Report: Advancing the Home Care Workforce


Worker Respect and Wage Recognition

Many programs made efforts to recognize workers’ value and advancement formally. This recognition came through formal title changes denoting upward career movement in the programs we identified that created advanced roles for HCWs. Examples of formal titles included “Advanced Home Care Aide Specialist”, “Supportive Home Care Aide”, “Level 2 Peer Mentor”, and “Senior Aide”. Several programs also instituted wage increases or compensation commensurate with advanced roles or specialty training – a factor advocates, and experts consider necessary to retain and sustain a strong home care workforce. Although applied inconsistently across programs in our scan, all those instituting formal advanced roles incorporated a pay increase. However, even when wage increases have been instituted for PCAs, they are still recognized as too low for a living wage for workers. 45 In most cases, workers in advanced roles received hourly wage increases. However, Care Connections Senior Aides and Cooperative Home Care Associates Level II Peer Mentors (both HHA programs based in NYC) are salaried, offering consistent pay with earnings significantly greater than those of entry-level HCWs. In addition, while the provision of health care benefits is associated with HCW job satisfaction and intent to stay at their jobs, many HCWs lack employer-sponsored health insurance. The SEIU Healthcare NW Training Partnership (WA), which offers a suite of basic and advanced training opportunities for PCAs, also provides medical, prescription drug, vision, and dental benefits to home care aides in Washington and Montana through the program’s sister Health Benefits Trust. The Trust is sponsored by a labor-management partnership, which includes the workers’ union, the state of Washington, and home care agencies. A case study on the training partnership revealed that aides highly valued health coverage. 4.2. Multiple Pathways for Advancement Many of the programs identified in our scan offered more than a “one size fits all” or “one and done” approach to career development by providing multiple pathways for HCWs to enhance their skills or advance in their roles. For example, the SEIU Healthcare NW Training Partnership (WA) offered career advancement opportunities ranging from formal advanced roles of a peer mentor and advanced aide, to upskilling in diabetes care or medication administration, to management opportunities within the training organization. The Apprenticeship Program in Michigan aims to develop a ‘staged credentialing’ program model in which HCWs advance from PCA to HHA to CNA with increased training. Other training programs, such as QuILTSS (TN) and several of the PHCAST models, have promoted clearly defined career lattices, along with graphics to aid in the visualization of career advancement from entry-level to professional management roles.


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