Iowa Fights for Training Standards in Direct Care

PHI recently released issue 18 in its #60CaregiverIssues campaign, a national public education campaign that’s tackling the growing workforce shortage in paid caregivers. The latest issue—Training Standards for Personal Care Aides: Spotlight on Iowa—highlights efforts by workforce advocates to enact a skills-based training system for direct care workers in Iowa.

In Iowa, the rapidly growing population of older adults is driving up demand for a well-trained direct care workforce. However, as with many states, Iowa faces high turnover and vacancies among direct care workers. Contributing to the challenge is a fragmented training system for direct care workers that reduces their occupational mobility. Training for personal care aides who provide home-based care was not applicable toward training to become a nursing assistant or home health aide, despite shared training criteria among these three direct care occupations.

In 2006, the Iowa state legislature created a task force to develop a streamlined approach to direct care worker training. After compiling a comprehensive inventory of skills sets needed by direct care workers across care settings, the task force recommended the training system be based on universal competencies, rather than setting- or population-specific skills.

In 2010, the legislature created an advisory council to realize this recommendation. The advisory council developed a modular approach to training. Under this proposed system, once a personal care aide achieves a mandatory basic certification, they can complete additional training modules to obtain any of three advanced personal care certifications and/or a certification that is equivalent to a nursing assistant or home health aide certification. The advisory council pilot-tested this approach using a core training and five advanced modules collectively titled the “Prepare to Care” curriculum. Trainees who participated in the pilot program reported high satisfaction with their training, and employers reported lower turnover among trained workers.

However, the state legislature has not yet implemented this system, due to sustained opposition from provider membership associations and long-term care consumers. Instead, the legislature funded the advisory council to disseminate the “Prepare to Care” training curriculum statewide. Currently, 80 trainers and instructors across the state use the curriculum to train personal care aides, home health aides, and nursing assistants.

This case study is the second in a three-part series on state-level examples for improving training for personal care aides. Read the full case study here.