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Speaking of the Economy
Speaking of the Economy - Mary Ann Gilmer
Speaking of the Economy
Jan. 26, 2022

Rural Spotlight: Resuscitating the Healthcare Workforce in Roanoke

Audiences: Community Advocates, General Public, Workforce Sector Leaders

Mary Ann Gilmer of Goodwill Industries of the Valleys discusses the nonprofit's training program for healthcare workers and the importance of this work in rural communities, especially during the COVID-19 pandemic. Gilmer is chief strategy and people officer at Goodwill.



Tiffany Hollin-Wright: Hi, I'm Tiffany Hollin-Wright, the Richmond Fed's community development regional manager for Virginia and West Virginia. Thank you for listening to "Speaking of the Economy." You can find more episodes and subscribe, and if you like what you hear, please leave a review and tell your friends and colleagues about us.

Today, I am joined by Mary Ann Gilmer, chief strategist and people officer for Goodwill Industries of the Valleys in Roanoke, Va., which I will refer to as Goodwill throughout the podcast. Mary Ann and I will discuss GoodCare, the agency's free healthcare training program. Mary Ann will share insights on why it's critical to build a rural healthcare workforce. And, she'll describe the program and what's working well as we talk about some of the barriers participants have to mitigate to reach completion and placement. Mary and I will dig deeper into the capacity challenges that agencies had to overcome, particularly those arising from COVID's impact. We'll conclude with Mary Ann's perspective on pandemic recovery implications for the healthcare sector and its workers, including policy recommendations.

This is one of many conversations that the Richmond Fed is hosting as part of its Rural Spotlight series on community economic development leaders who are leveraging resources to solve for some of the challenges their geographies face. We encourage you to learn more about the GoodCare program and perspectives on the rural health care workforce in the accompanying Rural Spotlight article on the Richmond Fed website.

I look forward to speaking with you today, Mary Ann. Welcome.

Mary Ann Gilmer: Thank you, Tiffany. It's my pleasure to be here and thanks for that introduction.

Hollin-Wright: Rural communities have a disproportionate number of medically underserved areas and health professional shortage areas. Out-migration and an increasingly aging population exacerbates this issue. In your opinion, what is the importance of a strong healthcare workforce in rural communities dealing with these issues?

Gilmer: We operate in a 35-county and 14-city area in southern Western and Central Virginia. What we find is most of our area that we serve is comprised of rural populations, and what we see there is just more chronic disease. We see, among the individuals that we're serving, more generational issues surrounding nutrition [and] surrounding obesity and related disease that occurs among children in those communities.

For us, the most critical aspect of building a pipeline of workers is that a lot of folks will not want to travel into those communities to deliver health care services. The workforce itself needs to be based within that rural community. That really enables health care providers to have a reliable and consistent and trained workforce that's local. Within rural communities, we know that trust is a huge issue. When health care organizations, hospitals, clinics [and] health departments are staffed by locally trained workers who can relate to the individuals in those communities, people are more likely to come out for healthcare, do preventive measures.

We saw that, for example, in a rural community in Galax, Va., where we've had a great amount of success with our GoodCare healthcare training program, in training folks to work directly in the clinics there, directly for the health department to become community health workers, and therefore building health care access and trust among the residents of that county, where their disease rate is, in many cases, twice as high as say, where we're headquartered out of in a more urban area in Roanoke, Va.

Hollin-Wright: It may be unexpected for some of our audience that Goodwill is addressing healthcare workforce training. Can you talk a little bit about the history of your organization and what issues you address in your service area? What catalysts propelled you to create the GoodCare program that directly addresses these issues?

Gilmer: A lot of people think about Goodwill and they think about our stores. But we are, in fact, a social enterprise and the revenue we receive from our retail and commerce operations goes directly to funding programs that help people gain the skills and employment they need to thrive.

Goodwill, nationally, was founded in 1902. The original intention of Goodwill when it was founded by Edgar Helms, who was a Methodist minister, was to help people to become more independent and to rise out of poverty.

Here at Goodwill Industries of the Valleys, we are just finishing up a celebration of our 90th anniversary. We have come in our strategic plan full circle back to the original founding of Goodwill, with a vision to eliminate poverty and to do so through empowering individuals, strengthening families and inspiring communities.

When we initially applied for federal funding to launch our GoodCare healthcare training program, we received that funding from the federal Department of Health and Human Services. We applied because we knew that the healthcare sector was one in which there was a huge demand for workers. We were having our health care providers tell us they couldn't get the staff that they needed. At the same time, many of the jobs that they were offering would provide that living wage to the people that were often in poverty and, thereby, strengthening the entire family system. So for us, it seemed like a natural fit.

Hollin-Wright: The impact of the GoodCare program, that's what really drew me to you, and the Richmond Fed. We've heard about your wonderful successes, and we'd love to learn a little bit more about that in this podcast.

Gilmer: Sure, I can do that.

We wouldn't be able to do anything we do without the partners that work alongside us. GoodCare was always a collaborative effort. We've worked with community colleges in our service area. They have bene instrumental in our success, as well as working directly with some private and online training providers.

Finally, many of the individuals who we serve, they need help in preparing for training. That has been a significant barrier to them entering their training, So, we provide them with the academic and career exploration skills that they need to get ready to go into their occupational training. We've partnered with five regional adult education programs who have come to our classrooms, providing that support to our students. It really is holistic support in getting people ready and getting them into training.

We've been very, very fortunate to serve over 700 individuals in the GoodCare program, and seen them be incredibly successful as they have entered into occupations ranging from pharmacy techs all the way through to registered nurses, respiratory therapists. They [have] seen a game change in their lives as they come in, oftentimes, in poverty. In some cases, they can earn up to 200 percent of poverty. Even then, we know that that's not enough to adequately sustain a family. It's been incredibly gratifying to see them earn credentials and to see them enter into higher wage jobs as a result of the program.

Hollin-Wright: I know it's really important – 700 new entrants into the healthcare marketplace is important to help address some of the shortages in rural areas. So, thank you for all that you've been doing.

We don't often hear about workforce programs that partner well with employers. I would be really interested to know what those partnerships look like.

Gilmer: Sure, absolutely.

I do believe that those relationships with healthcare employers were the linchpin to the success that we've been able to have in the program. We've worked with over 250 healthcare employers in our service area. We started off doing that through local employer advisory groups, where folks would come in from our assisted living facilities, as well as from our major medical systems, our local clinics, dentists, offices, you name it. We had representation from small to large healthcare systems within our service area. They were eager to come to the table because we were offering a worker pipeline solution to them. They'd tell us, repeatedly, we cannot get enough people entering into the healthcare sector and we want to work with any group that is reaching out to folks we haven't perhaps seen before as employees.

They've really helped us in so many ways. One way is really predicting the training that's going to be needed in the future. They provide a lens through which we see what we need to do to shape our program to be relevant to our program participants. Additionally, they interact with our students. They provide information on careers in the health care sector, as well help them prepare for interviewing, coach them on passing credentialing exams, and give them a direct pipeline into internships within these organizations and direct hires into jobs.

Now they've come to look at us as well for upskilling their own employees, particularly certified nurse aides. They want to be medical assistants, in some cases, LPNs.

Their advice has been just so incredibly important to us.

Hollin-Wright: Can you tell us a little bit about your service population and some of the challenges that they have, and some of the benefits of participating in this free training and having access to this network.

Gilmer: The individuals in our programs are typically or below 200 percent of poverty. We do obviously make exceptions for that for people who maybe they're earning a little bit more, but because of the stability of their family they need to advance their careers.

Most of these individuals do not have the preparation, meaning academic preparation or just in terms of general knowledge of what's involved in various healthcare occupations. What we saw previously, through our work with other programs and other funders for training, they had to go right into training. In many cases they were not successful, oftentimes less than 50 percent of them being successful by going right into a training program without some foundational knowledge. That's what we provide.

In addition, [we provide] the support that's necessary to get through a healthcare training program. Many of these programs, even if they are short term, there's not a lot of financial support for people while they go through training. The things that we've been able to do have been to provide some robust wraparound services to them. It can be anywhere from addressing food insecurity among these students as well as helping with childcare, helping with transportation, peer support, all those things that are necessary for people to have a build upon a series of successes.

A lot of our students are single parents. It is still primarily women in our program. We do have several men, but predominantly women and predominantly single parents.

Obviously, what's critically important to them is how not only they're going to get the childcare while they prepare for training, but how they're going to earn enough to compensate for loss of public assistance that they may be receiving. Most of the folks in our program receive SNAP benefits. Many of them receive housing subsidies and many other types of public assistance that are enabling them to make ends meet every month. Clearly, entering into an occupation that may result in a wage that sees a lot of those benefits drop off can be tough, so we also can provide support as they do their planning for their household income.

Hollin-Wright: This is exactly why Richmond Fed has partnered with Goodwill Industries of the Valleys through the Virginia Goodwill Network to really customize and deploy the Career Ladder Identifier and Financial Forecaster or CLIFF suite of tools. We can help providers and workers have the resources they need to understand how financial and career plans may need to be created in light of the potential of benefits cliffs resulting from some of these challenges you mentioned.

I'm going to skip a little bit and just talk about what your organization has had to do when you're trying to deploy a role healthcare workforce development project like this. Surely there are some internal capacities that you've had to build to strengthen your human, programmatic [and] financial capital. What does that look like for your organization, especially in light of the pandemic?

Gilmer: Tiffany, the pandemic was a huge game changer, especially for this particular program. But for all of our programs and services we were able, thankfully, to have already established some online training content at the time that everyone was having to operate under stay-at-home orders. How are they going to come to training? How are they going to interact with our staff? A lot of what we had to do with just be nimble and be super flexible. It was a lot of long hours and it was a lot of hard work.

In our training programs, we were able to continue to do academic preparation, soft skills training [and] all of those foundational career exploration activities virtually. In some cases, that meant connecting the individuals we serve with laptops to use at home and work with our internet providers within our communities to establish low-cost internet service that we could then [provide] to folks so that they could participate in virtual training and virtual learning. We also turned to some of our online training providers. That really enabled us to continue the occupational skills piece. Healthcare is a tough one to do online.

And, of course, it was difficult for our students to think about even entering into a healthcare environment when we did not have the vaccine. We focused as much as we possibly could on doing virtual training components and getting them as ready as possible. When we did have access to the vaccine, they were able to go in and do their clinical experience as well as be able to enter employment and feel relatively safe in doing so.

It was a big pivot, and it was very staff intensive. Our staff immediately went to work-from-home. We had to provide them training on how to do that, and how to provide coaching and support to our students [who weren't] able to interact with them personally [and] how to identify some of the barriers that our students were facing. We needed to provide additional tutoring support because not everyone is a great online learner. So it's a very staff-intensive activity. We do have to have the internal capacity – both from a leadership perspective and from our IT department and our technology training team – to keep folks being able to deliver services, even though we are not in a face-to-face environment.

Hollin-Wright: I didn't realize how big of a lift that is. You've provided some real insight and perspective on what you all have had to do. I don't think "nimble" quite captures all of what you just shared with us.

Summing up, as we think about what's happening in the world and particularly how this is impacting the healthcare sector, despite the shortages there are still some labor market quits that have disproportionately impacted healthcare. There has been some burnout for workers who are dealing with vaccination mandates and high patient loads. When you think about that, what is your recommendations, both policy and funding, to make it easier for these students that you've trained through GoodCare to transition into the sector and remain in the sector.

Gilmer: At its initial peak, COVID was hard. Some companies were laying off healthcare workers, so we had people that did struggle a little bit to find employment at times.

Assisted living workers was the biggest impact and, in many cases, has had real struggles coming back. We placed 148 nursing assistants with employers. Only 10 percent of those throughout this pandemic have remained employed and transitioned to more advanced roles. I think that speaks to the brutal hours and working environment that many of these folks were in. Throughout the pandemic, they were just really exhausted by the compliance protocols and everything they were having to do.

We know that access to employee assistance programs and mental health services and all of those things need to be promoted more now than ever before. There are capacity issues there, too. I think funding for supporting workers is almost as important as funding for training workers at this point in time.

We've adopted here at Goodwill, coming out of our Goodwill Industries International office, a model called the Opportunity Accelerator model that focuses much more on post-employment services than we ever have before. We've seen this as a real need for folks entering the healthcare sector, helping to coach them through access for their own mental and physical health, take care of themselves, take care of their families, and balance that out with their existing working conditions.

We continue to help fill those critical vacancies. That's what our employers need more than anything else – take the pressure off of their existing workers.

It's not an easy road forward in this sector. It's one of those that exhausts workers. I would just encourage funding and policies that support taking care of the folks that are in our healthcare sector.

Hollin-Wright: Mary Ann, we really appreciate you contributing to the Richmond Fed's Rural Spotlight Series. Just want to say thank you for your service. Thank you for helping us to recover from this pandemic by strengthening, bolstering the pipeline of rural healthcare workers that are so desperately needed today.

Gilmer: Well, thank you, Tiffany, and I say the same thing to you. Thank you for the work that's being done.

This CLIFF partnership has been so helpful to us in highlighting those areas where people need to see what that [benefits] cliff looks like. These income limits and all of these thresholds that are in place, they need to reflect increasing wages and preventing that benefits cliff for people who are trying to do better for themselves and their families.