Culture Change in the Workforce in an Aging America: Are We Making Any Progress?

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1 Culture Change in the Workforce in an Aging America: Are We Making Any Progress? Anne Montgomery Center for Elder Care and Advanced Illness Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit

2 United States Ranking in Health vs. Social Spending Health and Social Expenditures as Percentages of GDP Social Expenditures as a % of GDP Health Expenditures as a % of GDP France Sweden Denmark Austria Germany Belgium Finland Italy United States Netherlands Portugal Spain United Kingdom Norway Greece Ireland Japan Luxembourg Slovenia Hungary New Zealand Canada Source: OECD Health Data 2009, Health Expenditure Dataset, Paris, France (2009) Also in The American Health Care Paradox: Why Spending More is Getting Us Less, by Elizabeth Bradley and Lauren Taylor. Iceland Czech Republic Poland Slovak Republic Australia Estonia Israel Chile Korea Mexico 2

3 Women Will Continue to Comprise the Majority of the U.S. Population of Older Adults Blue Nudes, Henri Matisse,

4 Personal and Home Care Aide State Training Program (PHCAST) of The role of the personal or home care aide (including differences between a personal or home care aide employed by an agency and a personal or home care aide employed directly) 2. Consumer rights, ethics, and confidentiality (including the role of proxy decision-makers in cases of cognitive impairment) 3. Communication, cultural and linguistic competence and sensitivity, problem solving, behavior mgmt, relationship skills 4. Personal care skills 5. Health care support 6. Nutritional support 7. Infection control 8. Safety and emergency training 9. Training specific to an individual consumer s needs 10. Self-Care 4

5 PHCAST, cont. Grantee 3-year awards California: $2,242,738 Iowa: $2,244,596 Maine: $2,247,354 Massachusetts: $2,233,504 Michigan: $2,030,537 North Carolina: $2,022,504 5

6 PHCAST, cont. CA: Competency-based curriculum that leads to certification; 25 modules, IHSS focus ME: Choice of 3 entry-level positions personal support specialist, direct support professional, mental health rehabilitation technician MI: Personal care services curriculum based on PHI s work and trainings in dementia, home skills, prevention of adult abuse and neglect (one-day in-service training) NC: Training is integrated into high school and community college, targets unemployed workers and new entrants 6

7 The Steady Shift to HCBS Among Older Adults Source: Eiken et al. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013: Home and Community- Based Services were a Majority of LTSS Spending. Washington, DC: Truven Health Analytics

8 Geriatric Workforce Enhancement Program FOUR FOCUS AREAS: 1. TRANSFORMING clinical training environments to integrated geriatrics and primary care delivery systems to ensure trainees are well prepared to practice in and lead these kinds of systems. 2. Developing providers who can ASSESS and ADDRESS the needs of older adults and their families/caregivers at the individual, community, and population levels. 3. Creating and delivering COMMUNITY-BASED PROGRAMS that will provide patients, families and caregivers with the knowledge and skills to improve health outcomes and the quality of care for older adults. 4. Also providing ALZHEIMER S disease and RELATED DEMENTIAS EDUCATION to families, caregivers, direct care workers and health professions students, faculty, and providers. 8

9 GWEP, cont. 44 organizations awarded funding of $35 mil. in July 2015; $4 million targeted to training on Alzheimer s and related dementias 11 schools of nursing received awards, one Certified Nurse Aide training and certification program GWEP partners must include at least one primary care program and one community-based organization, and serve seniors, family caregivers Collaborations in New York and Illinois involve many providers, multiple settings 9

10 IOM Retooling Recommendations: Enhancing Geriatric Competence 1. Hospitals should encourage the training of residents in all settings where older adults receive care, including nursing homes, assisted-living facilities, and patients homes. 2. All licensure, certification, and maintenance of certification for health care professionals should include demonstration of competence in the care of older adults as a criterion. 10

11 IOM Retooling Recommendations: Enhancing Geriatric Competence 3. States and the federal government should increase minimum training standards for all direct care workers. Federal requirements for the minimum training of certified nursing assistants and home health aides should be raised to at least 120 hours and should include demonstration of competence in the care of older adults as a criterion for certification. States should also establish minimum training requirements for personal care aides. 4. Public, private, and community organizations should provide funding and ensure that adequate training opportunities are available in the community for informal caregivers. 11

12 IOM Retooling Recommendations: Redesigning Models of Care 1. Payers should promote and reward the dissemination of those models of care for older adults that have been shown to be effective and efficient. 2. Congress and foundations should significantly increase support for research and demonstration programs that promote the development of new models of care for older adults in areas where few models are currently being tested, such as prevention, longterm care, and palliative care. 12

13 Pedal to the Medal/Mettle 13