Best Practices in Training the Home and Community-Based Services Workforce

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Best Practices in Training the Home and
Community-Based Services Workforce

• Elyse Perweiler, MPP, RN
• UMDNJ-School of Osteopathic Medicine
• Associate Director, New Jersey Geriatric
  Education Center
• Director New Jersey AHEC Program
• Strengthening the HCBS Direct Service Workforce
• May 8-9, 2008
• Baltimore MD

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Objectives

• Discuss the social and policy context for
  training direct service workers (DSWs) to care
  for the elderly
• Identify best practices for training DSWs in the
  Geriatric Education Center network
• Describe the role of Community Health Workers
  (CHWs) in minority and underserved communities
• Identify models for training CHWs through the
  AHEC network

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What do we know about todays older Americans?

• Older adults are 12 of our population
• 26 of physician office visits
• 35 of all hospital stays
• 34 of all prescriptions
• 38 of all emergency medical service responses
• 90 of all nursing home use
• Have multiple chronic conditions and experience
  more mental health conditions
• Over 60 living in the community obtain LTC
  services (e.g., personal care, household chores)
• 70-80 of care to older adults receiving long
  term care services is provided by direct care
  workers

Institute of Medicine, Retooling for an Aging
America Building the Health Care Workforce,
2008, accessed at http//www.nap.edu/catalog/12089
.html
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What about the future?

• Demographic characteristics will differ
• More health care provided through technology
• Different expectations and preferences for care
• Financial realities will change Medicare benefits
• Greater need for health care services
• Older adults will become more active partners in
  managing their health

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Institute of Medicine ReportRecommendations

• Enhance competence of all individuals in delivery
  of geriatric care
• Increase recruitment and retention of geriatric
  specialists and caregivers
• Redesign models of care to increase flexibility
• Increase state and federal minimum training
  standards for all direct care workers from 75 to
  120 hours
• Include demonstration of competencies in caring
  for older adults as a certification requirement
• Provide training to informal caregivers and
  integrate them into the formal health care team

Institute of Medicine, Retooling for an Aging
America Building the Health Care Workforce,
2008, accessed at http//www.nap.edu/catalog/12089
.html
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Addressing Workforce Issues in Caring for the
Elderly

• Health care workforce is not sufficient to meet
  needs of the elderly
• Education of the formal health care workforce
  remains inadequate
• All health care workers need to be trained to
  care for older adults
• The reality Majority of care provided to the
  elderly is given by direct service workers or
  informal caregivers
• Between 2006-2016, personal and home care aides
  will represent the 2nd and 3rd fastest-growing
  occupations
• Little is done to increase competence of direct
  care workers to care for the elderly

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Direct Service WorkersStrengthening a Vital Link

• Focus on improving health care and access to
  minority and underserved communities
• Establishing key linkages in underserved areas
• Building a strong network
• Strengthening the health care team
• Increasing awareness of the role of Community
  Health Workers (CHWs)

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Geriatric Education Centers (GECs)

• 48 GECs
• Partnerships and collaborations
• Leveraging funds
• Support agencies that target paraprofessionals
• Provide in-service training to nursing homes
• CE activities and summer institutes
• Train Direct Service Workers through train the
  trainers models
• On-line learning and distance education models

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Best Practices in GECs

• Minnesota GEC
• Career Caregiver Leadership Program (CCLP)
• 6 month education and empowerment program for
  direct care staff
• Supports system changes and quality of life of
  staff and residents they serve
• Contact Lisa Edstrom, Ledstrom_at_umn.edu
  Phone [phone]
• www.hpm.umn.edu/coa
• Montana GEC
• Online Geriatric Education and Certificate
  Program
• 4 options personal use, CE, 45 hour geriatric
  training certificate, academic credit
• Contact Montana.GEC_at_umontant.edu Phone
  [phone] http//mtgec.umontana.edu

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Best Practices in GECs

• Nebraska GEC
• Interdisciplinary training of nursing home
  providers via delivered over Statewide Telehealth
  Network
• 6-month curriculum on dementia and mental illness
• Downloadable Tip Sheets
• Blog format for Q A
• Listserv for participating facilities
• Contact Lisa Bottsford, lbottsfo_at_unmc.edu
  Phone [phone]
• New Jersey GEC
• Train the trainers dementia curriculum for CNAs
  and Home Health Aides
• 7 modules with variable agendas for full days or
  half-day trainings
• Utilizes activities, games and audiovisuals to
  reinforce conceptual learning, overcome cultural
  and health literacy barriers
• Recommended by NJ Dept. of Health Senior
  Services as a model curriculum for dementia
  training in NJ long term care facilities
• Contact Elyse Perweiler, perweiea_at_umdnj.edu
  Phone [phone]

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Best Practices in GECs

• Wyoming GEC
• Foundations of Dementia Care
• Two 4-day trainings per year (dementia basics,
  meals, communications, pain, behaviors)
• Scholarships for family caregivers
• Wyoming Care with Confidence Curriculum
• 2-day train the trainer workshop for mental
  health professionals to train CNAs in LTC
• Will conduct 1 to 3 4-hour trainings in their
  regions
• Contact Jennifer Durer, Coordinator, WyGEC,
  JDurer_at_uwyo.edu Phone [phone]

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Best Practices in GECs

• GEC of Greater Philadelphia (GEC-GP)
• Teaching and Learning to Care for Caregivers in
  LTC (TLC for LTC) dissemination to direct
  care staff in personal care and adult day health
  agencies serving minority populations
• Contact Sangeeta Bhojwani, Sangeeta.Bhojwani_at_up
  hs.upenn.edu
• Phone [phone]
• Alaska GEC
• Collaboration resulted in Trust Training
  Cooperative
• LTC Apprenticeship Program 3 year pilot project
• Direct Service Specialist Occupational
  Endorsement
• Goal create a credentialing program for Alaska
  DSPs that will become the industry standard
• Contact Sheila Wright, ansjw3_at_uaa.alaska.edu
  Phone [phone]

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Area Health Education Centers (AHECs) Building
Best Practice Models in Underserved Communities

• 54 AHEC Programs, 208 AHEC Centers in 48 states
• Partner with academic institutions,
  community-based agencies, professional groups,
  state and federal government
• Leverage funds from other sources
• Implement competency-based and basic entry level
  core curriculum for Community Health Workers
  (CHWs)
• Promote CHW leadership
• Address requirements for certification
• Support and develop CHW preceptors and placement
  sites

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Community Health Workers (CHWs) A New Look at
Direct Service Workers

• Indigenous to and representative of the
  communities they serve
• Break down language and cultural barriers
• Have unique skills
• Known by many names
• Non-traditional students
• Not recognized as a profession by the U.S.
  Department of Labor

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AHEC Best Practice Models

• Arizona AHEC
• Community Health Worker National Education
  Collaborative (CHW-NEC)
• Establish promising practice educational
  program delivery strategies, instructional
  materials/methods, provide technical assistance
• 6 core Technical Assistance Institutions
• 15 Adapter Institutions
• National Advisory Council
• Expert consultants
• Evaluator

Contact dproulx_at_u.arizona.edu or www.chw-nec-org
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AHEC Best Practice Models

• Gulfcoast South AHEC
• Community Health Partnership Project
• Florida AHEC Network Cardiovascular Initiative
  funded by FDOH (2001-2002)
• 2003 Trained CHWs statewide in CVD prevention
• Leverages funds and provides stipends and
  incentives
• CHW Training Model (8-10 hours)
• Definition, role, rationale, confidentiality,
  adult learning presentation skills, community
  resources, evaluation, data collection, etc.
• Information on specific health topics (CVD,
  breastfeeding, diabetes) with resources and
  materials
• Each CHW trained presents at least 2 educational
  programs

Contact Ansley Mora, Community Education
Coordinator, amora_at_health.usf.edu
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AHEC Best Practice Models

• DC AHEC
• Community Health Navigator Project
• 2005 partnership between a parent advocacy group
  and DC AHEC Program
• Uses community participatory model of engagement
• 2006 initial curriculum redesigned and program
  formalized
• Guides or navigates underserved residents
  through service maze
• Provides health education and promotion workshops
  and training sessions to improve health outcomes
• Peer to peer training model (30-32 hr.)
• Paid a stipend
• Quarterly in-service training
• Annual recognition celebration

Contact Kim Bell, Executive Director,
kbell_at_dcahec,org Phone [phone]
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AHEC Best Practice Models

• NJ AHEC
• NJ Community Health Worker Institute
• Educational experiences for health professionals
  working with CHWs
• Pilot projects to show value of CHWs as part of
  the interdisciplinary team
• Course content on working with/supervising CHWs
• CHWs as instructors
• Career development for CHWs
• Core curriculum to standardize skills and
  competencies
• Standardized CHW job description for NJ Dept. of
  Labor
• Establishment of a CHW cluster infrastructure
  to provide training, technical assistance and
  support

Contact Dwyan Monroe, BA, Director, NJ
Community Health Worker Institute,
monroedy_at_umdnj.edu Phone (856)
566-6024
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Additional Contact Information

• Elyse Perweiler, MPP, RN
• Director, NJ AHEC Program
• Associate Director, NJGEC
• National Association of Geriatric Education
  Centers (NAGEC) representative
• perweiea_at_umdnj.edu
• [phone]