Outputs

Introduction: The rapidly aging US population is resulting in major challenges including delivering quality care at lower costs in the face of a critical health-care workforce shortage. The movement toward home care has dramatically increased the need for qualified, paid personal care aides (PCAs). Adequate PCA training that focuses on skills for person-centered, at home support is an imperative. This study provides evidence that clients of PCAs who have completed a comprehensive, evidence-based PCA training program, titled Building Training…Building Quality (BTBQ), report higher satisfaction and better health outcomes, compared to clients of PCAs with lesser or other training. Methods: A mixed-methods, quasi-experimental design was used to compare self-reported survey responses from clients of BTBQ-trained PCAs (treatment group) with responses from clients of non-BTBQ-trained PCAs (control group). Results: Clients of BTBQ-trained PCAs had significantly fewer falls and emergency department visits compared to clients whose PCAs had no BTBQ training ( P < .05). Conclusion: BTBQ-like PCA training reduces costly adverse events.

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.