Andrea Kimlinger was selling Internet service plans door to door when she learned of free training to become a certified nursing assistant — and a chance to get back to a caregiving career she once loved.

Two months later, she was certified and helping residents of Lake Minnetonka Shores, an assisted living facility in Spring Park.

"To be able to get back in the field, to bring great care to others, was important to me," she said.

The 46-year-old's rapid return was just what Minnesota leaders envisioned when they created the Next Generation Nursing Assistant initiative — providing free training through 19 state colleges and five training companies to address a shortage of long-term care workers that was exacerbated by the pandemic.

The program ended, at least temporarily, last month with 2,500 graduates over two rounds. Another 570 teenagers completed nursing assistant training in high schools and received free certification testing.

The idea emerged in December 2021, after Gov. Tim Walz ordered National Guard members to staff nursing homes that were overwhelmed with patients amid a severe COVID-19 wave and a shortage of workers when others were sick or burned out. He proposed training 1,000 certified nursing assistants, or CNAs, in one month to relieve the Guard members and increase the permanent workforce.

The target seemed like a "moonshot," but people filled training slots before they were even advertised, said Dennis Olson, commissioner of the Minnesota Office of Higher Education. The second round in fall 2022 allowed people on waiting lists to get their chance.

"That really was what this opportunity was about: looking for anyone and everyone that was willing to answer the call," he said.

How much it fixed Minnesota's workforce shortage is unclear.

Vacancy rates for nursing assistants and unlicensed aides decreased from 23% in assisted living facilities to 17% over the past year, according to a survey by the Long-Term Care Imperative, an advocacy partnership of Minnesota's aging-services providers. Vacancy rates also declined in nursing homes from 28% to 25% for CNAs, even as they remained unchanged for licensed nurses.

On the other hand, the number of jobs has declined as some facilities have closed or reduced bed numbers.

"Some providers [are] deciding to give up on filling a position," said Patti Cullen, chief executive of Care Providers of Minnesota, an advocacy group for long-term care facilities.

'Need is still out there'

Some training recipients were already working in long-term care.

Simone Peppers, 34, was providing elder care for an assisted living company when she enrolled in the free training and started night classes at Minneapolis Community and Technical College. Certification helped her earn an additional job at a Minneapolis detoxification center, with the two paychecks supporting her family of five children.

"I've been doing this for nine years," she said. "So when the opportunity came across to get my CNA certification, I hopped right on it. I thank God that I was able to get it for free."

The goal was to bring new workers into long-term care, but state leaders said they weren't upset that existing workers used the training to boost their skills and careers. Nursing positions remain unfilled in many facilities, and they are often filled by caregivers who work their way up from lower-wage CNA positions that pay $16 to $20 per hour.

"We wanted to add. We wanted to create brand new nursing assistants," said Valerie DeFor, executive director of HealthForce Minnesota, a health care training program in the state colleges system. "But we also recognized that advancement for people already in the occupation was another way that we could make an impact."

A survey over the past two months of 481 training recipients showed that half were working as CNAs in long-term care. Eighty didn't pass the exam, and others were looking for jobs or delaying their searches.

"I think that is a reasonable, fair number," said DeFor, who believes it will increase as more graduates pass exams or find jobs that fit their schedules.

Walz has proposed $1.5 million in each of the next two years to extend the program. The first two rounds each received more than $2 million, the first from federal emergency funding and the second from state funds earmarked for Minnesota's COVID-19 response.

Olson said continuing makes sense, because the pandemic only worsened a shortage of workers to care for the baby boomer generation. The state Department of Employment and Economic Development reported a 23% vacancy rate for nursing assistant jobs in 2021 that was among the highest for any occupation — and it is expected to remain high when 2022 data is released this spring.

"The situation is a little bit different as we enter a new phase of the pandemic," Olson said, "but the need is still out there."

Success could inspire free training for other high-need occupations, he said, which would have the added benefit of boosting sagging enrollment at some colleges. Changes if the program is funded could include spreading out classes, which by initial design were jammed over one crash-course month to get people into the workforce amid peak COVID-related demands.

Recruitment also could shift to rural areas with the greatest shortages, or target students who aren't already working in long-term care.

Countering turnover?

The Hillcrest and Serving Hart assisted living facilities in Hibbing and Chisholm have employed a dozen graduates of the CNA training, said owner Missy Steinbronn. Most were existing workers, who can serve as nursing aides without classroom instruction in certain circumstances, but she said the training improved retention.

"There are more that stick to it just because the training is better," she said. "A lot of times, the on-the-job training can be lacking in a lot of places, just because there are shortages."

Turnover is a challenge; 81% of CNAs left jobs in nursing facilities in 2022 — an increase from 57% in 2021, according to the Long-Term Care Imperative survey. Some people are devoted to caregiving, but others can be lured by equivalent wages in food service or other professions that come without the challenges of feeding, bathing and caring for elderly or disabled people.

"They can make more at McDonald's," Steinbronn said.

Some turnover is progress. Among 108 certified nursing assistants who were surveyed, 75% intended to become nurses.

Isaac Ndawula, 30, was farming in Goodhue County and couldn't afford education. Free training through Minnesota State College Southeast in Red Wing helped him gain work in a nursing home, and he is using the income to pursue a nursing degree.

Worker shortages at his facility occur, so he scoops up extra shifts to fund his tuition, he said: "Oh, the bills. It's not easy. I just have to rely on the CNA [paychecks]. But I'm doing it myself."

Kimlinger, the CNA worker in Minnetonka, doesn't have upward career ambitions for now. She cared for her mom before she died and was motivated to provide the compassionate care that everyone like her deserves.

"My joy," she said, "is to bring somebody else joy."

Correction: This story has been updated to correct the name of Minneapolis Community and Technical College.