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Persevering Despite the Pandemic

Juggling two jobs and school pays off for a nursing home worker

Starting a new career can be overwhelming for anybody, but doing it as a new nursing assistant in the middle of a pandemic presents its own challenges. For Martha Espinosa-Silva, trying to answer the questions from the people she takes care of are the toughest.

“They’re always asking, ‘When can I go out? Can my family come and see me?’” she says. “They’re asking me these questions and I don’t really have an answer.”

Espinosa-Silva is a Restorative Nursing Assistant (RNA) at Centinela Skilled Nursing & Wellness Centre (West) in Inglewood, where she helps residents with rehabilitation and therapy so they can improve their quality of life.

The coronavirus has devastated nursing homes across the nation. In California alone, more than 154,400 cases and 12,998 deaths have been reported at facilities across the state. Starting out as a new CNA during the pandemic, Martha faced long hours and many challenges.

“It’s very tough. We’re there (in the facility) regardless of whatever’s going on. And it’s a lot of things that you have to think about. You’ve got to take care of yourself, your residents and the people around you. And we have families that we go home to, so you make sure that you’re taking the proper steps to take care of them, too. So it’s been tough during the pandemic, but it’s getting better,” she says.

Espinosa-Silva had been working as a kitchen aide before she enrolled last summer in the Certified Nursing Assistant (CNA) and RNA certification courses offered by the Center for Caregiver Advancement (through the Education Fund).

She initially was uncertain if Centinela’s’s staffing schedule would be able to accommodate the days she needed to attend classes. Also, she was already working two jobs, one full-time and another part-time stint at another facility.

However, with support from her supervisor and her Education Fund coordinator, she started her training during the pandemic. For three months, she did not have a day off: She attended her classes on weekends, in between shifts at the two facilities where she worked.

“It was a little bit hard,” she admits about juggling work, her studies and her personal life. “But I was determined that I was going to do the program, that I was going to finish it.”

And she did. She passed her state CNA certification exam and, in August 2020, started working as a CNA.

Receiving her license was a reward for all her hard work and she was ready for her new job. However, she didn’t expect a struggle on her first day: She was so overwhelmed she almost walked away. She was used to staying behind the scenes, prepping meals in the kitchen, and not being on the floor with the residents. Despite the new challenges, she persevered.

“Everywhere you go, there’s something that challenges you as a person and it’s going to make you grow in many ways,” she says.

She found the work of a nursing assistant so meaningful that a few months later she enrolled in the Fund’s Restorative Nursing Assistant (RNA) program to move one more step forward in her career path.

“The certification that I have now, it means a lot. It’s something that is pushing me forward to either being an LVN or speech therapist. I’m holding on to this dream, for my future because I want to stay in the medical field.”

Climate Disaster Training for Caregivers

Training caregivers to be first responders in climate-related disasters can play a critical role in protecting California’s seniors and people with disabilities, helping them recover and build climate disaster resiliency. The Center for Caregiver Advancement (CCA) has been addressing this need for specialized climate disaster training, thanks to a grant from the California Workforce Development Board (CWDB).

CWDB recently announced that CCA, formerly the California Long-Term Care Education Center, is one of the recipients of its latest round of High Road Training Partnership (HRTP) grant awards. The grants, totaling $8.9 million, fund sector-based workforce development projects in several industries and areas that are critical to the state’s strategy for a just recovery from the COVID-19 pandemic and economic crisis while addressing climate change and community resilience. 

“The COVID-19 pandemic, on top of increasingly dangerous wildfires, extreme heat, and power shutoffs, has emphasized the essential role that caregivers play each and every day, taking care of our loved ones and providing critical services that many Californians can’t live without. This HRTP grant will give us the resources to prepare hundreds of in-home supportive services (IHSS) and nursing home workers to respond to health and climate related emergencies,” said Corinne Eldridge, CCA President and CEO.

CCA will receive a little more than $1 million for its Caregiver Resiliency Project, which will train 500 caregivers in the next two years on how to prepare for, respond to, and recover from adverse climate change impacts, most notably fires, power outages, extreme weather, and pandemics. By increasing the long-term care industry’s ability to plan for climate disasters on behalf of California’s most vulnerable communities, CCA’s project will positively impact the region’s climate resilience and contribute to reduced carbon emissions, transportation emissions, and water use. The project will train In-Home Supportive Services (IHSS) providers and nursing home workers, which may include CNAs and dietary, housekeeper and laundry staff.

“We are excited to support these partnership projects that are leading the nation in showing how workers, employers, and communities can and must work together to build an equitable, inclusive clean energy economy. We have an opportunity to advance quality jobs and accessible pathways for underserved communities,” said Dr. Angelo Farooq, CWDB Board Chair. “This productive infrastructure enables California’s high road employers to compete and flourish.”

This round of grant awards funds 11 innovative projects in transportation electrification, building decarbonization, offshore wind, tribal forest restoration, long-term care, and other industries. The projects are located throughout California in Los Angeles, the San Francisco Bay Area, Sacramento, San Luis Obispo, Kern County, rural communities in Fresno County, and the Greater Sierra Nevada region in rural Northern California. 

The selection of these projects reflects the state’s priorities in mitigating and adapting to climate change through technology and innovation as well as nature-based ecological solutions. They also highlight the importance of healthcare workers and caregivers in supporting community health and resilience, especially as climate-related threats and disasters increase and become more severe.  

ABOUT THE PROJECT

The Center for Caregiver Advancement’s Caregiver Resiliency Project is part of the California Workforce Development Board’s High Road Training Partnership, which is funded through California Climate Investments, a statewide initiative that puts billions of Cap-and-Trade dollars to work reducing greenhouse gas emissions, strengthening the economy, and improving public health, and the environment — particularly in disadvantaged communities.

www.cwdb.ca.gov

ABOUT CCA

The Center for Caregiver Advancement is the largest provider of training for long-term care workers in California. Our mission is to build the workforce of highly trained caregivers that many Californians can’t live without. Founded in 2000 by the long-term care workers who are now members of Service Employees International Union (SEIU) Local 2015, CCA provides quality educational opportunities to long-term care workers so they can build better lives for themselves and the consumers they serve. CCA serves two specific groups of workers: In-Home Supportive Services caregivers and nursing home workers in residential care and skilled nursing facilities.

www.ccaorg.wpengine.com

Caregiver Training Builds Trust

IN HER OWN WORDS:

“After caregiver training, I began to look at my consumer and the issue of trust differently. Now if I’m helping them eat or use the bathroom, I try to be respectful and do everything in my power to preserve their dignity. The value of this is more than something you feel in your heart. It also builds trust and allows for better communication among the care team… What I learned with CCA caregiver training and on the job is to find ways to take initiative and build trust. I don’t show up at my shift like a robot and go through the same motions. I’ll ask my stepmother (my consumer) if there’s something she’d like to do differently today. Do more than what’s on the schedule, you might say. Like we’ll sit on the porch or go outside a few steps if she’s feeling up to it. It might not sound like much, getting some sun and fresh air. But you should see the light in her eyes.” — Okesha Reese, IHSS provider

Sandra Owens-Taylor

Sandra is proof that it’s never too late to look for a new calling.

She was raised in Pomona, where her family had a successful garment business. Following in her father’s footsteps, Sandra worked as an executive in the garment industry for over thirty years before seeking out what she wanted next in life.

When Sandra retired, she began tutoring and giving in-home care. And what she found was so much more than a new calling. She found a way to help and uplift others while working as a caregiver— a way to spread joy. And a way to receive it as well.

“What I enjoy most is when I can see that it’s effective and that I’m making an impact on someone else’s life. I’m bringing joy. I’m bringing light. I’m supporting their independence.”

Sandra said the caregiver training she received from the Center for Caregiver Advancement had empowered her in her role. It not only helps her give better care but also better value herself and the generous work she does. 

“We really have to understand that we are important, number one, in the work that we do. And number two, we don’t know it all. We must stay abreast, and we must continue to educate ourselves. We can feel positive about what we’re doing because we know we’re doing it correctly,” she said.

This new path, and the caregiver training she has received, have brought new meaning and happiness to Sandra’s life. And those around her are taking notice.

“The joy that I carry is contagious. I’m active in my church as well. [They] have defined me as director of health and safety. So it definitely plunged me into a broader perspective, just even in my life, period.”

Lorena Sandoval

Lorena Sandoval was born in Mexico and grew up in Long Beach, California. She’s had to overcome a number of hurdles from an early age. At 16, she left home and was homeless before being taken in by a relative. At 18, she had her first child before welcoming another three along.

She worked in the kitchen in nursing homes and then worked as a housekeeper before taking the leap to become  the leap a Certified Nursing Assistant (CNA).

“I thought it’s now or never. It was really hard because I didn’t have much schooling, but I didn’t want to let my kids down, and I wasn’t going to let myself down.” Lorena said.

The Education Fund and Local SEIU 2015 representatives wouldn’t give up on Lorena either. They kept encouraging her to take the CNA training program and continue building her skill set as a caregiver.

“They kept telling us, ‘Don’t give up.’ It’s almost like it was personal to them that we reach our goals,” she said. “I’m so grateful.” Lorena learned not just how to become a CNA but to believe in herself again.

“Everything I learn, I hold on to it like the most precious thing I have,” Lorena said.

While building up her experience as a CNA, she challenged herself to keep learning. First, enrolling in the Restorative Nursing Assistant certification class, then taking advantage of the mental health and wellness workshops. Now, not only can she take better care of her patients, but she’s also able to take better care of herself.

“I love what I do with all my heart. I love working in nursing homes with the elderly. I love making them and my co-workers laugh,” she said.

Through the caregiver training she’s received from the Center for Caregiver Advancement and the Ed Fund, Lorena has built a better life for her family and proven to herself that she can achieve so much more than she imagined.

“As for dreams, I would love to do home health and become an LVN. I want to take advantage of life and what is given to me,” she said. “I want to prove to myself that I can do better.

Jennifer Davis: Making Daily Life Easier

In the world of caregiving, being able to properly help seniors and people with disabilities with simple activities of daily living can make a world of difference. For caregiver Jennifer Davis, it means giving the people you’re caring for “a lifestyle that allows them to feel like they have a life worth living.”

Davis was one of more than 300 In-Home Support Services (IHSS) providers who recently completed CLTCEC’s IHSS+ caregiver training program. The training’s curriculum covers essential caregiving skills such as nutrition, safety, medication, and personal care.

 Davis said that one of the most important sections of the training revolved around navigating activities that typically require manual dexterity. The module turned out to be critical information she needed to care for her partner, who is quadriplegic. “I learned how to properly assist with her medication. It was important to the two of us – being able to help her handle the meds in her hands and help her put it in her own mouth,” Davis said.

For Annie Gibson, who has been a caregiver for 20 years, the training opened her eyes to other things she could do to make life more comfortable for the people under her care. In the module dedicated to nutrition and diet, she learned about assistive devices that can help a person eat.

 “It was instrumental for me to learn how to use the modified utensils for eating, especially for my client who is in hospice,” Gibson said. She also made sure her client’s family knew how to use the tools to continue the standard of care when she’s not around. “I showed her son how to use the plate, spoon, and the attachment to the plate to help them push the food around.”

Training like this is “absolutely important so caregivers know the proper tools and techniques to do their jobs,” said Davis. “It provides uniformity for all providers so we can say to our clients, ‘This is how we were properly trained. We work with you and work for you.’ That’s important for them to recognize.”

Report: Home Care Integration Training Project Brief

In 2012, the Center for Caregiver Advancement (then known as the California Long-Term Care Education Center) received a three-year, $11.8 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services’ Innovation Center, established by the Affordable Care Act to test innovative service delivery models, for a pilot training project called the Care Team Integration of the Home-Based Workforce.

This training project’s innovative contribution to health care was to recast and enhance the role of home care providers through education and integration into the health care system. This project showed that training home care workers is associated with better care, stronger health outcomes and lower costs through reductions in consumers’ use of the Emergency Department and hospitalizations, particularly repeat visits to the Emergency Room and readmissions to the hospital, which has the potential to create tremendous cost savings to Medicare and Medicaid. Home care providers are in direct and frequent contact with the consumers they care for and are in the unique position to positively impact consumers’ health.

Thriving Together as CNAs

It’s easy to see why Team Caceres thrives. Sergio and Emerita Caceres, both Certified Nursing Assistants (CNAs) at Los Angeles Rehabilitation and Wellness Centre – Pursue Health, push each other to do better, dream bigger, and provide better quality of care.

Sergio is the strong, quiet one. Born and raised in Peru, he came to America in his 20s, learned English, and went to school while working in restaurants. His family boasts four CNAs, and the career path not only transformed Sergio’s future. It led him to his wife, Emerita.

The two met at work more than 20 years ago. Emerita, also from Peru, is the lively, sociable one of the couple, able to coax smiles out of patients and co-workers. Always on the go, she whirls from task to task with efficiency and cheer.

“If I have to pick the hardest part of the job, I can’t think of anything really, because we work as a team,” Sergio said. 

Aside from raising their two children, one of whom is USC-bound, the couple have also made time to enroll in most of the CNA training and other health classes offered by the SEIU 2015 Education Fund. Sergio and Emerita have completed classes and received certifications in CPR, Computer, Dementia, in-person Continuing Education Units (CEUs), as well as cell phone-based classes that focus on Vocational English and skills building.

“The great thing about Emerita and Sergio is that they have a really good work ethic,” said Jennifer Sierra, former Director of Staff Development (DSD) and current Infection Preventionist at Los Angeles Rehabilitation and Wellness Centre – Pursue Health. “It is very important for a supervisor or DSD to acknowledge their efforts in going above and beyond, trying to make sure that they’re educated and knowledgeable as CNAs and that they’re aware of everything that’s going on at work. That’s a big step: taking initiative to further your education and your knowledge in order to fully do your job to the best of your ability.”

The decision to enroll in so many classes to be better CNAs was easy, Emerita said. 

“We always want to help our patients, and when we improve, we do that,” she said. “It was hard to make time, but we did it together. And we learned so much, especially about Alzheimer’s patients and patients with Dementia. The training helped us understand them.”

Sergio said the classes have definitely enhanced their skills as caregivers.

“We are better CNAs for knowing more, for understanding more, and us learning more is better for all,” he said, adding that he most enjoys the practice they receive from the classes.

“We are 20 years on the job and we still love caring for the patients, and being compassionate with them,” he said.

SEIU Local 2015 representative Karen Rodriguez admires the couple’s dedication to their jobs and to their patients. “It just shows that they are always willing to continue that quality care for their patients,” she said. “They know that the more educated you are the more skilled you are. They already have the compassion, the care factor there, so anything above that is just amazing.” 

For Emerita, every day is a chance to make her work count, to uplift those who are suffering and make the world a better place. Working side by side with her husband is a happy bonus.

“We treat our patients like family, and you take care of family,” she said.

Related Reading: Aida’s Leap

Moving Mountains as New CNAs

CNA program means career advancement and a better life for two care workers.

For Laura Garcia and Elizabeth Sanchez, moving mountains is a matter of will.

The two nursing home workers are being recognized for completing all of the requirements of the SEIU 2015 Education Fund’s Certified Nursing Assistant (CNA) program through CCA. They accomplished this while working one full time, or two part-time jobs, as well as going to class during weekends for several months.

The Education Fund — through funding from the Employment Training Panel (ETP) — paid for their training toward certification. Garcia and Sanchez just finished the required 500 work hours at their current facility, Huntington Park Nursing Center – Covenant Care.

Certified Nursing Assistants Elizabeth Sanchez and Laura Garcia at Huntington Park Nursing Center – Covenant Care.

“I worked many hours and had to give up plenty of time with my family, but it paid off,” said Laura Garcia, a former In-Home Supportive Services (IHSS) home care worker. “I wanted a better career and better life for my family and this has helped me prepare for my future.”

The Education Fund established the CNA program to address a statewide shortage and retention of CNAs at nursing homes. The Fund is a joint effort between employers and SEIU Local 2015 to provide additional training and career pathways to workers through building skills and earning industry-recognized certificates. Aside from a reimbursable down payment, the CNA program is completely free for students.

Marthen Lumingkewas, Executive Director at Huntington Park Nursing Center – Covenant Care, said the Education Fund’s training is a critical part of setting a high standard for both patient care and CNA job satisfaction.

“Being a caregiver is not an easy job,” said Lumingkewas, whose own parents worked as nursing assistants and would often bring their child to work. “It’s more of a calling. You have to have compassionate care, be patient, listen, be a therapist, be an advocate. A program like this is critical because it could be a mirror, something people could see that could be duplicated.”

Their training is already making a difference, according to Lumingkewas. “I’ve only heard good things (about Laura and Elizabeth). They’re confident in their job ability and duties,” he said. “If you want staff competency, retention and confidence in their ability to do their job, I think programs such as this are very critical. It’s a blessing not just for one person, it can affect others, too.””

Most workers who have participated in the Education Fund’s CNA program previously worked in nursing homes as kitchen aides, in housekeeping or in activities, or — like Garcia and Sanchez — as home care workers. They undergo several months of intensive training, then have to pass the state exam. After they get their certification, students need to complete 500 hours working as a CNA at their current facility as part of the program requirements.

The expectation around the Fund’s CNA program is for SEIU 2015 bargaining unit members to “graduate and be hired, preferably by the facility where they work. But this is also an avenue for them to grow and to improve their lives,” said Ericka Ochoa, SEIU 2015 Region 1 Coordinator for Huntington Park Nursing Center – Covenant Care. “With quality training, we can make sure that CNAs are respected by society and their employers.”

Garcia and Sanchez have done it all. Both say it wasn’t easy, but the support they received from the union and the Education Fund staff have made a difference.

“I always like to see the glass half-full than half-empty and it helps me see that I’m almost to the end,” Garcia said. “The classes made me more aware and gave me more knowledge on how to treat my patients.”

The struggle to complete training and certification fuels both women’s dreams. For Garcia, it is to continue giving 100 percent effort to help her patients. She is also driven to inspire her four children.

“What I love most about my job is when patients tell me I’m doing great,” Garcia said. “The most challenging part is thinking I won’t complete my assignment for the day.”

Both women said they are grateful the Ed Fund helped empower them. The Fund and its team pushed them to work even harder to make their piece of the American dream a matter of fact.

“This was a terrific program and changed my life for the better,” Garcia said.

L.A. Care: Caregiver Training Reduces ER Visits

Providing caregivers with high-quality training reduces visits to the emergency room and hospital admissions, according to an analysis of utilization data of L.A. Care members whose caregivers participated in the Center for Caregiver Advancement’s competency-based training program.

“L.A. Care’s utilization report proves that trained caregivers have a tremendous impact on the health of the people they care for and on the larger health care system,” said Corinne Eldridge, President and CEO of CCA.

The November 2019 report, titled Evaluation of IHSS Training on Health Care Outcomes and authored by Dr. Matthew Pirritano and Nancy Fang, concludes that training caregivers benefits L.A. Care members. Comparing the number of L.A. Care members’ emergency room and inpatient visits before and after their caregivers’ training, the report found that there was a “significant decrease in ER and inpatient utilization after the training.”

The authors studied the impact of training for five cohorts who completed CCA’s 10-week program, using member utilization data from 20 months prior to the caregivers’ graduation up to 19 months post-graduation.

“Separate follow-up regression analyses of the pre- and post-training periods revealed that there was really no relationship between time and ER visits prior to the training – the relationship was flat. But after the training the relationship was significantly negative indicating that ER utilization decreased after the training,” the report noted. The same was true for the inpatient analysis.

The report concluded that “the pre-post design which aggregated results across multiple classes bolsters the argument that the training might be causally related to the changes in utilization.”

L.A. Care is the nation’s largest publicly operated health plan and provides health coverage to low-income Los Angeles County residents. It partnered with CCA (CLTCEC) in 2017 to provide training for In-Home Supportive Services (IHSS) workers caring for seniors and people with disabilities covered by the health plan.

“At L.A. Care, we understand that the majority of people prefer to stay in their homes, even when living with chronic and complex illnesses, and IHSS caregivers carry enormous responsibilities. This training has provided caregivers the tools necessary to improve our members’ health and comfort at home,” said John Baackes, CEO, L.A. Care Health Plan.

The Center for Caregiver Advancement (formerly CLTCEC) is the largest provider of training for long-term care workers in the state. Its IHSS+ training program is a comprehensive, competency-based course designed to enhance the skills and knowledge of IHSS workers who play a crucial role in maintaining the health and well-being of the people to whom they provide care. The modules cover essential caregiving skills such as communicating effectively, reducing caregiver stress, managing repetitive behaviors, and assisting with personal hygiene and activities of daily living.

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