The Increase in Contract CNA Staffing in US Nursing Homes and Associated Care Quality Outcomes

Higher levels of certified nursing assistant (CNA) staffing are positively associated with improved care quality outcomes for nursing home residents, but low wages and other job-quality concerns drive high turnover and job vacancies within the CNA workforce. Evidence suggests that nursing homes have addressed workforce pressures by increasing their reliance on contract CNAs from staffing…

Leader States in Personal Care Aide Training Standards

Although previous research has demonstrated a paucity of standards in most states, a few have engaged in a rational approach to designing personal care aide (PCA) training standards with the goal of better preparing these essential frontline workers to provide care. This research brief highlights 7 “leader states” in training standards for Medicaid-funded personal care…

The National Landscape of Personal Care Aide Training Standards

Some state Medicaid-funded programs enable older adults and individuals with disabilities to reside safely in their homes and participate in their communities. In the absence of federal standards, there exists wide variation in minimum training requirements between states and between programs within states. Most of the existing state training requirements are relatively undeveloped compared with…

California’s Medicaid Personal Care Assistants: Characteristics and Turnover Among Family and Non-Family Caregivers

Personal care assistants (PCAs) provide support that enables older adults and individuals with disabilities to remain in home and community settings. This study characterizes the role played by family members and non-family PCAs in California’s Medicaid program, which oversees the nation’s largest consumer-directed personal care assistance program. We describe factors that affect turnover among PCAs,…

Entry and Exit of Workers in Long-Term Care

In the past decade, the health care industry, and long-term care (LTC) in particular, saw substantial job growth. In anticipation of growing demand for LTC due to an aging demographic, employment opportunities in LTC are expected to surpass those of other US sectors. Workforce planners are concerned about ensuring an adequate pipeline of appropriately trained…

Education, Certification, and Roles of Peer Providers: Lessons from Four States

Peer providers are individuals hired to provide direct support to those undertaking mental health (MH) or substance use disorder (SUD) recovery, often referred to in the literature as “consumers.” The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a peer provider as “a person who uses his or her lived experience of recovery from…

Dementia Care Coordination Workforce and Practices in Seven Duals Demonstration States

As health systems continue to evolve toward more managed care models, care coordinators are playing an increasingly important role in ensuring that people with Alzheimer’s disease or related dementias (ADRD) receive appropriate, well-coordinated, and cost-effective care. Research has shown that effective care coordination and referral to services and supports for patients with ADRD and their…

The Peer Provider Workforce in Behavioral Health: A Landscape Analysis

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines a peer provider as “a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and resilience. Peer providers have traditionally worked as…

Trends in Licensed Practical Nurse/Licensed Vocational Nurse Education and Licensure

Licensed practical nurses (LPNs), referred to as licensed vocational nurses (LVNs) in some states, are the second-largest health care occupation that requires postsecondary education. More LPNs work in long-term care (LTC) than in any other sector. Demand for LPNs among long-term care providers is expected to increase substantially over the next several decades. Thus, there…

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