Testing U.S. State-Based Training Models to Meet Health Workforce Needs in Long-Term Care

The US health care system and its workforce is rapidly changing to meet the triple aim of reducing costs, increasing quality of care and improving the patient experience. There is a need to align training models with system needs and patient preferences in ways that allow the most cost effective members of the care team to shoulder increasing shares of this care (Ricketts and Fraher, Health Affairs, 32(11), 1874-1880, 2013). One entry-level and in-demand class of health care workers are personal and home care aides (PHCAs). The US Bureau of Labor Statistics projects a 26% increase in PHCAs to over 2.2 million workers by 2024 (OOH 2014). System needs for rebalancing care from institutional settings into the community and patient preferences for in-home care have aligned to drive the need for PHCAs. The increasing prevalence of chronic disease, medical complexity and dementia mean that these workers will be required to handle increasingly challenging clients and function as a key member of increasingly integrated health care teams. Therefore, the development of new models of education and training are necessary. Standards for PHCA training are quite low (Marquand and Chapman 2014) and states leave most training to employers with little to no oversight (Kelly et al. Journal of Applied Gerontology, 32(7): 804-832, 2013). The purpose of this study is to present case studies of six state-based training models for PHCAs funded by the Affordable Care Act. We discuss state approaches to recruitment of trainees, curriculum design and delivery methods, and key lessons learned to inform model development internationally.