Corinne Eldridge, President and CEO of the Center for Caregiver Advancement: Why In-Home Caregivers Need Training

Van Ton-Quinlivan

Hello, I’m Van Ton-Quinlivan, CEO of Futuro Health, welcoming you to WorkforceRx, where I interview leaders and innovators for insights into creating a future-ready workforce.

As the US population continues to age and rates of dementia increase, policymakers, advocates and other stakeholders are paying closer attention to what’s needed to produce an adequate direct care workforce to meet the need.

A new study on the efficacy of online, competency-based training for this workforce has yielded some interesting results and we’re going to take a look at those findings, and at other training innovations, with Corinne Eldridge, president and chief executive officer of the Center for Caregiver Advancement, which was involved in delivering the training.

Since its founding 25 years ago, CCA has trained more than 70,000 in-home caregivers and nursing home workers. Thanks very much for joining us today, Corinne.

Corinne Eldridge

Thanks so much for having me, Van. It’s really a pleasure to be here with you today.

Van

Absolutely. Well, let me just ask you the big question that is on people’s minds: in this rapidly aging nation, what should we be worried about when it comes to having the care workforce that we need either for ourselves or for our loved ones?

Corinne

Gosh, starting out with quite the big question here! There’s so many things to be worried about. I think that there’s a lot of things that we should really be doing to contemplate how we attract and retain care workers to take care of older adults and individuals with disabilities, because it actually is both.

The older adult population is certainly increasing as we look at the demographics across the country, but certainly within California. And then if we look at the language needs for those older adults in California, it’s also really important to have culturally competent, linguistically competent caregivers. When we think about training to ensure that older adults are getting quality care, there’s actually no consistent funding for training for IHSS workers across the state. There’s so many things to unpack here and you know with the caregiving population, IHSS caregivers are caring for Medi-Cal eligible older adults and people with disabilities and so there are several layers about what is needed to really help ensure our most vulnerable across the state have what they need to age in place and in their place of choice in their home.

Van

Corinne, I’m curious, are other states doing better than the state of California?

Corinne

It’s a hard question to answer in that way. California is really unique in that California prioritizes home and community based services. That’s a really good thing. And so instead of having a large number of institutions compared to our population, we have an IHSS workforce that is over 700,000 workers which is more home care workers in California than there are in all of the other states combined.

When you look at institutional care like skilled nursing facilities, there’s about a thousand in the state, which for a state our size, is small. You know, there’s pros and cons. There are other states that have a much smaller workforce for home care. Like Washington…I think they have about 40,000 home care workers and they do have a very robust training program there with wages and registries and things that really connect workers to the consumers who need the care. So I think every state has a different set of both population and government situations that folks are working on that are really unique to the state.

Van

That’s helpful to understand the state-by-state differences. So, Corinne, you’re a big believer in being informed by research and data and have formed a number of academic research affiliations, and the study I referenced at the beginning is the most recent example. Please do share your research efforts and how they’ve influenced the work of your organization.

Corinne

Thanks so much for that question. The research and impact studies are one of the things I’m most proud of for our organization. We’ve really been able to build partnerships in terms of building the value of what training can do for both the IHSS worker and the consumer who is receiving the care.

We have been a pioneer in this work, starting with a study that ended in 2016 which was the first of its kind across the nation where training was the intervention. Researchers at UC San Francisco measured the impact that the training had on consumers who received that care. This was a Center for Medicare and Medicaid innovation program. And we were able to show that by training IHSS workers, there was reduction in emergency room visits and

hospitalizations for consumers. It also showed that there was greater retention for the workforce when you looked at workers who had taken our training program compared to workers who had not.

We’ve continued building up these research partnerships since then. In 2017, we built up our first Alzheimer’s disease and related dementia training program in a partnership with UCLA through a geriatrics workforce enhancement program that they were running. That was done with Dr. Lourdes Guerrero, who’s now at UCSD, and Dr. Zaldy Tan. This study was able to show that courses proactively and positively impacted students’ knowledge and knowledge gain, and that they could really better translate that care for older adults who are the IHSS consumers.

The Alzheimer’s disease and related dementia — which is the study I think that you were talking about — that work is really special to us in knowing that there are a lot of different layers of individuals who have Alzheimer’s disease and related dementia. Especially when we look at the demographics of California, studies show that it’s Black and Brown communities that have a higher prevalence of the disease, and they are also the communities that are underdiagnosed. When we look at the population of IHSS consumers, there certainly is a higher prevalence of older adults who meet those demographic needs as well, and so having IHSS workers who are trained in this set of skills really makes a difference in being able to understand the signs and symptoms of disease.

That is really what we were able to show in this research study that we just finished last year with Dr. Jarmin Yeh and the UCSF team — I believe she’s been on your show. We trained workers in Alameda County and Los Angeles County and we were able to show that online training improved dementia caregiving skills and improved knowledge significantly, and it also improved self-efficacy to manage the care recipients’ dementia symptoms. Those are pretty significant improvements that we’ve been able to document.

Van

Congratulations. And just to make it real for the listeners, what is an example of how the caregiver may behave pre-training versus post-training, for example?

Corinne

Sure, I think that there’s really a confidence building. Caregivers come to this work because they care, they have a big heart, but having a big heart doesn’t mean that they are prepared to do what is a both a mentally and physically taxing job. And so the skills that they learn in the class really help them understand how to recognize signs and symptoms. When you look at a disease like Alzheimer’s disease and related dementia, it has a wide variety of shifts that happen over time, and it helps an IHSS caregiver be able to recognize what those signs are and manage particular behaviors like repetitive behaviors, sleep behaviors, wandering, things like that that you may not know how to respond to, or there may very much be an emotional reaction of ‘why are you doing that’ if it’s your mom, right?

You know, it’s hard to separate who you are if you’re related to that person compared to if you are their caregiver. How do you separate those two pieces? And so we actively work on a tangible set of skills as well as helping to separate, you know, if this is a person from your family that you’re caring for, how are you really mindful of focusing on that as opposed to your role as a family member?

Van

Corrine, you might know a more current statistic, but I had gotten the impression, if I recall correctly, that maybe 40% of elder care is done by the family members themselves. And so in this training, does it differ if it’s a family member versus someone who is in the formal IHSS worker classification?

Corinne

Yeah, so in the IHSS population of workers, about 70% of them are family members. But just as a reminder, there’s no mandatory training for IHSS workers, and there’s no funding for it consistently across the state. We train about 2,000 workers a year. And so if you think about the 700,000 plus workers that there are across the state, it’s less than one-third of one percent of workers that have access to multi-week, sequential training programs on a regular basis.

To get back to your question though on family caregivers or non-family caregivers, we teach the same thing. We typically have about 50% who are non-family, 50% who are family. We consistently hear from workers who are family members, though, that having the training program really helps them bucket being a family member and how to separate out what they need to do when they are actually in that caregiving role.

Van

So, we just spoke about Alzheimer and Alzheimer-related conditions. This is not your first foray into condition-specific caregiver training. Can you give some examples of other training programs and their effectiveness?

Corinne

Sure, thank you. We have continued to build on our conditions-specific training programs over the last several years. We had also developed, in 2021, an emergency and disaster readiness training program, which really meets the needs of the population of older adults and people with disabilities who have access and functional needs. When emergencies come up and disasters come up, which we know they do all the time in California, it teaches the caregivers a set of skills around how to prepare for, respond to, and recover from emergency and disasters. For instance, we did have folks who were trained, who were then able to better help their consumers through the fires in Altadena.

We have been able to also expand our programs through the state’s Career Pathways program. Through that program, we had autism spectrum disorder training — which had wait lists in the thousands — which I’m sure you can imagine is a big need. Traumatic Brain Injury, diabetes care, nutrition, heart and lung disease….so a wide variety of condition specific training programs.

It’s important to know that we really pride ourselves in delivering quality training programs. We do what’s called a rapid cycle feedback process where we have consumer feedback in part of building our curriculum. We get IHSS worker feedback in building our curriculum and we always do knowledge competency checks in all of our modules. And so we’re measuring what students learn across all the languages that we teach in. That way we have a consistent feedback loop in terms of is the training doing what we want it to do, and if it’s not, how do we look at it a little bit differently? And then how do we make sure that we’re reporting those results out so that the broader stakeholders who care about this workforce and these consumers see the value of how training really can make a difference, not just for the worker, but for the consumer that they care for.

Van

So I’m sure you’re tracking the trend of shorter hospital stays that then result in the need for more complicated care to be provided in the home. How is CCA addressing that trend or how are you thinking about that trend?

Corinne

Well, I think it really depends on the level of care that an individual needs. So if somebody is coming out of a hospital stay, but they still need clinical care, they’re probably getting care from a home health aide, which is actually different than an IHSS worker. Home health aides provide clinical care, and they’re under the supervision of a licensed nurse. And there absolutely is mandatory training for home health aides. It’s a little bit more than what a Certified Nurse Assistant receives and so that’s more in line with what the shorter hospital stays would require.

Van

I am wondering also, Corinne, this is a tough profession that we need a high volume of workers in and historically the pay has been one of the big issues. So, how are you thinking about career pathways and developing retention in that workforce?

Corinne

Yeah, that’s a great question. It’s the question, right? How do you attract and retain individuals to do this work? This is where we really think about training as a component of building quality jobs. You know, wages are a component of quality jobs, but so is being able to have benefits such as health insurance, retirement benefits, being able to have access to training that makes you feel more confident in your work and that actually keeps you in the work because you have something to look forward to and a way to advance.

Hence our condition specific training programs that really help home in on a set of skills for particular individuals. Those skills also really help create healthier and safer working environments. This is very physical work, so musculoskeletal injuries are very common because you need to know how to lift individuals, and so safe working conditions is also a component of this quality job piece.

Worker agency and voice is something that we also always include in our training programs in terms of how we’re building the training programs and how we’re getting that feedback, because nobody knows better than the worker themselves in terms of what their day-to-day activity is. It’s very isolating, right? They’re not going to a common workplace. They’re working in individuals’ homes, so being able to have that component really helps individuals feel invested in this work knowing that they have some agency to be able to voice their opinion.

Van

Well, thank you for comprehensively thinking about the worker and what the worker needs in order to stay in the job and continue in those roles. I want to give you a moment to talk to us about CCAs in-home supportive services pathways.

Corinne

Yeah, I’d love to be able to talk to you about that. We were very privileged to be able to receive a grant from the California Workforce Development Board for a High Road Training Partnership grant that we just started building out July 1st of this year. It takes several different components of work that we have been doing and builds it out.

We have our IHSS training program for all Alzheimer’s disease and related dementia and our emergency and disaster readiness training program that I’ve mentioned. We’re actually delivering those in e-learning for the first time — which we’re very excited about — in three different languages in three different counties in Northern California: Santa Clara, San Mateo and San Francisco. So we’re very excited about that.

We also have a randomized controlled trial, which is the gold standard of research, that we are doing with J-PAL (Jameel Poverty Action Lab) out of MIT, and they are part of this project too. What they are helping to measure is our essentials training program that’s running in Los Angeles, which is a ten- week training program.

So, when we look at those components together — between our Alzheimer’s disease related dementia, emergency and disaster readiness, and our essentials training program — we have about 2,000 workers. Now of those workers, we’re going to be moving about 200 of them onto our nurse assistant training program to become certified nurse assistants in skilled nursing facilities — and we run those training programs too — and then about 250 of them in Los Angeles County to the backup provider system.

In both of those opportunities, individuals get wage increases associated with their learning. And so it takes the basic level of skill building, allows those individuals who actually want to do something different to be able to take advantage of that opportunity, build a new set of skills, and have wage increases that are commensurate with those higher level of skills.

Van

What does the grant underwrite in this project?

Corinne

The grant underwrites the e-learning components that we have in the Alzheimer’s disease related dementia, emergency and disaster readiness in those three counties. It also is helping to underwrite some of the research that J-PAL at MIT is doing.

We also have a full support system for workers that I haven’t talked about, which is what makes our training program so successful. Our team does recruitment and enrollment support for workers. We do it across all the languages that we teach in. And for e-learning, it may sound like it’s all online, but we also have instructors who are built into the process, so that way when students are going through e-learning and if they have questions, then those questions can be answered not just by a robot but by a real instructor who understands the workforce, understands the teachings, and can really ensure that that is being answered in appropriate ways.

Van

Do you expect a high rate of participation?

Corinne

Yeah. There are employers of record for IHSS workers in every county called public authorities that are actually partners with us in this grant, the same way SEIU Local 2015 is. We’ve worked collectively with them when we wrote the grant and then as we’re building out the work right now. They are also part of the enrollment and recruitment process for this training program. There’s about 850 slots for the eLearning and there’s tens of thousands of workers in those three counties, so we know that there will be high demand and we won’t be able to meet it during the Career Pathways program.

Just as a note, our website used to crash when classes became available. We used to say, gosh, it’s like the Taylor Swift tickets. There’s a real high demand for training. IHSS workers really do see the value in it for what they learn and then how they can bring that back to the consumer to provide better care.

Van

Well, we’re learning about all sorts of good practices and model workforce development programs, thanks to our time with you. It’s so important because as a nation, we have a growing population of the aging, and so the demand on caregivers will be great.

So, let me close out and give you the opportunity to tell us what makes you optimistic about the future of the direct care workforce.

Corinne

You know, there’s no time like the present to see what is a dire need for this workforce and a dire need for the older adults and people with disabilities who depend on them. And so galvanizing people around that during this time is really critical. It’s also time to be creative. I’m a big fan of the phrase, ‘perfect is the enemy of the good,’ so try new things, see what works and maybe pivot from what we’ve always done because it’s a different time right now.

IHSS workers keep people healthy in their homes and that absolutely is something that is optimistic considering so many layers of things that are going. People want to be in their homes and out of institutions, and so we really need to continue to talk about the value of this workforce and tell those stories so that the narrative changes about women, women of color and immigrants who do this work, and their efforts are really seen as a value into the broader healthcare system.

Van

Well, thank you very much, Corinne Eldridge, for joining us today.

Corinne

Thank you so much, Van. It was a pleasure to be here, and I really do appreciate your interest in our work and IHSS workers.

Van

Please keep up the good work. I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.