Empowerment and Constraint: Design of a Homecare Worker Training Program

Abstract

A worker education center in California requested the development of a job training pilot program for 6,000 state-remunerated homecare workers. These workers provide personal care services to Medicaid-eligible adults over 65 years of age and to adults with disabilities, enabling them to remain living at home. In recognition of the homecare workers’ position as a first line of defense against health crises and costly hospitalizations, the center sought to enhance their roles by training them to be more engaged members of the care team and more knowledgeable in health and safety topics. The training design was challenging for two reasons. First, in California, consumers (recipients of care) are the legal employers of their homecare workers and are their designated job trainers. This hard-won right clashed with elements of the center’s training initiative. Second, diverse linguistic backgrounds limited education and low literacy levels among homecare workers led to a non-traditional approach to worker training that required buy-in from diverse stakeholders. The design process was fast-paced and iterative, involving research around themes established by committee, coordination with an illustrator, and numerous revisions in consultation with subject matter experts, including a disability rights advocate who was also a consumer. The result was a hands-on, collaborative design rooted in social constructivist learning theory. After two years, health outcomes among consumers whose homecare workers received training were positive, leading us to infer that both the design and the efforts to address learners’ needs and consumers’ concerns had been effective.