Joe Carlson's article "Safe at home” understates the number of direct-care workers in the home-care industry. He cites a government source, which tracks home health aides but does not include personal-care aides. Today's home-care workforce is more than double Carlson's estimate, or 2.5 million workers. That includes 924,650 home health aides, 820,600 personal-care aides and 800,000 independent providers employed in public programs. Personal-care aides top the list of fastest-growing occupations in the nation this decade.

Yet there are no federal training standards for personal-care aides. And a recent Paraprofessional Healthcare Institute analysis found that 23 states have at least one publicly funded personal assistance program with no training requirements for personal-care staff.

Federally mandated criminal background checks may help screen out disreputable people in the rapidly growing home-care field, but federal training standards and well-designed recruitment practices for personal-care aides would do much more to ensure that consumers receive quality care.

Jodi Sturgeon
President, Paraprofessional Healthcare Institute, New York