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REPORTS: State Training Standards for Personal Care Aides Are Inadequate and Inconsistent

November 13, 2014

The vast majority of states have extremely weak or non-existent standards for training personal care aides (PCAs), while a few states do better, according to two complementary research reports co-authored by PHI and the UCSF Health Workforce Research Center on Long-Term Care (HWRC). 

The main report, “The National Landscape of Personal Care Aide Training Standards,” concludes that fewer than half the states (45 percent) have no PCA training requirements for one or more of their Medicaid-funded PCA programs; 22 percent have no PCA training requirements at all. Only four states have implemented rigorous PCA training standards that are uniform across all Medicaid-funded programs.

Authors Abby Marquand, PHI director of policy research, and Susan A. Chapman, HWRC co-director, said that most state training programs for PCAs are “undeveloped” compared with standards for certified home health aides and nursing assistants.

“With projected demand for PCAs skyrocketing and states reporting difficulty attracting and retaining enough high-quality workers, we are fast approaching a crisis,” Marquand said. “We believe that improving training standards is a critical first step in meeting the coming demand.”

According to the report, the number of people in the United States needing personal assistance services is expected to grow from 13 million in 2000 to 27 million by 2050.

“The need for PCAs is predicted to increase almost 50 percent between now and 2022,” said HWRC Director Joanne Spetz. “For the sake of these indispensable health care workers as well as the well-being of the people they care for, it is important that states bring PCA training standards up to some level of rigor and uniformity.”

A companion research brief, “Leader States in Personal Care Aide Training Standards,” describes the approaches of seven “leader states” — Alaska, Arizona, Arkansas, Idaho, Minnesota, Virginia, and Washington — that Marquand and Chapman credit as having achieved rigor and consistency in their PCA training programs.

“There is no ‘one size fits all’ approach to improving standards,” Chapman said. “All of these states provide different examples for how to begin to go about this process.”

“The diverse routes taken by the seven leader states may prove useful starting points for those states that are developing or reforming their standards,” Marquand concluded.

The reports were funded by the U.S. National Center for Health Workforce Analysis and issued by HWRC on October 31.

— by Deane Beebe

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