Little Training, Oversight Puts Home-Based Caregivers in Tough Position

Each day, thousands of home-based caregivers are put into life-and-death situations with little training and virtually no direct supervision, mainly because state payments are too low to cover additional training and oversight expenses, reports the Star Tribune.

The Minneapolis-based newspaper interviewed more than two dozen personal care attendants and found that only one had received more than an hour’s training from their agencies. This lack of training has led many to feel overwhelmed and unqualified to help patients with serious illnesses and disabilities. 

A previous report suggests the home health care industry has become a draw for less educated workers, who account for nearly 49% of the total health care workforce in the nation’s largest metro areas. And combining that with a lack of training or supervision may have less than desired consequences. 


Most personal care aides are trained on the job. There are no formal education requirements for personal care aides, but most have a high school diploma, according to the Unites States Department of Labor

“Despite a decade of explosive growth in the $95 billion home health industry, which is swelling to meet the demands of an aging population, there are no federal standards for the training, credentials and supervision of personal care attendants,” the Star Tribune writes. 

State laws vary, but some require personal care agencies to check in on patients and their caregivers every few months — and some agencies neglect that law, waiting years before visiting patients. 


State lawmakers and local officials have voiced concerns about this lack of oversight, the article states. In one review of the system, a legislative auditor found that just 57% of patients received visits from qualified professionals required by state law. And even when these visits occurred, one-third were less than half an hour per month. 

Although personal care aides are unlicensed and only provide patients with self-care and everyday tasks, some feel pressured to provide medical attention when faced with life-and-death situations. 

“If someone needs an injection of insulin or a painkiller, you can’t always say, ‘No,’ or ‘Just wait for a professional,’ ” said Shawntel Harry, a home caregiver from St. Paul’s East Side. “You give it to them or they suffer or they die. That’s the situation we’re left in day after day.”

State authorities have resisted periodic efforts to expand regulation by licensing personal care agencies and their workers, Star Tribune writes. Reformers proposed licensing in 1991, and again in 1997, when the program was about a third of its current size. But the high cost of implementing the reforms proved an insurmountable barrier; legislators never appropriated funds so no action took effect.

Read the full Star Tribune article here.

Written by Emily Study

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