Training & Credentialing

Featured Resources

State Training Requirements -- PHI has documented the training standards in each state for the three main occupations that make up the direct-care workforce: home health aides, nurse aides, and personal care aides. Training standards can vary widely from state to state.

Personal and Home Care Aide State Training Program (PHCAST) -- In 2010, six states won three-year federal grants as part of the PHCAST program. The six states—California, Iowa, Maine, Massachusetts, Michigan, and North Carolina—are developing and testing competency-based training, assessment, and certification for personal care aides, an entry-level caregiving position for which, currently, there are no federal training standards.

What We're Doing

  • Advocating for a new and expanded federal investment in training for direct-care workers.
  • Advocating for a significant upgrade in federal training standards.
  • Designing competency-based, adult learner-centered curricula for direct-care workers and assisting educators to deliver adult learner-centered training.
  • Advising states on designing and implementing updated systems for training and credentialing direct-care workers.
  • Advising states on payment policies to enhance investment in training.

PHI's Workforce & Curriculum Development Services designs training and support programs for direct-care workers.

PHI's Position

A significant investment in training standards, curricula, and infrastructure is needed to prepare greater numbers of workers for direct-care jobs in order to keep up with the demand for eldercare and disability services.

Good training is critical to ensuring the quality of those services and maintaining independence for people with disabilities and chronic care needs.


As changes in the demand for long-term services and supports have increasingly shifted care from institutions to consumers’ homes and other residential settings, systems for training direct-care workers have not kept pace, in three important ways:

  • Outdated training curricula fail to provide workers with the skills and competencies they need to deliver person-centered care in the community without the benefit of on-site supervision or support.
  • Federal training requirements are outdated and do not reflect skills and competencies that address the complex needs of today’s older and frailer consumers.
  • Our training infrastructure is underfunded and fractured, and lacks the capacity to train the projected one million new direct-care workers that will be needed over the next decade.

Ultimately, poor training and inadequate training systems undermine worker confidence, inadequately address the needs of consumers, and increase turnover. High turnover costs squander scarce public dollars and provider resources, while further diminishing the quality of care.

Additional Resources

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