Personal and Home Care Aide State Training (PHCAST) Information Session

September 28, 20119:30-1:00PM

MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES& EXECUTIVE OFFICE OF ELDER AFFAIRS PRESENTS:

Disclosure2

This project is supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under HRSA PHCAST Program Announcement HRSA-10-288 CFDA No. 93.512. Massachusetts PHCAST Grant Project T82HP20323 was awarded $738,993 for year 1, $744,769 for year two, with expected continued funding for year 3. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any official endorsement be inferred by, the DN, BHPr, HRSA, DHHS, or the US Government.

The PHCAST Team3

PHCAST Co-Principal Investigators Ann L. Hartstein, Secretary, Executive Office of Elder Affairs Rosalie Edes, Deputy Assistant Secretary of Disability Policies and

Program, Executive Office of Health and Human Services

Project Director Leanne Winchester, RN, University of Massachusetts Medical School

Senior Advisor Mary Kay Browne, University of Massachusetts Medical School and

EOHHS

Project Coordinator Kate Russell, University of Massachusetts Medical School

PHCAST Partners Bristol Community College Commonwealth Corporation MA Council for Home Care Aides

Paraprofessional Healthcare Institute (PHI) UMMS MassAHEC Network PCA Workforce Council

PHCAST Advisory Group

Association of American Retired Persons (AARP) Massachusetts

Arc Massachusetts Association of Developmental

Disabilities Providers Boston Center for Independent Living Department of Public Health Department of Developmental Services Department of Mental Health Department of Transitional Assistance Department of Youth Services Executive Office of Elder Affairs Executive Office of Health & Human

Services Executive Office for Work, Labor

Development Local 509 Service Employees

International Union (SEIU) Massachusetts Association of Behavioral

Healthcare Massachusetts Senior Care Association Massachusetts Aging Services

Association

Massachusetts Assisted Living Federation of America (ALFA)

Massachusetts Clubhouse Coalition Massachusetts Commission for the

Blind Massachusetts Commission for the Deaf

and Hard of Hearing Massachusetts Council for Home Care

Aide Services Massachusetts Home Care Massachusetts Community Colleges

Executive Office Massachusetts Commission for the Deaf

and Hard of Hearing Massachusetts Rehabilitation

Commission National Empowerment Center PCA Quality Workforce Council 1199 SEIU United Healthcare Workers

East Smith College / PCA Employer The Home Care Alliance The Providers Council

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Agenda5

1. Background and Vision2. PHCAST core competency curriculum

development process, outcomes and objectives

3. Presentation of Skills & Knowledge Competency Training

4. Break5. Looking ahead – open discussion6. Break7. Demonstration of PHCAST Core

Competency Module

Project Context 6

Personal & Home Care Aides are among those direct care workers who play a vital role in job creation and economic growth, particularly in low-income communities.

PHCA provide an estimated 70 to 80% of the paid hands-on long-term care and personal assistance received by Americans who are elderly or living with disabilities or other chronic conditions.

The Bureau of Labor Statistics projects that PHCA will be the fourth fastest growing direct care occupations in the U.S. between 2008 and 2018, with an increase of 46 percent. Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES- Health Resources and Services Administration-

Bureau of Health Professions -Division of Nursing

Background: Massachusetts Long-term / Direct Care Workforce Landscape

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Massachusetts currently employs and/or pays for long-term support direct care workers through a number of state agencies including but not limited to: EOEA, MassHealth Office of Long-term Care, DDS, DPH, Soldiers’

Homes, MRC, DMH, DCF, DYS, MCB

The Commonwealth spends >$4B on long term supports for people with disabilities, ~47% in community settings

These workers provide the following types of direct care supportive services: Assistance with Activities of Daily Living (ADLs) and

Instrumental Activities of Daily Living (IADLs) Skills training Cueing / monitoring & other communication & behavioral

support Other

Background: Workforce Landscape, cont.

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Challenges faced by consumers, workers, agencies: Same worker may be employed through various programs

(i.e., paid by various agencies) to provide same type of care

Agencies may have different requirements for workers in each setting (often dependent on funding stream)

Needed core competencies may be the same across consumers but not required across agencies / settings

Worker titles are multiple and overlapping i.e., Direct Care Workers? Direct Support Professionals? LTC Direct Care?

Worker pay varies, not always based on competencies

Direct Care Workforce Turnover

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Turnover rates are extremely high among direct care workers, almost half of workers are employed at more than one job in a 2 year period

2/3 of direct care workers surveyed reported that turnover interferes with their ability to do their job

Source: U.S. Department of Health and Human Services. 2011. “Understanding Direct Care Workers: A Snapshot of Two of America’s Most Important Jobs” Washington, D.C.

PHCAST Core Competency Curriculum Development Time Line

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November 2010, the team developed a cross walk of their current trainings with the Affordable Care Act core competencies

Winter 2011, the team conducted gap assessment of current curricula

Spring 2011, the team developed the first draft of four of nine core competency modules

Summer 2011, began year 1 pilots December 2011, complete the first draft of the

remaining 5 modules January 2012, the year two pilots will begin

PHCAST Core Competencies11

Curriculum Development12

Adult Learner-Centered Training Approach

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Emphasis is placed on the learning process of the learner The teacher acts as a facilitator rather than an information

expert How the Adult Learning Cycle “Works”

Facilitators refer to the learners’ prior experiences Facilitators help the learner to focus on key points from

their experience and shares ideas and reactions with others

Facilitator guides the learner to new insights; provides new information

Facilitator coaches the learner through feedback, advice and encouragement

ALCT at it’s core assumes learning is active, not passive. ALCT begins with actual experiences using multiple training methods

Module: Roles and Responsibilities of a Personal & Home Care Aide

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Goal: to ensure that participants will have a basic understanding of the day to day tasks as well as the limits on what tasks they can perform; understand the importance of the position to the consumer and the health care system; and recognize differences in roles and the opportunities for career advancement in the health care field.

Objectives: by the end of the session, participants will be able to:

Explain the potential benefits of the personal and home care aide can provide for the consumer;

List the various employers and employment opportunities; Define and list ADLs and IADLs; and Explain the limits of service/care of the personal and home

care aide.

Module: Personal Care Skills and Nutrition

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Goal: Participants will learn the skills necessary to assist consumers with three of the activities of daily living—bathing, dressing, and eating. They will also explore the importance of applying the principles of person-centered care and consumer direction, in order to show respect and promote the dignity of the consumer while assisting with personal care.

Objectives: by the end of the session, participants will be able to:

Explain the importance of communicating with the consumer and respecting dignity, privacy, and the consumer’s preferences during bathing.

Explain how to apply basic principles of person-centered care when assisting the consumer with personal care such as bathing, pericare, mouth care and skin care.

List things to observe and report when assisting with bathing. Explain the importance of body mechanics during bathing. List the steps of infection control during bathing.

Module:Consumer/ needs-specific Training

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Goals: Participants will have a basic understanding of the variety and complexity of

individual consumer needs they are likely to encounter in the workplace; Participants will also learn to recognize and explore assumptions, biases and

misconceptions they may hold or may encounter in the workplace; and Participants will be able to define and understand the importance of Consumer

Autonomy and Consumer Direction when providing care.

Objectives: by the end of the session, participants will be able to: Explain the range of consumer needs, including ranges in age and behaviors,

cognitive and developmental abilities; List some common assumptions about the population they will work with; Discuss the impact these biases or assumptions can have on consumer care; Define of Consumer Autonomy and Consumer Direction; and Discuss the impact of Consumer Autonomy and Consumer Direction on practice.

Module: Gentle Touch (Basic Restorative)

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Goal: participants will learn about providing gentle, competent, and respectful physical assistance to support consumers in the manner they prefer.

Objective: Describe strategies to maintain the consumer’s dignity while

assisting with toileting ADLs. Describe and demonstrate proper body mechanics Demonstrate methods to safely assist the consumer to

ambulate, transfer and reposition Describe types and uses for assistive devices for ambulation

and toileting Describe healthy toileting practices

Module:Consumer Rights, Ethics, and Confidentiality

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Goal: participants will understand basic consumer rights and how to protect and respect those rights.

Objectives: Define and discuss a health care proxy and how it is used Define and understand the consumer’s right to privacy and confidentiality

as defined by the Federal Health Insurance Portability and Accountability Act (HIPAA)

Explain the role the personal and home care aide has in ensuring consumers’ right to privacy and confidentiality

List the common laws protecting elders and individuals with disabilities from abuse, neglect and fraud

Define and understand their role as a mandated reporter Recognize and respect consumer values, beliefs, preferences and

directives, particularly when handling finances Identify special circumstances in which participants will provide

assistance outside of the normal routine, to enable consumer participation in group and family activities

Module: Interpersonal Skills

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Goal: to ensure participants develop strategies to reduce job-related stress and improve job satisfaction through skills acquisition that strengthen their relationships with their consumers.

Objectives: Define the stress response system (fight or flight); Recognize the impact of good and bad stress on their physical,

mental and emotional health and well-being; Describe time management strategies; Discuss coping strategies for unplanned and unanticipated

stressors, including death or dying; Explain effective communication strategies, including

perspective taking, checking understanding and active listening techniques; and

Describe basic conflict resolution techniques.

Module: Infection Control

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Goal: prepare participants to practice infection control effectively and apply the principles of standard precautions appropriately in everything they do with consumers and to safeguard the consumer, themselves and their families

Objectives: by the end of the session, participants will be able to: Define universal precautions. Explain why universal precautions are used for infection control. Demonstrate proper hand-washing procedure. Demonstrate application of the principles of infection control in all

activities. Demonstrate the use of standard precautions as indicated.

Module:Safety and Emergency Training

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Goal: to prepare participants to support a safe living environment for the

consumer. Recognize and address risk factors for falling by the consumer and

the PCA/PCHM. Respond to emergency situations in the home—including medical

emergencies, fire, and other situations that would require evacuation. Provide basic first aid to the consumer.

Objective: Define a support a safe, clean, and comfortable living environment. Describe methods ways to reduce falls in and outside the home Describe ways to avoid worker injuries Explain emergency response procedures.

Module: Health Care Support

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Goal: ensure that participants understand their role in supporting the

health and well-being of the consumer within the limitations of their role as defined by their employer; and

increase the participants’ awareness of health altering situations and events.

Objectives: Discuss the differences that exist between various employers

regarding provision of care (e.g., medication administration); Discuss the differences that exist between various employers

when reporting and responding to life saving and/or threatening events;

Discuss the signs and symptoms of life threatening events such as: stroke, heart attack, and seizure; and

List signs of changing health status (e.g., decubitus ulcers (bed sores) )

Skills & Knowledge Testing

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The goal of the PHCAST demonstration project is to develop a core curriculum that can effectively impart the basic knowledge, skills and attitudes required of all direct care workers.

Upon successful demonstration of skills and knowledge the participants will receive a certificate of achievement.

Skills & Knowledge Testing24

The knowledge portion of the test includes 65 multiple choice questions.

The skill portion of the assessment requires students to demonstrate 8 core skills Hand washing, putting on/taking off gloves, proper

body mechanics, helping consumer with dressing, toileting, transferring, bathing, and mouth and hygiene care.

Each competency will be scored as Skilled Satisfactory Needs review

Skills Assessment25

Sample Knowledge Test26

1. PHCA/PCA often helps with:a.personal careb.shoppingc.transferring to a wheelchaird.all of the above

2. When you need to lift a heavy object, the best way is to:a.Arch your back, take a deep breath, and liftb.Keep your knees straight; bend your back by leaning forwardc.Keep your back straight, bend your knees, and then lift using your leg musclesd.Keep your arms bent and one foot directly behind the other, and then lift

3. A client/consumer’s culture influences their nutrition by:a.What foods are selectedb.The methods of food preparationc.The types of spices used in cookingd.All of the above

4. A person who has had a stroke (CVA) may have the following symptoms:a.Depressionb.Slurred speechc.Weakness or paralysis on one side of the bodyd.All of the above

5. The most common accident in the home is:a. Getting burnedb. Chokingc. Poisoning d. Falling

6. The consumer has a right to: a. safetyb. choosec. educationd. all of the above

7. The most important thing the PCA/PCHA does when communicating is:a.Giving adviceb.Listening carefullyc.Having your emotions influence your cared.Not making eye contact

8. The most effective method of preventing the spread of infection is:a.wearing protective eyewearb.to not touch a client/consumer who is infectedc.wearing gloves the entire time you workd.hand washing

9. The very FIRST sign of a possible decubitus ulcer (bed sore) is:a.A red mark that does not go away after ten minutesb.A black and blue areac.Wrinkle marks on the body that go away within 5 minutesd.A large draining wound

Sample Knowledge Test27

Results

Year 2 Objectives28

Implementation Train 260 personal and home care aides (Jan-May) Evaluate the core curriculum Revise new core curriculum based upon Year 1 evaluation

Integration Integrate curriculum into existing state training venues Identify topics for continuing education, including

Alzheimer’s care-taking Dissemination

Engage new training venues across the Commonwealth Begin work on alternate training formats for Spanish

speakers

Integration Steps29

Share the curriculum with state training leads

Cross walk with existing training requirements to identify alignment with core competencies

Explore what steps may be needed by each agency to integrate the curriculum into their operations.

New Venues30

Year 2 includes plans for new venues, possible considerations include: ILCs PCMs Additional Community Colleges Vocational schools Online trainings (proposed for year 3)

Thoughts and ideas from attendees

Break31

30-minute Interactive Demonstration

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Health and Safety Module Activity: Home Safety

Example Core Curriculum

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Contact Information34

To remain involved please contact Leanne Winchester, Project Director

Phone: (617) 573-1823 Email: Leanne.Winchester@state.ma.us

Kate Russell, Project Coordinator Phone: (617) 573-1830 Email: Kate.Russell@state.ma.us