Disease-Specific Training for Home-Based Care Workers Can Improve Staffing, Boost Quality

Personal care aides are tasked with caring for seniors with a variety of health conditions — many of which they are not properly trained in.

And without the proper training, those aides operate in highly stressful environments without the tools to care for their patients adequately. That can hurt health outcomes, increase the caregiver’s emotional burden and also make turnover far more likely in both home health care and home care.

“I think our research suggests that if you equip home care workers with the tools they need, they’re likely to feel more confident and more satisfied with their job,” Dr. Madeline Sterling, a health services researcher in the Division of General Internal Medicine at Weill Cornell Medicine, told Home Health Care News. “So, are there ways in which we could potentially empower these workers — and retain them?”


Of the over 6 million Americans that suffer from heart failure, many rely on personal care aides — both caregivers and home health aides — for support. But formal training in heart failure is not currently “widespread, formalized or required,” according to a recently published study from Cornell.

Cross-campus research from Weill Cornell Medicine and the ILR School led to researchers surveying 323 personal care aides about their training, job satisfaction and care of heart failure patients. The findings were startling in one way — and logical in another.

For instance, about two-thirds of the survey respondents had received none or just “a little” training in heart failure.


For those that had, however, their job satisfaction was 14% higher. They were more likely to feel prepared and comfortable, and they felt that they were performing their job well and providing meaningful assistance.

Of the home-based care workers that had received at least some sort of training in heart failure, over 70% felt confident providing that type of care. Just 30% of those that hadn’t received training felt confident.

“From our prior qualitative work, we’ve also found that a lot of workers would welcome training, especially in certain conditions that they find complex, whether that be heart failure, or other others,” said Sterling, who was a lead author of the Cornell study.

It’s not just that workers would perform better because they’re satisfied with their job.

Knowing what to do — and how to do it — also helps the care outcomes, in general.

The same goes for other diseases.

Dementia and Alzheimer’s disease, for instance, are widespread among home-based care beneficiaries, yet many personal care aides are still not always familiar with best practices when it comes to caring for those patients.

That’s why agencies like Tender Rose Dementia Care Specialists search for top-line workers in the field, and then train them with specific instructions for dealing with memory-impaired patients.

“The biggest difference, I see, between what we do, and what traditional home care does is … we get to know the person who has dementia,” Jim Kimzey, Tender Rose’s founder and CEO, told HHCN in November. “We engage them in activities that bring them joy and meaning, at whatever level they can still participate. What traditional home care tends to do is focus on the physical needs of the client.”

That keeps workers from trying to care for those dementia or Alzheimer’s patients in the same way that they would others. Caring for them in a non-specific way can not only be futile, but also counterproductive.

Training and staffing

Staffing is one of the most important issues facing the home health and home care industries right now. Whether before or during the COVID-19 crisis, agencies have had trouble with finding the right workers and keeping them.

“Could improvement in training — and policies or funding that allow for that training to occur — be one mechanism by which we improve workers’ overall experience and ultimately keep them in the field?” Sterling said.

In the home health industry, the turnover rate increased to 22.18% in 2020, according to the Home Care Salary & Benefits Report from the Oakland, New Jersey-based Hospital & Healthcare Compensation Service.

Caregiver turnover rates in home care are even worse. In 2018, the industry hit a record high with a 82% turnover rate. It dropped in 2019, but still exceeds 60%.

“This study is important because it demonstrates that investing in disease-specific training among home care workers – for example, in cardiovascular disease – may be a way to improve their experience caring for patients,” Sterling said. “These findings support the need for additional training requirements for those home care workers caring for patients with complex clinical conditions, like heart failure.”

Lack of training in cancer care

The same problems exist in at-home cancer care. The cancer care that personal care aides provide can be extremely taxing psychologically.

Still, the vast majority of home-based care workers are in the dark when it comes to the details on specific cancers, especially if they’re not medically trained.

New York City-based Belong.Life, a developer of social and professional networks for navigating treatments in various medical environments, is trying to change that with its Belong Cancer app, which aims to help caregivers with treating cancer patients in the home.

The app gives critical information and tips for home-based care workers, and also lends mental support to users. There are hundreds of thousands of users on the app, which operates in over 100 countries.

“It’s very important to support the caregivers, because without them, patients won’t do as well,” Dr. Daniel Vorobiof, the chief medical director of Belong.Life, told HHCN. “And if we can help the caregiver, to then help the patients, I think that’s a win-win situation. So that’s why we started this.”

The app is free and anonymous — and both patients and personal care aides can join the network. Then there are groups for different communities — for those with cancer, for those supporting loved ones and for professionals delivering actual care.

“The majority of caregivers are not well trained on how to manage specific problems in patients, and we provide them with that,” Vorobiof said. “And also, although caregivers are there for others, they should also be caring for themselves. And we need to give them that support.”

The massive success of the platform thus far is a testament to how wide-range of a problem under-training is among personal care workers, and how addressing it could provide tailwinds to at-home care agencies and associations moving forward.

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