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Statistics and Projections

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(1)

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%

(2)

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

(3)

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 skills

o  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

(4)

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

(5)

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

(6)

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

o 

Home Care Nurse Aide

n  Turn key curriculum

n  Reality-based education modules n  Adult learning principles n  Learning styles

(7)

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

(8)

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 outcomes

n  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)

(9)

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

o 

Care 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 care

delivery

o  Medication reminders o  Falls prevention

o  Observe, record and report changes before hospitalization or ED visit

(10)

Trained Direct Care Workers: A Critical

Piece of the Care Transitions Puzzle

o  Keeping MD appointments, decreasing no show

rates

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

References

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