Why Upskilling Caregivers Can Improve Patient Care, Retention

As the demand for home-based care services continues to soar, so does the industry’s shortage of workers, with as many as 7.8 million caregiving positions projected to sit unfilled by 2026.

The multimillion-dollar question for agencies remains how to survive the staffing crisis, which industry leaders have identified as the No. 1 challenge within home-based care. One possible answer — and solution to rising health care costs and quality concerns — could be upskilling, a new Health Affairs blog post argues.

“To achieve quality care to meet today’s demand, and growing, future demands, there must be a change in how the home care workforce is valued,” writes author Angelina Drake, COO at PHI, a national nonprofit that advocates for direct care workers. “Demonstrating that value through upskilling and optimal deployment will show that these workers can do more, and deserve more, than the current system imagines.”


Upskilling entails improving workers’ skill sets by offering increased specialty training. Upskilling varies from current practices at many agencies, as training is often minimal.

There are currently no federal training standards for personal caregivers, and only five states require more than a week of training before workers start their jobs. Meanwhile, home health aides are federally mandated to go through 75 hours of training, but only six states require 120 hours of training — the duration recommended by the National Academy of Medicine.

By offering additional training, Drake argues direct care workers can provide better care for patients and come into the job more prepared, thus reducing turnover.


Drake points to studies to back up her claims: For example, in California’s In-Home Supportive Services Program, upskilling training and care team integration of more than 6,000 workers helped reduce rehospitalization and ER readmissions by more than 40% each, saving up to $12,000 per patient.

Other examples of upskilling include offering specialty training, such as dementia education and behavioral management classes — programs multiple agencies started offering last year in an effort to boost retention and improve care.

Maryland-based home care agency Regent Healthcare announced the development of its dementia training programs in November. The goal is to boost retention for the provider’s roughly 300 professional caregivers — and boost revenue by offering clients another form of service, which bills at higher hourly rates.

Also last year, Sunrise, Florida-based Interim HealthCare and Omaha, Nebraska-based Right at Home rolled out dementia programs for similar reasons, with a big perk being creating specialized caregiving positions, offering workers a career ladder and an opportunity to make more money.

While such efforts are a step in the right direction, agencies can’t do it alone, Drake said, noting that little research on the home care workforce exists.

“Some state-level funding initiatives are now targeting the long-term care workforce. Value-based payment programs also present opportunities to support investment in home care workers by rewarding insurance plans and employers that improve job quality for this workforce and maximize its contributions,” she wrote. “At the federal level, passing bills introduced to fund upskilling initiatives in home care could build the evidence base for these interventions while providing better jobs to thousands of low-income workers.”

Launching specialized training programs could be costly — and implementation isn’t always easy. But investing in upskilling often pays off in the end, as the direct cost of worker turnover is $2,600, according to research firm Home Care Pulse, with indirect costs being much higher.

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