Young mixed race female nurse writes something on a clipboard while preparing for a weekly staff meeting. An open laptop is on the table.
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Foreign-born workers account for 27% of the nation’s direct care workforce, but many states maintain strict, English-only testing and training requirements that can prevent some immigrants from entering the workforce, according to the results of a new analysis.

PHI looked at five state initiatives working to address those language-based barriers to workforce training and certification with a goal of expanding opportunities for workers who do not speak English as their primary language.

“The importance of immigrant direct care workers to meeting our country’s long-term care needs and ensuring the quality of that care will only grow as the long-term care sector struggles to fill an estimated 9.3 million direct care job openings in the next decade, and an increasingly diverse population of older adults requires culturally competent and language-appropriate care,” Jake McDonald, PHI senior state policy advocacy specialist, wrote in a blog.

PHI highlighted initiatives in five states — California, Massachusetts, New York, Washington and Wisconsin — using approaches deemed innnovative to make progress in addressing language access barriers for direct care workers. 

What states are doing

In March, the Wisconsin Department of Health Services released a Spanish version of its online training and exam for certified direct care professionals, WisCaregiver Careers. The workforce development program is a public-private collaboration between the state and the Wisconsin Health Care Association / Wisconsin Center for Assisted Living and LeadingAge Wisconsin, offering scholarships to address the shortage of certified nursing assistants.

PHI said that the expansion of the program is an important step to providing “inclusive, empathetic care” for Spanish and English speakers and opens the door to Spanish-speaking workers for a career path in long-term care. Wisconsin plans to translate its program into additional languages in the future, according to PHI.

Meanwhile, Massachusetts will begin offering its CNA certification exams in Spanish and Chinese this year in an effort to fill more than 3,000 CNA vacancies in the state. Proposed legislation would add Portuguese, Haitian Creole, Spanish and Chinese translations, as well as require the state to add additional languages down the road. 

And New Jersey is considering similar legislation to translate CNA and home health aide certifications into multiple languages.

In California, where more than 200 languages are spoken, the state Department of Social Services is expanding language assistance resources for home care aides in its In-Home Supportive Services program. Several pieces of legislation have required the state and counties to translate training and support materials into Spanish, Chinese and Armenian. Advocates are now looking to introduce legislation requiring the state to translate its CNA certification exam into Spanish.

New York and Washington have collaborated with community-based organizations to create training programs  for home health aides and personal care aides in various languages, as well as develop English as a Second Language training and employment programs. 

“Ultimately, investing in language access is strategically necessary for states struggling to recruit and retain direct care workers, as well as meeting the needs of individuals and communities needing linguistically diverse care,” McDonald concluded.