Trained Direct Care Workers: A Critical
Piece of the Care Transitions Puzzle
Kathy Turner, RN – Division of Health Service Regulation Jan Moxley, MS – Division of Aging and Adult Services Kathie Smith, RN – Association for Home & Hospice Care of NC Michelle White, MSN, BSN,RN – Home Care Providers/Alamance CARES
Statistics and Projections
o In the next 20 years the number of persons 65 and older will almost double from 1.3 million to 2.3 million
o North Carolina is 10th nationally in size of total population, and 9th in those 60 and older o By 2025, 86 of the NC’s 100 counties are
projected to have more people over age 60 than age 17 and under
Demographics
o Status of North Carolinians 65 and older:
n Living alone 29%
n Veterans 22%
n Have a disability 38%
n Median household income 27%
n Income below poverty level 10% ($10,778) n Income is between 100-199% of the federal poverty level 25%
Personal and Home Care Aide State
Training Grant (PHCAST)
o Federal Grant from US DHHS Health
Resources and Services Administration (HRSA) o NC 1 of 6 states selected
o Create a “Gold Standard” for minimum training
Reasons for PHCAST
o Increasing demand for direct care workers
o Personal Care Aides and Home Care Aides
are the fastest growing occupations o Nurse Aides are in the top 11 jobs in terms
of largest job growth
o Trained, competent workers are essential to quality care
Key Concepts of NC PHCAST
o Builds on prior direct care worker initiatives o Creates 4-phased framework for training and
competency to better prepare new and incumbent workers
n Focus primarily on direct care workers in home and
residential care settings
o Training Venues: n Community Colleges n High Schools
Overview of NC’s 4-Phase
Approach
o Phase I – Introduction to Direct Care Work o Phase II – Direct Care Basics (pre-Nurse Aide
level)
o Phase III – Nurse Aide I
o Phase IV – Advanced NA Training/Competency
n Home Care Nurse Aide
n Geriatric Nurse Aide
n Medication Aide
o Option for in-service use across settings
Phase I: Introduction to Direct Care Work
o Essential job readiness skillso Exposure to direct care field
o Job screening and other minimum requirements for employment
o Basic computer, reading, writing and math skills as appropriate
o Introduction to necessary soft skills o CPR- Lay Person
Phase II: Direct Care Basics
o Non-nurse aide personal care tasks o Basic home management tasks
o Integration of additional soft skills that more directly associate skills learned with actual service provision
Phase III: Nurse Aide I
o
Refinements and enhancements made to
curriculum
n Realistic grouping of tasks n Common “threads” concepts n Redesigned method of delivery n Statewide implementation n Updated skills
Phase IV: Advanced NA Training
o Home Care Nurse Aide
n Advanced concepts and skills that build on NA 1 training/competencies
n Focuses on unique care delivery challenges
associated with providing care within the home
n Encompasses more in-depth knowledge and clinical skills, and more advanced soft skill development
n Creates a track parallel to Geriatric Aide and
PHCAST & Community Colleges
o PHCAST fits well with Community College programs
n Phases I & II conducted through Human Resource Development (HRD) programs
o Aligns with HRD goals
o PHCAST needs align with HRD core services
(Assessment, Employability Skills, Career Development)
o Possible fee waiver
n Phases I-IV conducted through Continuing Education program
n Phases III & IV also available through Curriculum program
Community
College Phase I Phase II Phase III Phase IV
Asheville-Buncombe * Central Carolina * * * Central Piedmont * Coastal Carolina * * * Forsyth Technical * Mitchell * * * Roanoke-Chowan * * Sandhills * * * Southeastern * * * Stanley * * * Tri-County * * * Wake Technical * * *
Community College
Pilot Sites
Includes both pilot years Excludes Halifax CC & Cape Fear CC/Elder House
Pilot Participant Completers
o Phase I only: 20 o Phases I & II only: 139 o Phase II only: 70 o Phase III only: 53 o Phase IV only: 139 o Phases I, II, & IV: 10 o Total: 426
Care Transitions & Trained Direct Care
Workforce: A Winning Combination
PHCAST Phases I and II
o NC PHCAST addresses the following objectives: n Helps prospective workers have an understanding of
educational and training requirements for each long- term care sector pathway
n Provides a uniform pre-nurse aide training program
through community colleges that covers essential soft-skills, basic home management and personal care skills (non-nurse aide level providing limited assistance to clients)
PHCAST Phase IV
oHome Care Nurse Aide
n Turn key curriculum
n Reality-based education modules n Adult learning principles n Learning styles
The Industry Connection
-Relevance-
Emerging Programs and
Payment Delivery Methods
o Care transitions - funding new models of care through the Affordable Care Act
o Accountable Care Organizations
o Focus on non-clinical type services to keep people at home - helping hospitals with readmissions
o Chronic care management- role for In-home aide agencies
The Prevalence of Chronic Conditions
o Between 2000 and 2030, the number of Americans with
one or more chronic conditions will increase 37 percent, an increase of 46 million people
o Some 28 percent of Americans have two or more
chronic conditions and they are responsible for two-thirds of health care spending
o In the Medicare program over two-thirds of the
expenditures are for beneficiaries with five or more chronic conditions
Chronic Disease and Non-adherence
o Non-adherence contributes to:n Increase in number and length of acute care visits ( 25% of hospitalizations due to medication errors)
n Increase in Emergency Department (ED) visits
n Unnecessary changes in treatment
n Overuse of scarce and expensive medical resources
n Loss of productivity and decreased quality of life
PHCAST and Home Care
o Growing need for continuum of care
o Rising cost of care & shortage of trained workers o Greater efficiency in healthcare delivery
(lowering cost while improving delivery) o Promote quality care for increasing numbers of
older adults and persons with disabilities
( Division of Aging and Adult Services)
What Is At Stake?
o
Potential risks during care transitions:
n Poor outcomesn Costly hospital readmissions n Avoidable ED use
n Medication errors
n Poor communication & coordination of care
across settings
(Family Caregiving and Transitional Care; A critical review-Gibson, Kelly, Kaplan)
What Is At Stake?
o Inpatient and outpatient
healthcare professionals must communicate, plan and coordinate services
o Transition from a bio-medical
approach to a public health model of care
PHCAST and Care Transitions
oCare Transition Education May Include:
n Chronic disease management n Patient centered care
n Patient and/or staff coaching
n Health Literacy
n Observation, Reporting and Recording Within the aide’s level of responsibility
Trained Direct Care Workers: A Critical
Piece of the Care Transitions Puzzle
o Chronic or acute exacerbation model of caredelivery
o Medication reminders o Falls prevention
o Observe, record and report changes before hospitalization or ED visit
Trained Direct Care Workers: A Critical
Piece of the Care Transitions Puzzle
o Keeping MD appointments, decreasing no showrates
o Assistance with managing appointments
o Nutritional assistance
Giving Value to the Importance
of the Direct Care Worker
o
How do we quantify?
Questions?
o Kathy Turner: Kathy.Turner@dhhs.nc.gov
o Jan Moxley: Jan.Moxley@dhhs.nc.gov
o Kathie Smith: kathiesmith@homeandhospicecare.org