How to keep the nursing in long-term care facilities

It’s no secret that the United States has a nursing shortage, one that promises to grow to alarming proportions—particularly in this country’s long-term care facilities. Too many nurses are retiring and too few are entering the profession. To compound the problem, within the next five to 10 years, more than 76 million baby boomers are scheduled to retire from the workforce, with a significantly smaller number of Generation Xers available to fill the healthcare jobs being vacated. There already is a shortage of healthcare workers. It’s going to get worse. Nursing homes and long-term care facilities need to be prepared.

Molly Forrest

The Annenberg School of Nursing

At a time when the country is deeply confronted with this crisis of care, the Los Angeles Jewish Home recently became one of the only U.S. multilevel senior-living facilities to also be home to a school of nursing. The new Annenberg School of Nursing at the Jewish Home is a full-time program that prepares students to pass the state-required exam for licensure. The intensive curriculum engages students 40 hours per week in the classroom or at clinical sites, plus three hours of reading per day. All students receive 500 hours of classroom instruction and 980 hours of clinical training at local hospitals.

California’s nursing shortage

The nation’s nursing shortage is particularly acute in California where the Jewish Home is based. According to the California Economic Development Department, the state is expected to be short more than 100,000 registered nurses and 25,000 licensed vocational nurses by 2010. Like our fellow healthcare providers, those numbers mean that the Jewish Home must confront the dual dimensions of this challenge: recruiting new nurses and retaining existing ones. Only by doing both can the Home—and the entire industry, for that matter—ensure that professional, well-trained nurses will be available to serve future needs as society ages.

In deciding how to tackle this challenge, we realized early on that two amazing untapped resources were located in our own backyard. The first was our own multigenerational group of employees, many of whom had worked with us for decades and felt a deep affinity for our organization and those we serve. The second was our facility’s deeply rooted community ties; after all, the Jewish Home has been around for nearly 100 years. So, rather than looking for Band-Aid® solutions (like tracking temporary pools of nurses), we thought strategically about what could be done to serve our current and long-term needs as well as build our community and enhance the Home as an employer of choice.

Instructor David Cooper and students in computer lab

What we quickly realized was that the establishment of a school of nursing would provide the answers. The Annenberg School of Nursing offers wonderful career development opportunities for our multigenerational employees as well as for members of the community in which we operate. Knowing that we would need financial assistance to make this concept a reality, we researched logical philanthropic partners whose mission complemented ours and whose support would help us reach our nursing goals. Ultimately, we approached the Annenberg Foundation and the UniHealth Foundation to partner with us to formally begin a nursing program of our own.

Director Marie Fagan works with students Marvin Nierras and Rong Schindler in the Annenberg School’s computer lab

Our philanthropic partners

Established in 1989 by Walter H. Annenberg, the Annenberg Foundation provides funding and support to nonprofit organizations both in the United States as well as globally. Its major program areas are education and youth development; arts, culture and humanities; civic, community and the environment; and health and human services. In addition, the Foundation operates a number of initiatives that expand and complement these program areas. The Annenberg Foundation exists to advance the public well-being through improved communication and, to achieve this goal, the Foundation encourages the development of more effective ways to share ideas and knowledge. And that’s exactly what our school of nursing endeavors to accomplish.

We think there are many aspects of the template we’ve established that can be followed by others in the long-term care and nursing home industry.

All of us talk about giving our staff opportunities to advance in their careers. Doing something about it is a whole different ballgame. But it can be done on your own site with fantastic results. Our employees now look at our nursing school as a step up in professional and financial growth. At the same time, we have been pleased to discover that our school promotes interest in the children of our staff and our community residents, who are looking down the road for job opportunities. What’s more, when people are trained on our site, they are exposed to our residents, learn about our community’s diversity, and become part of the social framework in which they will be immersed upon graduation.

In the Annenberg School’s skills lab,students Suki Manning and Oscar Ventura practice using a feeding tube
Student Mandeep Kaur practices giving an injection

To make this program even more appealing, we’ve been able to build in significant financial incentives for our students. The total tuition for each student in the program is $17,500; but, through generous gifts from the Annenberg Foundation, the UniHealth Foundation, and private donors, students receive a $10,000 tuition assistance loan, interest free. This loan is “forgiven” over time: When a licensed nurse position with the Home is accepted, for every six months of full-time employment, 25% of the loan is credited. In two years, the loan is paid in full. That creates a true win-win for both the organization and its students. Also available are no-interest scholarship loans through the L.A. Jewish Free Loan Agency (JFLA). The JFLA Nursing Loan program was initiated with a major gift by Jewish Home donors and supporters.

Creating the program

Our program has taken on some very difficult issues endemic to our industry, including therapeutic communication techniques, supervisory skills, workplace diversity, long-term protocols, and moral and ethical concerns related to death and dying. We’ve also had to learn how to navigate many administrative and organizational issues, such as dealing with state and local bureaucracies, recruiting professionals to staff the school, and addressing the marketing challenges of finding participants.

Over the past year we’ve learned quite a bit about what it takes to conceptualize, capitalize, and actualize a program such as this. To any other institution considering starting a nursing school of its own, we offer the following 10 suggestions for creating a thriving, growing nursing program:

  • Be aware that continuously relying on a temporary pool of nurses is a short-term option; temporary labor does not provide quality nursing or available nurses in the long run.

  • Have a long-term plan and stick to it. In our case, we’ve started with an LVN (Licensed Vocational Nurse) program and plan to add a registered nurse three-year program in the next few years.

  • Be willing to make the necessary financial commitment, which also means taking the longer view toward your organization’s future needs.

  • If you are in a “for profit” institution, consider establishing a nonprofit subsidiary foundation in which your school can be housed and through which financial support can be solicited.

  • Develop a curriculum that includes both the classroom and clinical settings so your students are fully prepared to pass the state-required exam for licensure.

  • Augment your program by working with other local nursing schools or recognized experts who can provide insight and perspective on issues relating to geriatric care.

  • Don’t wait for others to step in and help solve your nursing shortage. You need to make your own future.

  • Make sure the people you choose to work with—both students and faculty—care deeply and passionately about the elderly and then show your support and appreciation for that caring by emphasizing recognition.

  • Create a positive environment for both students and staff. That includes ensuring that your Human Resources department is charged with seeking creative and meaningful ways to motivate staff.

  • Make a commitment to promote from within, thus adding additional incentives for current employees to enroll in the program and achieve career advancement without having to look elsewhere.

We’re making a bet on our staff and our community. We’re betting that by providing an opportunity for personal growth and new challenges, they will be able to “return the favor” to the residents of our Home about whom we care so deeply.

Molly Forrest is CEO/President of The Los Angeles Jewish Home. Founded in 1912, the Los Angeles Jewish Home is one of the foremost continuing care senior-living facilities in the United States and is the largest single-source provider of senior housing in Los Angeles. The Home is a nonprofit organization that relies solely upon donations from individuals, corporations, and foundations.

For more information, phone (818) 757-4407 or visit To send your comments to the author and editors, e-mail

Long-Term Living 2009 February;58(2):20-25

Topics: Articles , Clinical