According to a new analysis by the Paraprofessional Healthcare Institute (PHI), training standards for personal care aides (PCAs), one of the healthcare occupations that the federal government projects will grow by more than 70 percent between 2010 and 2020, are lacking across the country.
PHI, a national nonprofit that advocates for the direct-care workforce, found that 23 states have no training requirements at all for PCAs for at least one publicly-funded (non-participant-directed) personal assistance program.
“PCAs have been a much less visible part of the nation’s direct-care workforce but that’s really been changing because now there are more PCAs than home health aides,” said Dorie Seavey, PhD, PHI’s director of policy research. “The composition of the nation’s direct-care workforce has really evolved and changed so that now the predominant part of it is (a) home- and community-based workforce and no longer a facility-based workforce. Within the home care workforce, the fastest growing part now are personal care aides.”
While there are federal training requirements for home health aides and certified nurse aides, there are none for PCAs, so each state is left to apply standards. Some states have very basic standards – PCAs must be at least 16 years old and have a criminal background check, for instance – while others have more rigorous standards – such as credentialing requirements.
“It’s not enough to just look at the universality of requirements within a given state because they could be universally weak,” Seavey said. “You also have to look at how rigorous they are in terms of what standards are required within the training and where these states requirements fall on a spectrum of least-to-most rigorous.”
PHI researchers examined training standards from state to state, focusing on number of training hours, specified skills and competencies, availability of a state-sponsored curriculum, exams and credentialing.
PHI’s analysis found:
- Of the states with training requirements, 35 percent have a requirement for training hours; 22 percent have a state-sponsored curriculum; 35 percent require an exam; and 18 percent require certification.
- Of those states with training hour requirements, 68 percent required 40 hours or less of training.
- Nineteen states have established uniform requirements across different PCA programs but only five states specify detailed skills and a curriculum.
“I think there’s a good chance that this issue (training standards for PCAs) is going to become a very big deal for both state and federal policymakers,” Seavey said.
The federal government is already looking at the issue through the Personal and Home Care State Training Program (PHCAST), a three-year demonstration project in six states that seeks to set a training “gold standard” for personal and home care workers.
PHI, in a Capitol Hill briefing in September, recommended that PCA training be a reimbursable Medicaid expense.
“At the end of the day, were we to create, in general, a direct-care workforce that is better trained and better paid, I think we’ll see lower turnover, fewer injuries and less dependence of these workers on public subsidies to help make ends meet,” Seavey said. “There’s a longer term business case about a better workforce being more cost-effective for American society, but what part of this the federal government is going to invest in – we’ll see.”