Direct care workers are still undervalued, undertrained and have little opportunity for career advancement, according to a new report from PHI.
Ultimately, that’s bad for home-based care agencies — and their bottom lines.
New York-based PHI is a direct care worker and senior care advocacy organization. PHI typically classifies direct care workers as personal care aides, home health aides and nursing assistants, or more generally those who support seniors and individuals with disabilities.
“Quality care is [contingent upon] quality direct care workers,” Angelina Drake, PHI’s COO and the author of the report, told Home Health Care News. “They will deliver higher-quality care and contribute more meaningfully to the client’s health, safety and well-being if they are better paid, trained and supported.”
Among other findings, PHI found that the direct care workers suffer from inadequate training, a lack of outside understanding of the complexity of the work they do and a system that does not allow many opportunities for meaningful career movement.
One solution in regard to improved training: mandated federal training requirements, according to PHI. This already exists in home health care, as home health aides are required across the U.S. to undergo at least 75 hours of training.
In contrast, personal care aides have no federal requirements and are governed by a mixed bag of state laws and regulations.
PHI recommends that each direct care worker be trained to the point where they have a grasp on a set of core competencies. Broadly, that’s defined as having the skills, knowledge and abilities to complete one’s role.
“The report does conclude with a recommendation that there be a set of core competencies that underlie all direct care,” Drake said. “Once agreed upon and required for states to adopt these standards, they can then build additional training for roles that have greater responsibilities or more specialized responsibilities.”
No agreed upon requirements means that direct care workers’ capabilities look different across state lines, potentially hurting themselves as well as the seniors they’re serving, PHI argues. Workers should also be able to show that they are improving their skills during training — and not just hitting an hourly training threshold — before moving forward.
“Whether you are a personal care aide, home health aide or nursing assistant, there are core competencies that are really central to delivering quality care, and we need to at least ensure that those are in place,” Drake said. “We want competency-based training, which means that participants will need to show that they have acquired skills before they can move forward.”
Only about 60% of states have some sort of home care licensure requirements, according to the Home Care Association of America (HCAOA).
More regulation could help both agencies and direct care workers. Universal training for direct care workers will give them more confidence on the job, allow them to increase their capabilities and ideally get promoted, PHI claims.
That sort of room for improvement creates value for the workers and leads to better care, both of which benefit home care agencies.
“Turnover costs are some of the major expenses that long-term care providers face,” Drake said. “These can be improved by better preparation and job quality for the direct care workforce. And consumer satisfaction is another driver of business that can be improved by quality jobs.”
Other aspects of the direct care workers’ environment that have gone underappreciated are the physical, social and emotional demands, according to the report.
These, of course, have been exacerbated by the COVID-19 crisis.
“Employers need to look at what they can do to improve job quality for direct care workers,” Drake said. “Employers are often limited in their ability to change the base wage for workers, but there are other things they can do to improve job quality to make this a better job all around. A really important piece of that is training.”