Although most of us don’t want to admit it, we’re all getting older. Population demographics indicate that U.S. residents are aging at an unprecedented rate. By 2030, 20% of the population will be older than 65; by 2035, that percentage will rise to 25. “Such numbers will only increase the prevalence of people needing assistance to live independently,” said Clare Luz, a gerontologist at MSUCOM. “There will be greater need for special housing, transportation and basic living help, such as bathing, cooking, cleaning, dressing, transportation, even staying socially connected.”
Unfortunately, accompanying this increase in demand for long-term supports and services is a severe shortage of personal care assistants, or PCAs. Known by many titles, unlicensed PCAs provide in-home assistance to those who are sick, injured, disabled or elderly and fragile. In Michigan alone, it is estimated that 32,000 additional direct care workers will be needed by 2020.
Fortunately for Michigan—and the nation—Luz, an assistant professor of Family and Community Medicine with extensive clinical and research experience in the aging field, particularly related to PCAs and the home care workforce, has been conducting research and outreach on this topic for decades. She recently received a second two-year grant from the Michigan Health Endowment Fund to continue her work through IMPART (Integrated Model for Personal Assistance Research and Training) Alliance, an organization aimed at building an infrastructure in Michigan to support the PCA workforce.
IMPART grew out of an earlier federally funded project that allowed Luz, in collaboration with the state Office of Services to the Aged, PHI, and multiple community partners, to develop and to test a comprehensive 77-hour, 22-module PCA training program. No federal training or competency requirements currently exist for PCAs. Called BTBQ (Building Training…Building Quality), the program was enormously successful in terms of increased PCA knowledge, skills, job marketability and other positive outcomes. Two follow-up studies demonstrated a clear association between BTBQ training and reduced costly adverse client events, such as falls and emergency room visits, confirming the need for such training among the PCA workforce. Luz continues to pursue ways in which BTBQ can be affordably and practically adopted by PCA employers.
This federal grant project was followed by an initial grant from the Michigan Health Endowment Fund to support the establishment of IMPART Alliance. In addition to training, IMPART explores the reasons behind the PCA shortage and works to address them— from the need for proper training to inadequate pay for the work performed. IMPART Alliance believes all the reasons need to be addressed simultaneously in a statewide, systematic, integrated, coordinated way.
“Another goal for this grant was to build capacity and infrastructure to scale up BTBQ, so it could be taught statewide, even nationwide,” explained Luz. “To implement this program throughout the state, we quickly realized that we would need more trainers, so we developed an IMPART- BTBQ Trainers Certificate Program. Two cohorts of people receiving this training are just now finishing up the pilot program, which will give us 24 new trainers.”
However, Luz explained that such training becomes irrelevant if the numbers of PCAs remains low because of poor compensation. “Current PCAs make less than $11/hour, so IMPART Alliance also works to increase the perceived value of these workers. “We address the reasons behind the shortage from multiple angles: training, advocacy and trying to start a PCA professional association. The workforce needs to be professionalized, with ethical and educational standards, even networking opportunities.”
The current grant, which extends from 2018 to 2020, includes developing a Master Trainers Certificate Program so there will be master trainers to teach the next cohort of BTBQ trainers—and continue the expansion of a well-trained PCA workforce. Luz is currently establishing a Caregiver Training Academy—an umbrella organization for all of IMPART’s training programs. There are plans to move some of the knowledge-based BTBQ modules, such as understanding dementia or the philosophy of person-centered care, online. Hands-on training, such as bathing and transferring a patient to a wheelchair, would remain classroom based. Luz is also developing an outreach program to establish a PCA technical training program for high school seniors in partnership with the Grand Ledge School District. Funded by the Michigan Health Endowment Fund, planning is underway and the first class of students will begin a pilot year at Grand Ledge High School in October 2019.
With programs such as IMPART Alliance and people like Clare Luz leading them, there’s hope for the future of the aging population and those who care for them.