Wanted: 9,000+ home care workers

The state has a massive need for more home care workers, but the lack of clear standards for the jobs makes it difficult for the work force development system to create training programs, an education and work force expert said Friday.

“The work force system is set up to provide training based on the acquisition of an industry certification if possible at the end of the training, so we can guarantee that training resources are aligned with employers’ needs,” said Alice Pritchard, executive director of the Connecticut Women’s Education and Legal Fund. “In this instance, we can’t find anything to grab ahold of.”

Pritchard spoke as part of a forum on meeting the demand for the home care work force, hosted by the Connecticut Commission in Aging.

The state is expected to need more than 9,000 additional home care workers by 2016, and officials say meeting the demand is critical to meeting the state’s goal of allowing significantly more people to receive long-term care at home or in community-based settings, rather than in institutions. By 2030, the population of Connecticut residents aged 65 and older is expected to grow by 64 percent, while the population under 65 is projected to shrink.

The Commission on Aging has developed a strategic plan for work force development, which calls for promoting work force initiatives that both support consumer choice and self-direction and enhancing recruitment, retention and training of direct care workers; creating a pipeline of direct care workers with opportunities for career ladders through work with the state’s work force system; creating equity across state-funded home care programs operated by different agencies; and raising awareness of the importance and value of home care work and unpaid caregivers.

While an effort to unionize home care workers in state-administered programs has drawn attention to the jobs’ wages and lack of benefits, much of the discussion at Friday’s forum focused on other aspects of the work force, including the idea of creating standards and the need to develop policies that support the choice, autonomy and dignity of the people receiving services.

Home health aides are licensed by the state and must receive training, but many people who provide home care through state-funded programs are unlicensed and get their training from the people they serve. Some people advocate creating centralized training or certification standards as a way to help build the work force.

But others say it could be problematic because the work is individualized, and many people who get services prefer to train their workers themselves.

Pritchard said if the work force system knew what core competencies home care workers needed, it could work with community colleges to develop training.

“You don’t want them to train for you until you tell them what you need, so you have to decide what you need,” she said.

But she acknowledged that doing so could be challenging, since some people who get home care want to provide all the training to their workers while others would prefer their workers come fully trained with specific expertise. There likely won’t be just one set of competencies, she said.

Sherry Ostrout, director of government initiatives for Connecticut Community Care Inc., said there’s agreement that core competencies for the work are attitudes, values and relational skills that are fundamental to “person-centered work.”

“Anything above and beyond that are skills, they are task-related, they are a different type of competency, but I think we all can agree on the relational aspects of things,” she said.

As for certification, she said, “I do not believe that there’s anyone around this table who is fundamentally against certification. I think where the discrepancy is or where there’s disagreement is around any type of mandate around certification.”

Ostrout said it will also be important to have a pipeline for people to become home care workers, career ladders so people could advance to other jobs, and a way to make home care a valued, visible profession.

“Sometimes I feel like it’s an underground profession,” she said.

Dawn Lambert, a Department of Social Services official who serves as project director for the Money Follows the Person Demonstration, the vehicle for the state’s efforts to expand the availability of home care, spoke of the importance of ensuring that policies preserve people’s autonomy, including their ability to choose to take risks. She noted that people choose to take risks when they get in their cars, get on an airplane or go skiing.

“The question then is that why does a sudden onset of disability or the fact that we are graying and aging mean that those choices and the ability to be autonomous in our daily lives is taken away from us?” she said.

Lambert noted that the government’s role is to protect people, but said it’s critical to find a balance that allows people who receive long-term care services to make choices about what’s best for them, even if they’re not the decisions professionals would make.

“It’s so fundamental, from the perspective of Money Follows the Person and the systems we’re designing,” she said.

Susan Raimondo, senior director of advocacy and programs at the National MS Society’s Connecticut Chapter and one of an estimated 711,000 unpaid caregivers in the state, spoke of the need to support caregivers and make it easier for people to get coverage for home care. Her husband, who has multiple sclerosis and lives at home, has been on a waiting list for a state program that would help with his care for more than a year. But Raimondo said expanding access to the program wouldn’t mean that family caregivers would suddenly stop helping out and lead to even more demand for paid services, as some policymakers fear.

“When he gets that program, that program will help us increase the amount of help, but I’m not going to stop using our own funds, I’m not going to stop doing what I’m doing,” she said. “But it’s going to make it a little easier.”