State Activities: Virginia

Background
Direct Care Workforce Initiatives
Laws and Regulations
Reports
Practice Profiles
Key Contacts
Government Offices

Background

State Statistics
(see below for key to abbreviations)



PC/HC Aide = Personal Care/Home Care Aide
HHA = Home Health Aide
CNA = Certified Nursing Assistant
Avg DCW = Average Direct-Care Worker
United States and state abbreviations are used (ex: VT = Vermont)

In 2000 792,333 (11.2%) of Virginia's 7,078,515 citizens were aged 65 or older, a 19.2% increase since 1990. The US Census estimates that by 2030 Virginia's elder population will increase 132.7%. By that year the traditional caregiving workforce (women aged 25 to 44) will increase by 15.9%.

The Bureau of Labor Statistics reports that in 2006 50,350
nursing assistants, home health aides, and personal care/home care aides worked in Virginia earning an average of $9.36 per hour. These numbers do not include many direct-care workers who are self-employed. The Virginia Employment Commission anticipates 19,211 new direct-care positions will be created by 2014, a 38% increase over the number of positions in 2004.

According to a survey by the American Healthcare Association (AHCA) in 2002 the statewide vacancy rate for Virginia CNAs was 8.2% and the turnover rate was 73.2%. It is anticipated that the state's already high rates of direct-care worker vacancies and turnover will get worse as the population continues to age, and the 'care gap' between those needing care and those available to care for them continues to widen.

Sources:

1) The 65 years and over population: 2000, Census 2000 Brief
2) The Virginia Employment Commission, Virginia Electronic Labor Market Access (VELMA)
3) Bureau of Labor Statistics, Occupational Employment Statistics (OES), National, State, and Metropolitan Area Occupational Employment and Wage Estimates, May 2005
4)American Health Care AssociationResults of the 2002 AHCA survey of nursing staff vacancy and turnover in nursing homes, 2003




Direct Care Workforce Initiatives


* This list of on-going initiatives is incomplete as our research is in process; please let us know of any initiatives that should be included here.

Virginia

College of Direct Support Demonstration Program
Beginning in 2003, Virginia's Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) explored using the College of Direct Support (CDS) as the primary trainer of Direct Support Professionals in Virginia. With funding from the state, local government, and grant monies from the Virginia Department of Business Assistance, Workforce Services, DMHMRSAS began a CDS demonstration program in March 2004. This demonstration project was evaluated the participating system stakeholders and the Human Resources and Workforce Development staff of the Department of Mental Health, Mental Retardation and Substance Abuse Services, click here, to view a report of the findings.

Beginning in August of 2005, the College of Direct Support program was offered statewide.

Contact:
India Sue Ridout , Workforce Development Manager
Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services
Virginia e: india.ridout@co.dmhmrsas.virginia.gov

Community College Caregiver Training Initiative
In July 2007, The Caregiving Project for Older Americans and the MetLife Foundation awarded 12 grants to community colleges across the country for innovative in-home caregiver training programs.

The Piedmont Virginia Community College has devloped a 48-hour curriculum for a home health aide noncredit certificate program. A panel local experts on aging devloped modules based on their experience, the training will include Companion/Light Housekeeping Aide, Personal Care Aide and Administrative Aide.

Virginia

Health Reform Commission
In July 2006, Virginia's Governor Kaine established a Health Reform Commission through Executive Order 31. The mission of the Commission is improving access to competent, affordable healthcare for all Virginians. The Commission is composed of four workgroups to address specific areas of health care reform, including a Health Care Workforce Workgroup and a Long-term Care and Consumer Choices Workgroup.

Virginia

Website: www.hhr.virginia.gov/Initiatives/HealthReform/index.cfm

Improve the Direct Service Community Workforce grant
This three-year Demonstration to Improve the Direct Service Community Workforce grant was awarded to the Virginia Department of Medical Assistance Services in 2004. The Department of Medical Assistance Services received $1.4 million to: 1) Improve the retention of personal care aides by making health coverage available; 2) Significantly increase levels of job satisfaction and career commitment among personal care aides who complete training opportunities; and improve retention in agencies that participate in training opportunities of the worker, supervisor, and the families of the clients; 3) Recruit undergraduates, high school students, former caregivers, and persons with disabilities to be direct-service providers; 4) Use SkillSource Centers to produce larger numbers and greater efficiency of recruitment, referral, and employment retention of personal care workers and provide linkage to enhanced training opportunities. The SkillSource Centers will market, screen, and refer potential direct-care workers from three main target groups: TANF recipients, low-income adults, and dislocated workers; 5) Develop a campaign that will promote jobs in the direct-care field.

Update
In June of 2007, Demonstration to Improve the Direct Service Community Workforce grantees gave updates on their progress to the National Direct Service Workforce (DSW) Resource Center:

  • The Department of Medical Assistance Services contracted with the Northern Virginia Skill Source Center to help recruit people into the direct support jobs

  • The SkillSource Centers developed ''Make Care Your Career'' brochures in multiple languages.

  • DMAS has also worked in partnership with the Virginia Geriatric Education Center (VGC) at Virginia Commonwealth University to recruit family caregivers into the direct-care workforce.

Contact:
Teja Stokes, Project Director
Department of Medical Assistance Services
600 East Broad Street, Suite 1300
Richmond, Virginia 23219
e: Teja.Stokes@dmas.virginia.gov

Northern Virginia Direct Care Workforce
The Fairfax County Long Term Care Coordinating Council (LTCCC) and the Northern Virginia Workforce Investment Board (NVWIB) are working together to explore and develop new models of best practice for recruitment, training, and retention of a direct-care workforce for Northern Virginia. The Northern Virginia Community College is represented on both the NVWIB and the LTCCC and provides a key community partnership for direct-care workforce education and training.

The Fairfax County Board of Supervisors has also made the week of June 12 Direct Care Workers Week

Contact:
Janice Schiff, Long Term Care Council
Virginia t: (703) 324-3535
e: janice.schiff@fairfaxcounty.gov

Website: www.co.fairfax.va.us/service/dfs/News_press_releases/060804.htm

Virginia Association of Professional Nursing Assistants Inc. (VAPNA)
Virginia Association of Professional Nursing Assistants Inc. seeks to advocate for nursing assistants in Virginia, as well as offer direct-care workers an opportunity to network with other workers, and feel pride in their profession.

Virginia Association of Professional Nursing Assistants 's (VAPNA) president has outlined the organization's mission and vision:
V Visionary and Veteran
Our group of nurse assistants has come to realize the origin of our role in health care. Over the years we have taken notice of its evolution, but we have remained dissatisfied with its potential destiny. Our experience is a total of 110 years.
A Attitude, Accessibility, and Accountability
We strive to lift up the morale of the nurse assistant first, and then we seek to raise understanding of self, while linking it to the tremendous responsibility of our charges. We strongly believe that providing the tools of an educational forum will further enhance the care delivery process, for the nurse assistant and the resident.
P Principle, Practice, and Patience
We practice what we teach. For the past three years we have sought to create community awareness of the certified nurse's assistant role and link it to resident care. Those who embrace this concept can be assured that quality care will become a reality for seniors now and later.
N Navigator and Nurturer
Our young organization is like that of a small child; it must be trained, and guided on the road to success. When we fall, we get right back up and brush ourselves off and try again. Nurse Assistant need time to network with their fellow co-workers so they may better serve residents. Thus creating a wholesome atmosphere for all.
A Advocate
In long-term care, the recipient has been abridged far too long from the one that can make care happen. We seek to bridge those gaps with proper education in both the community and the health care industry. The adults of tomorrow may choose to become a nurse assistant, if they do, we should begin now to advocate for change so our children will not fear to tread our path in caring for us.

Contact:
Lorrene Maynard, CNA, Executive Director
P.O. Box 1822
Newport News, Virginia 23601
t: (757) 595-1483


Laws and Regulations

Agency-Directed Personal Care Services Training Requirements
In Virginia, personal care aides who provide direct care to individuals are required to complete 40 hours of training that meet the standards of the Department of Medical Assistance Services.
12VAC30-120-180. Agency-directed personal care services

Personal Care Aide Training Curriculum

Assisted Living Training Requirements
Staff are required to be trained in specified areas to protect the health, safety, and welfare of residents. When the assisted living level of care is provided, direct care staff must be registered as a certified nurse aide or complete one of the other specified educational curricula.

22VAC40-71-80. Staff training and orientation.

Home and Community-Based Services (HCBS) Waivers for Aged and/or Physically Disabled Adults
Virginia has three home- and community-based services waivers serving this population.

The first, the Elderly and/or Disabled Waiver includes personal care, adult day health care, and personal emergency response systems (PERS). Of all of Virginia's waivers, this waiver serves the largest number (over 10,00) of individuals.

A second waiver, the Consumer Directed Personal Attendant Services Waiver provides consumer-directed attendant care services to the aged and disabled population.

The third is the Technology Assisted Waiver. This waiver serves medically fragile, technology-dependent individuals and includes private duty nursing, personal care, respite care, and environmental modifications.

The third is on temporary extensions pending conversion to a regular waiver. Prior to conversion, this model waiver is small (serving less than 500 individuals). This waiver serves medically fragile, technology dependent individuals and includes private duty nursing, personal care, respite care and environmental modifications. In the last year of the current renewal, the State projects serving 268 recipients.


For more information call the Department of Medical Assistance Services at (804) 692-0481.

The Centers for Medicaid and Medicare Services (CMS) website below describes all such services nationwide.

www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/

Home and Community-Based Services (HCBS) Waivers for MR/DD Adults
Virginia has two waivers for persons with mental retardation and developmental disabilities.

One waiver, the Individual and Family Developmental Disabilities Support Waiver, provides services to individuals 6 years of age and older who are developmentally disabled. Services include, but are not limited to, personal care, respite care, habilitation, skilled nursing, assistive technology, environmental modifications, PERS, companion services, family caregiver training, therapeutic consolation, and crisis stabilization.

The second waiver, the Mental Retardation Waiver, provides services to individuals younger than the age 6 who are at developmental risk. Services include but are not limited to personal care, respite care, habilitation, crisis stabilization, environmental modifications, skilled nursing, assisted technology, PERS, companion services, and therapeutic consultation. Of all of Virginia's waivers, this waiver serves the second largest number of individuals (6,571).

For more information call the Department of Medical Assistance Services at (804) 692-0481.

The Centers for Medicaid and Medicare Services (CMS) website below describes all such services nationwide.

www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/

Nurse Aide Registry and Certified Nursing Assistant Training
Virginia requires 120 hours of training (which exceeds the federal requirement of 75 hours) and a competency examination.

Virginia also has an ''Advanced Certified Nurse Aide'' job title. To become an advanced certified nurse aide an applicant must have been a CNA for three years in good standing (with no findings of misconduct), get a recommendation for advanced certification from a licensed nurse, and completed 120 hours of training. 18VAC90-25

Regulations Governing Certified Nurse Aides

The state Department of Health Professions tracks disciplinary actions against nurses and nurse aides, and this information can be accessed through their website.

Click here for a list of Virginia Nursing Assistant Training Programs


www.dhp.state.va.us/nursing/nursing_forms.htm#CNA

Nursing Home Staffing Rates
No additional state minimum staffing requirement. Follows federal rule.

The federal requirement for nursing home Staffing Rates:
Nursing facility is required to use the services of a registered nurse 8 consecutive hours a day, 7 days a week. This requirement may be waived given certain conditions.
42 CFR 483.30: Most recent available section: CFR Title 42 Part 483 Section 30(text)

Nursing Scholarship and Loan Repayment
SB564 (2000)- Board of Health establishes scholarship and loan repayment program from Nursing Scholarship Fund to eligible students who agree to work in long-term care facility for a specified period of time; includes nurse aide programs.


Reports
Chart of direct-care workforce activities in Virginia. Paraprofessional Healthcare Institute and the North Carolina Department of Health and Human Services. March 2004.

This chart describes existing or enacted direct-care workforce initiatives in this state as of March 2004. The information was collected as part of a national survey of state initiatives on the long-term care direct-care workforce. Additional details about this state may be found in the full report.

  • Read Full Item
  • View Item Details & Ordering Information
    Citizens Taskforce for Long Term Care final report. Fairfax County Long Term Care Task Force. 2002.

    In 2000, Fairfax County commissioned a Long Term Care Task Force to develop a Strategic Plan to meet the long term care needs of the Fairfax community. A final set of recommendations was developed and endorsed in December 2001. One of the four recommendations was to Improve Recruitment, Increase Retention and Improve Quality in the Long Term Care Provider Workforce

  • Read Full Item
  • View Item Details & Ordering Information
    CMS direct service workforce demonstration grants: Overview and discussion of health coverage interventions. Paraprofessional Healthcare Institute (PHI). April 2006. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS).

    This report provides an overview of the efforts of six Center for Medicare and Medicaid Services (CMS) grantees to make health care coverage more affordable and accessible to direct-care workers. It discusses the key advantages and disadvantages of three approaches employed by grantees: subsidization of employer-based coverage, combining basic insurance and tax-free accounts, and funding outreach programs, which promote public-private partnerships. An attached spreadsheet provides a description of each intervention, identifying key components, costs, and their potential sustainability.

  • Read Full Item
  • View Item Details & Ordering Information
    CMS direct service workforce demonstration promising practices in marketing, recruitment and selection interventions. University of Minnesota, Research and Training Center on Community Living and The Lewin Group. December 2006. Centers for Medicare & Medicaid Services (CMS) .

    This report identifies promising practices in direct care worker marketing, recruitment, and selection in states receiving Centers for Medicare & Medicaid Services (CMS) grants. Grantees used different techniques to improve recruitment and retention outcomes, including computer-based registration, marketing campaigns, realistic job previews, structured interviewing, and expanded orientation or mentoring of new employees. The report concludes that sustaining and replicating these interventions will require further research about associated costs and benefits and dissemination of this information.

  • Read Full Item
  • View Item Details & Ordering Information
    CNA focus group project report. Duss Donna J. and Beverley A. Soble. November 2000. Virginia Health Care Association.

    This report summarizes the findings of a series of focus groups that took place across Virginia in the year 2000. The authors identified two major themes: CNAs perceived an inequality between experience and pay, and a lack of respect by supervisors.

  • View Item Details & Ordering Information
    Consumer direction of personal assistance services in Medicaid: A review of four state programs. Claypool, Henry, and Molly O'Malley. March 2008. Kaiser Family Foundation .

    Based on interviews with program administrators of consumer-directed programs in California, Colorado, New York, and Virginia, each of these states is profiled. State profiles identify and discuss eligibility criteria, participant support services, and the method of financial management used by Medicaid beneficiaries to pay their direct-care workers.

  • Read Full Item
  • View Item Details & Ordering Information
    Effects of the Workforce Investment Act of 1998 on health workforce development in the states . Center for Health Workforce Distribution Studies, University of Washington, Seattle. November 2004. Health Resources and Services Administration, Bureau of Health Professions, Health Resources and Services Administration .

    The goals of the Workforce Investment Act of 1998 (WIA) are to increase the employment, retention, and earnings of participants in Department of Labor (DOL) employment and training programs. This report explores how WIA resources have been used to support the healthcare workforce across the states, including, but not limited to, the direct-care workforce.

  • Read Full Item
  • View Item Details & Ordering Information
    Hope for health care. Seldon, Joan. 2002. Richmond Redevelopment Housing Authority.

    This article provides an overview of the Richmond Redevelopment and Housing Authority's Hope for Health Care program, which recruits, screens, and trains residents in public housing for careers as certified nursing assistants. The paper reports statistics on the program, describes the program's budget and timeline, and outlines RRHA's requests for funding and partners.

  • Read Full Item
  • View Item Details & Ordering Information
    The long-term care workforce crisis: Dementia-care training influences on job satisfaction and career commitment . Coogle, Constance L., Colleen A. Head, and Iris A. Parham. September 2006 . Educational Gerontology, Vol. 32, No.r 8. Routledge/Taylor & Francis Group.

    This study of a training collaborative to improve dementia care showed an expected increase in extrinsic job satisfaction but an unexpected decrease in career commitment. Discussing their findings in relation to other relevant recent studies, the authors posit several explanations for the outcomes, including the time lag in data collection, and emphasize the need for successful training programs to exist within a context of organizational and systems-based change.

  • View Item Details & Ordering Information
    The Nursing Assistant Institute . Simone, Kristin. 2002; Updated in 2004. Promising Practices in Home and Community Based Services CMS and Medstat.

    The Virginia Nursing Assistant Institute (NAI) was established in 1999 to address the shortage of nursing assistants in central Virginia. The institute works to improve training and support for CNAs, thereby increasing recruitment and retention, and ultimately provide better care for consumers.

  • Read Full Item
  • View Item Details & Ordering Information
    The Nursing Assistant Institute: Working to develop a well-trained, stable workforce of direct-care providers to meet the health care needs of the Thomas Jefferson planning district. Jefferson Area Board for Aging. May 1999. Jefferson Area Board for Aging.

    This paper outlines one region's response (the formation of an institute) to the current and imminent challenges observed in stabilizing the direct-care workforce (recruitment, retention and training). It describes the institute's objectives, planned activities, anticipated results, proposed budget, and plan to sustain the institute.

  • View Item Details & Ordering Information
    The value of geriatric care enhancement training for direct service workers. Coogle, Constance L., et al.. 2007. Gerontology & Geriatrics Education, Vol. 28, Issue 2

    The authors evaluate a two-phase training series aimed at increasing professionalism and self-efficacy through problem-solving, communication, and stress management skills. The article describes the curriculum and draws a couple of conclusions: that training was more highly rated by those committed to geriatric care, and that continued training is correlated with an increase in positive impact on job performance.

  • View Item Details & Ordering Information
    Together we care: Helping caregivers find support. National Council on the Aging. June 2001. National Council on the Aging.

    This report describes five innovative, high-quality community-based programs that offer respite and supportive services to family caregivers: Bozeman Senior Center Adult Day Services (Bozeman, Montana), Care Links (Clifton Park, New York), Day Break Adult Day Center (Anchorage, Alaska), Family Caregiver Support Service (Big Stone Gap, Virginia), and Interfaith Carepartners (Houston, Texas). The report identifies outcomes, resources, partnerships, and sponsors of each program

  • Read Full Item
  • View Item Details & Ordering Information
    Virginia's Nursing Assistant Institute. Cooper, Cheryl. January 2001. Journal of Nurse Assistants

    This article describes the Virginia Nursing Assistant Institute (NAI) and addresses the shortage of nursing assistants with a focus on recruitment and retention.

  • View Item Details & Ordering Information


    Practice Profiles

    Practice Profiles are descriptions of recruitment, education and retention programs.

    The Care Advantage Nurse Aide Academy: Certified nursing assistant training program



    Key Contacts

    These individuals and organizations are included here because they are actively involved in leading direct-care workforce activities in this state.


    Virginia Association of Personal Care Assistants
    www.virginiapca.org

    PMB 172
    7109 Staples Mill Road
    Richmond, Virginia 23228-4110
    t: 1-800-893-8343

    Virginia Association Of Professional Nursing Assistants Inc.

    Lorrene Maynard, CNA, Executive Director
    P.O. Box 1822
    Newport News, Virginia 23601
    t: (757) 595-1483

    Department of Medical Assistance Services

    Vivian W. Horn, MSW, Long Term Care Policy Consultant
    600 East Broad Street, Suite 1300
    Richmond, Virginia 23219
    t: (804) 786-0527
    f: (804) 371-4986
    e: vivian.horn@dmas.virginia.gov



    Government Offices

    State of Virginia homepage: www.virginia.gov

    Department for the Aging - State Unit on Aging
    www.aging.state.va.us

    1600 Forest Avenue
    Suite 102
    Richmond, Virginia 23229
    t: (804) 662-9333 or 1(800) 552-3402 (toll free)
    f: (804) 662-9354
    e: aging@vda.virginia.gov

    Department of Medical Assistance Services
    www.dmas.virginia.gov

    600 East Broad Street
    Suite 1300
    Richmond, Virginia 23219
    t: (804) 786-4231

    Virginia Association of Area Agencies on Aging
    www.vaaaa.org

    Joani Latimer, State Long Term Care Ombudsman
    530 East Main Street
    Suite 800
    Richmond, Virginia 23219
    t: (804) 565-1600

    Virginia Board of Nursing
    www.asisvcs.com/indhome.asp?CPCAT=0753NURSE

    Nurse Aide Registry - For information about training, certifcation, and transfer
    6606 West Broad Street
    4th Floor
    Richmond, VA, Virginia 23230-1717
    t: (804) 662-73l0

    		• Spacer Image