Finding Solutions to Long Term Care Workforce Shortages

In this episode, host Debbie Stadtler is joined by Rachel Bunch, executive director of the Arkansas Healthcare Association, for a conversation about innovative approaches to addressing workforce shortages in long term care. Bunch shares her professional journey and discusses how the association responded to member needs by launching the Arkansas Healthcare Association School of Nursing. What began as a medication assistant program designed to help CNAs expand their responsibilities and allow nurses to practice at the top of their license evolved into a tuition-free, employer-focused CNA-to-LPN pathway. The discussion explores how the program incorporates accelerated coursework, coordinated work schedules, and wraparound student support to improve retention and completion rates. Bunch also highlights the school’s strong outcomes, including a nearly 92% graduation rate, ongoing expansion efforts across the state, a focus on geriatric care training and faculty development, and future plans to explore an LPN-to-RN pathway. She also reflects on the importance of listening to members and being willing to pursue nontraditional solutions to workforce challenges.

 

Perspectives in Long Term Care is produced by Association Briefings.

 

Transcript

Debbie Stadtler: We know that finding workers in long term care is a challenge. Learn more from the Arkansas Health care Association, who have seen great success in starting a nursing school to address that need.

Hi, I'm Debbie Stadtler, editor-in-chief of Provider Magazine, the flagship publication of the American Health care Association (AHCA) and the National Center for Assisted Living (NCAL).

I'd like to welcome you to this episode of Perspectives in Long Term Care, a monthly podcast produced by AHCA and NCAL. Each month, we'll talk with long term care and assisted living professionals about the opportunities and challenges impacting the long-term and post-acute care profession. Today, my guest is Rachel Bunch, executive director of the Arkansas Health Care Association.

Rachel also serves on the Governor's Council on Aging and the Alzheimer's Disease and Dementia Council. She is the president of the Arkansas Health Care Association’s School of Nursing, which we are going to talk more about shortly. Welcome, Rachel. 

Rachel Bunch: Thank you very much. 

Debbie Stadtler: Let's start at the beginning. Tell us about your career journey. What led you to get started in long term care?  

Rachel Bunch: I guess you could say it's one of those... What's the quote about the best laid plans are not plans? So I actually started working at the Arkansas Health Care Association when I was in college back in 2008. Started working there and really enjoyed it.

I, at the time, didn't know really what an association was or the role that they played, and really enjoyed my work there so much with them, and then did a lot of different duties with them. Started in my position at the end of 2013, and so I'm going on my 18th year now with the Health Care Association in Arkansas, which is really wild and hard to believe that it's been that long.

Time flies when you're having fun, right? Definitely. A little bit of a non-traditional route. 

Debbie Stadtler: We know that workforce challenges are top of mind for long term care providers, and the Arkansas Health Care Association decided to help address this challenge with a nursing school. Tell us more about it.

Rachel Bunch: Sure. Thank you. So it's been a really exciting journey and something that has really, we've laid the groundwork over the last several years. We didn't necessarily seek out to do this. We've done education at the association for many years, just like a lot of the other state affiliates offer, and this really started with our medication assistant program in 2023.

That was a, a level in our workforce, a licensure level that a lot of other states had, and we didn't, and worked to add that through legislation and with various state boards in Arkansas. And once we started offering that program, it really took off, I think because we were a little bit behind the curve on having those professionals in the state, but also the workforce shortage was so great.

And the key difference that it made for us, it allowed us... The structure of our program, it allowed us to take existing CNAs and put them through this medication assistant program for higher wages, more responsibility, and they went through the program, and they were so motivated to go to school.

The facilities really embraced it, and it went well because it gave our nurses on the floor got time back in their day to do other nursing tasks other than pass meds, and it really allowed those nurses to work at the height of their license, which made such a difference. And so that was the beginning, and we had a lot of motivated students, a lot of motivated providers that really had done some tuition reimbursement before but hadn't had a real structured process to be able to offer those things, and it took off from there.

And here we are today, just finished our first graduation and looking forward to beginning our second cohort this summer. 

Debbie Stadtler: It's really been awesome. The nursing school is quite unique because it's the first nursing school run by a state provider association, and you're training CNAs to become LPNs in long term care facilities, and students have a guaranteed position when they graduate.

That's huge. So what other things make the nursing school special and just right for Arkansas? 

Rachel Bunch: I think one of the biggest things is that we, through our work with a lot of our facilities and a lot of work with our students, we've really made this facility and employer-focused, and in turn, there's a lot of student focus that went into it as well.

So we identified a lot of the reasons. Again, we did not start out seeking to do this, but it really made sense, and it seemed like a great service that we could provide to our members. So we identified a lot of the barriers with traditional programs. We don't believe that this competes with traditional programs.

We think that we're serving a different population of people that would otherwise never go on to a traditional higher ed program. But we identified the barriers. What has held these people back? What has kept someone who's been a CNA for their career, and they've loved it and found meaning and purpose in that role, but they're willing and able to do more.

They've just not had the opportunity. We identified a lot of those barriers and tried to eliminate those as much as we could with the program. I would say the biggest ones are that the program is tuition-free for students, which is a really big bonus, and what a gift for them and their families. The other thing is that the tuition-free is due to a combination of grant money, matching money from the facilities, and then some help from our association as well.

It's a true group community effort to make them successful. The other thing that we do is partner with our member facilities to coordinate work schedules of our students. In the traditional school, you might be in class Monday to Friday, eight to five, but then you can't work nights and then go to school. It just makes it impossible to do.

So our program, we have the students in school Tuesdays, Wednesdays, Thursdays, and then they work in the facility Monday, Friday, and then either Saturday or Sunday. And the employers help them with some wraparound supports and gap pay, and we coordinate those things together to make it possible for them.

And it is fast-tracked, but we help them with things that we're helping the students with licensure fees. The facilities are helping reimburse us for the licensure fees. That's a common barrier. We looked at a lot of research, and we interviewed even a lot of our staff members that had attempted a traditional nursing program in the past, but they weren't successful for one way or another.

And it was really interesting to hear their stories and understand why that didn't work. But here we have a great employee that is dedicated, committed to our facility locally. They want to do more and grow in their role, but there have been different barriers that have prevented that. And so we just, we really try to work hard to eliminate those.

Debbie Stadtler: I love what you said about this is a different audience, and you guys tried to eliminate a lot of these barriers, because some of the things that you're talking about we've heard over and over about go to school and work at the same time and things of that sort. It's working out. The nursing school has had great success so far.

Like, you mentioned the first class, it boasted a graduation rate of nearly 92%. That's amazing. And enrollment for next classes is growing fast. What do you think contributes to that success? 

Rachel Bunch: It's one of those things that it's been a really hard journey, it's been a lot of work, but it's one of those things that is so worthwhile and paying off for our members.

We're so excited about it. I think it's one of those things that we're going to look back and think, "Why in the world did we not do this 10 years ago?" It's one of those things, it's so obvious, but it was also so different at the time and hadn't been done, and we took a chance on it. I remember saying many times throughout the process, "This hasn't been done before, and I hope I don't figure out why."

It was really just a very different approach, and just it took some time. But yes, 92% graduation rate for the first class. We had 66 students that graduated a couple of weeks ago. The ceremonies were so special involving both their families and friends, their children, but also their facility family, their, the facility staff, their administrators, their DONs, the facilities there to cheer them on.

So just having all of that together was really special. So far, out of the 66 graduates, 51 of those have now passed their NCLEX exam. And so- Wow ... we have two students that are taking the NCLEX right now this morning, and some more later this week, and we've got more scheduled in the next couple of weeks, and so we're so excited to see the success.

And I love hearing the stories about our students that are already working shifts on the floor as an LPN. They're going through orientation and starting to work as an LPN in their new role, and we're so excited about that. And then the next class will begin officially in July of this year, and our three locations that we've had for the first year, where we're going to have students at all of those again, but we are doubling the enrollment at our Little Rock class, and then we are adding an additional location in the River Valley area of Arkansas.

And so we have admitted, we have 113 students that will begin their journey with us in July. 

Debbie Stadtler: That is quite a story of growth. And I love how you mention the successes and the celebrations, because that's really just so personal for folks and gives you that satisfaction of seeing this journey of Arkansas Health Care Association pay off.

Rachel Bunch: Absolutely. These students are not numbers to us. They are people with names and stories and families and facilities, and we've been involved and try to do our best to support them through the process, and we were so excited to celebrate with them. 

Debbie Stadtler: That's awesome. You mentioned a new location and an expanded class for the coming year.

What are some other plans that you have in the works for the school? I foresee great growth for the school. Tell us more. 

Rachel Bunch: Yes. So I would say two things on that. We are working with our state agency. I think most people are familiar right now with the Rural Health Transformation programs. So we are very hopeful and optimistic that we might be able to benefit from that program in Arkansas.

Our application there focuses on growth and sustainability of the program. That would be a grant. But the other thing that I'll add that we are doing, that I think is meaningful to our facilities and model for others, we are focusing highly on geriatrics for our faculty and for the training. We cover all the traditional things, of course.

We have to cover infant and pediatrics, mental health, a lot of other things that we don't typically see. Some, a lot of the things that aren't necessarily long term care, because our curriculum has to align with the NCLEX test plan. However, I do think we have a really great opportunity here to really focus on geriatric training.

You hear a lot about specialty nursing schools and medical schools that focus on maternal newborn or just different things, and we think that's great for those populations. But I think it's such a disservice that we are the largest collective national employer and state employer of LPNs, and yet we are sending people to work in long term care facilities that have a unique set of regulations, patient population, and expectations, and I don't feel that traditional programs equip them to be fully trained in geriatrics.

And so part of our application to the Rural Health Transformation program is to purchase a lot of equipment, so geriatric simulation and equipment. And then I've just heard from things from our members, we've polled our members a lot, we just really want to make this member-centric and focused, polled them on things that, what do you feel that new grad nurses that you see all the time, what do you feel that they're lacking in long term care?

And sometimes I heard that might be higher competency on IVs and things that they can do on assessments to try to help keep patients out of the hospital. And so we're working on equipment and materials to be able to better equip them as well. I've also had a number of conversations with my friend Dave Kylo at AHCA, working with him on the GeroNursePrep program.

So the GeroNursePrep program is something we've known about in Arkansas, we've promoted it to our members, but we thought recently what a great opportunity to take that information and material, and it's our goal that before the next cohort begins, that all of our faculty members at each of the locations will complete the GeroNursePrep program to help better equip them to teach our students on the areas that they need to know more about working in long term care.

Debbie Stadtler: I think it's really interesting that you're still keeping it very employer-focused by asking, "What is it that you need more of," kind of thing. Really specializing in geriatric and the GeroNursePrep program, we have research that shows how beneficial that is, so it's great to hear that's the direction that you're headed.

This connection that you have with members and with employers, what have you heard is really the largest pain point in the workforce challenges? Is it recruiting? Is it hiring, retention, maybe something else? What are some other things that you're hearing from folks? 

Rachel Bunch: Unfortunately, I think it's all of it.

I think it's probably a little bit of all of those things. I think it's a lot of those things, that retention is a problem, that staff members that jump around in different health care sectors or even different long term care facilities. You hear about recruitment, that is such an issue. I think the shortage in Arkansas is great.

The traditional programs in Arkansas over the last decade have produced 40% less LPNs this last year than they did a decade ago. And so I think those programs, we've got a lot of really great ones in Arkansas, really great programs that serve our members and serve them well. But the numbers show that the overall number has declined by 40%, and I think the shortage is the biggest pain point there, and we hope to be able to help address that 

Debbie Stadtler: That is really a surprising statistic.

I can see why the School of Nursing has had such success in that situation when there's fewer graduates coming out that are needed. What other ways is the Arkansas Health care Association helping providers to recruit, hire, and retain? What other programs and things do you have to offer? 

Rachel Bunch: That's always a work in progress for us, and definitely a more recent focus for us in Arkansas.

But I'll say that we are piloting a new partnership in Northwest Arkansas with a high school. One of our nurse instructors that does CNA work is currently, we have a daytime and an evening program at a high school where we're doing CNA program, and there've been a lot of CNA high school programs for years.

That's not necessarily new in itself, but we are doing it as the association. That's new for us, and then what we are doing with that program is connecting those students with local long term care facilities that might be closer to their home address for them to get part-time jobs. And then this summer we are hosting a high school-based medication assistant program for any of those CNAs who are working at the time in long term care facilities.

And so we're excited to see the outcomes there. It's been a little bit of a different challenge with high school students than you do with 34-year-olds like our other program, but still meaningful and exciting. So we're excited to see where that goes and where we might be able to apply that to other places in the state.

The other thing that we are working on in addition to our traditional kind of education and work that we do at the association is helping to develop some co-branded collateral and material. It would be my goal that for any of our member facilities in the state, my vision would be that they use the association, they use us as a vehicle to help them with some of their workforce needs.

We want to be responsive to our members, and we want to be able to help them with these things, and I would, I'd love for, to have a more seamless process when they have applicants come in, someone who's never been a CNA before, who's maybe never been to a traditional higher education program before, where they come in and ask for a job and our facility could easily lay out for them, "Here's a career," not a job, but, "A career opportunity that we have for you," and to be able to show them, if you show up and work hard, this is where we could take you over a matter of just a few years, and it could be tuition-free.

And so I think helping our members to connect those dots for applicants will be really important and will be really important in the coming days. And I should've mentioned this earlier, and I didn't when you were asking about growth, but the other thing that we are exploring is an LPN to RN pathway.

That seems like the next logical step. I don't know exactly what that will look like yet, but if we could take someone who comes in without experience and show them, "Here's a pathway for you to do CNA to medication assistant to LPN to RN. You can work the entire time, and we'll have this program that supports you and wraps around you, and you're guaranteed employment at this facility in your hometown, in your community here all throughout the program," I think that's going to be a game changer for our members.

Debbie Stadtler: How could anyone say no? 

Rachel Bunch: Yeah. 

Debbie Stadtler: It's such a great career ladder, and the fact that you have those supports and wraparound at each stage of the game from someone who has never even done this type of work to becoming a CNA to a medication assistant, LPN, eventually RN, to just have that path laid out and everything coordinated so beautifully, I think that's really going to be so important.

What advice do you have for an organization that maybe wants to launch a new program to address workforce challenges? Any sort of advice from your learning as you guys have set up the school of nursing? 

Rachel Bunch: Sure. So I think the biggest advice that I would have is to really listen to your members.

Start by listening to your members and hear their concerns. I'm not a nurse. I'm not an educator, but I try to be a good listener. I probably am sometimes more than others, but try to be a good listener. And I think just talking to the members and hearing their pain points from them and not going and making the traditional excuses really.

You can look at the different traditional models, and if that doesn't fit, don't be afraid to try something different. Try something different, and it might just work out. But we had to create a unique pathway here. It was not without some pushback and not without a lot of doubt, but we knew that we were doing right by our members, and we had enough data that was on our side to show the need, and then enough feedback from our members.

And then the results are just, they're speaking for themselves, seeing the NCLEX pass rate. And then the biggest thing, I think, to me on the other side have been just hearing the stories from those students that have completed the programs, those single moms, those non-traditional students. We've had several students in their 50s that thought, "I'm going to be a CNA my entire career, and I want to give to my facilities and residents," and look at them now.

They're LPNs, which is so exciting, and I know that they're going to be really great LPNs. So it's so good to hear and to see, but just don't be afraid to invest in those people and don't be afraid to listen and try a really non-traditional route, because it can pay off. 

Debbie Stadtler: Absolutely. Expanding the vision beyond just the traditional folks that you might be looking to recruit and hire, but really being open-minded about non-traditional students and things of that sort.

Really a great place to look for folks in our industry. Thank you so much for being with us today, Rachel. I really appreciate it, and I'm sure that we will see big things from the Arkansas Health Care Association School of Nursing in the future. 

Rachel Bunch: Thanks so much for having me. 

Debbie Stadtler: Visit ahcancal.org or careersincare.org for more workforce resources.

Thanks to everyone for listening to this episode of Perspectives in Long term care. Join us each month as we discuss issues that impact the long-term and post-acute care profession. And be sure to subscribe to this podcast wherever you listen to your favorite podcasts. Take care.