Rural Spotlight: Resuscitating the Health Care Workforce Pipeline in the Valleys

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January 27, 2022

Rural Spotlight: Resuscitating the Health Care Workforce Pipeline in the Valleys

Health care and allied health professionals are in high demand across the nation, yet the sector faces substantial worker shortages, in part due to an aging population and healthcare workforce, as well as increases in chronic disease and behavioral health needs. Challenges for the current and future health care workforce have only intensified. At the onset of the pandemic, health care employment declined significantly and has yet to fully recover. Employment at nursing and residential care facilities has continued to fall, with moderate to severe labor shortages reported in 82 percent of assisted living facilities and 89 percent of nursing homes. A recent study by Mercer projects health care worker shortages of 3.2 million within five years, especially among medical assistants, home health aides, and nursing assistants.

Rural areas are particularly prone to health care workforce shortages. Sixty-one percent of health care professional shortages areas are rural, according to the federal Health Resources and Services Administration. Additionally, rural hospital staff are more likely to have lower salaries and more intense workloads. The need for new entrants in the health care sector has only increased during the pandemic.

Improving health care training access, acceleration, and completion is one approach to addressing these gaps. This Rural Spotlight explores the Goodwill Industries of the Valleys (GIV) GoodCare Program, which offers free education and supports to aspiring health care professionals.

The GoodCare Model

Goodwill Industries of the Valleys was founded in Roanoke, Virginia, on Oct. 10, 1931. The small city's population has grown to about 100,000 people. Originally founded as Union Mission, GIV is now a member of the Virginia Goodwill Network, serving the broader commonwealth. In 2020, at the onset of the pandemic, GIV offered virtual job readiness, skills training, employment placement, and wraparound services to 63,000 people. GIV helped 2,598 individuals earn employment and supported attainment of over 6,321 industry-recognized credentials.

GIV services are offered in the Central, Western, and Southern regions of Virginia. Its programs target 13 small cities and 31 counties, of which 24 are rural. The GoodCare program is open to eligible residents of the Roanoke Valley, Franklin County, Pittsylvania County, Danville City, Martinsville City, Lynchburg, Madison Heights, the New River Valley, Carroll County, and Galax City. (See Appendix.)

Over six years ago, GIV received federal funding to launch the U.S. Department of Health and Human Services Health Professionals Opportunity Grant (HPOG). Coupled with funding from the Anthem Foundation and the U.S. Department of Labor, GIV uses these funds to sustain the GoodCare program.

Initially, the program targeted Temporary Assistance for Needy Families (TANF) recipients and individuals earning low incomes. Current enrollment is also open to referrals from Workforce Innovation and Opportunity Act (WIOA) providers. Signed into law in 2014, the WIOA was designed to strengthen and improve the public workforce system, removing barriers that facilitate hiring and retaining vulnerable workers into high-quality jobs. Major medical center partners also refer their existing workforce to the program.

Participants can choose from three occupational tracks: health information, nursing, and health care support. After matriculating through a mandatory six-week foundations training course at community colleges or adult education centers, participants gain soft skills, become workplace ready, acquire digital, computer and financial literacy, master medical terminology, and engage in community service. Health care modules and tutoring are provided online and in person. Participants can accelerate their training to begin working sooner.

Upon receipt of the multiyear HPOG award, GIV's goal was 625 GoodCare enrollees. The program has exceeded this by 27 percent and continues to grow. Eighteen percent of the current 800 enrollees joined the program in 2021; 33 percent of the new class are TANF recipients. To date, most enrollees who have completed the program have become nursing assistants (215), licensed practical nurses (54), and medical assistants (50).

Barriers to Career Progression

Despite effective GoodCare partnerships that support worker skill building and pathway completion, program participants still must navigate nonskill barriers resulting from insufficient social services supports, low entry-level wages, benefits cliffs, and pandemic impacts on the health care workforce.

Goodwill continues to fine-tune its model to encourage pathway completion by addressing participant nonskill barriers, especially transportation. Since the program began, 67 percent of participants have requested assistance with gas vouchers or bus passes. In addition to these requests, GIV and its network of community service organizations address requests for car repairs, utility payments, and eyeglasses.

While only 3 percent of training participants have requested help for child or dependent care assistance, "Child care and school closings inhibit existing workers from holding on to their jobs as well as hinders others from returning to work," says Mary Ann Gilmer, Chief Strategy and People Officer at GIV. Employers may be less forgiving of frontline worker timeliness and absenteeism related to these issues.

Hourly wages of GoodCare graduates range from $29.35 for a hospice and palliative nurse to $10 for a medical insurance coder. Graduates have benefitted from a recent uptick in health care wages. However, Gilmer maintains that similar to pre-pandemic, rural wages remain 25 percent behind suburban or urban health care hubs. Not surprisingly, those trained in rural areas often pursue jobs with more competitive wages elsewhere.

Wage rates for some lower-wage occupations have increased as employers compete to attract and retain workers, and legislation has incrementally increased minimum wages in some states. Yet, public assistance income criteria thresholds have not been adjusted to account for marginal wage increases among early career workers.

Consequently, when GoodCare program participants earn $2 to $3 more in wages in entry-level positions, they may lose eligibility for public benefits, such as Supplemental Nutrition Assistance Program. Even a modest wage increase may create benefit cliffs that raise household expenses and potentially disincentivize workers from pursuing incremental wage growth and promotion.

Gilmer confesses, "We are careful about how we scale some of our entry-level health care workforce programs. Some career pathways are shorter to complete but may offer lower wage entry-level jobs with few early promotion opportunities," acknowledges Gilmer. "It is too challenging financially for these workers to earn a livable wage once they complete training. They are quite likely to face benefits cliffs."

The Richmond Fed partners with GIV to provide a customized version of the Atlanta Fed's Career Ladder Identified and Financial Forecaster (CLIFF) Dashboard, a digital resource that projects when a worker may experience a loss of public assistance as their income increases. It provides workers, GIV coaches, and employers insight on when families may need additional support during their career progression. The CLIFF Personal Planner allows providers and workers to compare career pathways, estimate how long before training is completed, and project how a worker's wages may grow over time.

Current versions of CLIFF, however, do not address barriers related to health care worker retention. Willful health care attrition stems in part from historic sector challenges as well as burnout from intensified COVID-19 protocols, vaccination mandates, and high patient loads. "They are exhausted from the increased frontline worker compliance protocols," shares Gilmer.

Investments for the Future

The Administration for Children and Families recognizes the GoodCare program's promising practices. Additionally, in 2021, Goodwill received a $10 million award from MacKenzie Scott, allowing GIV to redesign the program and integrate the Goodwill Industries International Opportunity Accelerator model. The model fosters deeper connections between workers, educators, and employers to better assess and address nonskill barriers, like child care to pathway completion.

Goodwill operationalizes this model through partnerships with education institutions and employers essential to the program's success. Community colleges and adult education programs in the GIV service region provide training, and when necessary, remediation to address participant academic gaps. Goodwill convened regional hubs comprised of a network of 250 health sector employers. Eighty employers participate in the core advisory group that explores how best to invest in frontline health care workers. The network also provides funding, conducts mock interviews, arranges facility tours, facilitates job placement, and advances opportunities for GoodCare graduates. The partnership aims to fill employer human capital gaps in the region and encourages higher quality job standards for a more resilient health care workforce.

GoodCare is not alone in its efforts to resuscitate the health care workforce pipeline. Aspiring health care workers may be eligible for former Virginia Gov. Northam's "Get Skilled, Give Back, Get a Job" program, which provides free health care education at community colleges. Area Health Education Centers also train aspiring health care professionals nationally and provide scholarships. These programs are adapting their curricula to prep their students for health care model advances that will require new competencies from the workforce to integrate sector innovations in telehealth, digital technology, and hospitals and health systems. Rural communities in particular will need resources such as the U.S. Department of Agriculture's Rural Development Distance Learning and Telemedicine program to deliver health care education to remote areas.

Building a health care workforce pipeline has unique challenges in rural areas. Growing shortages of rural health care workers necessitate exploring funding and policies to boost health care training enrollment, bolstering completion of programs like GoodCare, and accelerating deployment of graduates into the workforce.

Appendix

This section contains demographic and employment data for the GoodCare service area, which includes the following localities: Roanoke City (Urban - 2), Salem City (Urban - 2), Roanoke County (Urban - 2), Botetourt County (Urban - 2), Franklin County (Urban - 2), Craig County (Urban - 2), Pittsylvania County (Rural - 4), Danville City (Rural - 4), Martinsville City (Rural - 4), Lynchburg City (Urban - 2), Amherst County (Urban - 2), Floyd County (Rural - 3), Giles County (Rural - 3), Montgomery County (Rural - 3), Pulaski County (Rural - 3), Radford City (Rural - 3), Carroll County (Rural - 7), Galax City (Rural - 7), and Wythe County (Rural - 6).

Demographic and Education Statistics

	Total Population	% of Population Age 25-64	% of Population (25-64) with High School Degree or Higher	% of Population (25-64) with Bachelor's Degree or Higher
GoodCare Service Area	787,097	48.6%	90.6%	28.4%
Virginia	8,590,563	52.7%	91.3%	40.7%
Fifth District	32,962,831	52.2%	90.2%	36.1%

Source: American Community Survey 2019 5-Year Estimates.

Employment Statistics

	2019 Employment to Population Ratio (25-64)	2019 Labor Foce Participation Rate (25-64)	November 2019 Unemployment Rate	November 2020Unemployment Rate	November 2021 Unemployment Rate
GoodCare Service Area	72.5%	75.8%	2.6%	5.2%	2.8%
Virginia	75.5%	80.1%	2.3%	5.5%	2.7%

Sources: U.S. Census Bureau, American Community Survey 2019 5-Year Estimates; U.S. Bureau of Labor Statistics Local Area Unemployment Statistics; author's calculations.

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