REPORT: Licensing and Training Requirements for Home Care Vary by State

A study published in the October issue of Journal of Applied Gerontology calls attention to the wide range of state standards for licensing of privately funded home care providers.

Unlike nursing homes and home health agencies, these home care providers are not reimbursed by Medicare and thus have no federally specified standards.

Standards for Medicaid-funded personal care programs (pdf) are usually outlined by the state agencies that oversee those programs.

In comparison, state oversight for privately funded home care (if it exists at all) is provided through state licensing standards. Only 29 states require providers of home care to be licensed, the study found.

Of these states, the vast majority (26) require some orientation for personal care aides (PCAs). However, only eight states specify the required duration of orientation. (Durations range from 8 to 60 hours.)

Additionally, 16 states specify some content areas for orientation, although most of these require only review of agency policies and abuse and neglect reporting, the study found.

Other findings from the study include:

• 15 states require in-service training
• 15 states mandate on-site supervision of home care workers after they have been hired.

Identifying Core Competencies

The study’s authors examined the content of required orientation programs in order to identify core competencies for PCAs. They recommend certain basic skills and knowledge, based on the content identified in several state standards, but also advanced skills and competencies that states have yet to adopt.

Together, if implemented broadly, these competencies could provide a foundation for training the U.S. home care workforce, the study’s authors argue.

“These findings are a perfect complement to our recent study of PCA training standards in Medicaid-funded programs, in which we showed that few states have outlined robust or rational standards for these essential workers,” said Abby Marquand, PHI Associate Direct of Policy Research.

“According to the Journal of Applied Gerontology study, the situation appears even worse when you look at home care licensing, with more than a third of states lacking licensing standards,” she continued. “Better oversight of agencies and training for the workers are important if we want to ensure a sufficient and stable workforce to provide high quality care.”

— by Matthew Ozga