Imagine a solution to the staffing crisis that not only brings skilled and enthusiastic team members into a facility but also gives people new hope for their families and themselves. AHCA/NCAL is piloting such a solution with a partnership in Iowa and California to train and place refugees in long term care facilities.

According to Dana Ritchie, CAE, Senior Director of Not For Profit and Constituent Services, AHCA/NCAL has been working on a project with partners in prominent refugee organizations. Association leaders also participated in a virtual roundtable with CEOs from major U.S. companies to discuss Operation Allies Welcome, an effort by the White House to support Afghan refugees as they settle in the U.S. “We have two pilots with refugee organizations in California and Iowa, with more possible for the future,” said Ritchie.

The Opportunity, The Need

As of January 21, approximately 76,000 Afghan refugees have come to the U.S. following the political upheaval there, and more than 62,000 have already moved off military bases into communities across the country. A variety of organizations are working to help these individuals find homes, obtain needed training and skills, qualify and apply for jobs, and enroll their children in school.

According to Lucas Johnson, Workforce Development Manager at the International Rescue Committee (IRC) in Sacramento, Calif., over 50% of refugees enrolled in the organization’s employment programs arrive with a Bachelor’s degree and under 10% have professional experience in the medical field.

Brodey HansonBrodey Hanson, Executive Director at The Bridges at Ankeny, part of the Iowa pilot, said, “The growth of COVID highlighted some areas where staffing has become an issue across the nation. We had some openings we thought refugees could fill and believed it would be mutually beneficial.” He said, “I have friends from all over the world. Refugees need someone to help them get started, and we have an opportunity to help them and enable them to better their lives.”

Johnson, who is working with AHCA/NCAL on this pilot, is sharing some best practices on how to ensure refugees are ready for their new lives. “We take time to get to know refugees and potential employers,” said Johnson. They conduct assessments, address career goals, and provide soft skills and vocational training. Then they can match them with the right employer. He added, “We use a variety of technical assessments to make sure people are a good fit and can understand and meet expectations.”

Refugees need more than just specific job skills. Johnson said, “We have weeks of courses where we will go through professionalism, interview skills, resume development, professional writing, and more.” They also learn about adjusting to culture and work in the U.S., Johnson stresses, “Our job is to make sure the refugees we work with truly understand the cultural expectations of the workplace. We also try to engage the community as much as possible and work with local organizations to help with the cultural exchange.”

Overcoming Barriers

While many refugees have at least some command of English, this isn’t necessarily a dealbreaker for refugees who have an interest in health care but lack language skills. Hanson said that those who don’t speak the language well can possibly start in housekeeping or other positions that will give them a chance to learn English. At the same time, they are required to take English as a Second Language classes. As their communication skills improve, they can move into direct patient care or other roles that match their knowledge, talents, and interests. He added, “We can help train them, even if they don’t stay at our facility. We can train them and [transfer] them to other facilities when the time comes.”

People in the local community with language skills also can be helpful. For instance, Hanson said, “I have a friend who speaks the same language as many of the refugees and is willing to tutor some of them.” In the meantime, he noted, “We try to keep things easy to understand. For instance, we use things like checklists and short, simple instructions.”

Johnson said, “A big challenge is the lengthy process of becoming re-certified here. For a physician, for example, it can take years and tens of thousands of dollars.” This can be difficult for refugees who have the training, education, and even the experience to fill clinical or other specialized roles but lack certification or licensure.

Many refugees come here with little more than the clothes on their back. Churches and various community groups and organizations can help provide people with clothes, toys, and even food. Hanson noted, “To make these jobs more attractive, I’ve gone to apartment buildings and arranged a discount for refugees to live there.” He added, “It’s important to realize that it is pretty common for them to send most of their paycheck back home to help family there. If they can save on expenses, that is a benefit. He also observed that arranging rides or transportation to and/or from work also is a plus.

The Elephant in the Room

While everyone isn’t necessarily embracing of immigrants, Hanson said that intolerance doesn’t seem to be a problem. “Our biggest challenge is residents who have dementia and may revert to old ways of thinking about people who are different.” He suggested that conversations with families and staff are key to working through these challenges and helping to create an environment of acceptance and understanding.

Bringing in refugees actually presents an opportunity for staff and others to learn about another culture and for immigrants to share their traditions, food, and other aspects of their homeland with their new colleagues. At the same time, staff can participate in helping refugees get acclimated to life in American and understand how they can be successful in work and life.

The family structure is different in countries like Afghanistan, and parents and grandparents often are cared for in the home. “It is helpful for refugees to see what care is available in nursing homes. At the same time, many individuals we work with have formal or informal caregiving experiences, which is a valuable skill set in long term care,” Johnson said. He added, “Right now, 90% of individuals going through our nursing assistant courses are refugee women, and we are seeing high completion rates.”

This requires a lot of work and heavy lifting upfront, Hanson said, “We are developing policies and procedures that are not specific to our facility and can be adapted by others for use in their buildings. These include ‘cheat sheets,’ onboarding instructions, etc.”

Claire EnrightJohnson observed that when the team— including refugees—focuses on caring for residents, “the strengths they bring become clear.” Especially when there is a huge staffing crisis, teams can focus on refugees’ skills and their contributions to resident care that ease the burden on other staff.

“You have to be open minded, and you need a workforce that is unique, nurturing, and respectful. It takes a real concerted effort and some self-examination,” said Claire Enright, Executive Director of the Quality Care Health Foundation, another partner in the pilot. While this takes work, in the end facilities can provide an oasis away from the chaos and difficulties both refugees and staff have experienced in the past year, and they can work together to create something positive they can all take pride in.

Adapting the Pilot’s Vision

In addition to California and Iowa, Texas, Arizona, Oklahoma, Maryland, Michigan, Virginia, Missouri, New York, Georgia, North Carolina, Alabama, Arkansas, Delaware, Louisiana, Mississippi, Montana, North Dakota, Alabama, and Mississippi are all expected to receive refugees. While some states are expected to get more refugees than others, this presents an opportunity to attract new workers to nursing homes and other long term care settings.

Enright noted, “We are looking at what processes can be documented to make onboarding of refugees easier. Many aspects of this program can be duplicated in other locations and various settings.”

These programs often start from seeing the need for various skill sets. “We have skilled refugees arriving from Afghanistan looking for a career, and there are some with either experience or an interest in health care,” Johnson said. “If you want to be part of something like this, there are IRC offices throughout the U.S., and employers can reach out to them. These organizations provide excellent career development,” he said.

Addressing the Reckoning

“I think an internal reckoning—looking at what we’re doing and what we can do differently—is a way to find a light at the end of the tunnel,” suggested Enright. “We need to look at what has brought us to this workforce crisis, why some of us have stayed in the field, and why others have left. This pilot will help enlighten us about that.”

Ritchie said, “This pilot lays the foundation for other programs, and we look forward to the possibility of more partnerships in the future. We want to welcome our new neighbors to work in our centers and create a great career path.”

Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.