Rural Colorado is trying to fill healthcare worker gaps with apprenticeships

GRAND JUNCTION, Colo. — During her 12-hour night shift, Brianna Shelton helps residents of BeeHive Homes Assisted Living go to the bathroom. Many have dementia and some cannot get out of bed on their own. Few can remember her name, but that doesn’t matter to her.

“They’re somebody’s mother, somebody’s grandmother, somebody’s great-grandmother,” Shelton said. “I want to take care of them like I would take care of my family.”

Shelton trained to be a personal care aide through an apprenticeship program designed to meet the growing need for health care workers in rural Western Colorado. Here, far from Denver’s bustling urban corridor, worker shortages are growing as baby boomers retire, young people move away from these older communities and demand for home and facility health care grows.

Rural areas often have a higher proportion of residents aged 65 or older than urban areas. And the most rural regions have relatively fewer direct care workers, such as personal care aides, to help people with disabilities than less rural regions, according to a recent study in the journal Health Affairs.

In addition to increasing the number of direct care workers, Colorado’s apprenticeship program offers opportunities to improve the earning capacity of residents who live at or below the poverty line, who have lost their jobs during the COVID-19 pandemic, or who are unemployed or underemployed. They train to become personal care aides, who help patients with daily tasks such as bathing or housekeeping, or certified nursing assistants, who can provide some direct health care, such as checking blood pressure.

Apprentices take courses at the Western Colorado Regional Health Education Center in Grand Junction, and the center pays for students who live in more rural areas to take classes at the Technical College of the Rockies in Delta County. Apprentices receive on-the-job training at one of 58 local employers – such as an assisted living center – and are required to work there for a year. Each apprentice is mentored by an employer. Western Colorado AHEC staff members also provide mentoring, plus the center has a life coach.

“We really just want students to get into health care, get jobs and keep those jobs,” said Georgia Hoaglund, executive director of Western Colorado AHEC, which has 210 active apprentices and was supported by a $2 million grant from the Department of US labor in 2021

Some apprentices are recent high school graduates. Others are single mothers or veterans. They often have educational or economic barriers to employment. Hoaglund and her staff of 10 buy the apprentices scrubs so they can start a new job in the right uniforms; otherwise, they may not be able to afford them. Staff members pay for apprentices’ gas if they can’t afford to fill up their tanks to drive to work. They speak to apprentices on the phone every month, sometimes every week.

Although the apprenticeship program gives these workers a solid start, the jobs can be stressful, and burnout and low pay are the norm. Career advancement is another obstacle, Hoaglund said, because of the logistics or cost of higher education. Hoaglund, who calls her staff family and some of the apprentices her children, dreams of offering more advanced training — such as in nursing — with scholarship money.

Apprenticeships are perhaps better known as a workforce training tool among electricians, plumbers, carpenters and other trades. But they’re also seen as a way to build the needed pool of direct-care health workers, said Robin Stone, senior vice president of research at LeadingAge, an association of nonprofit providers of aging services.

“Traditionally, health care employers hire people after they complete a training program,” said Susan Chapman, a registered nurse and professor at UC San Francisco’s School of Nursing. “Now we’re asking the employer to take part in that training and pay the person while they’re training.”

The pandemic has exacerbated a shortage of direct care workers, which could encourage employers to invest in apprenticeship programs, Chapman and Stone said. Federal investment can also help, and the Biden administration’s initiative to improve the quality of nursing homes includes $35 million in grants to address workforce shortages in rural areas.

Shelton had never worked in health care before moving to Fruita, a small town that is about 12 miles northwest of Grand Junction and is surrounded by red sandstone towers. She left Fresno, California, a year ago to care for an uncle who has multiple sclerosis. She and her 16-year-old daughter live in a trailer home on her uncle’s property, where Blackie, her rescue Labrador retriever, roams the hens and cats.

Blackie also sometimes accompanies Shelton to the BeeHive to visit the residents. Shelton said it’s more than a job for her, and she’s grateful to the apprenticeship program for helping her get there. “It opened a door for me,” Shelton said.

Shelton works three 12-hour shifts a week in addition to caring for his uncle and daughter. Still, she said, she struggles to have enough money for gas, bills and food and has taken out small loans to make ends meet.

She is not alone. Personal care aides are often underpaid and undervalued, said Chapman, who has found significantly higher poverty rates among these workers than among the general population.

Direct care workers nationwide earn an average of $13.56 an hour, according to research by the nonprofit policy group PHI, and those low wages make it difficult to recruit and retain workers, leading to further shortages and instability.

In an effort to keep workers in the state, Colorado raised the minimum wage for personal care aides and certified nursing assistants to $15 an hour this year with money from the American Rescue Plan Act. And the Colorado Department of Health’s 2023-24 budget request includes an increase to $15.75. Similar efforts to raise wages are underway in 18 other states, including New York, Florida and Texas, according to a recent document from the National Governors Association.

Another way to retain apprentices and encourage career and wage growth is to provide specialist training opportunities in dementia care, medication management or behavioral health. “What an apprenticeship offers is career mobility and progression,” Stone said.

To practice in Colorado, new certified nursing assistants complete classroom training, complete clinical rotations, and pass a certification exam composed of a written test and a skills test. Hoaglund said the testing requirements can be stressful for students. Shelton, 43, passed the written exam but must retake the skills test to be licensed as a certified nursing assistant.

Hoaglund’s program started in 2019, but really took off with the federal grant in 2021. Since then, 16 people have completed the program and received raises or promotions. Twice as many people left without finishing. Grand Junction’s largest hospital, Intermountain Healthcare-St. Mary Medical Center is recruiting for the program.

Hoaglund said every person who enters the health care field is a win.

Brandon Henry, 23, was a student at Colorado Mesa University in Grand Junction and worked at PetSmart before joining the apprenticeship program in 2019. After enrolling, he trained and worked as a certified nursing assistant through the worst of the pandemic. As an apprentice, he said, he learned the importance of having grace while caring for patients.

He returned for additional training at Western Colorado AHEC to obtain a license that allows him to dispense medication in accredited facilities, such as assisted living centers. He now works at Intermountain Healthcare-St. Mary’s Medical Center, where he attended wound care and physical therapy courses at the hospital. He will graduate from Colorado Mesa this winter with a bachelor’s degree in nursing.

“At the hospital, I found more opportunities to raise wages and increase work,” Henry said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operational programs at KFF (Kaiser Family). KFF is a charitable, non-profit organization providing information on health issues to the nation.

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