Two organizations in Philadelphia are playing crucial roles in building a more diverse healthcare field and laying a foundation for economic mobility for immigrants.
By Jensen Toussaint, November 1, 2024.
Accesso Care and Quality Caring Professionals collaborate to help immigrants become Certified Nursing Assistants (CNAs) and Home Health Aides (HHAs), supporting their career development in healthcare. (Photo: Courtesy of Nicole Watson.)
The healthcare industry is crucial for people from all walks of life, regardless of race, ethnicity, age, gender, or social status. However, the nation’s diverse communities are underrepresented within the industry’s workforce.
A 2022 analysis by the Bureau of Labor Statistics found that racial diversity among U.S. nurses had reached its highest level in 19 years and was greater than in other areas of the healthcare field.
The data found that 32% of all healthcare practitioners in the U.S. are Black/African American, Asian, or Hispanic/Latino/a. For nurses, that percentage is 33%.
CNA Study Guide. (Photo: Inti Media.)
However, those groups make up 39% of the U.S. population.
Among healthcare careers, becoming a certified nurse assistant (CNA) may be the first step for many immigrants to enter the field and have a profession with a stable income.
Still, we are currently facing a nationwide nursing shortage, which the American Association of Colleges of Nurses projects will only intensify, given the aging population and the growing need for healthcare.
The demand for more nurses exists, but the certification path may need to be clearer to navigate for populations with less access to this information.
In Pennsylvania, CNA requirements include at least 80 hours of training. However, most CNA training programs recommend 120 hours, aligning with the Pennsylvania Department of Education.
In Philadelphia, those who have long been in the industry’s trenches have strived to better the industry for themselves, their colleagues, and their patients.
Fostering skilled immigrant CNAs at Accesso Care
Dr. Esther Castillo President & CEO of Accesso Care. (Photo: Inti Media.)
That can be said about Jimmy Zhang, the founder of Accesso Care (formerly Building Care).
“He’s been in the nursing home industry for about 15 years, and it has always been something that he has been thinking about because he saw the needs around staffing and around increasing quality of care for residents in nursing homes,” said Dr. Esther Castillo, Zhang’s wife and President & CEO of Accesso Care.
Accesso Care was launched in 2023 to address the challenges that CNAs face in providing compassionate care, as they often don’t receive the support they need.
According to the Population Reference Bureau, the U.S. population of people aged 65 and older is projected to increase by 47% by 2050. For those reasons, having a high-quality, compassionate, and diverse workforce within this industry is paramount.
“They’re providing 90% of the care in nursing homes, yet they don’t have the care to care for themselves, so then they can be reenergized, and their cup can be filled to provide care for other people,” Dr. Castillo said of CNAs.
CNAs are essential to providing elder care in facilities outside the home. Yet, their compensation remains relatively low, with a median wage of $14.56 per hour in 2021.
The work is difficult and can be risky, and advancement opportunities are limited without further education — factors that contribute to ongoing burnout, turnover, and staffing challenges.
Although demanding work conditions and new federal regulations contribute to the ongoing shortage of CNAs in nursing homes, many immigrant workers remain interested in the field — despite facing significant barriers to entry.
In a short time, Accesso Care has built a reputation for empowering immigrant caregivers.
Dr. Castillo opens her house to host study groups. (Photo: Inti Media.)
According to its website, they are “driven with the shared belief that quality care begins with supporting those who provide it, ensuring dignity and compassion for every community.”
With her background in community health, Dr. Castillo attests to why community building is such an important component of this work.
“A lot of the workers that we work with also need to be taken care of and need a community that they turn to,” Dr. Castillo said, adding that a supportive community can help those workers increase resilience, return to work regularly, and prevent burnout.
Accesso Care taps into its network of community-based connections to connect it with Philly’s immigrant communities.
Once someone from the community expresses interest, Accesso Care workers speak with them to share essential details about what working in the field entails.
“After that, we send them to our partner school,” Dr. Castillo said.
Quality Caring Professionals
Dr. Castillo and Nicole Watson with students at the graduation ceremony in August. (Photo: Jimmy Zhang Courtesy of Accesso Care.)
That partner school is Quality Caring Professionals (QCP).
The organization was co-founded by Nicole Watson and Dr. Angel McCullough, two healthcare professionals with 20-plus years of experience in the industry.
Dr. McCullough, instructor and program administrator at QCP, has spent the bulk of her 23-year career as a registered nurse working in the acute care setting with a nursing leadership track.
While working as a manager and director within the hospital setting, she started to see a dramatic shift within the industry about a decade ago.
“I found that the motivation for people coming into the work and wanting to do the work had changed,” Dr. McCullough said, adding that she found a lack of compassion and empathy from those in the industry.
Nicole Watson, a licensed practical nurse, saw a similar trend in her 27-year career.
According to the U.S. Chamber, the number of registered nurses in the workforce decreased by over 100,000 from 2020 to 2021, the most substantial decline in the last 40 years.
(Photo: Courtesy of Nicole Watson / Quality Caring Professionals.)
So, they launched QCP to develop a more well-rounded healthcare workforce.
“I wanted to make a difference,” said Watson, program director at QCP.
QCP features a center that provides high-quality training and education for aspiring healthcare professionals.
The nursing aide training program is a five-week Pennsylvania Department of Education-approved training program that provides the essential skills needed to succeed in the profession.
The skills tested include hand washing, bathing, dressing, grooming, measurements, blood pressure, pulse, respirations, and more.
“We teach all those skills that the state requires, but we also teach the theory so that students understand why they do what they do,” said Watson.
The program’s first three weeks are spent in the classroom, the fourth week covers clinical practice at a nursing home, and the final week is where the students do test prep for the final written exam.
Once complete, the students can officially become certified.
After that, Accesso Care also supports the new CNAs by placing them in nursing homes throughout South Philadelphia. They purposely focus on that area so workers who don’t own a vehicle can get to work via public transportation or biking.
The most recent cohort featured 16 new graduates.
Yinmin Ra, a native of Myanmar who arrived in Philadelphia in 2008 after spending over 7 years in a refugee camp in Thailand. (Photo: Inti Media.)
One of those recently graduated students is Yinmin Ra, a native of Myanmar who arrived in Philadelphia in 2008 after spending over 7 years in a refugee camp in Thailand.
Although she admitted that getting through the program wasn’t easy, she stressed the importance of studying.
“You have to study hard, and you can pass your test,” Ra said.
Another recent graduate is Rully Sirat, who is originally from Indonesia and have been living in Philadelphia for the past twenty years.
Rully Sirat, who is originally from Indonesia and has been living in Philadelphia for the past twenty years, recently graduated as a CNA.
Her long-time goal has been to arrive in the States and become a CNA.
Her reasoning is quite simple.
“I love to take care of older people,” said Sirat.
For the many immigrants who have participated in the program, being a CNA can provide a path toward more economic mobility, and a deep sense of personal fulfillment.
“I’ve talked to some of them, and they told me having a job in the nursing home as a healthcare worker helps them earn respect from their children, and that means a lot for them,” Dr. Castillo said.
Addressing barriers and creating opportunities
“Because we specialize in working with immigrant communities,” said Dr. Castillo. “For a lot of them, English is their second language.” (Photo: Inti Media.)
The healthcare industry isn’t without its challenges.
One of the biggest challenges is the language barrier.
“Because we specialize in working with immigrant communities,” said Dr. Castillo. “For a lot of them, English is their second language.”
Although Pennsylvania is a diverse melting pot with people representing countries all over the world, the state exam to become a CNA is only administered in English and Spanish.
Despite those being the region’s two most commonly spoken languages, thousands of other native speakers are still at a deficit.
“We really struggle at times to help people who have only been in the country for a few months, but … they put in the work,” said Watson. “They put in the work to try to learn English as quickly as they can.”
Beyond the standard language barrier, there are also differences in medical terminology.
Ra highlighted that “some medical words are not in a regular dictionary.”
Therefore, some terms will be hard to learn or comprehend without one.
Dr. Castillo also noted the technology gaps as another potential barrier. Although the exam could be taken online, many may not have access to the exam or the technical skills to do so.
She regularly opens her South Philadelphia home to study groups with students who would like extra support to prepare for the written and practical exams or even technology support. Her dedication even goes as far as driving the students to the test center in the suburbs so they can be there on time.
Vasili, who came as a refugee and is now a CNA, shared the moment when she received the good news. Esther called me and said: “You passed.” I said, “Thank you, Jesus,” “Thank you, Jimmy and Esther. I was so excited, I can’t explain.” (Photo: Inti Media.)
The efforts have paid off, as QCP and Accesso Care have already had success stories. One of them is Vasili, who came as a refugee from Myanmar and is now a CNA. Vasili shared the moment when she received the good news.
“Esther called me and said: “You passed.” I said, “Thank you, Jesus, thank you, Jimmy and Esther. I was so excited, I can’t explain.… It changed my life a lot. [With my work now] I also realized the meaning of human life. I understand it more.”
Dr. Castillo, an immigrant herself, knows firsthand the importance of supporting immigrants’ success while acknowledging their significant contributions to the country’s economy.
“We live in a society that has this false narrative that immigrants are here to take our jobs. It's just not true that immigrants are here to take jobs that Americans want. They're filling a need that is sorely needed in our society. I think if immigrants can improve economically, our whole society is going to be better,” said Dr. Castillo.
Working with immigrant communities to help them become CNAs directly creates a more diverse healthcare workforce, which addresses another barrier.
“There is a trust factor,” said Dr. McCullough.
“You realize that there is a lot of mistrust in healthcare, in general, and I think it stems back to you being able to have confidence in that person who’s in the white coat of sitting behind the big desk understands what you’re going through, what your experiences [are],” she concluded.
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