As low-wage, “unskilled” workers, PCAs don’t get much respect. With a median wage of $9.49 an hour, PCAs are among the lowest paid workers in America. As a result, more than half rely on public benefits to support their families. Yet these workers are essential to the lives of millions of Americans who rely on them to get out of bed in the morning, to bathe and dress, eat healthy meals, pay bills, and go to work, school, church, doctors’ appointments, and much more.
Many baby boomers rely on these workers to provide support to frail and ailing parents who want to age in place but can no longer manage alone. When we hire PCAs, we want workers who are skilled and reliable, and who will treat us—or our loved ones—with care and compassion. We expect a tremendous amount from PCAs, including the patience to assist an 85-year-old with Alzheimer’s or a young veteran who is struggling with post-traumatic stress and her first prosthesis.
Yet, the federal government has devoted virtually no attention to building this essential workforce —there are no federal training standards, no federal minimum wage and overtime protections, and no requirements for states to assess the adequacy of their workforce by monitoring worker recruitment and retention. Most workers in this field are hard-working, dedicated, and deeply committed to caring for others, but they need better wages, training and support to continue as caregivers. Otherwise, the result is high turnover which interferes with quality care and wastes scant public resources.
Findings from a recent PHI research project show that, without federal standards, states have implemented a hodge-podge of training requirements, which, when they exist, typically have little uniformity across programs in a state. Nearly half the states have at least one personal assistance services (PAS) program with no training requirements. And less than 20 percent have a state-sponsored curriculum or certification requirement for PCAs. In general, these requirements are not nearly robust enough to ensure the skills needed to provide quality care.
On September 24, PHI, along with the Senate Special Committee on Aging and the Senate Health, Education, Labor and Pension Committee, sponsored a Capitol Hill briefing on the progress of a federal demonstration project addressing the need for better training for PCAs. Through the Affordable Care Act (ACA), California, Iowa, Maine, Massachusetts, Michigan, and North Carolina received three-year grants to develop statewide competency-based curricula and credentialing standards. According to the federal agency in charge of administering the grant program—the Health Resources and Services Administration (HRSA) — “It is expected that the training standards established under these State grants would be utilized as a "Gold Standard" for future training of personal and home care.”
To establish that gold standard, the six states are experimenting with new teaching approaches, including interactive classroom education and online training. They are also equipping PCAs with the communication and interpersonal problem-solving skills necessary for caring for people with complex physical and psychological needs. Finally, they are exploring career paths that allow PCAs to move between settings and into occupations such as home health aide, certified nursing assistant, and licensed practical nurse.
Improving training for PCAs is one step toward ensuring that America is prepared to care for its burgeoning population of elders and people with disabilities. But the federal government must go further. The ACA includes a federal Personal Care Attendant Workforce Advisory Panel to consider how to strengthen this workforce to meet our future needs. Convening this panel would provide an opportunity to bring together our nation’s experts to develop a real plan for strengthening and stabilizing America’s fastest-growing workforce.
Sturgeon is the president of PHI (Paraprofessional Healthcare Institute in Bronx, New York.