There need not be a single approach to solving most problems.  It could be argued that taking the one approach stance tends to create more problems than it solves.  Certainly, the single approach tactic results in the tendency to leave fundamental elements of complex problems unaddressed or unresolved.

Those of us who are immersed in the LTC industry know there is a looming shortage of Personal Care Aide (PCA) workers for the home care and assisted living segment.  We also know there is a persistent shortage of PCAs available for the work who are really of the caliber we would want working for our own loved ones. We also know that costs of providing even the most basic level of customer care are in delicate balance and are being threatened with escalation.  We know that escalation will prove catastrophic for our industry.

I own a Long Term Care (LTC) business, and as a business person I am deeply aware of the juggling the impact of operating costs and managing realistic payment options.  These are issues any business owner must constantly dwell upon when navigating the ever changing waters of providing services in a complex and changing society.

I am not a union representative nor do I own an agency or facility.  My work involves finding ways to make the LTC / home care industry better for everyone involved in it.

Much thought and experience leads me to propose a combined approach to solving the PCA shortage of both quantity and quality of workers.  This combination consists of a simple, fast and easy three pronged approach. The three pronged approach takes into account the three constants of modern LTC in either the domestic or residential facility environment.

Note the solutions proposed result in zero cost to agency / facility owners.

1 Require self-pay PCA certification.  Why should an agency have to pay for someones’ education?  In what other field does this happen? Because the requirements for PCA education are only going to increase over time, PCA self-pay will help agencies keep costs all around down.

2 Require primary family/informal caregivers certification as PCAs.  This better prepares them from the beginning for home care responsibilities.  This front end requirement will result in their involvement in care being more helpful than stressful to them, other care staff, and the frail elder.

3 Combine the use of technology for appropriate tasks with PCAs (professional or informal) for the ‘human touches’ so necessary to wellness and quality of life. This can reduce stress and overload of caregivers as well as improve quality of life for the frail elder.

Advocating for the use of this three pronged approach to solving the PCA shortage and low quality problem can check off three boxes rather than just one and might well result in a ‘low to no’ impact resolution of the problem.


Dr. Cathleen V. Carr, Executive Director,



About Elder Care Advice blog

Get professional elder care giving advice, advocacy, education and tips for those who care for and about the frail elderly at the ElderCareAdvice blog. We are generously sponsored by Most posts are written by Cathleen V. Carr, unless attributed otherwise. We welcome relevant submissions. Submit your article and by-line for publishing consideration (no promises!) to Havi at, our own editor who will ensure submissions are given the best possible treatment and polish before publication, ensuring a professional level of publication. There is a nominal service fee involved ($45). Allow up to 30 days for publishing.
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