Person-Centered Training Reduces Home Care Aide Turnover

A person-centered approach to training personal care aides (PCAs) could be home care’s solution to reducing staff turnover, while also improving job satisfaction and quality of care, a recent report suggests.

With employee turnover rates spiking by as much as 60% in the face of a booming demand for personal care aides (PCAs), the home care industry has been wracked with finding a way to retain qualified caregivers while simultaneously providing quality of care.

But while PCAs hold the potential for providing low-cost, yet high-quality in-home supports and services to the nation’s swelling aging population, this workforce has been hindered by costly high-turnover rates that threaten quality of care and outcomes.


For this reason, it is imperative for home care providers to take a different approach to training this workforce—one that is person-centered, says the report “Filling the Care Gap: Personal Home Care Worker Training Improves Job Skills, Status, and Satisfaction,” by Clare Luz, PhD and Katherine Hanson, MS, of Michigan State University’s College of Human Medicine – Department of Family Medicine.

Evidence supports that training can have a positive impact on improving quality of patient care and clinical outcomes. And for home care, person-centered training can significantly reduce staff turnover and promote greater job satisfaction.

“Training can change the lives of PCAs by providing a set of skills that are increasingly desirable as our society ages and this workforce expands at an extraordinary rate,” write Luz and Hanson. “We submit that it can change the lives of employers/providers and clients as well. Improving the continuity and quality of in-home care will lead to lower costs, better health outcomes, and higher quality of life for everyone.”


One such program spotlighted in the Michigan State report is the Personal and Home Care Aide State Training (PHCAST) project, which was developed in 2010 as mandated by the Affordable Care Act. The demonstration project was administered by the Health Resources and Services Administration, which funded six states to develop, implement and test new PCA training programs.

The Michigan State brief highlights Michigan’s PHCAST program, titled “Building Training…Building Quality” (BTBQ). The program focuses specifically on several key findings that indicate a significant correlation between training and improved job skills, status (employment standing, conditions and tenure) and job satisfaction.

What sets Michigan’s BTBQ apart from other direct care worker trainings is the program’s emphasis on “person-centeredness,” as well as its use of interactive, adult learner instructional strategies and content related specifically to home care.

BTBQ is comprised of a 77-hour core curriculum developed through partnerships with the Michigan Office of Services to the Aging, a registered nurse project director, Michigan State University, the Paraprofessional Healthcare Institute, along with various community partners and six local organizations who contract with the state to administer Michigan’s Home and Community Based Services for the Elderly and Disabled waiver programs titled MI Choice.

The program was implemented in five regions of the state, in both rural and urban settings, with nearly 400 “learners” having completed the core training. Based on the success of the program, findings indicated significant improvements in knowledge, skills, job status, and key characteristics of a “gold-standard” PCA training program were identified.

In measuring the BTBQ program, researchers surveyed all 585 enrollees on a variety of questions to determine whether or not they were employed; if their paid work was in health care; their work setting and position; length of employment; pay rate; number of paid hours per week; number of clients; and benefits.

There were also questions related to job satisfaction and enrollees’ “intent to stay,” their “intent to leave,” as well as their perceptions and value of PCA work in general. Additional data were collected via a three-month follow-up survey mailed to enrollees

Results from questions posed to members in the follow-up surveys indicated that 13% felt that BTBQ helped them get a job; while 38% stated the program helped them become a better PCA in their current job; and 10% felt they had advanced to a better job because of BTBQ.

In another indicator of improved job status, the follow-up results indicated that the unemployment rate dropped significantly among BTBQ participants from 58% to 36%, and those reporting health insurance through Medicaid declined from 40% to 24%.

Completion of the BTBQ program also led to high degrees of job satisfaction among participants. Among those who responded to the follow-up questionnaire, more than three quarters (77%) stated their job satisfaction improved due to BTBQ and 99% would recommend the program to others interested in becoming PCAs.

“The overall findings provide strong evidence that learners realized the value of PCA work and mastering PCA skills contributed to the potential for successful employment if given the chance,” write Luz and Hanson.

The findings also suggest that training alone is insufficient.

Not only do trained workers need access to decent jobs, but researchers advocate that developing a qualified workforce requires employers who recognize the value of comprehensive PCA training and providing individuals compensation proportional to their skills.

“Training this workforce will not only support workforce development but it will also support economic development and independent living for older adults, and can serve as the basis for an increasingly relevant model of in-home supports and services for everyone,” conclude Luz and Hanson.

Written by Jason Oliva

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