March 2025

This month is Women’s History Month, celebrated in the U.S., U.K., and Australia, and International Women’s Day was March 8. Women comprise a disproportionate share of workers providing long-term services and supports, with the share of women ranging from 50% among those with doctorates to nearly 90% among those with less than a high school degree, according to research led by our colleague Janette Dill at the HWRC focused on the public health workforce at the University of Minnesota. As we celebrate and learn more about women’s history in the U.S., we recognize that it is closely intertwined with the care work that women provide both here and worldwide. 

Joanne Spetz, PhD, FAAN

Director

The increasing prevalence of Alzheimer’s disease and related disorders (ADRD) presents significant challenges to health systems. Primary care clinicians, often the first point of contact for patients with ADRD, play a crucial role in their care. Despite being frontline providers, primary care clinicians face numerous barriers, including insufficient knowledge, lack of training, and inadequate resources, which hinder the effective diagnosis and management of dementia. In a Health Affairs Scholar publication, Allisa Berstein Sideman, Assistant Professor of Medical Anthropology and Health Policy at UCSF, and colleagues highlight their findings on family physicians’ perspectives on outcomes, processes, and policies in dementia care. This qualitative study consisted of semi-structured interviews with 20 family physicians across the U.S. to explore their perspectives on ADRD care. The study aimed to identify outcomes that primary care providers consider most important in caring for people with ADRD and propose strategies to enhance care quality. 

New Report on Tribal Community Health Representatives (CHR)

The Community Health Representative (CHR) Program, initiated by the Indian Health Service (IHS) in 1968, serves as a pivotal component of healthcare delivery in American Indian and Alaska Native (AIAN) communities. Distinct from non-tribal Community Health Workers (CHWs), CHRs are tribally-based community health workers who provide culturally responsive health services, primarily under tribal operation.

A new publication by Jackie Kaslow, Kurt Schweigman, Celena Donahue, and Susan Chapman assesses the sufficiency of the CHR workforce in tribal and urban settings, particularly regarding their training, resources, and ability to meet the healthcare needs of elders. By centering the voices of CHRs, the study sought to understand the impact of organizational support, structural and community-level determinants, and AIAN culture on the CHR role.

One CHR described caring for tribal elders: “I would say I am their comfort person. I'm their middleman between the doctor and the patient or the elder. I am their support. I mean, that's what I feel. I'm their go-to if they need me in any way night or day. If I can't help that night, I definitely will that next morning, first thing that morning. But if emergency, I'm definitely there.”

Read the report here.

Training Standards for Personal Care Aides Across States: An Assessment of Current Standards and Leading Examples

There is no national standard for Personal Care Aide (PCA) training. As a result, PCAs are not consistently prepared for their roles and are often unable to translate their knowledge and experience from one state, setting, or employer to another. Our first report on PCA training standards in 2014 found that 11 states had no PCA training requirements, and only 19 had uniform requirements across all programs.

This new report provides a detailed update of the current landscape of PCA training standards in the United States and high-level recommendations for universal standards that should be adopted to ensure consistent training and care. The study aims included:

• Identifying training requirements in Medicaid state plans, home and community-based services (HCBS) waiver programs, and home care licensing rules for every state and the District of Columbia;
• Assessing training requirements in each state with regard to the consistency and rigor of those requirements and the portability of the required training;
• Describing “leader states” with the most consistent, rigorous, and portable requirements and portable credentials.

Findings indicated that while there have been gains in state-based efforts to improve PCA training, there is still a need to improve training consistency, rigor, and portability across states.

Read the report here.

The UCSF Health Workforce Research Center on Long-Term Care (UCSF HWRC) is a dynamic hub of policy-oriented research and investigation, established through support from the National Center for Health Workforce Analysis in the U.S. Bureau of Health Workforce. UCSF HWRC closely examines the health care workforce and helps shape policies to meet expanding LTC needs. Our research includes the workforce in nursing homes, home health care, adult day care, community-based settings, and home settings, and includes all LTC occupations.

Director: Joanne Spetz, PhD, FAAN

Deputy Director: Susan Chapman, PhD, RN, FAAN

Associate Director for Research: Laura Wagner, PhD, RN, FAAN

Visit: https://healthworkforce.ucsf.edu/about

Follow on Twitter: @ucsfhwrc

This newsletter highlights new HWRC publications, as well as workforce-related research conducted by our team at the Institute for Health Policy Studies and Healthforce Center at UCSF, and other research partners.