First Compilation of State Training Standards for Personal Care Aides Now Available in New PHI Report

– Training Standards Vary State by State, Within States, and Are Nonexistent in Nearly Half of States, Analysis Finds -

Bronx, NY — PHI has published the first compilation of state training standards for personal care aides (PCAs) employed through publicly funded programs. There are no federal training requirements for PCAs — the fastest-growing occupation in the nation.

Where they exist at all, state training standards for personal care aides — who provide home and community-based services and supports to elders and individuals with physical, intellectual, and/or developmental disabilities — vary state by state and from program to program within states, the PHI analysis found. 

"Without federal training standards for PCAs, there is a scattered landscape of differing state-by-state training requirements, and where they exist, most are very minimal," said Abby Marquand, PHI policy research analyst and author of the report, Personal Care Aide Training Requirements: Summary of State Findings. "A well-trained workforce is important in ensuring that elders and individuals with disabilities receive the quality care they need and deserve."

Marquand assessed the rigor and depth of PCA training standards in each state's Medicaid Personal Care Option and home and community-based waiver programs and found that 10 states (20 percent) have no training requirements for PCAs in any of their programs.

In states with one or more programs:

• 23 states (45 percent) have no training requirements of any kind;
• 27 states (53 percent) leave the sufficiency of PCA training to the agency-employer;
• 25 states (49 percent) specify required training hours for PCAs; however, of these, 14 (27 percent) require no more than 40 hours of entry-level training; and
• approximately a quarter of states have a state-sponsored PCA curriculum and/or require certification.

Training Uniformity

Marquand also looked at the uniformity of standards, or consistency of PCA training requirements across state Medicaid programs and populations, finding:

• 12 states (24 percent) have training requirements in only some of their PCA programs.
• 7 states (14 percent) have training requirements for PCAs in all of their programs, but these are not uniform across programs.
• While 22 states (43 percent) have uniform training requirements for PCAs across all programs, only 5 of these specify detailed skills and a curriculum for PCAs. Additionally, 4 of the 22 states require PCAs to complete home health aide training. The remaining states have far lower standards.

"Best case, if two PCAs are working in different programs but doing essentially the same work, they should encounter the same core training standards and be able to move from one program to another," said Dorie Seavey, PHI director of policy research. "That means the training should be portable across programs."

"Having disparate requirements across programs within a state for PCAs who perform the same work doesn't make sense: it's inefficient from a systems perspective, confusing for consumers and workers, and ultimately impedes the development of a stable, competent, and fluid personal assistance services workforce."

Participant-Directed Care

Marquand also examined training standards within Medicaid participant-directed personal care programs, where PCAs are employed directly by the program participant and not an agency. The prevalence and size of such programs have increased in recent years, with many individuals preferring to self-direct their in-home care. She found that the vast majority of states either leave training up to the program participant or do not address training for participant-directed aides.

Fastest-Growing Occupation

The federal government requires home health aides and nursing aides employed by Medicare- or Medicaid-certified agencies or facilities to have 75 hours of pre-employment training. These direct-care workers perform similar tasks to PCAs.

In 2011, nearly 821,000 PCAs (pdf) were employed by agencies. This occupation is projected to be the fastest-growing (pdf) in the country between 2010 and 2020, increasing by 71 percent and generating over 600,000 new jobs. Not included in these figures is the projected growth in Medicaid participant-directed programs, where estimates show an additional 800,000 independent PCAs are currently employed.

Funding for the PHI "50-State PCA Training Project" was provided by the Center for Personal Assistance Services at the University of California, San Francisco, the Centers for Medicare and Medicaid Services, The SCAN Foundation, and the Ford Foundation.

More Information

See the Personal Care Aide Training Requirements on the PHI website to learn whether a state has PCA training standards for its Medicaid and home and community-based waiver programs, and what kind of training.

Visit the PHI Training & Credentialing webpages to learn more about training for the direct-care workforce.

For state-by-state information on PCA wages, benefits, and other demographics, see the PHI State Data Center on the direct-care workforce.

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PHI Michigan is a program of PHI (Paraprofessional Healthcare Institute), which works to transform eldercare and disability services, fostering dignity, respect, and independence — for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality supports and services.

Deane Beebe, PHI Media Relations Director, dbeebe@phinational.org, (646) 285-1039