Exposure, Understanding, and Interest in Career Opportunities in Health Services: Differences between Traditional and Non-Traditional Students

Posted on

Abstract

As the nation faces a projected care gap for older adults, recruiting undergraduate students into health care and gerontology-related majors is critical. With the number of non-traditional students in higher education growing, the purpose of this study was to investigate similarities and differences between traditional and non-traditional student exposure, understanding of, and interest in career opportunities in health services and gerontology-related careers.  Findings from three focus groups (N=26) noted differences between traditional and non-traditional students’ awareness of career opportunities with older adults and exposure to the discussion of older adults in college courses. Non-traditional students were more likely to report an awareness of various careers in health services and aging compared to traditional students. Both groups of students suggested that more needs to be done to increase awareness of the various career paths available in healthcare and gerontology. However, suggestions for raising awareness varied among the student groups. 

Introduction

Recently, the health care industry surpassed manufacturing and retail to become the largest private sector employer in the United States (United States Census Bureau, 2018). While there are various reasons for expansion, one of the biggest drivers contributing to the growth is the rapidly aging nation. The health care industry is projected to continue increasing, with five of the top ten fastest-growing occupations over the next decade being in health care and senior assistance (Bureau of Labor Statistics, 2017). Individuals in the health industry speak of the approaching “2030 problem” when the last of the Baby Boomers will turn 65 and an impending care gap is anticipated (Eldercare Workforce Alliance, 2018). Many areas of the country are already experiencing serious workforce shortages in the health care sector, and the aging population will continue to drive up demand. 

As the nation faces an impending care gap for older adults, the recruitment of undergraduate students into healthcare administration and gerontology-related programs is viewed as critical (Stone & Harahan, 2010). Employment opportunities will not be limited to direct care positions. Instead, a variety of careers will be needed including but not limited to nursing home administrators, hospital and clinic directors, home health managers and aides, medical assistants, allied healthcare workers, lab technicians, and health educators (Bureau of Labor Statistics, 2017; Mercer, 2017). 

 Despite the expected supply and demand issues related to health services careers, colleges report low enrollment in many healthcare and gerontology-related degrees and certificate programs (AARP, 2007; Pelham et al., 2012). In addition, no research to our knowledge has focused on non-traditional student population perceptions of careers in aging. The changing demographics in higher education necessitate investigating non-traditional student perspectives of health services and aging careers. The non-traditional college population is growing, and they are quickly becoming the majority in higher education (CLASP, 2015). As higher education faces times of unprecedented change, better understanding the needs and perceptions of non-traditional students should be viewed as both an opportunity and a priority. 

Method

Participants

Students enrolled in a Midwestern, Liberal Arts University were invited to participate in focus groups on their awareness of careers in health services and aging. At this University, non-traditional students significantly outnumbered traditional campus-based students with almost 80% of students falling into the non-traditional category. Students with majors in Business Administration with an emphasis in Health Services Administration, Health Services Administration, Human Services, and Psychology were invited by email to participate. Focus groups were conducted in three different locations: on campus, at a Center, and online (i.e., Zoom), allowing researchers to gather information from traditional and non-traditional students in a variety of modalities. Focus group questions ranged from exposure to aging content in their coursework to awareness of opportunities in health services and aging careers, and how to better promote careers in aging (Table 1). Human Subjects’ approval was obtained before researchers began the study.

Table 1

Focus Group Questions

  • In what ways was aging or gerontology talked about in high school?
  • Did you have opportunities for interaction with older adults in high school? 
  • Follow up: rural versus urban school differences
  • Have you ever considered a career in health services or gerontology? Explain.
  • If you’re interested in working with older adults, what first attracted you to this career?
  • What career opportunities in health services or gerontology are you aware of?
  • Service learning is a form of learning where students apply academic knowledge and skillsets to help address needs in the community. What type of service learning opportunities with older adults would you be interested in?
  • When selecting a career, what is the most important consideration?
  • What can we do as a university to promote healthcare and aging services?
  • In how many of your college classes are you talking about aging?
  • Did your work experience encourage or promote an interest in gerontology?
  • Follow up for non-traditional students: Why did you return to school for this?
  • Awareness of trends in aging (researchers shared some of the population trends)
  • Do aging stereotypes decrease the likelihood of students choosing careers in health services and aging?
  • How can we promote aging options for online students? Is there anything to make it come to life more?

Demographics. A total of 26 participants participated in focus groups. Participant characteristics can be found in Tables 2 and 3. Approximately 80.77% of participants were female and the majority of participants were White (61.54%).  Most participants reported that their primary method of taking classes was face-to-face and at a center (38.46%) or residential campus location (38.46%). In addition, the age range of participants spanned from 19 to 43 years (M = 26.46). 

Table 2

Participant Characteristics 

ItemNumberPercentage 
Sex

Female 2180.77
Male519.23
Total 26100.00
Race/Ethnicity 

African American415.38
Asian Indian13.85
Multi-racial27.69
Other Asian13.85
Hispanic13.85
White1661.54
Did not report 13.85
Total 26100.01
Modality 

Online519.23
Center1038.46
Residential Campus  1038.46
Both Online and Center13.84
Total 2699.99%

Table 3

Participant Demographics

ItemNumberPercentage 
Major

Business Administration with Health Services Administration Emphasis26.90%
Health Services Administration 517.24%
Human Services1034.48%
Psychology1241.38%
Total29100.00%



Procedure

Researchers explained the informed consent documents with participants and discussed the parameters of the study. Participants at the center and residential campus completed the demographic questions on paper, whereas participants on Zoom completed the information using SurveyMonkey. Each focus group lasted approximately one hour. Participants received a $10 Amazon gift card for participating in the study.

Data analysis. All focus groups were audio recorded and transcribed verbatim. Researchers independently read and coded each transcript and used an inductive thematic coding approach where codes were derived from the data, rather than using pre-existing codes (Braun & Clarke, 2006). Initial coding was conducted using Track Changes in Microsoft Word. Higher-order coding was completed by grouping similar codes together. Codes were grouped under categories in Excel and categories merged into themes. Word and Excel were used instead of qualitative software to keep costs at a minimum. 

Trustworthiness in qualitative research. Lincoln and Guba’s (1985) criteria for trustworthiness were used throughout this study to increase validity and reliability. Both authors engaged in triangulation by sharing initial codes and discussing student comments in the transcripts. Coding from both researchers was similar, with additional discussion needed on the wording used for categories. Transferability often includes rich, thick descriptions of the participants. Several assumptions were made throughout the study including the assumption that what students reported was true and reflected their honest perspectives. Dependability was demonstrated by cross-checking the transcribed data against the audio files to ensure all data has been accurately transcribed. In addition, the authors engaged in discussions of the codes and categories for each focus group transcript. The authors also engaged in coding each focus group several times before finalizing the codes and categories and committing to themes. Confirmability was achieved using the steps above to ensure accurate interpretation of the data. The procedures outlined above also provide an audit trail for other researchers who are interested in completing similar studies.  

Results

RQ1: Did traditional-aged student exposure, understanding of, and interest in career opportunities in gerontology differ from non-traditional-aged students?

Exposure

Non-traditional students were much more likely to have recalled talking about older adults as compared to traditional students. For example, one non-traditional student said…

“In my diversity class, it was [talked about] the main gen ed class and then I also took, it was a women’s literature class, but it focused on like older writings and…so like, you had to focus more on how those generations were and those that are still with us, and that kind of thing”

Another non-traditional student commented “We did in our business class…just talking about finances…So we talked a lot about that with retirement, saving for retirement, being able to retire. All of those things…” Another non-traditional student reported, “… I will say that I think that in every single course whether it be face-to-face or online, it’s been discussed to some degree everywhere from birth to elderly…to death.” Another non-traditional student said, “it was in religions class and cultures around the world.”

Traditional students were more likely to say that childhood received more attention compared to late adulthood in their lifespan courses. One student said, “older adults are thrown in last minute.” Another traditional student said, “I think, like, a little bit in human sexuality, like, the way your sexual activity changes when you get older.” Similarly, another traditional student commented, “I’m a senior now, and I’ve never taken any of those classes [that included discussion on older adults].” Both traditional and non-traditional students agreed that there was room for improvement by integrating more aging content into the college curriculum. One student even mentioned that she felt “… gerontology should be a mandatory class.” 

Awareness of Careers in Health Services and Aging

When reflecting on available career choices working with older adults, non-traditional students were able to recall a broader range of career options. For example, a non-traditional student said, “You don’t just necessarily have to be a CNA in a nursing home, providing the physical cares, that there are other careers out there.” One non-traditional student went on to talk about careers working in an “adult day center” Another student also mentioned, “You could go from like the social work to like the CNA, uh, LPNs, nurses, doctors, the psych doctors…” as possible career opportunities. Another student said, “Well, I already work with older adults I’m a physical therapist assistant in a skilled care nursing home setting.” Another student said “occupational therapy.” Another student said “social work is very important.”

Traditional-aged students were more likely to focus on careers in aging that were limited to the physical cares of older adults. One student said, “I don’t think I’d be good with like changing the old people and stuff.” Another traditional -aged student commented, “…when I think about working with older people like going into the nursing home. It just feels like I’d feel sad to like watch the people that I have to care for decline all the time. It would just be sad for me, so I don’t think I could do it.” An additional traditional-aged student mentioned another reason she was hesitant to work with older adults, “I would say like seeing them like needing people and having to take care of them so long and then like they die, like just to keep on going through that hurt.” Another student said “Because a lot of people, I want to be honest with you, don’t want to see other people nude.”

Interest in Choosing a Career in Health Services and Aging

Non-traditional students were much more likely to have work experiences that influenced their career choices. One student said…

“Um, my plan is to be a nursing home administrator. I’ve worked in nursing homes like I said for 16 years, half my life. I started out wanting to get my RN and go that aspect. Currently, I’m actually the activity director so I stepped into a supervisor role. I also help out with their nurse management team, so…it’s almost like a next step for me [serving as a long-term care administrator].” 

However, one non-traditional student expressed concerns about the complexities of the Medicare and Medicaid system as reasons for not selecting a career in health services and gerontology. Although she considered it, she said, “And the main reason I would say I wouldn’t want to do it would be… all of the changes and Medicare and Medicaid and all of that. It’s become so complex and so difficult and so hard to navigate that.”

One traditional student did report interest in being a long-term administrator. She said, “I did freshman year [consider a career in aging].” If traditional-aged students were considering a career in aging, they were more likely to be inspired to work in the field by a family member. One traditional-aged student mentioned feeling inspired by her great-grandmother. She said, “I would say my great-grandma, but I don’t know just like through a passion of mine. I guess I just have a passion for elders.” 

Increasing Interest. Traditional and non-traditional students agreed that increased awareness for career opportunities working in health services with older adults was needed. One student said, “Make it better known what work fields you can go into. With this degree, it opens up these doors here.” Relatedly, another student commented, “For me, I guess everyone always just talked about being in the health care field. No one ever broke it down into all of the specific categories that are covered as far as healthcare is concerned.”

However, suggestions for how to increase and promote careers in aging varied between traditional versus non-traditional students. Non-traditional-aged students were more likely to suggest hands-on training programs preparing students for specific positions with older adults. For example, one non-traditional student said, “I would like to see an AIT [Administrator in Training] program offered.” Another non-traditional student responded similarly and said…

My administrator that I currently have, um, has done a couple AIT programs, following with him in other facilities and so he propositioned me with that if I wanted to do that with him. But it would be nice for it to be offered through the college as well.

Another student also mentioned having the opportunity to gain work experience through courses. The student explained, “…internships or working in the facilities more while you are still taking classes instead of when you freshly graduate or you have a little bit of experience would be helpful…”

Traditional-aged students were more likely to suggest spending increased time with older adults to increase the likelihood of selecting a career in the field of aging. A traditional student said, “…Even if you became a buddy with or like getting them to your sporting event, or at least some of the local ones.” Another student mentioned the benefits of intentional volunteer opportunities with older adults. She said…

“So, I took like a volunteer class in high school, so I think it’d be kind of cool to, like, have a volunteer class here at like UIU and maybe if that’s just going to [long-term care facility] you know for an hour or so whatever but I feel like that would get people more interested in working with older adults…”

One traditional student spoke of engagement in a more general sense by engaging in shared activities together. She said, “I think even if we just did, like, activities…like, you could get a group together who are interested in people and elderly, like, you could do like a movie night or something.” Other students expressed interest in service learning opportunities. One student said, “I think it would be cool, like, if we took classes that went up there [long-term care facility].”

Discussion

The purpose of this study was to investigate differences between traditional and non-traditional student exposure, understanding of, and interest in opportunities in health services and gerontology-related careers.  Given the growing aging population and increase in non-traditional students pursuing higher education, examining this issue was particularly timely. Several themes were identified from the focus group transcripts and can be found in Table 4. 

Table 4

Categories and Themes

Theme 1 = Increasing VisibilityTheme 2 =
Lack of Awareness		Theme 3 = Opportunities to Engage
Career opportunities Opportunities beyond direct care of older adults Training programs leading to specific careersLack of discussion courses  Stereotypes Focus on youthService Learning Interaction with healthy older adults  Volunteering

RQ1: Did traditional-aged student exposure, understanding of, and interest in career opportunities in gerontology differ from non-traditional-aged students?

Exposure 

Although both traditional and non-traditional students reported increased inclusion of content related to older adults was needed in their courses, non-traditional students were more likely to recall discussion of older adults in a variety of different courses. Perhaps instructors teaching non-traditional students were more likely to include information on older adults as they perceived it to be more relatable to their life stage. In addition, Francois (2014) reported that adult learners are eager to participate in education that is applicable to real life and the daily roles they are involved in. It is also possible that non-traditional students were more likely to recall discussions about older adults given other roles they were involved (e.g., caregiving). 

One way to increase student exposure to courses focused on aging is to incorporate them into General Education requirements. Obhi et al. (2019) suggested that gerontology courses could even be tailored to each discipline. This intentional integration would also theoretically expose students to aging content earlier in their college experiences (Damon-Rodriguez & Effros, 2008). In addition, Merz et al. (2017) explained that even when students are not considering a career in aging, they still need to understand basic information on aging in order to better meet the demands of an aging population.

Awareness and Interest in Careers in Aging

Both traditional and non-traditional students in this study were often unaware of career opportunities in health services and gerontology-related fields. Pelham et al. (2012) suggested partnering with employers and organizations to pursue mutually beneficial relationships where students are trained in the skillsets agencies desire and are considered for those positions after graduation. These opportunities may be particularly appealing to non-traditional students who often seek out efficient educational programs that lead to employment after graduation (U.S. News & World Reports, 2016). Collaborating with a wide range of employers to reflect the vast range of careers in health services would also help expose traditional students to careers outside of physical caregiving positions.

Im (2019) explained the importance of revamping college program requirements to better meet the needs of non-traditional students. Currently, internships are often unpaid and pose barriers to students unable to forgo earned income (Rothschild & Rothschild, 2020). The growing aging population and increasing numbers of non-traditional students offers universities a unique opportunity to expand and encourage partnerships between employers in the field of aging and non-traditional students. Several successful models of employer partnerships already exist and could be replicated to increase numbers of students pursuing health services careers in aging.  The apprenticeship model has gained popularity in the UK. However, successful apprenticeships require buy-in and collaboration from all stakeholders when building the program (Mulkeen et al., 2019). Establishing stakeholder trust in early stages is critical, particularly as the reputation of apprenticeship models is relatively unknown to most stakeholders compared to a “traditional” college degree with typical requirements. In addition, micro-internships have been defined as short-term experiences for students that are often highly flexible, allowing students to work remotely and on short-term projects tailored to their areas of interest (Wingard, 2019). 

For traditional students, increasing positive exposure to older adults through volunteering or service-learning was also a suggested strategy. Structuring Freshman seminars around service learning with older adults may be an intentional way to increase traditional student exposure to older adults. Levy et al.’s (2018) Positive Education about Aging and Contact Experiences (PEACE Model) provides a framework of how to build successful intergenerational contact between students and older adults. Elements include education focused on the factual components of the aging process, exposing students to positive role models of older adults, and creating positive experiences between older adults and students (Levy et al., 2018). 

Limitations and Future Directions

Geographical and regional differences may have impacted participant perceptions of careers in aging. Individuals in this study were all affiliated with the same private Midwestern liberal arts college, with the residential campus located in a rural area.  Students attending larger universities and/or universities in highly urban areas may have access to more student resources and may have had very different life experiences.  

It should also be noted that participants were predominantly female making up 80% of the study group. Invited participants were from four majors including health services administration, business administration with an emphasis in health services administration, psychology, and human services. Assessing students with different majors may have yielded different results. For future research, it may be beneficial to broaden the study to other majors. Future researchers could also add to these results by conducting research with gerontology majors and specifically investigating why they chose that major and career path.

This is the first study assessing perceptions from non-traditional students that we are aware of and we are curious how our findings compare with other non-traditional students at other universities. With non-traditional students changing the landscape of higher education, additional research on this population is needed. As higher education works to navigate through times of unprecedented change, having a better understanding of the needs and perceptions of non-traditional students should be viewed as both an opportunity and a priority. 

References

  • AARP (2007). The Role of Community Colleges in an Aging Society. https://assets.aarp.org/www.aarp.org_/articles/research/CommunityCollegeReport.pdf
  • Alberti, H., Randles, H. L., Harding, A., & McKinley, R. H. (2017). Exposure of undergraduates to authentic GP teaching and subsequent entry to GP training: a quantitative study of UK medical schools. British Journal of General Practice, 67(657), e248-e252. https://doi.org/10.3399/bjgp17X689881
  • Braun V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa
  • Bureau of Labor Statistics (2017). Employment Projections: 2016-26 Summary. https://www.bls.gov/news.release/ecopro.nr0.htm
  • CLASP (2015). ‘Yesterday’s Non-Traditional Student is Today’s Traditional Student’. Center for Postsecondary and Economic Success. https://www.clasp.org/sites/default/files/publications/2017/04/CPES-Nontraditional-students-pdf.pdf
  • Damon-Rodriguez, J. & Effros, R. (2008). Innovations in student-centered interdisciplinary teaching for general education in aging. Gerontology & Geriatrics Education, 29(3), 270-289. https://doi.org/10.1080/02701960802359516 
  • Eldercare Workforce Alliance (2018). The best prescription for healthier older adults: Quality coordinated care. https://eldercareworkforce.org/research/issue-briefs/research:education-and-training/
  • Eshbaugh, E. M., Gross, P. E., & Satrom, T. (2010). Predictors of self-reported likelihood of working with older adults. Educational Gerontology, 36(4), 312-329. doi:10.1080/03601270903058481
  • Francois, E. J. (2014). Motivational orientations of non-traditional adult students to enroll in a degree-seeking program. New Horizons in Adult Education & Human Resource Development, 26(2), 19-35. https://doi.org/10.1002/nha3.20060 
  • Fricke, H., Grogger, J., & Steinmayr, A. (2018). Exposure to academic fields and college major choice. Economics of Education Review, 64, 199-213. https://doi.org/10.1016/j.econedurev.2018.04.007 
  • Gross, P. E. & Eshbaugh, E. M., (2011). Tuning them in versus turning them on: How do we interest students in working with older adults? Gerontology & Geriatrics Education, 32(2), 122-134.  https://doi.org/10.1080/02701960.2011.572037 
  • Hashimoto, K. & Tabata, K. (2008). Population aging, health care, and growth. Journal of Population Economics, 23(2), 571-593. https://doi.org/10.1007/s00148-008-0216-5
  • Hittepole, C. (2016). Nontraditional Students: Supporting Changing Student Populations A Guide for Chief Academic Officers & Chief Student Affairs Officers. https://www.naspa.org/images/uploads/main/Hittepole_NASPA_Memo.pdf
  • Im, K. (2019). Making it work: Securing a gerontology internship for the nontraditional distance education learner. Innovation in Aging, 3(Sppl 1), S537-S537. doi: 10.1093/geroni/igz038.1973
  • Jeste, D. V., Avanzino, J., Depp, C. A., Gawronska, M., Tu, X., Sewell, D. D., & Huege, S. F. (2018). Effect of short-term research training programs on medical students’ attitudes toward aging. Gerontology & Geriatrics Education, 39(2), 214-222. https://doi.org/10.1080/02701960.2017.1340884
  • King, B. J., Roberts, T. J., & Bowers, B. J. (2013). Nursing student attitudes toward and preferences for working with older adults. Gerontology & Geriatrics Education, 34(3), 272-291. https://doi.org/10.1080/02701960.2012.718012
  • Levy, S. R. (2018). Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) Model. The Gerontologist, 58(2), 226-232. https://doi.org/10.1093/geront/gnw116
  • Lincoln, Y. S. & Guba, E. G. (1985). Naturalistic inquiry. Sage. 
  • Mercer. (2017). Demand for Healthcare Workers Will Outpace Supply by 2025: An Analysis of the US Healthcare Labor Market. https://pmfmd.com/wp-content/uploads/2019/12/PMF-2018-TCWF-Grant-Cal-Wellness-CA-WF-Demand-for-Healthcare-supply-by-2025.pdf
  • Merz, C. C., Koh, D., Sakai, E. Y., Molinari, V., Karel, M. J., Moye, J., & Carpenter, B. D. (2017). The big shortage: Geropsychologists discuss facilitators and barriers to working in the field of aging. Translational Issues in Psychological Service, 3(4), 388-399. https://doi.org/10.1037/tps0000137
  • Mulkeen, J., Abdou, H. A., Leigh, J., & Ward, P. (2019). Degree and higher level apprenticeships: an empirical investigation of stakeholder perceptions of challenges and opportunities. Studies in Higher Education, 44(2), 333-346. https://doi.org/10.1080/03075079.2017.1365357
  • Pelham, A., Schafer, D., Abbott, P., & Estes, C. (2012). Professionalizing gerontology: Why AGHE must accredit gerontology programs. Gerontology & Geriatrics Education, 33(1), 6-19. https://doi.org/10.1080/02701960.2012.638348
  • Rothschild, P. C. & Rothschild, C. L. (2020). The unpaid internship: Benefits, drawbacks, and legal issues. Administrative Issues Journal: Connecting Education, Practice, and Research, 10(2), 1-17. https://doi.org/10.5929/2020.10.2.1 
  • Stone, R. & Harahan, M. F. (2010). Improving the long-term care workforce serving older adults. Health Affairs, 29(1), 109-115. https://doi.org/10.1377/hlthaff.2009.0554
  • United States Census Bureau (2018). Healthcare Still Largest U.S. Employer.  https://www.census.gov/library/stories/2020/10/health-care-still-largest-united-states- employer.html 
  • U.S. News & World Reports (x). Time & money: Contemporary college students want cost-efficient and flexible schooling options. https://media.beam.usnews.com/df/59/1ecb103c4614ab960cf3dd1e2494/usn-partnerinsights-strayer.pdf
  • Wingard, J. (2019, March 4) Why mico-internships will be the next big thing. Forbes. https://www.forbes.com/sites/jasonwingard/2019/03/06/why-micro-internships-will-be-the-next-big-thing/?sh=3363f111700c