States consider various strategies to improve delivery of HCBS and to support the recruitment and retention of the direct care workforce as demand rises for home care. Some states and health plans target improved reimbursement and workforce protections such as workers’ bill of rights laws. Others focus on training programs for direct care workers to help improve skills and job and consumer satisfaction.
Benefits, Wages & Workforce Protections. Some states have looked to wages, benefits and other workforce protections to support their direct care workforce. Colorado SB 238 (2019) establishes a new hourly minimum wage for employees who provide direct care. Maryland HB 166 (2019) increases the rate of reimbursement for community service providers, including direct care staff, each fiscal year (beginning with a 3.5% increase in 2019).
Other bills passed in recent years support better benefits and worker protections. In 2017, Wisconsin increased the direct care portion of funds paid to managed care companies that go towards wages, bonuses, time off, or benefits through the general appropriations bill. Additionally, a handful of states, including Oregon, Illinois and Nevada, have passed “Domestic Workers’ Bill of Rights” laws. These generally extend workplace harassment and overtime protections to domestic workers, which often include home care workers.
Training. Other states focus on strategies to improve the quality of the direct care workforce through training and career advancement opportunities. Research indicates direct care workers succeed when they can access high-quality entry-level training, ongoing education opportunities and defined career ladders. Some efforts may also enrich the perceived value of direct care jobs for future candidates and improve recruitment and retention.
Washington passed a 2011 ballot initiative that expanded learning objectives, increased training hours
, and introduced certification requirements for PCAs. The initiative requires the state to approve all pre-service training and continuing education, and the curricula must be more relevant to the specific needs of patients, service settings and the trainees’ career development. After meeting the certification requirements, PCAs can complete condensed training to become an HHA or a nursing assistant. Arizona also addressed training by implementing a uniform, statewide and state-funded training system in 2012, following recommendations from their Direct Care Workforce Committee.
Other policies focus on specific curricula to meet the unique needs of certain populations. Illinois enacted SB 2301 (2016), establishing minimum training requirements for employees of home health agencies providing services for people with Alzheimer’s and related dementias. Similarly, Oregon’s HB 3359 (2017) outlined specific training on dementia care to direct care workers.
Other Strategies. A few states are looking at alternative policies that help address their workforce needs. The Texas Health and Human Services Commission issued a 2018 report as mandated by the legislature) to improve recruitment and retention among state Medicaid-funded personal care aides.
Some states, including Maine and New Mexico, have convened stakeholder task forces to consider ways to support and strengthen the direct care workforce.
In 2018, Minnesota launched Direct Support Connect, a statewide job board that helps consumers find direct care workers and helps workers find the right employment fit. The Minnesota Department of Human Services created this resource to help address the shortage of direct support workers in the state.