Abstract
The US health care system and its workforce is rapidly changing to meet the triple aim of reducing costs, increasing quality of care and improving the patient experience. There is a need to align training models with system needs and patient preferences in ways that allow the most cost effective members of the care team to shoulder increasing shares of this care (Ricketts and Fraher, Health Affairs, 32(11), 1874–1880, 2013). One entry-level and in-demand class of health care workers are personal and home care aides (PHCAs). The US Bureau of Labor Statistics projects a 26% increase in PHCAs to over 2.2 million workers by 2024 (OOH 2014). System needs for rebalancing care from institutional settings into the community and patient preferences for in-home care have aligned to drive the need for PHCAs. The increasing prevalence of chronic disease, medical complexity and dementia mean that these workers will be required to handle increasingly challenging clients and function as a key member of increasingly integrated health care teams. Therefore, the development of new models of education and training are necessary. Standards for PHCA training are quite low (Marquand and Chapman 2014) and states leave most training to employers with little to no oversight (Kelly et al. Journal of Applied Gerontology, 32(7): 804–832, 2013). The purpose of this study is to present case studies of six state-based training models for PHCAs funded by the Affordable Care Act. We discuss state approaches to recruitment of trainees, curriculum design and delivery methods, and key lessons learned to inform model development internationally.
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References
Browne, C. V., & Braun, K. L. (2008). Globalization, women’s migration, and the long term care workforce. Gerontologist, 48(1), 16–24.
Bureau of Health Workforce (2010). Report to congress: personal and home care aide state training (PHCAST) demonstration program evaluation. Retrieved November 27, 2016 from Health Resources and Services Administration http://www.hrsa.gov/about/organization/bureaus/bhw/reportstocongress/phcastreport.pdf.
Centers for Medicare and Medicaid Services (CMS) (2014). National health expenditure fact sheet. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.
Frogner, B. K., Spetz, J., Parente, S. T., & Oberlin, S. (2015). The demand for health care workers post-ACA. International Journal of Health Economics and Management, 15(1), 139–151.
Gruppen, L. D., Mangrulkar, R. S., & Kolars, J. C. (2012). The promise of competency-based education in the health professions for improving global health. Human Resources for Health, 10(1), 1.
Hussein, S., & Manthorpe, J. (2005). An international review of the long-term care workforce: policies and shortages. Journal of Aging and Social Policy, 17(4), 75–94.
Kaye, H. S., & Harrington, C. (2015). Long term services and supports in the community: toward a research agenda. Disability and Health Journal, 8, 3–8.
Kelly, C. M., Morgan, J. C., & Jason, K. J. (2013). Home care workers: interstate differences in training requirements and their implications for quality. Journal of Applied Gerontology, 32(7), 804–832.
Luz, C and Hanson, K (2015a). Training the personal and home care aide workforce: challenges and solutions. Home Health Care Management and Practice, 1–4© 2015 SAGE Publications, doi:10.1177/1084822314566301.
Luz, C and Hanson, K (2015b). Filling the care gap: personal home care worker training improves job skills, status and satisfaction. Home Health Care Management and Practice, 1–8 © 2015 SAGE Publications, doi:10.1177/1084822315584316.
Marquand, A., and Chapman, S.A. (2014). Leader states in personal care aide training standards. Retrieved from http://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/files/Issue_Brief-Leader_States_in_Personal_Care_Aide_Training_Standards.pdf.
Nakrem, S., Vinsnes, A. G., Harkless, G. E., Paulsen, B., & Seim, A. (2009). Nursing sensitive quality indicators for nursing home care: international review of literature, policy and practice. International Journal of Nursing Studies, 46(6), 848–857.
Ochylski D, Luz C and Shen X (2017). Direct care workforce training: Internet accessibility and acceptance. Journal of Gerontological Nursing. Accepted for publication.
Patient Protection and Affordable Care Act (ACA) (2010). 42 U.S.C. § 18001.
Richardson, B., McCrory, K. T., Abbott, A., Landsman, M., Hartley, C., Wells, T., & Hayashi, V. (2014). Evaluation of the personal and home care aide (PHCA) training demonstration project. Iowa City: The University of Iowa School of Social Work, National Resource Center for Family Centered Practice.
Ricketts, T. C., & Fraher, E. P. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874–1880.
Thomas, G. (2011). A typology for the case study in social science following a review of definition, discourse, and structure. Qualitative Inquiry, 17(6), 511–521.
U.S. Department of Labor, Bureau of Labor Statistics (DOL BLS). (2014). Personal and home care aides. Occupational outlook handbook, 2014–2015. Retrieved from http://www.bls.gov/ooh/personal-care-and-service/personal-care-aides.htm.
Wilson, R. (2015). Building career ladders in the age of the affordable care act. Retrieved from: http://www.jff.org/publications/building-career-ladders-age-affordable-care-act.
World Health Organization (2008). The solid facts: home care in Europe. WHO regional Office for Europe. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0005/96467/E91884.pdf.
Acknowledgements
The authors would like to acknowledge our partners and the coalitions of stakeholders that implemented and evaluated these large and complicated state-based projects. While there are too many names and organizations to list, we would like to express our gratitude to the state-based coordinators, planners, managers, instructors, advocates and especially the direct care workers and trainees that participated in the six projects and their evaluations. The demonstration projects described here were funded by the United States Health Resources and Services Administration through the Personal and Home Care Aide State Training grant program.
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Morgan, J.C., Edris, N., Luz, C.C. et al. Testing U.S. State-Based Training Models to Meet Health Workforce Needs in Long-Term Care. Ageing Int 43, 123–140 (2018). https://doi.org/10.1007/s12126-017-9286-6
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DOI: https://doi.org/10.1007/s12126-017-9286-6