Optimizing the Role of the Home Health Aide to Improve Patient Outcomes

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Optimizing the Role of the Home Health Aide to
Improve Patient Outcomes

• Carol Rodat
• New York Director
• Paraprofessional Healthcare Institute

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Paraprofessional Healthcare Institute

• National organization dedicated to improving the
  quality of jobs in long-term care through
• Workplace practice
• Public policy/advocacy
• Field building
• Model building

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Why are the Home Health Aides important in this
process?

• HHAs provide 90 of hands-on paid (formal) care
  (eyes and ears)
• HHA job satisfaction is related to retention,
  continuity and therefore quality
• HHAs spend more time with patients and family
  caregivers than other personnel

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Role of Paraprofessionals in QI

• In nursing home studies, findings that nursing
  assistants observations predictive of acute
  illness before onset observed by others
  (Boockvar, K., Journal of the American Geriatrics
  Society, 481086-1091, 2000)
• Evaluation of Better Jobs/Better Care found
  relationship between job satisfaction and
  resident satisfaction and therefore retention

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Optimizing HHAs

• Incorporating HHAs into the clinical care team is
  a paradigm shift
• In NY, it requires a different business model and
  partnerships
• Initiating a project or pilot should be viewed as
  process improvement

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Seeking Quality in HHA Services

• What are the turnover rates of your partners?
• What investments are they making in the
  workforce?
• Do they have the capacity and willingness to
  partner in a project (staffing, reporting
  ability, commitment of leadership)

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Quality in HHA Services

• Is there variation among your LHCSA?
• Is there a pattern within specific LHCSAs?
  (length of service of aides, training,
  coordinators case loads, mentoring/supervision,
  management systems)
• What kind of training do your aides have?

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Investigation

• Which of your patients are experiencing the
  highest rates of hospitalization or emergent care
  use? (age, acuity, diagnosis, day of week, time
  of day, physician, family caregiver, cause for
  admission)
• Communication that occurred prior to
  hospitalization? (patient, family member, LHCSA,
  LTHHCP/CHHA, coordinator/supervisor, RN)
• Was the family caregiver involved?

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Designing an Intervention

• Analyze process
• Identify transition points
• Analyze communication patterns
• Identify education needed
• Design and test intervention
• Gather data and provide feedback

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Leveraging Change

• What are the communication patterns Who do
  family members call? Who do aides call?
• Are all parties familiar with signs of
  exacerbation or distress? (Green, yellow, red
  conditions)

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Leveraging Change Examples of Optimization

• HHAs are being used in agencies in NY and
  elsewhere to install telehealth and provide
  patient teaching
• HHAs in congregate settings support one another
  as patient conditions change
• HHAs in other states are trained and credentialed
  to assist with medications

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Bigger Picture Policy Change

• Whats needed to optimize the home health
  workforce?
• What would be needed to work on preventing
  hospitalizations?
• Demonstration funds
• Additional staffing
• Technology
• Training specific to populations

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PHIs 9 Elements of a Quality Job

• Family sustaining wages
• Affordable health insurance
• Full-time hours if desired and stable work
  schedules
• Excellent training
• Participation in decision making
• Career advancement

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PHIs 9 Elements of a Quality Job

• Linkages to organizational and community services
  as well as public benefits
• Supervisors who set clear expectations and
  require accountability and at the same time
  encourage, support and guide the direct-care
  worker
• Owners and managers willing to lead a
  participative on-going quality improvement
  management system

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More Information

• www.paraprofessional.org
• www.directcareclearinghouse.org
• www.coverageiscritical.org
• crodat_at_paraprofessional.org
• [phone]