Training Direct Care Workers in a Pandemic Isn’t Impossible

The workforce shortage in long-term care is already worsening because of the novel coronavirus (COVID-19). Staggering numbers of direct care workers (over 380,000, according to one estimate) will catch the virus over the course of the pandemic, and countless more workers will need to take time off to care of their families. This bleak outlook raises a pressing question: who will take their place to provide much-needed care?

To prevent untenable staffing shortfalls during this crisis, some states and the federal government have begun attempting to increase the emergency supply of direct care workers by relaxing training regulations. However, waiving already minimal requirements raises significant job quality and care quality concerns—putting both workers and clients at risk. Instead, we outline four alternative (and immediate) state solutions for recruiting and training direct care workers during the COVID-19 pandemic.

The challenge: Direct care workers do not feel prepared to navigate this pandemic.

Unable to socially isolate due to the in-person nature of their work, direct care workers are understandably fearful that they will contract the disease and/or spread it to their clients and their own families. This anxiety is already driving many workers out of the field.

One immediate solution: Widely disseminate training on COVID-19 (as well as personal protective equipment).

While many workers have completed training in infection prevention and control, they have not been prepared to deal with pathogenic threats on the scale that we are currently facing. Specialized training on preventing and managing the spread of COVID-19 could help assuage workers’ concerns, while also ensuring they take every possible precaution on the job. As well as training, workers need immediate access to personal protective equipment (PPE) and other infection prevention supplies.

State governments should immediately commission a home care training expert to develop, test, and rapidly bring to scale a remote COVID-19 training program.

The challenge: In-person, classroom-based training is dangerous during the pandemic.

Every state has restricted movement outside of the home for most people—and for good reason. In-person interactions, even when individuals are asymptomatic, can accelerate the spread of the virus. This makes classroom-based group training dangerous and unfeasible.

One immediate solution: Implement short-term remote training options.

Remote training opportunities will ensure that workers gain the skills and confidence they need without putting them (or their instructors) at risk of infection. As with in-person training, remote training should be competency-based, and it should incorporate interactive, adult learner-centered instruction methods to the best extent possible. For example, training modules could be presented by an online training facilitator who leads the learning activities and assesses workers’ knowledge, skills, and attitudes.

Notably, virtual training is not an option for everyone, particularly those without access to computers and high-speed broadband. For these trainees, training programs that employ proper social distancing measures will remain important.

State funding must be made available to move existing training programs online and, where this is not possible, to allow trainers to access adequate space and equipment for safe in-person training.

The challenge: Inconsistent training requirements limit the flexibility of the direct care workforce.

Inconsistent training requirements—which vary by state, program, setting, and payer—make it difficult to deploy direct care workers where they are most needed. In particular, it can be difficult for direct care workers to quickly move between roles (such as from home care to a nursing home) or to re-enter the field after time off.

One immediate solution: Implement “bridge training” and “challenge testing” to optimize the workforce.

We should maximize the competency of the existing workforce by creating “bridge training programs,” to augment workers’ prior training with new setting-specific content.

In addition, when hiring workers with prior experience that cannot be easily verified—such as former nursing assistants with lapsed certifications or foreign-trained health care workers—“challenge testing” can eliminate or reduce the need for duplicative training. Through challenge testing, these experienced workers can demonstrate their competencies and quickly move into practice.

States should consider revising certain training regulations or issuing new regulations to grant more flexibility to training providers and employers, without compromising essential skills training.

The challenge: Beyond training content and methods, the pandemic poses unique barriers to recruiting new direct care workers.

To avoid the disaster of a severe workforce shortage, an immediate influx of new direct care workers is needed. But how can we realistically reach people who will be willing to take on this challenging and risky work, and how do we move them into vacant positions as quickly as possible?

One immediate solution: Invest in the employment pipeline for direct care workers.

Three main strategies could boost the supply of new direct care workers. First, targeted recruitment campaigns could raise awareness about the value and immediate need for direct care workers, reach those who are best-suited for these positions, and connect them to employers who can place them immediately. Second, given many jobseekers’ limited incomes, training should be provided free of charge. Finally, candidates should be assured that they’ll enter jobs with proper personal protective equipment and workforce protections.

To implement a comprehensive, rapid recruitment program, states could look to existing statewide recruitment models, like the WisCaregiver Careers program.

Along with other long-term care leaders, states have an important responsibility to ensure that the direct care workforce is prepared to meet the demands arising from this emergency. The bottom line is that we do not have to choose between having competent workers and having enough workers—we can and should strive for both.