How to Build the Personal and Home Care Aide Workforce

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What’s the best way to recruit, train and retain personal and home care aides (PHCA)? Meet workers where they are, says Registered Nurse Leanne Winchester from the Massachusetts Executive Office of Elder Affairs.

What’s the best way to recruit, train and retain personal and home care aides (PHCA)? Meet workers where they are, says Registered Nurse Leanne Winchester from the Massachusetts Executive Office of Elder Affairs.

That’s what Winchester and her partner team did during a 3-year federal demonstration program aimed at developing, implementing and evaluating competency-based curricula and certification programs to train qualified PHCAs.

Six states participated in the Personal and Home Care Aide State Training (PHCAST) Demonstration Program from 2010-2013. The Health Resources and Services Administration (HRSA) administered the program, which was authorized by the Affordable Care Act (ACA).

The LeadingAge Center for Applied Research is helping to conduct an ACA-mandated evaluation of the program.

Meeting Workers Where They Are

Massachusetts trained more than 800 individuals during its PHCAST demonstration program. Almost all prospective trainees were woman. Many faced a variety of challenges, including low incomes, unemployment and difficulty speaking English.

Program staff in Massachusetts kept all of these challenges in mind when developing the PHCAST demonstration’s training curriculum, which was based on 10 core competencies identified in the ACA.

“We really looked at the challenges of the workforce,” said Winchester, who directed the Massachusetts PHCAST project. “We knew that if (participants) could complete the training it was more likely that they would stay in the workforce.”

Massachusetts took 3 approaches to ensuring the success of PHCAST trainees:

  • It instituted a flexible training schedule to help participants blend the demands of training with the pressures they were experiencing in their daily lives.
  • It provided case management services, and later partnered with local organizations, to fill the gap in supports that were available to help participants succeed in the classroom.
  • It offered bilingual training materials and sessions to help overcome the obstacles created by participants’ limited English-language proficiency.

A Flexible Training Schedule

Program organizers recognized early that PHCAST trainees were juggling many responsibilities that could keep them from attending PHCA training sessions.

To promote consistent attendance, Winchester and her colleagues developed 13 stackable training modules for the 60-hour PHCAST training program. With one exception, no module involved more than 3 hours of training time.

“We found that the workers were not really prepared to spend more than 3 hours in a training session on any given day,” said Winchester during the PEAK Leadership Summit in March. “Many of them had to go to work afterwards or they had family responsibilities. So if the training was more than 3 or 4 hours long, oftentimes, they didn’t stay.”

Case Management Services

The cost of case management services was written into the first year of Massachusetts’s PHCAST budget. The goal was to give trainees the support they needed to successfully complete the training program.

“In a class of 18-20, there might be 3 to 5 participants that the case manager really needed to work with,” said Winchester. “These might be individuals who didn’t show up for class, were consistently late or seemed to be having a hard time. The case manager would approach these individuals and find out what type of additional supports they needed to be successful. When we offered those supports, we found that the attrition rate was reduced.”

During the second and third years of the demonstration program, Winchester and her colleagues began working with regional partners to provide case management services. Partnerships with Head Start programs, community colleges, regional employment boards, and other community organizations helped reduce the cost of case management services. 

It also helped ensure that the program’s case-management component could be sustained after federal funding ended.

In one innovative arrangement, Head Start programs in each of the state’s 5 regions helped recruit PHCAST trainees from among the parents of children in their programs. These Head Start programs also agreed to offer supports, when necessary, to the PHCAST participants they recruited.

“If it seemed that (a participant) was struggling, we could communicate that to the Head Start program,” said Winchester. “Head Start would then communicate with the participant and offer the support that the participant needed. That might include translation support, transportation or extended childcare. This was a great partnership.”

Bilingual Training

By the end of the PHCAST program’s first year, it became apparent that lack of English-language proficiency among prospective trainees was affecting recruitment efforts, said Winchester. A significant number of candidates were choosing not to enroll in the training program because they anticipated having problems understanding material that was presented in English.

“We saw this as a lost opportunity,” said Winchester. “We really wanted to embrace these workers and offer an opportunity for them to join the classes.”

During its second year, the Massachusetts PHCAST program sought and received permission from HRSA to translate its training materials into Spanish, Haitian Creole and Brazilian Portuguese. In the third year, the program began offering some of its classes in Spanish and Haitian Creole. Interpreters helped selected participants in English-language classes understand the material.

Pre- and post-tests conducted during each year of the PCHAST demonstration showed the dramatic impact that bilingual options had on learning. In the first and second years, when all training was delivered in English, participants demonstrated a 15%-20% knowledge gain during the course of the training.

Knowledge gain soared after bilingual options were introduced.

“When we offered the training to participants in their native language we had an almost 40% knowledge gain for those participants,” reported Winchester during the PEAK session. “This was huge. We definitely saw great improvements and opportunities for this workforce when we provided materials to them in a manner that they could understand.”