The Future of Home Health Care Workshop Summary (2015) / Chapter Skim
Currently Skimming:
5 The Home Health Care Workforce
5 The Home Health Care Workforce
Pages 49-64
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 49... ...
In one panel of the workshop, four speakers addressed the role of each person on the home health care team (as well as the team itself) and how to facilitate their roles in ways in which they will be needed for the future ideal state of home health care.
|
From page 50... ...
After several hospitalizations, the medical team recommended transition to a nursing home, but the veteran refused, saying, "I'm going to die if I'm admit ted to a nursing home." The health care team took his preferences to heart and rewrote the care plan. Instead of the nursing home, he was discharged to home with home-based primary care and home health aide services.
|
From page 51... ...
Achievement of that goal, Edes said, depends on • Increases in veterans' access to home-based services, • Minimization of avoidable hospital days, and • Prevention or optimization of nursing home care. Differences from Medicare Edes drew a distinction between the VA home-based primary care and traditional Medicare home care.
|
From page 52... ...
Edes noted that the VA program covers key gaps in Medicare home care that had been emphasized by previous speakers, including the inclusion of people with complex, multiple chronic conditions and not merely those with post-acute care needs or remediable conditions; it takes a more comprehensive approach to the provision of care; and it has a focus on patient needs and not homebound status. Edes said that the care team members are truly interdisciplinary and work together to create a unified plan of care for each patient.
|
From page 53... ...
Like the VA home-based primary care program, the Independence at Home model targets complex, chronic, and disabling conditions; provides interdisciplinary, longitudinal care in the home; emphasizes skills in geriatrics care; uses electronic health records; and uses evaluation metrics that include quality and satisfaction, as well as reductions in the number of inpatient days. At a minimum, Independence at Home demonstration sites are projected to produce a 5 percent cost savings, and if they achieve more, the additional savings will be shared with the site.
|
From page 54... ...
During those same years, the cost of home hospice services paid for by the VA increased more than 400 percent, the number of inpatient palliative care consults grew 25-fold, the amount of home-based primary care that it provided increased 55 percent, its medical foster home placements nearly tripled, and its home- and community-based services increased 87 percent. Still, overall costs rose only 2 percent.
|
From page 55... ...
The importance of mobile electronic documentation will increase as point-of-care diagnostics and hospital-at-home programs become more prevalent, he said. Edes concluded that too many people see the growing population of people with multiple chronic disabling diseases and their concomitant need for long-term services and supports (LTSS)
|
From page 56... ...
For that reason, she said, "we need to think of the family caregiver as a member of the care team" and to build scalable models of care that are truly patient and family centered and that can accommodate people with multiple chronic conditions. Lessons on ways in which to do that may come from states that have created strong home- and community-based care programs that involve not just medical and health care professionals but also individuals who provide supporting services, such as personal care, companionship for people with Alzheimer's disease, and transportation.
|
From page 57... ...
It is not just a matter of semantics, she said, but confusion shows up in the data about home care and becomes ever greater in discussions of new service delivery models. Data are collected for at least three categories of direct care providers: home health aides, home care aides or personal care attendants, and hospice aides.
|
From page 58... ...
About half are white, and about 35 percent are black, although Stone predicts more diversity in this workforce in coming years, along with the greater diversity in the population of elderly individuals. The work situation of hospice aides is somewhat better than that of home care or home health care aides, Stone said, as they receive higher wages and have greater access to employer-sponsored health insurance and other employee benefits.
|
From page 59... ...
Improving the Direct Care Workforce According to Stone, principal strategies to resolve problems with the direct care workforce for home-based care include the following: • Competency-based training that includes good clinical placements; • Improved supervision focused on coaching and mentoring; • Protocols for resolution of problems; • Continued staff development and career advancement potential, but not necessarily career ladders ("Not every home care aide or personal care attendant wants to be a nurse," Stone said.) ; • Policies that permit direct care workers to specialize in, for ex ample, dementia care or medication management;
|
From page 60... ...
Program, a six-state demonstration program funded through the ACA.4 North Carolina's PHCAST project, for example, is a four-phase program that develops career lattices and career ladders, is involved with the state's high schools and community colleges, and has established certifications for different levels of training. She also cited the Eldercare Workforce Alliance's advanced direct care worker concept, which, again, proposes career lattices so that workers can become home care and personal care aides with more advanced capabilities.
|
From page 61... ...
We are actually adding value by helping people remain direct care workers." The promotora6 model, he believes, can be adapted to enable direct care work 6 A promotora is a community health worker used in Hispanic communities. "As trusted members of their community, promotoras provide culturally appropriate services and serve as a patient advocate, educator, mentor, outreach worker, and translator.
|
From page 62... ...
Labson, The Joint Commission, asked how prepared the professional staffs of home health agencies are to conduct the types of training suggested for direct care workers. Stone said that she does not believe that they are trained in this at all.
|
From page 63... ...
George Taler, Washington Hospital Center, asked if, when the VA enrolls someone in the home-based primary care program, a mechanism is in place for assessing the ability and willingness of caregivers in the home to provide care, the caregivers' integration with the service community, and the household's financial resources that can be directed to care. According to Edes, the VA's home-based primary care program does not require that veterans have a caregiver in the home.
|
From page 64... ...
The home-based primary care providers are the VA staff, and they rely on community providers for home health aide and hospice services. It can be harder to embrace these non-VA staff as team members.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.