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Recently the National Association of Geriatric Nursing Assistants (NAGNA) had a brain-storm-a way to simultaneously get people off welfare and improve nursing home care by reducing the nurse aide shortage. NAGNA hatched a program we call "Welcare," which remedies the CNA shortage by routing welfare recipients into positions in the state's long-term care facilities.

"Welcare" is the result of a meeting between Lisa Goff, NAGNA State Director in Texas, and a frustrated Ft. Worth facility administrator who, like most long-term care administrators, was in critical need of nursing assistants. Following that meeting, Ms. Goff immediately went to work writing up the "Welcare" plan, which she submitted to me last August for review. I immediately shared the plan with Missouri State Senator Marvin Singleton. The Republican senator from Joplin was so impressed with the idea that he had me meet with the State Directors of Aging and Family Services to develop an action plan. Within three months of the writing of "Welcare," long-term care facilities were reaping the benefits. Applicants for their difficult-to-fill CNA positions had begun materializing -- in short, a whole new pool of applicants had been created.

Jobs in long-term care are a natural for getting people off of welfare. Because of the CNA shortage, there is job security. But more than that, this is a profession in which people with few work skills can land a job, and -- unlike many other job categories for unskilled workers -- have prospects for a career ladder, should a person wish to climb.

I am an example of this, having started as a dishwasher in a skilled nursing facility. I pursued certificates as a CNA, CMT, AD and SSD. At age 26, after only five years of long-term care experience, I went from $4.25 an hour to $25,000 a year as an AIT.

This is an experience that I share with recipients during orientation sessions held at the welfare offices. Though I was never on welfare, and cannot compare myself and my situation with welfare recipients', I try to make the point that, if they can work, there are opportunities in long-term care that far outweigh those of other industries.

Facilities are reporting that "Welcare" is working. Obviously, not an applicants are appropriate under this program, but facilities are reporting that 25 to 35% have been appropriate and hired. One facility reported to NAGNA that only were the applicants appropriate, but eager, and many of them showed up with more positive attitudes than many employees hired through more traditional measures. One new nurse assistant, I was told, appeared not only in a freshly starched uniform, but a lab coat, as well!

Some facilities, not surprisingly, have shown skepticism; some, for example, have voiced concerns for patient care if workers are "made to work against their will." This has not, in fact, been the case. Though the welfare office mandates that recipients appear for an interview, facilities are not obligated to hire anyone. If there are "diamonds in the rough," it is our job as employers to find them, train them and retain them.

Concerns frequently raised about "workfare"-type programs regarding child care are dealt with by the facilities and the welfare agency on a case-by-case basis. Concerns about loss of Medicaid coverage are likewise individualized, although recently NAGNA was able to create a plan for limited medical coverage for members -- 80% medical and pharmaceutical costs for the member, up to $1,000 a year, with a $50 deductible. The $24 a month premium is frequently picked up by the facility as a small price to pay for the new nursing assistants. In many instances, children's medical expenses are still covered by Medicaid.

Although the program is new and there are few statistics to demonstrate its long-term success as yet, it has received some positive reviews from administrators. For example, Dave Buller, Administrator of Hillside Healthcare, a Joplin-area facility, says, "This is a shot in the arm for long-term care, and a great debt is owed to NAGNA for making this opportunity open to us all."

Meanwhile, it appears that it wont be long before long-term care has to compete with other industries for the benefits of this program. Already in Missouri, temporary agencies, poultry producers and electronics industries are voicing a desire to participate. I am urging our long-term care facilities to "get there first."

It has been my experience that welfare recipients, as a whole, are not undesirable employees. They lack direction, guidance and self-esteem. If the industry can nurture them as it did me, five years from now we will have thousands of success stories to relate.

NAGNA encourages facilities in other states to consider developing similar approaches, particularly where welfare reform is under active review. There is no reason why what is happening in Missouri can't happen nationwide.

Lori Porter is Founder and Executive Director of the National Association of Geriatric Nursing Assistants. For more information on Welcare and NAGNA, write or fax NAGNA at 403 West 5th Street, Joplin, MO 64801; phone: 1-800-784-6049, or 417/623-6049; fax: 417/623-2230.