Policy and Research Needs to Maximize Independence and Support Community Living Workshop Summary (2016) / Chapter Skim
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4 Workforce Needs to Support Community Living
4 Workforce Needs to Support Community Living
Pages 33-54
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From page 33... ...
The four speakers in the workshop's second panel explored how to support and enhance this workforce through changing the workforce culture to support an aging America, enhancing training and job satisfaction for the direct-care workforce, and identifying research gaps and needs and emerging workforce trends in the post-Patient Protection and Affordable Care Act (ACA)
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From page 34... ...
Given the rapidly aging society in the United States, Montgomery suggested that the United States might be over-invested in acute health care services and under-invested in social supports and services. This underinvestment, she added, is mirrored in the workforce dedicated to older adults.
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From page 35... ...
The Administration for Community Living's Business Acumen Learning Collaborative that Kathy Greenlee described is one such initiative, and Montgomery discussed two other successful efforts: the Personal and Home Care Aide State Training (PHCAST) Program1 and the Geriatric Workforce Enhancement Program (GWEP)
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From page 36... ...
The curriculum includes 25 modules, 7 of BOX 4-1 Required Core Competencies for Personal and Home Care Aides in the Personal and Home Care Aide State Training Program Demonstration 1. The role of the personal or home care aide (including differences between a personal or home care aide employed by an agency and a personal or home care aide employed directly by the health care consumer or an independent provider)
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From page 37... ...
In North Carolina, training is integrated into both high school and community colleges and targets both unemployed and new workers. North Carolina has developed basic, intermediate, and advanced training levels, with advanced training divided into home care, geriatric care, and medication aide specialties.
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From page 38... ...
Progress in Enhancing the Geriatric Care Workforce In her final comments, Montgomery returned to the recommendations for enhancing geriatric competence that were outlined in the IOM report Retooling for an Aging America (see Box 4-2) to discuss the progress that has
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From page 39... ...
For the first recommendation -- that hospitals should encourage the training of residents in all settings where older adults receive care, including nursing homes, assisted-living facilities, and patients' homes -- there are a few modest reforms included in the ACA regarding general medical education that allows hospitals to train residents in long-term care settings, nursing homes, assisted-living facilities, residences, and other places. Montgomery said she believes that this will be tremendously important for the aging society and suggested tracking whether this education is happening.
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From page 40... ...
ENHANCING AND SUPPORTING THE DIRECT-CARE WORKFORCE Jodi M Sturgeon President, Paraprofessional Healthcare Institute The core focus of PHI's quality care and quality jobs mission is the direct-care workforce -- personal care aides, home health aides, and CNAs -- and the critical role they play in supporting community living, said Jodi Sturgeon of PHI.
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From page 41... ...
In addition to working on the core job of the direct-care worker, PHI has developed what Sturgeon called "advanced role" jobs that support home health aides and test technology to improve communication and reduce client hospital and emergency department visits. Aides holding one of these types of advanced roles are embedded within interdisciplin ary care teams and their inclusion in these teams has increased ICS client 6 For more information, see http://www.chcany.org (accessed January 29, 2016)
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From page 42... ...
These advanced aides support home health aides who have an identified subset of ICS clients who are at risk for hospital readmission or have an extensive history of emergency department visits. Sturgeon added that PHI is using technology primarily as a tool to improve communication between the clients and the aides and not as a means of connecting people in their homes to clinicians.
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From page 43... ...
She said that there are national standards for home health aides and CNAs, but she added that research is needed to understand how to link these different standards. Chapman said she is involved in another project studying what managed health care plans should be expected to provide in terms of care management, case management, training, and the minimum expertise needed for care management.
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From page 44... ...
DRIVERS OF WORKFORCE CHANGE IN THE HEALTH CARE SYSTEM Patricia Pittman Associate Professor, The George Washington University In the panel's final presentation, Patricia Pittman of The George Washington University focused on the major drivers of systems transformation and the impacts they might have on the workforce. She noted she was drawing information specifically from two studies -- one funded by HRSA that looked at how large health systems are changing the way they do workforce development and planning, and the other funded by the Office of Minority Health looking specifically at community health workers.
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From page 45... ...
Care coordination is moving away from registered nursebased telephonic care to a model that may rely on home visits, often conducted by nurse practitioners (who can prescribe medications) in coordination with community health workers.
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From page 46... ...
As a result, the demand for community health workers is rising, raising questions about what the right level of education, training, and certification should be for community health workers. There are also the questions of how to integrate behavioral health into care coordination and how to meet the growing demand for workers with behavioral health training, as well as how to address the social determinants of health and the competencies and payment models needed to affect those determinants.
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From page 47... ...
The Medicaid waiver that states can have that allows them to use and license assistive personnel for preventive services will likely be a driver of this increased use of community health workers, though few states have begun making use of that provision. Pittman said there is an expectation and a hope that Medicaid plans will be able to bill for the services that community health workers provide or have them covered under the Medical Loss Ratio regulations.
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From page 48... ...
This could be in the form of a community health worker as a supervisor or a supervisor sensitized to the very specific and unique work of community health workers and the tendency of health delivery organizations to shape things around the needs of the health system. Community health workers are just one example of a growing occupation within the system that is going to be important for long-term care, Pittman said.
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From page 49... ...
Sturgeon said that this is an opportunity for a collaboration with the nursing community to address the concerns of registered nurses about expanding the scope of practice for direct-care workers, to which Chapman replied that scope-of-practice and regulatory issues are ultimately turf and political battles. Amy York of the Eldercare Workforce Alliance asked the panelists for their ideas on how to provide incentives for people to go into geriatrics at all levels of care.
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From page 50... ...
Financing • A lack of payment models for various workforce classifications and for bundled service agreements that focus on services rather than workforce designation and fee codes (Alkema) • A lack of government funding for programs such as the ACL Business Acumen Learning Collaborative initiative (Campbell)
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From page 51... ...
• Difficulty implementing policies at the state and federal level that would beneficially affect the workforce (Parks) Research and Policy Priorities The facilitated table discussions produced the following list of research and policy priorities to enhance and support the workforce, as noted by the table rapporteurs.
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From page 52... ...
• Engaging community health workers who in turn can advocate for and empower individuals, such as programs like Promotores de Salud (Alkema) • Focusing on training direct-care workers and family caregivers, which the Center for Medicare & Medicaid Innovation is study
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From page 53... ...
Nagro reported that the discussion at her table raised the point that clarifying the definitions of terms such as "direct-care workforce" would be helpful for policy makers. Simon-Rusinowitz suggested that it would be valuable to look for best practices identified by other health care occupations and determine if they can be adapted to the LTSS sector.
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