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States Require Little or No Training for Personal Care Aides, PHI Analysis Shows

September 24, 2012

Federal Guidance Needed to Ensure Fastest-Growing Workforce in the Nation Is Adequately Trained to Care for Nation's Aging Population and People with Disabilities

Washington, DC – A recent PHI analysis of state training standards for personal care aides (PCAs) — the fastest-growing job in the nation — found that 23 states (45 percent) have no training requirements of any kind for at least one publicly funded personal assistance program.

Today, 1.5 million PCAs provide supports and services to our nation's elders and people with disabilities. The number of PCA jobs is projected to increase by 70 percent between 2010 and 2020, surpassing 2 million by the end of the decade.

Of the states with training standards for PCAs, the standards vary widely from state to state and even lack uniformity between the publicly funded programs within each state. The researchers examined: number of training hours; specified skills and competencies; availability of state-sponsored curriculum; exams; and credentialing. They found that even in states with uniform requirements across publicly funded programs, most training requirements are woefully inadequate.

There are no federal training standards for PCAs, as there are for home health aides and certified nurse aides (CNAs) employed by Medicare-certified agencies. Both of these occupations — which require many of the same skills as PCAs — require 75 hours of pre-employment training. States may require additional training for these direct-care occupations, and more than half do.

"Our findings that very few states have any standardized PCA training with a comprehensive statewide curriculum show that states need strong federal guidance to encourage them to adopt a 'Gold Standard' for PCA training," said Dorie Seavey, Ph.D., PHI director of policy research. Seavey presented the findings today at a Capitol Hill briefing co-sponsored by the U.S. Senate Special Committee on Aging and the U.S. Senate Health, Education, and Labor and Pension (HELP) Committee.

"Requiring that PCAs are adequately trained in every state, and uniformly trained from program to program within states, allows PCAs to work in multiple long-term care programs and settings, which helps to prepare our nation to build the workforce it needs to ensure quality care for consumers," Seavey said.

"We are facing severe shortages of health care workers who are adequately trained and prepared to care for older and disabled Americans," Senate Special Committee on Aging Chairman Herb Kohl said. "As we work to meet this critical need, we must build on the successes of the direct-care worker demonstration projects that were enacted as part of the health care reforms in order to help begin developing uniform training standards for personal and home care aides. In order to achieve our goal of allowing older and disabled Americans to live as independently as possible we must have a well-trained workforce."

PCAs provide a range of essential personal care services that make it possible for elders and people with chronic illnesses and disabilities to live in their homes.

The researchers found that of the states with training requirements, standards ranged widely:

  • 35 percent of states have a requirement for training hours
  • just 22 percent of states have state-sponsored PCA curriculum
  • only 35 percent of states require an exam
  • only 18 percent of states require PCA certification

Of states that have a requirement for training hours, 68 percent require 40 hours or less of training.

The researchers also analyzed the training uniformity within the states' programs and whether required credentials are portable across different programs or populations being served. They found that:

  • 19 states have established uniform requirements across their different PCA programs.
  • However, only five specify detailed skills and a curriculum. Another four states require PCAs to complete home health aide training and competency evaluation.

Today's briefing included reports on the Personal and Home Care Aide State Training Program (PHCAST), a three-year federal demonstration project under the Affordable Care Act (ACA) to establish statewide competency-based curricula and credentialing standards for PCAs. The Health Resources and Services Administration (HRSA), which administers the demonstration program, awarded a total of $4.2 million in funding to six states: California, Iowa, Maine, Massachusetts, Michigan, and North Carolina. The intent of PHCAST Program is that these state training programs will serve as models for establishing federal training standards.

PHI Recommendations

To address the training needs of personal care aides, PHI recommends that federal and state governments invest in:

  • Comprehensive federal training standards for PCAs that address core competencies, including communication and problem solving skills necessary for delivering quality care.
  • A credentialing process that ensures that PCA training articulates with federal training standards for Home Health Aides and Certified Nursing Assistants.
  • A training infrastructure that offers accessible, learner-centered teaching which is effective for adults with multiple learning barriers.
  • Reimbursement for PCA training expenses for workers providing Medicaid-funded long-term services and supports.

More Information

To learn more about the PHI analysis on state training requirements for personal care aides — including which states require training — and the PHCAST program, visit the PHI website.

See the PHI State Data Center on the direct-care workforce for state information, including workforce size and employment projections.

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PHI, the Paraprofessional Healthcare Institute (, 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 care.

Deane Beebe

PHI Media Relations Director


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