Testing U.S. State-Based Training Models to Meet Health Workforce Needs in Long-Term Care

Aug 30, 2026

The U.S. health care system and its workforce are rapidly shifting to meet the triple aim of lowering costs, raising quality of care, and improving patient experience. Demand is rising for personal and home care aides (PHCAs) as chronic disease, medical complexity, and dementia increase client needs. State training standards for PHCAs are often minimal, with employers providing limited oversight. This study presents case studies of six Affordable Care Act–funded state training models, outlining recruitment, curriculum design and delivery, and transferable lessons for international model development.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages18

Reading Time45 min

AccessFree to download

Introduction

Need for long-term care workforce capacity

Shifting system priorities in the U.S.

Purpose and study approach

Six state-based training models for PHCAs

Recruitment, curriculum design, and delivery methods

Testing U.S. State-Based Training Models to Meet Health Workforce Needs in Long-Term Care Jennifer Craft Morgan 1 & Nadine Edris 2 & Clare C. Luz 3 & Daniel P. Ochylski 4 & Anita Stineman 5 & Leanne Winchester 6 & Susan A. Chapman 7 \# Springer Science+Business Media New York 2017 Abstract The US health care system and its workforce is rapidly changing to meet the triple aim of reducing costs, increasing quality of care and improving the patient experience. There is a need to align training models with system needs and patient preferences in ways that allow the most cost effective members of the care team to shoulder increasing shares of this care (Ricketts and Fraher, Health Affairs, 32(11), 1874–1880, 2013) . One entry-level and in-demand class of health care workers are personal and home care aides (PHCAs) . The US Bureau of Labor Statistics projects a 26% increase in PHCAs to over 2.2 million workers by 2024 (OOH 2014) . System needs for rebalancing care from institutional settings into the community and patient preferences for in-home care have aligned to drive the need for PHCAs. The increasing prevalence of chronic disease, medical complexity and dementia mean that these workers will be required to handle increasingly challenging clients and function as a key member of increasingly integrated health care teams. Therefore, the development of new models of education and training are necessary. Standards for PHCA training are quite low (Marquand and Chapman 2014) and states leave most training to * Jennifer Craft Morgan [jmorgan39@gsu.edu](jmorgan39@gsu.edu) 1 Gerontology Institute, Georgia State University, PO Box 3984, Atlanta, GA 30302-3984, USA 2 University of Southern Maine, Portland, ME, USA 3 Michigan State University, East Lansing, MI, USA 4 Jonas Nurse Leader Scholar, Washington, DC, USA 5 College of Nursing, University of Iowa, Iowa City, IA, USA 6 University of Massachusetts Medical School, Worcester, MA, USA 7 School of Nursing, University of California at San Francisco, San Francisco, CA, USA employers with little to no oversight (Kelly et al. Journal of Applied Gerontology, 32(7): 804–832, 2013) . The purpose of this study is to present case studies of six statebased training models for PHCAs funded by the Affordable Care Act. We discuss state approaches to recruitment of trainees, curriculum design and delivery methods, and key lessons learned to inform model development internationally. Keywords Workforce . Long term care . Training models . Direct care workers Introduction Providing high quality, person-centered, aged care is a persistent challenge for many countries with rapidly aging population structures. Most developing countries, whether or not they have single payer or public health service, are experiencing limits to their capacity for service provision for long term care (Nakrem et al. 2009) . Shortages in the long term care workforce, especially among home care aides and nursing assistants have been persistent and well documented in the US and Europe (Hussein and Manthorpe 2005) . Strategies for meeting the aged care labor force needs are varied from encouraging immigration for domestic and care laborers (Browne and Braun 2008), to encouraging women’s labor force participation, to developing home safety and monitoring technology, and developing systems for individuals to share care labor where the individual pays in with care labor now and saves credits for when they have need. While a large numbers of workers are needed to meet the need for services, both the cost and the quality of service provision is central to developing capacity regardless of country context. Due to both high cost and projected shortage of health care professionals in nursing and medicine, the established hierarchy of health care professions does not meet the required capacity. A World Health Organization (WHO) report on home care in Europe found a global concern about a shortage in the home car

FAQs

Why are personal and home care aides (PHCAs) a growing priority in the U.S. long-term care workforce?

PHCA demand is driven by rebalancing care toward the community and by patient preferences for in-home care, alongside rising needs from chronic disease, medical complexity, and dementia.

What problem does the study highlight about existing PHCA training standards?

PHCA training standards are described as relatively low, with many states leaving most training to employers that provide little to no oversight.

What does the study aim to do with six state-based training models?

The study presents case studies of six Affordable Care Act–funded models and analyzes state approaches to trainee recruitment, curriculum design and delivery, and key lessons for informing model development internationally.

Aug 30, 2026

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