Direct Care Worker Training Some But Not All States Require More Training Than Federal Recommendations

Career Ladders Could Inspire Careers and More Training

A new PHI analysis found that only 15 states require home health aides to have more training hours than are federally mandated, yet 30 states and the District of Columbia require certified nurse aides (CNAs) to have more training hours than the federal requirements.

According to PHI, in 1987, the federal government set a training standard of 75 hours, including a minimum of 16 hours of clinical training, for both home health aides and CNAs who are employed by Medicare-certified nursing homes or home care agencies.

"Our analysis shows that state home health aide training requirements have not kept pace with their nursing home aide training requirements, even though these direct-care workers provide essentially the same care and services," said Steve Edelstein, PHI national policy director. "Although it is clearly time to revisit the federal standards, having states move ahead on their own to upgrade training requirements is a step in the right direction."

In Retooling for an Aging America, a 2008 report, the Institute of Medicine (IOM) recommends that the federal minimum training requirement be raised to at least 120 hours for both CNAs and home health aides and that competency in elder care be demonstrated as a criterion for certification.

The PHI analysis also found that:

• 4 states meet the IOM recommended training standard for home health aides
• 14 states meet the IOM recommended training standards for CNAs
• 13 states require more than 16 hours of clinical training for home health aides -- the federal minimum training requirement
• Of the states that exceed the federal training standard, 9 require home health aides to be CNAs, and 4 allow CNAs to become home health aides with supplementary training.

The majority of direct-care workers, including personal care aides, are employed in home and community-based settings. And with the growing of hospice and other services look for this to continue. By 2018, home and community-based direct-care workers are likely to outnumber facility workers by nearly two to one.

"Current federal training standards have not kept pace with changes in public policy and services delivery and do not adequately prepare the direct-care workers who provide the lion's share of paid hands-on long-term care," Edelstein said.

This is particularly troublesome in the wake of increasing scrutiny and regulations such as Red Flag Rules and other requirements.

Some of this gets back to the issue of whether long-term care work is a "job" or a career and it needs to be the latter. That is why career ladders in long-term care are so important.

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@Jorg Greuel, Getty Images