Strengthening the Direct Care Workforce
for Long-Term Services and Supports
Suggested Approaches From a National Panel of Experts
There were divergent opinions among panelists regarding the advisability of increased training requirements for DCWs. Acknowledging the various types of DCWs and the corresponding range of skills, knowledge, and expertise required, some panelists expressed the belief that increased training requirements could be a barrier or deterrent to increasing the supply of DCWs. They also pointed out that associated training costs for providers would increase, although their reimbursement would not. Much of this discussion centered on whether DCWs actually required additional training to perform home-related chores and basic personal care tasks. The argument was made that adding “clinical” hours would lead to “medicalizing” home care and would work against the delivery of person-centered care.
Other panelists were of the opinion that home care workers are increasingly serving individuals who suffer from multiple chronic conditions and have complex medical needs requiring additional training, especially given consumers' preferences for home care over institutional care. According to these panelists, requiring additional training and licensing would lead to higher standards and wages. These panelists maintained that special attention and advocacy efforts are needed to raise the federal and state training requirements for DCWs, specifically, certified nursing assistants and home care workers. These requirements have not been amended since the passage of OBRA in 1987 [§ 1891(a)(3)]. As of 2009, there were 20 states that had not increased the entry-level training requirements from the OBRA-mandated 75 hours, while 13 other states and the District of Columbia changed them to require 120 hours or more (PHI, 2009). In the state of Washington , legislation has been passed to update requirements for training hours and curriculum content, combined with requirements that home care aides have certification.
Panelists also noted that entry-level training for these workers should include more clinical experience to develop their skills and to have a fuller understanding of the nature of the work. Peer-to-peer and mentoring programs were viewed as a valuable component of entry-level training programs. Regarding DCWs' continuing education requirements, there have been calls issued over the past decade for increases in the annual requirement of 12 hours and mandates for specific training content such as skills and techniques for person-centered care (U.S. Department of Health and Human Services, 2002).
One recommendation by the panel was to have evidence-based training curricula and programs designed around the core competencies necessary for the job, including interpersonal and team skills to foster the care recipient's independence. These core competencies should be aligned with those specified in Title V of the Patient Protection and Affordable Care Act of 2010. Students for whom English is not their first language were seen as requiring special attention and adjustments to training curricula and programs, as were low-income persons and those with cultural backgrounds that influence delivery of care.
Some panelists endorsed the development of a set of core competencies that cut across age and disability groups as a method of helping to enhance the skills of DCWs and their employability in a wider variety of care settings. One program mentioned by a panelist as exemplifying a successful approach to training DCWs to serve older adults and adults with disabilities was SPEAK (Support Providing Employees' Association of Kentuckiana), a network of provider organizations guided by two lead agencies – The Council on Mental Retardation and Seven Counties Services, Inc. SPEAK provides networking opportunities to “Direct Support Professionals” who serve a wide range of individuals, such as those with developmental disabilities, mental illness, and emotional disturbances, and the elderly. SPEAK also provides pre-service orientation to give job applicants a realistic preview of the work before they are hired, a mentorship/apprenticeship program to help new hires adjust and learn best practices from a peer, and training and recognition opportunities (SPEAK, 2010).
In the wake of health care reform, there may be new opportunities for specialized training for DCWs. For example, the “medical home” model of care delivery includes comprehensive training to coordinate care, along with an ongoing relationship between a provider and patient, 24-hour access to medical consultation, and patient-centered care. DCW specialists specifically trained in post-hospital care could work within a care receiver's medical home to facilitate smooth care transitions that help prevent unnecessary emergency department use and acute care hospital readmissions.
Panelists also noted that in decades past, AoA has historically supported specialized training programs in aging using Older Americans Act Title IV funds to better educate professionals in gerontology and long-term care. Future investment in these types of training programs for DCWs can both attract new people to the field of long-term care and ensure that those working in the field are properly prepared to perform their jobs. Paying trainees during training was also mentioned as a necessity by one panelist.
Partnerships were viewed as central to expanded and improved training programs, as were demonstration grant initiatives to implement workforce innovations and evidence-based best practices in various programs and states. Such partnerships could include high schools, community colleges, universities/centers of excellence, boards of nursing, Alzheimer's Association chapters, AARP, disability advocates, immigrant advocates, labor unions, United Way , ADRCs, and coalitions such as the Long-Term Care Working Group in Washington , D.C. Among state and federal government entities, partnerships between AoA and Workforce Investment Boards, Departments of Labor and Education, Centers for Medicare and Medicaid Services, Veterans Affairs, Assistant Secretary for Planning and Evaluation (ASPE), Health Resources and Services Administration (HRSA), and Housing and Urban Development (HUD) offices could result in coordinated and sustained attention to training program initiatives that will ensure ongoing advances in the quality of the long-term-care workforce.
Approaches to Improve the Readiness of DCWs
3.1 Include a proposal in the Administration's recommendations for the OAA reauthorization for DCW training programs that are focused on the core competencies needed by specific types of DCWs, as specified in Title V of the Patient Protection and Affordable Care Act, along with career advancement programs, career ladders, and standardized certification that transfers to different locations.
3.2 Make greater use of OAA Title IV funds for demonstrations, training and education programs, including train-the-trainer programs for DCWs, and ensure these are evidence-based training programs directed to core competencies, aligned with the provisions of the Patient Protection and Affordable Care Act.
3.3 Promote training programs for DCWs that are designed to accommodate the needs of low-income persons, immigrant persons for whom English is a second language and those with cultural backgrounds that influence their approach to and delivery of care.
3.4 Consider a variety of partners to develop and implement recruitment and training programs for DCWs, including special apprenticeship programs targeted to HCBS; some of these may include Workforce Investment Boards, community colleges, Department of Labor, Department of Education, labor unions, boards of nursing, senior and disability advocates, advocates for immigrants, universities/centers of excellence, ADRCs, and United Way.
3.5 Explore possible mechanisms for funding child care and other expenses while persons are receiving DCW training.
3.6 Ensure that training programs include a pre-training component which provides applicants with actual experience of what the job is like and include more on-the-job training and peer mentoring for skill development.
|
