Report: Advancing the Home Care Workforce

5. Barriers and Opportunities for Large-Scale Adoption In prior sections, we identified some of the effective components of training programs designed to elevate and advance home care workers and how they have been funded, and whether they have been sustainable. In this section, we examine factors that affect the uptake, or what we call the large-scale adoption, of these kinds of programs, from a stakeholder perspective. Our analysis draws on published commentaries and our interviews (see Appendix 3). A summary of the main points is provided in Table 5. Table 5: Summary of Barriers and Opportunities for Uptake of Home Care Worker Training Programs 1. Worker uptake of the program depends on increased wages, social status, and the costs (including transportation and time constraints). 2. The low social status of workers is a barrier to families and clinicians recognizing the value of training and integration. 3. Nurse Practice Acts and concerns about liability continue to constrain advanced roles. 4. Labor Management Partnerships have been highly successful but are largely limited to large coastal cities. 5. Fragmentation of home care and home health industry and small size of most firms is a major barrier to uptake. 6. Health systems and MCOs do not yet see the value proposition but could be important change agents. 7. The most widely adopted programs had significant grassroots advocacy leading to state sponsorship. 8. The Federal government plays a role as payer and regulator, as well as the sponsor of innovative programs. The American Rescue Plan provides significant new funding for states that can be used to invest in the direct care workforce. 9. Philanthropy has played a role in creating training programs but has rarely helped with scaling up the initiatives.  Worker uptake of the program depends on increased wages and social status, as well as the costs (including transportation and time constraints) The literature and our expert interviews suggest that while training leads to feeling more comfortable in the job and better prepared, wage increases and recognition are key ingredients to ensure worker uptake and the sustainability of programs. That said, the ongoing THRIVE program (western NY, northeast OH, southeast MI) provides an interesting natural experiment that will help establish ether it is possible to improve retention through soft skills training, without wage increases tied to the educational achievement.

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