completed the training between September 26, 2017 and August 6, 2021. The participants were only included in the analysis if the consumers they were caring for were continuously enrolled in L.A. Care within a year prior to and after graduation from the program.
CCA has been approved to offer a hybrid CNA certification program as an official Nurse Assistant Training Program (NATP) provider by the California Department of Public Health.
The NATP will be offered in a hybrid format and will consist of 160 hours of instruction, split between 60 hours of live instructor-led theory and 100 hours of in-person clinicals. Participants will take part in on-the-job training while being employed at a partnering nursing facility.
The training program is the first step for those interested in nursing and providing quality care for others. Participants will be exposed to health care basics and have a chance to interact with residents at a skilled nursing facility and get hands-on experience. A CNA’s role typically involves assisting patients with activities of daily living, such as basic tasks that include bathing, grooming, toileting, eating, and moving.
CCA’s NATP is a Registered Apprenticeship Program, which means participants get paid for their training and classroom hours and they earn a nationally recognized apprenticeship credential from the U.S. Department of Labor upon program completion.
CCA’s program provides a wide range of support services, including a child care expense stipend of up to $1,600, and a grocery stipend of up to $400 and a transportation stipend of up to $100. To ensure success, CCA also offers mentorship through experienced CNAs. Participants will be paired with a case manager, coach and mentor who will be there to guide them throughout their training and initial months as a CNA. Upon completion of the program and passing the state exam, graduates will be promoted to CNA with a guaranteed wage increase.
Veronica Mendoza’s role as a nurse assistant apprentice is new for her, but she is no stranger to the healthcare field. Her journey began nine years ago when she became the caregiver for her aging father. After he passed away, Veronica continued in her role as an In-Home Supportive Services (IHSS) provider for other people who needed care.
“I felt that I could help others,” she said.
Recently, she decided to take another step in her career path when she enrolled in CCA’s Certified Nurse Assistant (CNA) Registered Apprenticeship Program. Her goal is to become a CNA and eventually a Licensed Vocational Nurse (LVN). Currently, she’s a nurse aide at Paramount Convalescent Hospital (Sun Mar Healthcare). Once she gets her state certification, she will be promoted to CNA at Paramount Convalescent with a guaranteed wage increase.
The CNA Registered Apprenticeship Program is a free training program* that is designed to create a pathway for existing SNF workers who are interested in a nursing career. The program helps to provide a solution to the staffing crisis in the nursing home industry by placing highly trained CNAs in skilled nursing facilities who are well-versed in the facilities’ procedures and practices.
On a personal level, Veronica said that she is participating in the program “to better myself, to learn more, and to advance in my career.” But the biggest motivation is her passion for helping others and as a CNA at a skilled nursing facility, she will be able to provide direct care to more people.
Veronica first found out about CCA’s apprenticeship program through SEIU Local 2015. She encouraged her daughter to enroll as well. They both agree that they have received great support from the Education Fund staff and their instructors throughout the program. “They’re always there for support. If I have any questions, I could be free to go and ask them anything,” Veronica said.
The Education Fund’s apprenticeship program provides robust support services to all participants and to the facilities where the apprentices are getting on-the-job training as nurse aides. A key factor to the participants’ success is the mentoring they receive while they’re in training and during their first months as CNAs after they pass their state exam.
“To me the training is motivating me to continue my healthcare career and I would say yes, 100%, it’s worth it,” she said.
