From 2010-2013, 6 states used grants from a federal demonstration program to develop and implement statewide programs to train personal and home care assistants in 10 core competencies.
Direct care workers provide up to 80% of the hands-on assistance that older adults and persons with disabilities receive every day. A growing subset of that direct care workforce is made up of personal and home care aides (PHCA), who often provide essential home and community-based services (HCBS) with very little training.
“There is a serious lack of attention to training this workforce,” says Robyn Stone, executive director of the LeadingAge Center for Applied Research. “If you’re a home health aide who works for a Medicare- or Medicaid-certified agency, you are required to have 75 hours of training a year. If you are a personal care worker or a home care worker, you may be in a state where there aren’t any requirements.”
Six states—California, Massachusetts, Iowa, Michigan, North Carolina and Maine—have taken steps over the past 3 years to change that.
With help from the $5 million Personal and Home Care Aide State Training (PHCAST) Demonstration Program, the states are developing programs to train and certify members of their PHCA workforce. The 3-year grants officially end on Sept. 30.
PHCAST was authorized by the Affordable Care Act (ACA) and administered by the Health Resources and Service Administration (HRSA). The Center for Applied Research is helping to conduct an ACA-mandated evaluation of the program.
Innovation on Display
From 2010-2013, PHCAST grantees developed and implemented statewide programs to train PHCAs in 10 core competencies identified in the ACA statute. The innovative strategies that states used to complete this task were on display in early September during an educational session at the National HCBS Conference sponsored by the National Association of States United for Aging and Disabilities (NASUAD). That session, which Stone moderated, highlighted grantees’ efforts to:
- Engage a variety of stakeholders in the PHCAST project.
- Address the special needs of direct care workers.
- Promote workers’ understanding of consumer direction.
- Create meaningful opportunities for career advancement.
Engaging Stakeholders
PCHAST grantees did not operate in isolation. Instead, all depended on local stakeholders to help them develop and implement meaningful training and certification models.
Direct care professionals (DCP) participated in every aspect of Iowa’s PHCAST project, including a 30-member DCP Education Review Committee.
“They were members of our Advisory Council,” says Project Manager Erin Drinnin. “They reviewed the curriculum. They tested our online data systems as well as exams and different evaluation systems. They also served as ambassadors who … helped us explain the project to other individuals.”
Iowa’s inclusive spirit extended to employers of direct care workers, who weighed in on curriculum. Even the program’s trainers offered feedback on how the curriculum was playing out in the classroom. After each review, the curriculum went back to content experts for tweaking, says Drinnin.
Michigan’s PHCAST team brought together 28 stakeholders to help develop a training and certification model that would align with the state’s Medicaid program. These stakeholders included Medicaid waiver agents, consumers, paid caregivers, home care agency owners and Workforce Investment Board staff.
Stakeholders were instrumental in recruiting curriculum experts, recommending local trainers, and marketing the training to prospective participants, says Lauren Swanson, a program specialist with the Michigan Office of Services to the Aging.
The Massachusetts PHCAST project worked with 5 of the state’s Head Start programs in one innovative partnership strategy.
“The Head Start programs were actually able to look through their family assessment and (identify) the parents who had ambitions to enter into this type of field,” says Project Director Leanne Winchester. “They were able to essentially hand-select those participants … and then support them.”
Helping Trainees with Special Needs
Massachusetts discovered that PHCAST trainees would need case management services, including life skills training, to help them complete the training program and find jobs. Local community colleges offer the bulk of those services, which are now embedded into the program’s core curriculum.
In addition, Massachusetts offers special services to trainees with limited English language skills. All training materials are presented at a 6th and 7th grade reading level to promote literacy. During its third year, the PHCAST project began offering bilingual training in Spanish, Brazilian Portuguese and Haitian Creole.
“When they could learn these core competency skills in a language that was familiar to them, we saw significant improvements in scoring on both the knowledge and skills assessment,” says Winchester.
Focusing on Consumer Direction
California designed its training curriculum to align with the state’s In-Home Supportive Services program, a Medicaid HCBS program that follows a self-directed model.
PHCAs needed special training to succeed within a program that allows consumers to hire, fire, train and supervise their own home care providers, says Program Evaluator Susan Chapman. To meet those needs, the PHCAST training teaches workers how to “really listen to consumers,” says Chapman. It also familiarizes them with a consumer’s right to make decisions and instills a respect for consumer choice regarding how care is delivered.
Offering Pathways to Career Development
North Carolina wanted its training model to provide workers with a career lattice that allows them to gain additional skills and competencies while remaining in the home care field. Creating that lattice entailed developing 4 training phases, according to Co-Lead Evaluator Jennifer Craft Morgan:
- Phase 1 provides a 16-hour introduction to direct care work.
- Phases 2 and 3 train workers as PCAs and Nurse Aides.
- Phase 4 provides training in 3 advanced specialties. Upon completion, workers can be designated as geriatrics nurse aides, home care aides or medication aides.
Workers receive an industry-recognized certificate of completion—and can go to work—after phase 2, 3 or 4.
A career lattice in Maine allows workers to move across populations without leaving the home care field. Maine had separate curriculum, training and certification processes for direct care workers serving the elderly, people with disabilities and people with mental illness. But it did not allow workers to move easily across populations.
The PHCAST program changed that by developing 1 core curriculum for workers serving all 3 populations, says Project Director Susan Rovillard. The project also created 3 specialized training tracks designed to meet the needs of specific populations.
Sustainability of PHCA Training
Stone ended the NASUAD conference session by applauding the efforts of PHCAST grantees and urging other states to follow their example.
“You need to pay attention to where your investment in long-term services and supports is going,” she told conference participants, many of whom represented state-funded HCBS programs. “However you spend your dollars for home and community-based services, you must acknowledge that most of those dollars are supporting this workforce. After all, these are the people who do this work.”