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Personal Care Aide Training Regulations Continue to Fall Short

By Stephen Campbell | August 5, 2019

Each one of us, or someone we love, will likely rely on a personal care aide at some point for assistance with daily tasks at home. We will want the best care possible—but are personal care aides prepared to meet our expectations?

To answer this question, I recently updated PHI’s research on personal care aide training standards in all 50 states and the District of Columbia.

Here’s what I found: even though the roles and responsibilities of personal care aides have grown more complex—due to an aging population and a changing policy landscape—training requirements for this workforce have not kept up. Unlike home health aides and nursing assistants, who must complete 75 hours of training, personal care aides are not subject to federal training requirements. Instead, states have developed a patchwork of requirements, which are largely inadequate.

The most troubling finding? Seven states have no training requirements for personal care aides at all. Among the remaining states, training standards are often inconsistent and lacking in how they regulate content, instruction methods, competency assessment, and duration.

Variation in Medicaid Training Standards

Just 26 states license home care agencies, and among them, only 21 include training requirements in their licensure rules. Instead, most states primarily enact training regulations through their Medicaid programs.

Since Medicaid is the primary payer for home care services, Medicaid-based training standards have a broad reach in the industry. But in many cases, enacting regulations through Medicaid means that states end up with inconsistencies between Medicaid-funded and non-Medicaid-funded home care agencies: same services, same workers, different rules.

To complicate matters further, training requirements vary between Medicaid programs in seven states. This variation arises when Medicaid programs for different populations (for example, older adults versus younger people with disabilities) develop in silos, without coordination across departments or consideration for the workforce.

Universal training standards could resolve these training disparities by ensuring that all personal care aides are prepared to support individuals with complex needs in a person-centered way. As one example of this approach, Arizona developed a flexible but universal set of training requirements with input from diverse stakeholders.

Rare Standardized Training Delivery

While consistent training standards for personal care aides are clearly needed, many states could do more to improve training quality as well.

Only 16 states address instruction methods in their training regulations, with wide variation among them. Montana, for example, prohibits the use of video-based training (in favor of in-person instruction)—while Massachusetts provides a detailed curriculum (The ABCs for Direct Care Workers) that promotes a range of adult learner-centered activities, like case scenarios and skills demonstrations. Altogether, 10 states and D.C. aim to disseminate best practices in personal care aide training through state-sponsored curricula.

Further, requirements for assessing trainees’ knowledge and skills development are often excluded from state training regulations—leaving no way of knowing whether training has successfully prepared personal care aides with the core competencies that they need. Twenty-nine states do not require workers to pass a knowledge-based exam, and 30 states do not require workers to demonstrate their skills in front of a trainer.

Adult-learner centered instruction methods and competency assessment take time. Required hours range from three hours for consumer-directed workers in Massachusetts to 75 hours for most personal care aides in Washington State. However, 26 states have at least one set of training regulations with no required hours.

Our research on personal care aide training standards demonstrates a clear need for improvement. Addressing the inadequacy in state training regulations requires funding, careful planning, and extensive stakeholder engagement, and this investment of time and effort is well worth it.

The work of personal care aides is invaluable–to the individuals they assist and to the long-term care system as a whole. It’s time we recognize the contributions of personal care aides through the training that we provide them.

Stephen Campbell
About The Author

Stephen Campbell

Data and Policy Analyst
Stephen Campbell is a Policy Research Associate at PHI. In this capacity, he contributes research, analysis, and writing on issues affecting the direct care workforce with the goal of impacting state and national policy.
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