I grew up in a small town in the middle of nowhere. My parents house was 19 miles East of the Colorado border. The adjacent Colorado counties were so sparsely populated that the ranches were open range. There were no fences. The local hospital where I got my tonsils removed only had 9 beds. The hospital is county-owned, as is the long-term care facility. Some of the local health care providers are subsidized by the county, with free office space and guaranteed incomes. Otherwise, the only health care providers would be miles away in other counties.
The way life usually works in rural areas with small towns is the college-bound kids leave to attend college or a technical institute for job training. They never return. They get jobs in metropolitan areas due to specialized skills and the desire to have amenities not available in small towns. That’s the way it worked with me and many of my classmates.
Who is left behind living in small, rural areas? Increasingly it’s seniors who are retired and low-skilled workers who didn’t leave to attend college. Doctors, nurses and other health workers often prefer living in metropolitan areas with more amenities and a more lucrative mix of patients with good health insurance. Practices that are inundated with Medicare, Medicaid and uninsured patients don’t provide as much revenue as practices near cities with corporate headquarters, high-tech employers and defense contractors.
As a result of shifting demographics, rural areas have an abundance of seniors with health needs and a dearth of health care workers to care for them. Kaiser Health News reported on a unique apprenticeship program in Colorado to train the low-skilled workers who remain in rural areas to be personal care aides and nursing assistants.
Besides increasing the number of direct care workers, the Colorado apprenticeship program offers opportunities for improving earning power to residents who live at or below the poverty line, who 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, like checking blood pressure.
Apprentices take training classes at Western Colorado Area Health Education Center in Grand Junction, and the center pays for students who live in more rural areas to attend classes at Technical College of the Rockies in Delta County. The apprentices receive on-the-job training with one of 58 local employers — an assisted living facility, for example — and they are required to work there for one year. Each apprentice has an employer mentor. Staff members at Western Colorado AHEC also provide mentorship, plus the center has a life coach on hand.
Although it is far more common for health care facilities to hire workers after they finished training, it is not unheard of. My former hospital employer had a similar program where it paid for the education of certified nursing assistants through a type of internship program. Sometimes it was low-skilled employees who already worked for the hospital and were well liked. I recall some coworkers who were patient transporters who went on to become certified nursing assistants. The internship program was a steady source of health care workers during a nursing shortage. It also helped the local technical community college match students with internships and graduates into jobs.
To practice in Colorado, new certified nursing assistants complete in-class training, do clinical rotations, and pass a certification exam made up of a written test and a skills test.
Another way to keep apprentices in jobs, and encourage career and salary growth, is to provide opportunities for specialized training in dementia care, medication management, or behavioral health. “What apprenticeships offer are career mobility and advancement,” Stone said.
My former hospital employer was in a major metropolitan area. I imagine Colorado would have more success with this type of program than states with less scenery and fewer outdoor activities. Also, Grand Junction has a population of 67,000 people. That’s a veritable metropolis compared to where I grew up.