Lifespan Respite Care Program: Advancing the Recruitment, Training and Retention of Respite Care Providers

Like many countries, the United States is experiencing a serious crisis in the direct care workforce. Direct Care Workers are also known as Direct Service Workers (DSW) or Direct Support Professionals (DSPs) and may include home health aides, home care workers, certified nursing assistants, personal or residential care assistants and respite providers, etc. Many people with disabilities and older adults and their family caregivers are unable to access the services they need to live in the community, including respite services, because there are not enough trained providers. ACL is committed to finding solutions to this crisis and has committed significant resources in a variety of areas to help address it.In 2020, ACL funded the first Lifespan Respite Special Projects to Strengthen Program Development, Implementation and Sustainability (#90LRSP0001) to focus on several critical areas of respite service delivery, including the need for a cadre of well-trained, competent respite care providers. The ARCH National Respite Network and Resource Center (ARCH), the ACL-funded technical assistance resource center for the Lifespan Respite Care Program, in collaboration with the National Academy for State Health Policy and the Respite Care Association of Wisconsin field tested and evaluated a competency-based online respite provider training curriculum for entry-level respite providers. That effort resulted in the development and roll out of the National Respite Care Provider Training (NRCPT).Given the success of the NRCPT in the states where it was piloted and the initial promise it demonstrates as an effective tool for the recruitment, training, and retention of respite care workers, ACL is interested in taking the NRCPT to the next level in a variety of areas. This NOFO seeks to accomplish that goal as described below.The initiative supports and advances President Biden’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers, signed April 18, 2023. This executive order directs federal agencies to take more than 50 actions including those that could expand access to home and community-based services; grow and strengthen the direct care workforce; support family caregivers; and more — giving us a unique opportunity to transform our long-term care systems and mitigate the challenges faced by family, kin, and tribal caregivers.Desired Goal and Anticipated OutcomesThe goal of this project is to strengthen and advance the recently developed National Respite Care Provider Training (NRCPT). ACL anticipates achieving, at a minimum, the following broad outcomes as a result of this project:Enhanced awareness and usage of the NRCPT.Improved retention of respite providers.Streamlined access for caregivers to trained respite providers.Priority Areas and Desired ActivitiesOver the course of the three-year project, ACL expects several key areas of focus will be addressed. Applicants to this NOFO should describe their approaches for undertaking the following activities in support of ACL’s overall goal and objectives:Support greater uptake and use of the NRCPT in new and emerging respite service delivery areas (e.g., states and local communities), nationwide. The NRCPT was field tested in ten pilot states across the U.S. The NRCPT includes a competency-based and enhanced entry-level respite provider training curriculum and a specialized recruitment campaign. Applicants should describe how they will support increased use of the NRCPT in more states, allowing for further refinement and enhancements to the program, as needs are identified.Develop and test approaches for connecting trained providers to family caregivers and those they support, across the age and disability spectrum (e.g., respite and provider registries or similarly accessible modalities). Ensuring the availability of a cadre of trained respite providers is an important step in meeting the service needs of family caregivers. However, it is critical that there be effective pathways for connecting the available respite providers to the families that need them. In this regard, ACL wishes to see the development and testing of possible approaches for fostering effective connections between respite providers and the families needing their assistance. Develop, test, and implement methods for retaining respite providers, including opportunities for career advancement and upward mobility. Recruiting and training of respite providers are two critical steps in ensuring the availability of well-trained respite providers. Retaining them and ensuring they are supported along a career path is equally as important. Applicants should propose how they would develop and test approaches for ensuring the retention of respite workers once they are trained and in the workforce. Additionally, ensuring opportunities for career advancement and upward mobility within the workforces should also be top of mind and considered as part of this project.Adapt the NRCPT for use among limited English-speaking populations, for whom career options are often limited. According to PHI, the direct care workforce, which includes those that provide respite services, is primarily composed of women and people of color, many of whom are lower income and face barriers to education and work in other fields or settings. Approximately one in four direct care workers (26 percent) was born outside the United States, with a range from 21 percent of nursing assistants and residential care aides to 31 percent of home care workers. Additionally, this field often relies heavily on immigrants to fill positions. PHI also noted that approximately one in four direct care workers (26 percent) was born outside the United States. Where opportunities are identified, ACL desires that this project identify and undertake additional opportunities to adapt the NRCPT for use among diverse, limited English-speaking populations, other than Spanish-speaking individuals, for whom the training has already been translated.Develop a framework for establishing a base of evidence for the effectiveness of the NRCPT. ACL has a long history of supporting the development and use of evidence-based/informed approaches across a variety of program areas to achieve its mission and goals. In this regard, ACL wishes to explore the degree to which establishing a base of evidence for the NRCPT is feasible and possible. To that end, applicants should describe their approach to employing the findings from the current evaluation of the NRCPT and determining the extent to which the establishment of feasible and possible steps may be needed to accomplish that aim.When developing proposals, applicants should carefully consider the approaches they will take to organizing this three-year, fully funded project, including the cadence that will be used to address the above priority areas and desired activities. Additionally, applicants should feel free to identify other, related areas for consideration and development that could be considered relevant to this NOFO.IMPORTANT: Applications will be scored, in part, on the extent to which the applicant demonstrates the expertise and capacity to undertake a project of this scope and intent. To that end, applications will be reviewed, in part, on the extent to which such expertise is demonstrated on the part of the applicant and/or attained through key partnerships on the project.Additional Application ElementsPost-Award Workplan and Budget Finalization PeriodACL recognizes the challenges posed by a 30-day window in which to complete applications and provide a highly detailed workplan for the project. Therefore, the successful grantee will be permitted up to three (3) months post award to work with the ACL program officer to finalize their overall project approach, workplan and, if necessary, refine budget allocations across tasks. The ACL program officer will work closely with grantee and relevant partners throughout this period to ensure a successful refinement of the workplan and overall budget prior to the formal launch of project activities.National Scope and ReachACL expects that the grantee and any partners will be working at the national level for the entirety of the project. Projects of a local scope or those confined to a single state, region, or area of the country will not be considered for funding.Reliance on Other Technical Assistance EffortsApplicants and their collaborating partners will be encouraged to avail themselves of the range of technical assistance and support available to them, including (but not limited to):The Lifespan Respite Technical Assistance and Resource CenterThe Direct Care Workforce Technical Assistance CenterCenter on Holocaust Survivor Care/Jewish Federations Institute on Aging and TraumaOlder Adults Equity Collaborative (OAEC)National Center for Advancing Person-Centered Planning and ServicesBridging Aging and Disabilities Networks at NACDD;National Resource Center on LGBTQ+ Aging;Resource centers for Older Indians, Alaska Natives, and Native Hawaiians;Sub-grants and/or subcontractsProvision of funding for sub-grantees or subcontracts to carry out specific activities is expected, as ACL believes this project will have a greater likelihood of success when a range of organizations or individual subject matter experts undertake the work and/or the applicant identifies a gap in expertise necessary to fully complete project goals and objectives. Applicants should describe their rationale and criteria for selecting sub-grantees/subcontractors, including their approaches for monitoring progress and ensuring successful completion of all tasks.Accessibility and 508 Compliance RequirementsACL requires that all information and materials developed by the grantee and partners for dissemination, regardless of method, will be fully accessible (i.e., 508-compliant), and meet the cultural and linguistic needs of the intended audience.Project SustainabilityACL expects to realize tangible, measurable, and sustainable outcomes from the grantee and its partners. Proposals should contain a plan for sustaining the project’s work after federal funding ends. Applicants will be scored, in part, on the extent to which a plan is included and appears feasible and likely.Project Outcomes and EvaluationProjects of this nature are best undertaken with clear and measurable outcomes known at the time of application along with a feasible plan for measuring the overall project’s impact. Therefore, applicants are expected to propose outcomes that demonstrate the project’s impact (i.e., the change that is anticipated to occur because of the work) and a plan for conducting an evaluation of the project.