How North Carolina is Breaking Down Workforce Training Silos

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A new training program in North Carolina will help personal and home care aides (PHCA) move more easily between care settings during their careers.

The state established its training program with help from the federal Personal and Home Care Aide State Training (PHCAST) Demonstration Program. Six states used funds from the 3-year federal demonstration program to develop, implement and evaluate competency-based curricula and certification programs to train qualified PHCAs.

PHCAST was authorized by the Affordable Care Act (ACA) and administered by the Health Resources and Services Administration (HRSA). The LeadingAge Center for Applied Research is helping to conduct an ACA-mandated evaluation of the program

Worker Mobility 

A broad-based partner team—consisting of advocacy groups, state agencies, employer associations, community colleges and high schools—designed North Carolina’s PHCAST program to help reduce turnover rates that can be as high as 80% in some of the state’s residential care settings.

The 4-phase training program provides an integrated career lattice for PHCAs, says Jennifer Craft Morgan, the program’s lead evaluator.

“There is recognition of the permeable boundaries between health care settings,” she told an audience at the PEAK Leadership Summit. “We know that these workers move around settings and they move between nursing homes and home care and home health over a career. If we can integrate the training, then they don’t have to go back and start all over again if they want to work in another setting.” 

A 4-Phase Training Program 

The first phase of the North Carolina PHCAST program is a 16-hour training module that teaches basic job readiness skills and provides a realistic preview of a PHCA’s job.

“This was important to us because we knew that there was high turnover right after training,” says Morgan. “A lot of folks invest 120 hours in the Certified Nursing Assistant (CNA) program. Then they get out into the workforce and within a week they’re gone because they haven’t had a good preview of what that job entails and whether or not they matched that job. So now they can develop that realistic job preview and only invest 16 hours.”

The 3 additional training phases include: 

  • Phase 2: Direct Care Basics. This 60-hour training introduces the personal care tasks that a trainee would need in order to work in home care or in assisted living. It also includes soft skill development.
  • Phase 3: Nurse Aide I. North Carolina’s existing nurse-aide training was enhanced using an adult learning curricular design, says Morgan. “We rewrote the curriculum to make sure it was facilitative rather than didactic,” she says. This phase takes approximately 120 hours to complete.
  • Phase 4: Home Care Nurse Aide Specialty. North Carolina already had advanced curricula for medication technicians and geriatric aides. The PHCAST team added a 100-hour training for home care nurse aides. The training teaches clinical and soft skills.

Multiple Points of Entry

The multi-phase PHCAST program was designed to appeal to a variety of workers who are at different stages in their lives and their careers.

“Not everyone is the same when they come in the door for an education,” says Morgan. “We have got unemployed workers who are looking to see if this direct care work is a possibility for them as a second career. We have older workers. We have incumbent workers looking to upgrade their skills.”

Not all trainees will begin the program with Phase 1, says Morgan. In fact, trainees have the option to begin the PHCAST program with either phase 1, phase 2 or phase 3.

“If you want to be a CNA and you know you want to be a CNA, of course you can go right into Phase 3,” says Morgan.

Trainees cannot enter Phase 4 without completing Phase 3, however. That’s because Phase 4 is an add-on to the nurse aide training. 

Working with High Schools and Community Colleges

Twelve community colleges and 5 high schools helped North Carolina pilot its PHCAST program. The state’s community colleges have already embedded the first 2 phases of the program—the job readiness phase and the Direct Care Basics training phase—into their course offerings.

Embedding the program at community colleges “allows us to take advantage of the tuition waivers offered to the unemployed and underemployed workers,” says Morgan. “So we have a sustainable way of paying for most of that training if the workers qualify. Unemployed workers enter through those portals and are able to find out if they want to do direct care work.”

Early Outcomes: Three Months After Training

The PHCAST training appears to spur participants to pursue new jobs and additional training. Three months after the training concluded: 

  • 56.3% of the trainees had enrolled or planned to enroll in a training program that would increase their job skills.
  • 48.2% had enrolled or planned to enroll in an education program that would lead to a college degree.
  • 45.9% had enrolled or planned to enroll in another health care occupation training program.
  • 37.9% had applied or planned to apply for a new direct care job. Morgan pointed out that this figure does not include the many trainees who were already working in the field and planned to stay in their current job.