Former California Employment Development Department Director and Milken Institute

One of the most significant but least-recognized parts of California employment is the workforce in California’s skilled nursing facilities. There are around 1300 licensed skilled nursing facilities in the state, employing more than 130,000 workers at the end of 2009. This skilled nursing facility workforce is one of the few sectors in California that has been growing in recent years and is projected for continued employment growth.

Nobody knows more about this workforce and how it has developed since the 1970s than Ken Merchant. For several years, Ken was the director of education and training for the California Association of Health Facilities (CAHF) , the main association representing long term care employers. Since 2005, Ken has been working with local Workforce Investment Boards, employers and unions to train new Certified Nurse Assistants (CNAs) and assist incumbent CNAs to higher-paying positions in the industry. Recently, I was able to sit down in Sacramento with Ken and get his thoughts on the present skilled nursing facility workforce, the growth in number of employees and wages, and the opportunities for career mobility within the industry.

According to data supplied by CAHF, the staffing at skilled nursing facilities has grown fairly steadily from 2004 to the present: 120,506 workers in 2004, 129,899 by 2007, and 130,937 in 2008. The staffing number for 2009 is still being calculated, but Ken estimates it will be continue to show some increase.

The growth of the long term care workforce has been due in good part to the solvency of the government reimbursement system for long term care under Medi-Cal. 70% of the funding for SNFs comes from Medi-Cal. In 2004, the state legislature enacted AB1629, the Skilled Nursing Facility Quality Assurance Fee Program. AB1629 stabilized the reimbursement system for facilities and even incentivized investment in increased staffing levels and worker training.

The largest part of the long-term care workforce is the CNAs. In 2000, 102,000 California workers had active nursing assistant certifications, and over 49,000 worked in long term care settings. The CNA position traditionally has been a lower-wage, high turnover position, with roughly 50% of CNAs leaving their firms over a three year period. AB1629 exerted upward pressure on wages, but CNA wages remain today among the lowest in health care. Ken estimates an average CNA wage in California of around $11.50 an hour, with higher wages near $14 an hour in the Bay Area.

A combination of AB1629 and the Great Recession has reduced turnover significantly. Ken notes, though, that employers continue to express concern about too many CNAs who are not appropriate by temperament or interest or skill for the job. Effective employer-based CNA training can identify workers who go into long term care as a possible career, rather than a short term placement. Such training also can identify a career path in long term care.

Within long term care there are opportunities for mobility. Over the past decade, a variety of training programs have been implemented to assist CNAs to advance to other paraprofessional jobs, such as Restorative CNA. More ambitious has been the training efforts to assist CNAs to become Licensed Vocational Nurses (LVNs), and to assist LVNs to become Registered Nurses (RNs). All of these training and upgrading programs are aimed at the professionalization of Califronia’s long term care workforce.

The long term care industry continues to be an opportunity for job training and placement today and in the foreseeable future, even as most other sectors in California are struggling to halt further declines.