Home Health Care Policies: The National Landscape of Personal Care Aide Training Standards

A new report published by UCSF Health Workforce Research Center on Long-Term Care (HWRC) indicated that there’s a major lack of proper training for personal care aids. The report states that 45% of states in the U.S. have one or more programs with no PCA training requirements and 22% of states do not require any training whatsoever. In fact, only four states have methodically implemented training standards for PCA caregivers.

The report titled “The National Landscape of Personal Care Aide Training Standards” analyzes the requirements and training nationwide and has concluded that, on the whole, training for PCA programs is undoubtedly lacking and subpar. The authors also state that the overall nationwide training for home health aids and nursing assistants are completely “undeveloped” when compared against the actual standards expected of them when performing their duties.

“Our findings indicate a paucity of state training standards for personal care aides. Only four states have implemented rigorous PCA training standards that are uniform across the various types of Medicaid-funded programs. The remaining 46 states have weaker and/or disparate training requirements across training programs, with 45% of states having one or more programs with no training requirements, and 22% of states having no training requirements in any of their programs.”

Abby Marquand, director of Policy Research at PHI, and Susan A. Chapman, co-director of the HWRC issued statements regarding these research results: “With projected demand for PCAs skyrocketing and states reporting difficulty attracting and retaining enough high-quality workers, we are fast approaching a crisis,” Marquand says. “We believe that improving training standards is a critical first step in meeting the coming demand.”

The report continues by addressing the impending surge in demand for healthcare resources:

“Current estimates report that more than a million PCAs are employed in the U.S, with demand for these workers expected to increase by nearly 50% between 2012 and 2022.4, 10 Long-term care industries are growing, with greatest growth expected to occur in the area of non-medical home care—the industry called “Services for the Elderly and Persons with Disabilities.” The number of people needing personal assistance services is expected to grow from 13 million in 2000 to 27 million by 2050. Demand for a skilled and stable workforce to provide these services will grow in parallel.”

The apparent lack of sufficient training will only grow into more consequential issues as the demand for caregivers continually increases and the aging population continues to boom into numbers larger than the country has ever seen. However, these early indicators should serve as a tool for states to reassess their training mechanisms in order to improve their overall standards for caregiving. Early preventative measures may serve the potential to provide a higher quality of care in the future.

A portion of the report’s conclusion states:

“Despite strong evidence that training for direct-care workers, such as PCAs, is a key component of job quality—with strong associations with job satisfaction, retention, and the quality of care—there are no federal training requirements for PCAs. Furthermore, few states have developed rigorous PCA training standards that are uniform across Medicaid-funded programs. In this way PCAs differ from workers in other direct-care occupations, i.e., certified nurse aides and home health aides, who perform similar tasks and are required to complete training and certification according to a federal minimum standard.

The findings from this study highlight the wide national variation in training standards—variation that could lead to significant disparities in PCA preparedness and skills. With demand for PCAs expected to exceed that of nearly every other occupation over the coming decade and many states facing workforce shortages, promulgating rational training standards and the necessary infrastructure to support the training of this essential workforce will need to be prioritized by states and the federal government.”

A link to download the full report is available below.