5 Things HCBS Providers Can Do to Improve Quality

A few weeks ago, I had the great pleasure of moderating a panel featuring representatives of 6 states who are doing something pretty incredible.

Those states -- California, Iowa, Michigan, Massachusetts, Maine and North Carolina -- have spent the past 3 years developing and implementing training and certification programs for personal and home care assistants (PHCA).

Who are these workers?

These are the individuals we're depending on to keep our home and community-based services (HCBS) programs going. In most cases, they are low-income women, many of whom speak English as a second language.

Each and every day, these workers provide the basic assistance that allows older adults and people with disabilities to remain in their communities. In the process, these workers also help their states save Medicaid dollars by keeping beneficiaries out of nursing homes and other expensive care setting.

Clearly, a lot is riding on these workers.

So it's inconceivable to me that we’ve invested so few dollars in training and supporting them.

State Efforts to Train PHCAs

The 6 states participating in my panel at the National HCBS Conference have been working since 2010 on programs to train PHCAs in 10 core competencies. The states are grantees in the Personal and Home Care Aide State Training (PHCAST) Demonstration Program, a federal program authorized by the Affordable Care Act (ACA). 

The Center for Applied Research is helping to conduct an ACA-mandated evaluation of the program.

PHCAST grantees have brought an incredible spirit of innovation and collaboration to their workforce development efforts. What they've accomplished so far has created an important awareness about the value of the PHCA workforce. Together, they’ve trained thousands of workers and discovered best practices that can help us all strengthen our HCBS programs.

But here's the thing. There were only 6 PHCAST grantees. And, collectively, they were able to spend $5 million of someone else’s money to fund their training and credentialing efforts.

What happens to their momentum when PHCAST funding ends on Sept. 30? And what about the remaining 44 states that didn't have access to ACA funds but who, nevertheless, need to address training and credentialing issues for this workforce?

These are questions that LeadingAge and its members need to be asking. And, as providers of high-quality home and community-based services, we need to care a great deal about the answers.

5 Things HCBS Providers Can Do

PHCAST grantees are working hard to sustain their individual programs, mainly by convincing high schools and community colleges to embed new training modules in their curricula. Those efforts, while laudable, will only take us so far.

There's plenty more that LeadingAge members could do to keep these training issues on the front burner even after PHCAST funding ends on Sept. 30. Here are a few ideas:

1. Talk to your state's Medicaid director. It's time to have a conversation about Medicaid reimbursement rates for home care. We simply cannot ignore the cost of training when we set those rates. If states are really interested in providing high-quality care through their HCBS programs, they must also be willing to pay for the high-quality workforce that provides that care.

2. Review the PHCAST materials. Read a summary of the panel presentations. Review the Report to Congress that grantees submitted last year. And look for our forthcoming evaluation of the 6 state programs. Thanks to the ACA, we've now got new models and programs from which to learn and on which to build. Help us create awareness of these models in your states and communities.

3. Make an investment in your own PHCAs. What can you learn from the PHCAST models? How can you partner with your local community colleges or high schools to develop similar training programs? Educating, developing and providing career pathways for these workers is the best way I know to increase the quality of the home and community-based services you provide. It is also our ethical and moral responsibility as not-for-profit, mission-driven providers.

4. Support the work of the LeadingAge Workforce Cabinet. The Workforce Cabinet will release a set of core competencies for direct care workers sometime next year. I hope you will make a commitment to hire people who have these competencies. I also hope you will support the training programs that will help workers acquire these competencies. 

5. Share your own experiences. The PCHAST grantees have created an informal learning collaborative over the past 3 years. They are continually sharing their experiences and knowledge with one another. In the process, they've strengthened their own programs as well as the HCBS field as a whole. Every provider who actively supports the PHCA workforce has a story to tell. Providers at the local, state and national levels would like to hear your story.

The PHCAST grant program has succeeded in creating tremendous energy around the development of the personal and home care assistant workforce. Now, it's up to us to decide what we're going to do with that energy.

Our workers deserve it. And so do the older people those workers serve.