California’s Medicaid personal care assistants: Characteristics and turnover among family and non-family caregivers

Source: Michelle Ko, Robert Newcomer, Andrew B. Bindman, Taewoon Kang, Denis Hulett, and Joanne Spetz, University of California – San Francisco, Health Workforce Research Center on Long-Term Care (UCSF HWRC), July 15, 2015

From the press release:
The US is facing a major shortage of workers in long-term care, including those who provide assistance with activities such as eating, bathing, getting dressed. Personal care assistance can enable older adults and individuals with disabilities to remain in their homes and community settings. A number of factors, including long hours and low wages, contribute to the overall shortage as well as high rates of turnover among personal care workers.

In their study, California’s Medicaid Personal Care Assistants: Characteristics and Turnover among Family and Non-Family Caregivers, UCSF Healthcare Workforce Research Center authors Michelle Ko, MD, PhD, Robert Newcomer, PhD, Andrew B. Bindman, MD, Taewoon Kang, PhD, Denis Hulett, MS, and Joanne Spetz, PhD examined two policies aimed at bolstering the personal care assistant (PCA) workforce: (1) paying family members to provide personal care services; (2) paying personal care assistants higher wages. The authors analyzed the relationships between these two factors and the likelihood of turnover among PCAs in California’s Medicaid personal care program, In Home Supportive Services (IHSS). IHSS is the largest Medicaid personal care program in the nation, serving nearly 470,000 recipients in home and community settings. It is also a consumer-directed program, which allows recipients to choose any individual, including family members, to provide care and be paid for these services by Medicaid. In California, family members make up over 60% of IHSS personal care assistants.

The analysis revealed: (1) The likelihood of turnover among family member PCAs was less than half that of non-family PCAs; (2) Higher payment rates for non-family PCAs was associated with a lower likelihood of turnover; and (3) Racial and ethnic minorities with non-family PCAs experienced disproportionately higher rates of PCA turnover. The authors conclude that paying family members to provide care and paying higher wages may be keys to stabilizing the long-term care workforce and improving continuity of care. Further, elder and disabled minorities who do not have family members to provide care likely need additional support to reduce turnover among their PCAs.