Statistics and Projections

Transcription

1 Trained Direct Care Workers: A Critical Piece of the Care Transitions Puzzle Kathy Turner, RN Division of Health Service Regulation Jan Moxley, MS Division of Aging and Adult Services Kathie Smith, RN Association for Home & Hospice Care of NC Michelle White, MSN, BSN,RN Home Care Providers/Alamance CARES 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, and 9th in those 60 and older By 2025, 86 of the NC s 100 counties are projected to have more people over age 60 than age 17 and under 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 % of the federal poverty level 25% 1

2 Personal and Home Care Aide State Training Grant (PHCAST) Federal Grant from US DHHS Health Resources and Services Administration (HRSA) NC 1 of 6 states selected Create a Gold Standard for minimum training Reasons for PHCAST Increasing demand for direct care workers Personal Care Aides and Home Care Aides are the fastest growing occupations Nurse Aides are in the top 11 jobs in terms of largest job growth Trained, competent workers are essential to quality care 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 Focus primarily on direct care workers in home and residential care settings Training Venues: Community Colleges High Schools 2

3 Overview of NC s 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 Phase I: Introduction to Direct Care Work Essential job readiness skills Exposure to direct care field Job screening and other minimum requirements for employment Basic computer, reading, writing and math skills as appropriate Introduction to necessary soft skills CPR- Lay Person 3

4 Phase II: Direct Care Basics Non-nurse aide personal care tasks Basic home management tasks Integration of additional soft skills that more directly associate skills learned with actual service provision Phase III: Nurse Aide I Refinements and enhancements made to curriculum Realistic grouping of tasks Common threads concepts Redesigned method of delivery Statewide implementation Updated skills Phase IV: Advanced NA Training Home Care Nurse Aide Advanced concepts and skills that build on NA 1 training/competencies Focuses on unique care delivery challenges associated with providing care within the home Encompasses more in-depth knowledge and clinical skills, and more advanced soft skill development Creates a track parallel to Geriatric Aide and Medication Aide career path options 4

5 PHCAST & Community Colleges PHCAST fits well with Community College programs Phases I & II conducted through Human Resource Development (HRD) programs Aligns with HRD goals PHCAST needs align with HRD core services (Assessment, Employability Skills, Career Development) Possible fee waiver Phases I-IV conducted through Continuing Education program Phases III & IV also available through Curriculum program Community College Phase I Phase II Phase III Asheville-Buncombe * Phase IV Central Carolina * * * Central Piedmont * Coastal Carolina * * * Forsyth Technical * Mitchell * * * Roanoke-Chowan * * Sandhills * * * Southeastern * * * Stanley * * * Tri-County * * * Wake Technical * * * Includes both pilot years Community College Pilot Sites Excludes Halifax CC & Cape Fear CC/Elder House Pilot Participant Completers Phase I only: 20 Phases I & II only: 139 Phase II only: 70 Phase III only: 53 Phase IV only: 139 Phases I, II, & IV: 10 Total: 426 5

6 Care Transitions & Trained Direct Care Workforce: A Winning Combination PHCAST Phases I and II NC PHCAST addresses the following objectives: Helps prospective workers have an understanding of educational and training requirements for each longterm care sector pathway Provides a uniform pre-nurse aide training program through community colleges that covers essential softskills, basic home management and personal care skills (non-nurse aide level providing limited assistance to clients) PHCAST Phase IV Home Care Nurse Aide Turn key curriculum Reality-based education modules Adult learning principles Learning styles 6

7 The Industry Connection -Relevance- Emerging Programs and Payment Delivery Methods Care transitions - funding new models of care through the Affordable Care Act Accountable Care Organizations Focus on non-clinical type services to keep people at home - helping hospitals with readmissions Chronic care management- role for In-home aide agencies The Prevalence of Chronic Conditions Between 2000 and 2030, the number of Americans with one or more chronic conditions will increase 37 percent, an increase of 46 million people Some 28 percent of Americans have two or more chronic conditions and they are responsible for twothirds of health care spending In the Medicare program over two-thirds of the expenditures are for beneficiaries with five or more chronic conditions (Chronic care -making the case for ongoing care- Robert Wood Johnson) 7

8 Chronic Disease and Non-adherence Non-adherence contributes to: Increase in number and length of acute care visits ( 25% of hospitalizations due to medication errors) Increase in Emergency Department (ED) visits Unnecessary changes in treatment Overuse of scarce and expensive medical resources Loss of productivity and decreased quality of life PHCAST and Home Care 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 ( Division of Aging and Adult Services) What Is At Stake? Potential risks during care transitions: Poor outcomes Costly hospital readmissions Avoidable ED use Medication errors Poor communication & coordination of care across settings (Family Caregiving and Transitional Care; A critical review-gibson, Kelly, Kaplan) 8

9 What Is At Stake? Inpatient and outpatient healthcare professionals must communicate, plan and coordinate services Transition from a bio-medical approach to a public health model of care PHCAST and Care Transitions Care Transition Education May Include: Chronic disease management Patient centered care Patient and/or staff coaching Health Literacy Observation, Reporting and Recording Within the aide s level of responsibility Trained Direct Care Workers: A Critical Piece of the Care Transitions Puzzle Chronic or acute exacerbation model of care delivery Medication reminders Falls prevention Observe, record and report changes before hospitalization or ED visit 9

10 Trained Direct Care Workers: A Critical Piece of the Care Transitions Puzzle Keeping MD appointments, decreasing no show rates Assistance with managing appointments Nutritional assistance Giving Value to the Importance of the Direct Care Worker How do we quantify? Questions? Kathy Turner: Kathy.Turner@dhhs.nc.gov Jan Moxley: Jan.Moxley@dhhs.nc.gov Kathie Smith: kathiesmith@homeandhospicecare.org Michelle White: whitmic@armc.com 10