Home care is a vital component of the United States healthcare delivery system. The demand for home care has steadily increased over the past decade and it is projected that this increase will continue over the next several decades. Moreover, the utilization of Medicaid waiver home and community-based care services has expanded to provide an alternative to the more costly institutional placement. In order to meet this growing demand while maintaining the cost-savings, the system relies primarily on the minimally trained, healthcare paraprofessionals known as Personal Care Assistants (PCAs). The present study examined the career commitment and job satisfaction of PCAs who provide Medicaid waiver home and community-based care services and participated in a 40-hour training intervention. Specifically, the study evaluated differences in pre- and post-training levels of career commitment as measured by the Career Commitment Measure (CCM), in terms of overall career commitment and the three subscales: career identity, career planning, and career resilience; and job satisfaction as measured by the Minnesota Satisfaction Questionnaire (MSQ), in terms of overall job satisfaction and the two subscales: extrinsic job satisfaction and intrinsic job satisfaction, between age groups and groups based on extrinsic job satisfaction. Additionally, the study examined the interaction of age and extrinsic job satisfaction as a moderator on the influence of the training intervention to produce a change in career commitment and the three subscales of career commitment, career identity, career planning, and career resilience job satisfaction. The results of analyses were varied across groups and measures. Specifically, there were no statistically significant differences across age group in terms of changes in career commitment or job satisfaction as a consequence of the training; however, post-hoc examinations revealed statistically significant within group changes. A decrease in the overall, intrinsic, and extrinsic job satisfaction score from pre- to post-training for the 40-49 age group was found. Likewise, the 50-59 age group showed a statistically significant decrease in the extrinsic job satisfaction scores from pre- to post-training. The PCA’s level of extrinsic job satisfaction did have a statistically significant differential effect on changes in overall career commitment and career planning scores as a consequence of the training. The exploration of the interaction of age and extrinsic job satisfaction to influence changes in career commitment as a consequence of the training found statistically significant main effects with respect to levels of extrinsic job satisfaction for overall career commitment, career identity, career planning, and career resilience. However, no main effects for age and no interaction effects were obtained. These study findings have important implications for future research, and the development of training curricula and evaluation. Results provide critical information about this largely overlooked group of healthcare paraprofessionals, which have practical application in more effectively improving job satisfaction through training initiatives, thereby increasing the recruitment and retention of the paraprofessional healthcare workforce.

Abstract The purpose of the study was to examine how personal assistants experience their psychological contract and how the psychological contract was fulfilled against their supervisor or manager.A qualitative method was used and seven interviews were conducted with personal care assistants from various workplaces. The interviews were analysed with thematic analysis and resulted in five main themes. Expectations, personal but not private, what really stands in the contract, how people look at the profession and fulfilment. In conclusion, the main result was that the personal care assistants experienced that the internal psychological contract consisted of the relation to the supervisor or manager and the accessibility to the employer. The personal care assistants felt that the contents of the external psychological contract consisted of the work duties, employment security, working hours and the attractiveness of the profession. The majority of the respondents felt that the internal and external psychological contract was fulfilled. None of the respondents considered that the internal and external psychological contract was not fulfilled at all.