If Texas cannot meet the demand for home care due to lack of staffing, the likely result is an increase in demand for nursing home and hospital admissions at great expense to the public care system and taxpayers-not to mention the dignity and independence of older Texans.  By 2030, 17% of Texas' population age 65 and older will need the services of personal attendants.  This means the number of personal care attendants needed will increase by 47% between 2000 and 2010.  

As the number of people receiving support at home increases, the shortage of qualified and motivated personnel to perform personal assistance tasks will be magnified. High turnover rates and inadequate training are key issues affecting the lack of qualified attendants to help our disabled and older citizens remain in their own homes.

For programs providing community services for the elderly and disabled, more than 82,000 are on waiting lists.  Currently, the CBA waiver program, which provides home and community-based services as an alternative to nursing home services to those who are disabled or elderly, 21,050 get served while 29,316 wait for services. Even if the Department of Aging and Disability Services (DADS) receives all of the funds requested for 2010-11, the state will not be able to serve a majority of individuals who need these services. An estimated 29,576 will be served while 43,389 will remain on a waiting list to receive attendant care services from the state.

Attendant Training
• In 2008, the Institute of Medicine (IOM) reported the median number of training hours required of personal care attendants at 28 hours, but state requirements range from 2 hours to 120 hours. (IOM report on Long Term Care, October 2008 )

• While Texas requires training for crossing guards, cosmetologists and dog groomers, the training requirements for personal care attendants in Medicaid agencies are not specified. (40 TAC § 47.25)

• In 2008, the Texas Department of Aging and Disability reported that lack of training plays a significant factor in both turnover and decreased quality of care. (Stakeholder Recommendations to Improve Recruitment, Retention, and the Perceived Status of Paraprofessional Direct Service Workers in Texas, June 2008 )

• As far back as 1991, our Texas legislature has reported on the need for training of direct care workers, and recommended core curriculum before any attendant begins working with a client. Still we have no standards for training requirements. (SB 95: Evaluation of Personal Attendant Training Programs, 2001 )                                                                                                                                                 

Attendant Wages
• In 2008, the Institute of Medicine reported that Forbes magazine profiled personal and home care attendants as one of the top 25 worst-paying jobs in America in 2007. (IOM report on Long Term Care, October 2008 )

• In 29 states, the average hourly wages for attendants are below 200% of the Federal Poverty Level (FPL) wage for full-time workers who live alone-low enough to qualify for many state and federal assistance programs. Texas has the lowest mean wage of all 50 states for attendants when compared to the Federal Poverty Level. (State Chart Book on Wages for Personal and Home Care Aides, 1999-2006, July 2008 )

• The turnover rate for direct care workers is estimated at greater than 100%. (Stakeholder Recommendations to Improve Recruitment, Retention, and the Perceived Status of Paraprofessional Direct Service Workers in Texas, June 2008 )

• According to the IOM, with poor wages, direct care workers are more likely to live in poverty, to lack health insurance, and to rely on food stamps than other workers. (IOM report on Long Term Care, October 2008 )