Rhode Island is still working on implementing its Medicaid global waiver, which aims, among other things, to try to keep seniors out of nursing homes by strengthening home- and community-based services. But already, the demand for such services is strong.
Homefront Health Care now employs about 260 certified nursing assistants who help frail seniors with their personal care and so-called “activities of daily living” – cooking, laundry, shopping, etc., often working closely with their families.
This month the nonprofit agency, which trains its CNAs at no cost to them, subsidized by a United Way of Rhode Island grant, sought applications for 20 more slots. Within a few days, it had more than 200 applicants and had to shut down the process three weeks early.
Bob Caffrey, president and CEO of Homefront, answered questions about the climate for home health care and how eager – but often unprepared – local workers are to enter the field.
PBN: How many people do you train every year, and how many jobs are you creating?
CAFFREY: We train about 100 new CNAs a year, and many of them come to work for us, but they also find employment elsewhere if home care is not suitable for them. And some of our training replaces turnover, but we’re also growing. [In this round] it’ll be probably half and half. …
We haven’t seen a significant increase [yet] from the Medicaid waiver, but that’s because the state has been struggling to implement it. … We noticed a falloff in referrals because of all the state case workers retiring last year. But we are preparing for a significant increase because of the global waiver. They’re now saying they have a target implementation date of July 1.
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PBN: How many people do you serve, and what services do you provide?
CAFFREY: We visit about 700 people each week throughout Rhode Island. The majority receive three or four two-hour visits each week, but we do go from an hour a week all the way to 24 hours a day if someone is paying privately and that’s what they wish to do. …
Homefront’s mission is to assist chronically ill people to continue to live as independently as they can in their own homes. We serve mostly frail elderly, but we also serve disabled adults and children. It’s primarily CNA work, but we also have a group of pediatric nurses who serve young children who are severely disabled, and we also have a small number of nurses who provide medication management to an older population. We’re about to become Medicare-certified, which will open up a whole new range of skilled services, nursing and physical therapy, speech therapy, those kinds of services.
PBN: What kind of training do you provide to your CNAs?
CAFFREY: Our training program is approved by the R.I. Department of Health, and when they complete their training, the CNAs are licensed by the state. They need to pass a state-administered exam, both a written and a practical exam. The minimum training right now is 80 hours class and 20 hours practical; we’re doing about 125 and 30. The practical includes three days in a nursing home, working under the direct supervision of a nurse, and also in our program, a day with another CNA, doing home visits, so they see what our CNAs do in the home.
PBN: You got 200 applications for this last round. How big of a change is that from before, and how qualified are the candiates?
CAFFREY: In about a year’s time, the number of applications has doubled, and if we’d held the application period open, it probably would have been more … but we had so many applicants that it was just foolish to continue. We actually had to rent a hall to give our literacy test because we didn’t have the space in our office. …
For the literacy test, they must be able to show literacy at the seventh-grade level, because we estimate that’s what the state CNA exam requires. In this last round, we invited 215 people to the literacy test, about 125 showed up, and about 50 percent passed. So we went quickly from 215 to 60-some applicants. We’re now in the process of interviewing them to make our selection for the class. But we’re finding that the average literacy has increased in our applicant pool, so there’s better-qualified candidates; however, what we’re really looking for are people with the qualities we think are necessary to be a good CNA, which has a lot to do with their ability to work with an older population, their empathy, and those kinds of things.
PBN: What kind of backgrounds are your candidates from?
CAFFREY: It’s a very diverse population. Particularly here in the metropolitan area, we have people of all backgrounds, all kinds of language skills – it really runs the gamut.
