North Carolina Personal and Home Care Aide State Training Grant (PHCAST)

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North Carolina Personal and Home Care Aide
State Training Grant(PHCAST)

• Curriculum Overview and
• Orientation to Phases I II
• Grantee NC Department of Health and Human
  Services
• PHCAST is funded by the US Department of Health
  and Human Services,
• Health Resources and Services Administration
  (HRSA)

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Welcome and Purpose

• Barbara Boyce

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PHCAST Management Team
Kathy Turner, RN, PHCAST Project Director,
Division of Health Service Regulation Jan Moxley,
PHCAST Grant Administrator, Division of Aging and
Adult Services Donna White, RN, Elder
Rights/In-Home Aide, Division of Aging and Adult
Services Susan Harmuth, Senior Program Manager,
NC Foundation for Advanced Health
Programs Phyllis Daw, PHCAST Program Coordinator,
NC Foundation for Advanced Health Programs Kathie
Smith, RN, Associate Vice President of State
Relations, Home Community-Based Care,
Association for Home and Hospice Care of
NC Cherie Rosemond, Research Scientist, UNC
Center for Health Promotion Disease
Prevention Tara Green-Royster, Program Manger,
UNC Center for Health Promotion Disease
Prevention Jennifer Craft Morgan, Assistant
Professor, Gerontology Institute, Georgia State
University Margaret Roberton, Director,
Continuing Ed-Training Standards, NC Community
College System Barbara Boyce, Assoc. VP,
Continuing Ed Workforce Initiatives, NC
Community College System
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Community College Pilot Sites
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
Includes both pilot years
Excludes Halifax CC Cape Fear CC/Elder House
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Overview of PHCAST

• Susan Harmuth

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Reasons PHCAST Was Funded Nationally

• Increasing demand for direct care workers
• Personal Care Aides and Home Care Aides are the
  fastest growing occupations
• Plus, Nurse Aides are in the top 11 jobs in terms
  of largest job growth
• Trained, competent workers are essential to
  quality care
• Create a Gold Standard for minimum training

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Key Concepts of NC PHCAST

• Builds on prior Direct Care Worker Initiatives
• Creates 4-phased framework for training and
  competency to better prepare new and incumbent
  workers
• Training Venues
• Community Colleges
• High Schools

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Overview of NCs 4-Phase Approach

• Phase I Introduction to Direct Care Work
• Phase II Direct Care Basics
  (pre-Nurse Aide level)
• Phase III Nurse Aide I
• Phase IV Advanced NA training/competency
• Home Care Nurse Aide
• Geriatric Nurse Aide
• Medication Aide
• Option for in-service use across settings

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Key Impacts

• Better matching/redirecting of prospective
  workers to job
• Competency based certificate or credential at
  each phase
• More consistent Pre-NA training
• NA I training more realistic
• Enhanced career paths, employability and responds
  to employer need (4-phase approach specialties)

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Key Impacts - Continued

• New and incumbent workers can enter at various
  points
• Expands state recognized career path options
  supports workers responds to employer need
• Broad based support for model
• Integration with other training QI initiatives
• Builds on prior direct care initiatives in NC

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Key Impacts - Continued

• More efficient use of NA I training programs
• Employer recruitment of workers more focused
• Reduces some barriers to training
• High School students job ready (NA I and Phase
  IV)

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Sustainability

• Framework makes sense for NC
• Phase I, II, linked to HRD programs
• State recognized job categories
• Responds to employer need (employer
  participation)
• Integration with other quality improvement
  efforts
• Potential to add new modules in future

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Questions
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Human Resource Development and PHCAST

• Margaret Roberton

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Human Resource Development Governance

• SBCC Code HRD Program Continuation
• Each college shall operate a Human
  Resources Development (HRD) program to provide
  assessment services, employability training, and
  career development counseling to unemployed and
  underemployed individuals. FTE shall be generated
  from HRD programs. Each college shall provide HRD
  instruction and support necessary for unemployed
  and dislocated workers to be served within the
  college service areas.
• Vision and Mission Statement
• HRD is a dynamic and vital workforce development
  program with proven economic, social, and
  educational success. The purpose of the HRD
  program is to educate and train unemployed and
  underemployed individuals for success in the
  workplace.

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HRD Program Goals

• Provide program outreach and student recruitment
  activities to targeted populations
• Assist students in accessing meaningful training
  and/or employment opportunities
• Enhance and develop the students employability
  skills
• Develop and promote the students ability to move
  towards economic self-sufficiency

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Human Resources Development
1D SBCCC 300.3 Program Classifications

• Core Services
• Skill assessment services
• Employability skills training
• Career development counseling
• Target Groups
• Unemployed adults
• Underemployed adults

• Core Components
• Assessment of an individuals assets and
  limitations
• Development of
• a positive self-concept
• employability skills
• communication skills
• problem-solving skills
• Awareness of the impact of Information Technology
  in the workplace

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HRD Fee Waiver Guidelines

• Eligibility Requirements
• HRD courses are not free Fees are waived
• Waiver is based on the individuals income
• Unemployed
• Underemployed
• Notification of pending lay-off

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HRD Eligibility

• For HRD purposes, underemployed is defined as
  individuals
• working and is eligible for the Federal Earned
  Income Tax Credit (FEIT) or
• working and earning wages at or below two hundred
  percent (200) of the federal poverty guidelines.

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PHCAST Needs Aligned to HRD Core
Services

• Assessment
• Ability to appropriately identify individuals
  prepared to enter healthcare fields
• Introduce occupational requirements to maximize
  success of students progressing into Nurse Aide I
• Introduce workplace realities of personal/home
  care environments vs. residential/institutional
  settings
• Outline pathway alternatives for health care
  fields
• Personal Home Care Aide
• Recognized standardized curriculum

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PHCAST Needs Aligned to HRD Core
Services

• Employability Skills
• Concepts contextualized for healthcare field
• Communication, listening skills, teamwork, and
  time/stress management
• Career Development
• Ability to problem solve independently
• Decision-making and management skills

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Specific HRD PHCAST Courses

• Phase I Introduction to Direct Care Work
• (Focus on job readiness skills, literacy,
  numeracy, keyboarding, and realistic job
  previewing)
• Career Exploration
• Self-Assessment
• General soft skill requirements
• CPR (lay person)

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Specific HRD PHCAST Courses

• Phase II Direct Care Basics
• (Focus on non-nurse aide personal care tasks
  and soft skill development 3) expanded nurse
  aide (NA-1) skills)
• Introduction to base skills
• Introduction to functional concepts within role
• Enhanced soft skills training
• Career counseling

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Questions
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Importance of PHCASTto Employers and
Personal Care Clients

• Donna White

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Importance of PHCAST to Employers Personal Care
Clients

• Growing need for Continuum of Care
• Rising cost of care shortage of trained workers
• Greater efficiency in healthcare delivery
  (lowering cost while improving delivery)
• Promote quality care for increasing numbers of
  older adults and persons with disabilities

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Employer Quote

• My PHCAST trained employees expressed joy in
  going to the classes. They were excited about
  what they were learning and they created a
  tremendous bond with each other. We had a special
  ceremony for them at our last meeting and they
  were given pins. Based on what I have heard from
  them, it was worth going through the class. They
  enjoyed it. I believe PHCAST will help with
  caregiver retention.
  Vice President/ Home Care Agency

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Statistics and Projections

• In the next 20 years the number of persons 65 and
  older will almost double from 1.3 million to 2.3
  million
• North Carolina is 10th nationally in size of
  total population, we are 9th in those 60 and
  older.
• By 2025, 86 of the NCs 100 counties are
  projected to have more people over age 60 than
  age 17 and under

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Statistics and Projections

• In 2025, one in four North Carolinians will be 60
  and older
• Over the next two decades, the 75-84 age group
  will be the fastest growing of those ages 65 and
  older
• The number age 85 and older will grow fastest
  beginning in 2030,when the oldest of our 2.4
  million baby boomers near their 85 birthday

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Statistics and Projections

• NC currently has more than 17,000 older adults
  with Alzheimers or other types of dementia most
  of whom are being cared for at home or by family
  and friends. By 2030, the total number is
  projected to rise to nearly 300,000
• For those age 75 and older, 13 live below the
  federal poverty level and 30 live at or between
  100-199 of the FPL

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Demographics

• Status of North Carolinians 65 and older
• Living alone 29
• Veterans 22
• Have a disability 38
• Median household income 27
• Income below poverty level 10 (10,778)
• Income is between 100-199
• of the federal poverty level
  25

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Employer Quote

• I saw a client today whose caregiver went through
  the program. After speaking with the client and
  his guardian, I understood that they are really
  impressed with the caregiver and the improvement
  they have seen. She is being very thorough, she
  is noticing different things in the home, and she
  is alerting the office. I think PHCAST is going
  to help aides improve the relationships and the
  care they are providing. The client was thrilled
  with the care.
  RN Clinical Supervisor/Home
  Care Agency

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NC Home Care Licensure

• 10A NCAC 13J allows for two levels of home care
  aide, limited and extensive
• There are multiple funding sources that fund
  these two levels of care need

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Limited Assistance

• Limited Assistance Care to a client who requires
  hands-on care involving guided maneuvering of
  limbs with eating, toileting, bathing, dressing,
  personal hygiene, self- monitoring of medications
  or other tasks assigned that require weight
  bearing assistance half the time or less during
  the activity

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Extensive Assistance

• Extensive Assistance Client is totally dependent
  or requires weight-bearing support more than half
  the time while performing part of an activity,
  such as guiding or maneuvering of limbs, and
  meets one of the following criteria
• Requires extensive assistance in more than two
  activities of daily living (ADLs) or
• Needs an in-home aide to perform at least one
  task at the nurse aide II level or
• Requires extensive assistance in more than one
  ADL and has a medical or cognitive impairment
  that requires total care more than 50 of the
  time

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PHCAST Role

• PHCAST Phase II prepares limited assistance aides
  for the workforce

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Employer Quote

• As a supervisor, I have noticed that PHCAST
  graduates are giving me more pertinent
  information.
• Nurse
  Supervisor/ Home Care Agency

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Questions
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Recruitment and Marketing of PHCAST

• Margaret Roberton

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Recruitment / Marketing Getting Their
Attention

• Program Outreach
• External Agencies
• Internal Resources
• Community

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Recruitment / Marketing Getting Their
Attention

• Program Outreach
• External Agencies
• JobLink Career Centers
• Division of Workforce Solutions (ESC)
• Social Services
• US Committee for Refugees and Immigrants
• Shelters
• National Guard/Family Employee Assistant Center
• Community-based Organizations

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Recruitment / Marketing Getting Their
Attention

• Program Outreach
• Internal Resources
• HRD classes
• Introduction to Healthcare Occupations
• HRD Strategies for Success
• CE Healthcare classes
• Back-to-Work intake sessions
• Basic Skills Plus

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Recruitment / Marketing Getting Their
Attention

• Program Outreach
• Community
• Flyers and brochures
• College catalogues
• College website
• Social Media
• Email
• Past HRD students (Phase I and Phase II)
• Current and Past NA I students (Phase IV)
• Local home care facilities

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Recruitment / Marketing Challenges

• Communication of value
• Home care agencies
• Benefit of contextualized training
• Benefit of advanced standardized training (Phase
  IV)
• Participants
• Benefit of credential for hiring
• Benefit of commitment to entire pathway
• Program schedule/mix

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Questions
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Curriculum Availability

• PHCAST Phases I and II
• Kathie Smith

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PHCAST Phases I and II

• Phase I Includes job readiness skills,
  literacy, numeracy, keyboarding, realistic job
  previewing
• Phase II Includes personal care tasks and soft
  skill development for non-nurse aide level
• An aide not listed on the NC Nurse Aide Registry
  as a Nurse Aide I (CNA) but may provide personal
  care to clients with limited assistance needs in
  Home Care and in other settings where a Nurse
  Aide I is not required

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PHCAST Phases I and II

• NC PHCAST addresses the following objectives
• Help prospective workers have an understanding of
  educational and training requirements for each
  long term care sector pathway
• Provide 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)

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Phase I and II Curriculum

• Curriculum must be followed as written but
  instructors may develop creative ways to
  disseminate the information, adding as needed,
  activities that are learner-centered focused
• Student attendance requirements are up to the
  individual college this includes how classroom
  information is mastered, with flexibility for
  making up absences as allowed by the college

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Phase I and II Curriculum

• At its core, adult learner-centered training
  assumes learning is active, not passive.
• Trainers using a learner-centered approach rely
  heavily on role plays, case scenarios, small
  group work, and other forms of interactive
  learning
• The curriculum includes instructor guides and
  interactive lesson plans

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Phase II- Skills

• The skills portion of Phase II curriculum (module
  10) must be taught by a Registered Nurse (RN)
• The RN also observes the correct demonstration of
  the skills by the student

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Phase I and II- Slide Presentation

• Where the curriculum calls for a pre-written flip
  chart, a PowerPoint presentation can be developed
  and used in its place

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Phase I and II Role plays

• Not every student will be comfortable with
  performing role plays
• Let students know that role play is a learning
  tool and it may be helpful to practice before
  they are actually faced with the scenario
• The de-brief and discussion that occurs after the
  role play is just as valuable to the learning as
  the role play itself - be sure to leave enough
  time to de-brief

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Phase I and II Duplication

• There is some duplication of subject matter in
  both phases to ensure that regardless of which
  Phase the student enters, pertinent information
  about Direct Care Work is covered
• Activities and information vary between the two
  phases to avoid exact duplication for students
  who attend Phase I and Phase II training
• Instructor should adjust accordingly if the same
  students attend Phase II that attended Phase I

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Phase I and II Guest Speakers

• Guest speakers for both phases
• Invite local guest speakers as appropriate for
  the material being taught.
• Examples
• Workers in the industry of personal care
• Law enforcement to talk about gangs and drugs
• Fire department to demonstrate fire safety
• Alzheimers disease and dementia specialists

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Phase I and II Resources

• Instructor should review and update, as needed,
  handouts, slides, and other information contained
  in the PHCAST modules related to statistics and
  standards of practice to ensure information is
  current and accurate

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Phase I and II Facilitator Guide

• A Phase I and II facilitator (instructor)
  tutorial is included with the PHCAST curriculum
  materials

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Questions
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Competency Skills Check List

• Donna White

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Use of Competency Skills Check List

• North Carolina Home Care Licensure 10 A NCAC 13J
  .1110 Supervision and Competency of In-Home
  Aides
• Each licensed home care agency shall document
  that its in-home aides are competent to perform
  client care tasks or activities to which they are
  assigned
• Such individuals shall perform delegated
  activities under the supervision of person
  authorized by state law to provide such
  supervision

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Licensure Rule Continued

• In-home aides who are not subject to occupational
  licensing laws, shall only be assigned client
  care activities for which they have demonstrated
  competency, the documentation of which is
  maintained by the agency
• Meeting competency includes a correct
  demonstration of tasks to an appropriate
  professional. Each agency shall document that its
  in-home aides demonstrate competence for all
  assigned client care tasks or activities

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PHASE II Direct Care BasicsSkills Check Lists

• Module 9 Home Management Skills and Module 10
  Personal Care Skills includes competency skills
  check list
• Each skill check list includes the required
  number of steps in order to meet competency in
  that skill

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PHASE II Direct Care BasicsSkills Check Lists

• The steps for each skill are numbered
• Each step has to be dated based on learners date
  of demonstrated competency
• Dated signature is required by the competency
  evaluator and the In-Home Aide

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Module 9 Check List

• Home Management Skills Competency Check List
  includes
• Housekeeping for clients
• Nutrition and meal preparation
• Food storage and safe food handling
• Budgeting and spending

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Module 10 Check List

• Personal Care Skills Competency Check List
  includes assisting
• client with a tub bath/shower
• client to wash hair
• with hair and scalp care
• client with mouth care
• with normal skin care
• a man to shave

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Module 10 Check List-Continued

• Assisting
• client to care for hands fingernails
• with care of toenails for clients without
  Diabetes/Peripheral Vascular Disease
• the client to dress
• with elastic stockings
• the client to move up in the bed

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Module 10 Check List-Continued

• Assisting
• client from bed to chair using limited assistance
• client to walk
• client with toileting
• with applying and removing eyeglasses, contact
  lenses, hearing aids and artificial body parts.
  (Optional demonstration)

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Module 9 Check List Example
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Module 10 Check List Example
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Questions
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Pilot Experiences-Panel Discussion

• Crystal McIver Joy McPhail
  Central Carolina Community College
• Alan Duncan
  Sandhills Community College
• Lynn Kavcsak
  Wake Technical Community College

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Wrap-Up

• Margaret Roberton