Report: Advancing the Home Care Workforce

2.1.2. Upskilling Upskilling is intended to bridge the gap between workers’ entry-level preparation and the competencies required to meet the complex needs of today’s long-term care consumers through additional training. As compared to formal advanced roles in which HCWs may acquire different skill sets, upskilling typically focuses on bolstering training in areas within workers’ existing scope of responsibilities and does not necessarily result in a promotion or wage increase. 17 Advocates we interviewed maintained that upskilling of HCAs is essential to seniors’ ability to age in place and receive LTSS in the home. However, the feasibility of upskilling PCAs and other HCWs is heavily determined by states’ nurse delegation and scope of practice regulations, which are codified in their nurse practice acts. This is especially true of nurses’ ability and willingness to delegate the administration of medications to HCWs. Nurse delegation considerations are discussed further in subsequent sections of this report. Eldercare advocates emphasize the need for HCWs to receive training in areas and tasks relevant for the geriatric population, including mental health, palliative care, Alzheimer's Disease and Related Dementias (ADRD) care, and effective communication with the interdisciplinary care team and family members. “Hard skills” taught may include medication maintenance and administration, wound care, insulin monitoring, and pain management. 23 The programs we identified that employed upskilling aimed to develop knowledge and competencies related to ADRD, mental health, chronic disease management, medication administration, diabetes care, heart failure, and health coaching. The state of Massachusetts provides a long-standing state model for upskilling through their Supportive Home Care Aide program, instituted in 1995. Training consists of 75 hours of HHA training plus 12 hours of advanced specialty training in either mental health or ADRD care. Continued upskilling support is provided through quarterly team meetings, case reviews and in- services, and ongoing supervision. Supportive Home Care Aides receive higher average starting wages than other DCWs in Massachusetts. 49 The Family Care Advocate Training for Experienced Aides (AR) provides a more localized example of an upskilling program for PCAs. Based at the University of Arkansas for Medical Science’s Schmieding Center for Senior Health and Education, the 40-hour Family Care Advocate training was restricted to experienced caregivers and focused on chronic disease management and communication. Additionally, experienced advocates were eligible to complete a 16-hour ADRD training. A CMS Healthcare Innovation Award allowed the center to extend the program to satellite sites in CA, HI, and TX and provide a microfinance option for trainees, but both initiatives were terminated at the end of the grant period. The Partners in Care Health Coaching Pilot Program, an NYC-based initiative, provided an alternate approach to upskilling by training HHAs to be health coaches. HHAs had to have at least


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