Peggy Powell

An interview with Peggy Powell, PHI Director of Curriculum and Workforce Development

As part of national health care reform legislation, the federal government is sponsoring several new programs that provide grant funding to improve recruitment, training, and advancement opportunities for direct-care workers. The Personal and Home Care Aide State Training Demonstration will provide funds to six states to design training and credentialing programs for personal care workers. Proposals are due July 19.

We asked Peggy to share some lessons learned from her 25 years of experience designing direct-care worker training programs. Below, Peggy talks about how states can design programs that meet the learning needs of trainees, result in high levels of worker retention, and improve quality care for consumers.

One of things I always hear you say, Peggy, is that you “need the right person for the job.” The Personal and Home Care Aide State Training (PHCAST) grants require states to identify a plan for recruitment and selection of trainees. What makes a strong recruitment strategy?

PP: In working with home care agencies — and even individual consumers — we have always emphasized that direct-care is not for everybody. This may not be an occupation that requires a lot of formal education, but that does not mean that any person in need of a job, with the right training, will provide quality services and supports.

We recommend what we call “targeted recruitment.” That entails working with agencies that serve low-income or ESL populations to identify potential pools of workers. But we add to that a rigorous screening process for each candidate. That might involve a process whereby a candidate must:

• Come to an information session to learn about the training and the job
• Follow up after the information session to express interest in being interviewed for the position
• Arrive on time and without children for an interview
• Follow up after the interview to find out if he or she has been accepted into the program
• Return for a reading and math literacy test to ensure basic skill levels

This process allows the employer or training program to assess the candidate several times, and indicates if the candidate is truly interested in the program and can meet job requirements such as being on time, finding appropriate child care, dressing professionally, and so on.

You’ve been designing training programs for direct-care workers for a long time. What do you think is most important to ensuring that trainees are successful in developing the necessary competency for delivering quality care?

PP: What we’ve learned is that the most important element of a training program is using an adult learner-centered approach to teaching. Many of our learners face multiple challenges: they may be ESL learners; they may have poor reading skills with little or no training in critical thinking; and often they have chaotic home environments which don’t allow for much studying. Many never made it through high school and have very negative feelings about being in a classroom.

So we begin with some core principles: the learning environment should be a safe space; adult learners may not have formal education but they bring life experiences relevant to the learning; learning should be active, not passive. All of our curricula use multiple learning activities to ensure learners of different types — i.e., those who learn by listening, those who learn by seeing, those who learn by doing — have the opportunity to engage with the material. We also have high expectations and hold learners accountable. This is a matter of respect for all the learners in the classroom.

Training personal and home care aides involves teaching knowledge and personal care skills, but another very important part of the training, especially for person-directed care, involves communication and interpersonal skills. How do you teach these skills?

PP: PHI has developed a whole curriculum that focuses on improving communication skills such as active listening, providing feedback, and managing emotions during a difficult conversation. But also, our entry-level training for personal care workers integrates these skills into the training. For example, when we are teaching bathing, we also teach the participant how to discuss bathing preferences, how to listen to a consumer who may be scared or uncomfortable, and so on. These skills need to be reinforced throughout the training, using realistic case scenarios and role plays that give trainees a chance to learn through practice.

The grant program asks grantees to propose continuing education and job supports to improve retention. After graduation from an entry-level training program, what kinds of supports help personal and home care aides to succeed on the job?

PP: As we know, the turnover rate among direct-care workers tends to be high, especially during their first year. This is because many agencies send people off to work alone in someone’s home, without proper supports. Our affiliate, Cooperative Home Care Associates, has been very successful at improving retention rates because it offers considerable support to new employees. CHCA has a terrific mentor program, which provides new employees with a peer to talk to about procedures and practices they may be unsure of, about challenging clients, or about the difficulties of balancing work and home responsibilities. CHCA also has an employment counselor who helps aides access public supports like housing, transportation, and child care assistance; counseling for domestic violence; or loans to help workers through a financial crisis.

These types of supports make a huge difference for low-income workers who don’t have the resources necessary to get through a crisis at home, and may as a result chronically call out or show up late for work. CHCA’s support system provides material help but also uses coaching techniques to help these employees learn the kind of problem-solving skills they need to succeed. I would recommend that states include these kinds of supports in their demonstration programs.

– interview by Karen Kahn, PHI Director of Communications