core competencies strengthening the home and community based workforce
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Core Competencies Strengthening the Home and Community Based Workforce. Pat Schommer , MA Associate Director U of M, Center on Aging & MN Area Geriatric Education Center Laurissa Stigen, MS Executive Director Central MN Area Health Education Center

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slide2

Pat Schommer, MA Associate Director

U of M, Center on Aging &

MN Area Geriatric Education Center

Laurissa Stigen, MS Executive Director

Central MN Area Health Education Center

Lori Sedlezky, MSW Director of Knowledge Translation

Annie Johnson Sirek, MSW Project Coordinator

U of M, Institute on Community Integration, Research & Training Center on Community Living

phenomenal fact
PHENOMENAL FACT

2/3 of the people,

in the world,

who have achieved

the age of 65,

are still alive today

Robyn Stone, DPH of Leading Age, Distinguished Lecture 4.17.13 at the U of M

phenomenal fact1
PHENOMENAL FACT

Minnesota is expecting a 54% increase in the 65 and older population between

2015 and 2030.

United Health Foundation, June 2013, 2013 Senior Report

unprecedented increases in minnesota s 65 population
Unprecedented Increases in Minnesota’s 65+ Population

Source: Minnesota State Demographer using 2010 Census Data

minnesotans age 85 increases 150 over next 30 years
Minnesotans Age 85+ Increases 150% Over next 30 Years

64.9%

32.0%

17.4%

Source: Minnesota State Demographer using 2010 Census Data

minnesota household growth 2010 2020
Minnesota Household Growth 2010-2020

The New Norm: Empty Nesters

and Older Adults Living Alone

Source: Minnesota State Demographic Center projection, 2012

12 139 total beds statewide percent of capacity in parentheses
12,139 total beds statewide (percent of capacity in parentheses)

29 Percent of Minnesota Care Center Beds Closed or Laid Away Since July 2000

(29.7%)

(24.5%)

(25.2%)

(27.7%)

(36.3%)

(28.9%)

(35.0%)

Source: Minnesota Department of Health, March 2013

more than twice as many housing with service units as care center beds
More Than Twice As Many Housing-with-Service Units as Care Center Beds

Source: Minnesota Department of Health, March of each year

phenomenal fact2
PHENOMENAL FACT

Minnesota is ranked at the top of the list of healthiest states for older adults.

United Health Foundation, June 2013, 2013 Senior Report

labor force growth about to slow sharply
Labor Force Growth About To Slow Sharply

Source: Minnesota State Demographer, 2011

minnesota saw a 30 jump in employees turning age 62 in 2008
Minnesota Saw a 30% Jump in Employees Turning Age 62 in 2008

Source: Minnesota State Demographer, 2011

minnesota to develop 46 more healthcare practitioners to meet needs
Minnesota To Develop 46% More Healthcare Practitioners To Meet Needs

Source: Minnesota Department of Employment and Economic Development (DEED) Occupation Forecasts, 2002-2012

employee retention percentage declining in care centers
Employee Retention Percentage Declining in Care Centers

Source: DHS Nursing Home Cost Reports

the wage gap
The Wage Gap

Senior Living Workers Underpaid in the Marketplace

Gap=$17.39 per hour

or $36,171 per year

Gap=$15.77 per hour

or $32,802 per year

Gap=$2.07 per hour or $4,306 per year

Gap=$1.81 per hour or $3,765 per year

Gap=$5.79 per hour or $12,043 per year

Gap=$6.13 per hour or $12,750 per year

Sources: 2011 LTC Imperative Salary Survey and 2011 MN Health Care Cost Information Service Hospital Salary Data

slide16

Direct Care Workers will be Largest Occupation Group in US by 2020

Source: Paraprofessional HealthCare Institute May 2012

slide17

US Demand for Workers from 2010-2020 Grows Most for Home-Based Services

Source: Paraprofessional HealthCare Institute, May 2012

core competencies applied in the direct service workforce

Core Competencies Applied in the Direct Service Workforce

Annie Johnson Sirek, MSWResearch Project Coordinator

agenda part 2
Agenda (Part 2)
  • Overview of the Direct Service Workforce
  • Role of Competencies
  • CMS Road Map Project to Define

Core Competencies

in Long Term Services & Supports

  • Strategies to promote quality outcomes in HCBS
  • Plan next steps: How to prepare our workforce
a cross disability perspective on the national direct service workforce
A Cross-Disability Perspective on the National Direct Service Workforce
  • Long-term Services and Supports (LTSS) Sectors:
    • Aging
    • Behavioral Health
    • Intellectual and Developmental Disabilities
    • Physical Disabilities
direct service worker dsw roles
Crisis intervention

Assessment, referrals

Teaching new skills

Self-determination/

self-direction

Working with families

Community integration

Companionship/ relation-ships

Direct Service Worker (DSW) Roles
  • Personal care/ hygiene
  • Home skills
  • Health and safety
  • Monitoring health/ health tasks
  • Transportation
  • Employment
  • Positive behavior support
occupational titles
Occupational Titles

No single, unified title…

  • More commonality in aging and physical disabilities services
    • Nurse Aide
    • Home Health Aide
    • Personal Care Assistant
  • Paraprofessional vs. professionalism within I/DD
    • Direct Support Professional
  • Behavioral Health
    • Peer Support Specialist
trends across service sectors
Trends Across Service Sectors
  • Deinstitutionalization
    • Community based settings
    • Smaller in size
    • Increase in variety and difference in places
    • Geographic dispersion of service delivery locations
  • Implications
    • DSW roles requiring greater skill, judgment, and accountability
    • Greater autonomy and responsibility
    • More independent problem-solving, decision-making
    • Need for adequate supervision and co-worker

interaction

direct support workforce challenges experienced across sectors
Direct Support Workforce Challenges Experienced Across Sectors
  • Status and Image
  • Vacancy rates
  • High Turnover / Low wages
  • Poor access and utilization of benefits
  • Limited access to training and education
  • Increasingly absent or ineffective supervision
strategic areas for collaborative planning and action
Strategic Areas for Collaborative Planning and Action
  • Training and education
  • Retention
  • Wages and benefits
  • Payment rate and procurement structures
  • Data collection, research and evaluation
  • Status and awareness
role of competencies
Role of Competencies

Used as a guidepost for workforce development activities and tools:

  • Recruitment, hiring, and selection
  • Curriculum development
  • Training program implementation
  • Career pathways, ladders and lattices:
    • Apprenticeship programs
    • Credentialing and certification systems
  • Continuing education and ongoing staff development
  • Performance evaluation

(Campion et al., 2011)

outcomes associated with competency based training
Outcomes Associated with Competency-Based Training

(Direct Service Workforce

Resource Center, in draft)

slide35

Road Map of Core Competencies for

the Direct Service Workforce

project framework
Project Framework
  • Objective: Identify a common set of core competencies across community-based long-term services and supports (LTSS) sectors:
    • Aging
    • Behavioral health (mental health and substance use)
    • Intellectual and developmental disabilities
    • Physical disabilities
  • Goals: Application of core competencies to facilitate:
    • Evidence-based practices for DSW training and employment.
    • Interagency collaboration in workforce development activities.
    • Assessment of workforce capacity within states and agencies.
    • Effective training policies to meet participants’ needs.
project framework1
Project Framework
  • Focus on Community-Based Settings
    • As defined by Section 2401 of the Affordable Care Act: Community First Choice State Plan Option: Home and Community-Based Setting Requirements (§ 441.530)
  • Content Based on Best Practices
    • Balance between best practice and “here and now.”
  • Strive for Common Language and Terminology
      • Structured to translate to workforce development tools.
  • A Foundational Lens for Direct Support Workers
    • Audience of all DSWs and those who supervise and train them.
competency based training model
Competency-Based Training Model

(O’Nell & Hewitt, 2005; Hewitt & Larson, 1994)

slide43

College of Direct Support (CDS) - UMN

  • College of Employment Services - UMASS
  • College of Personal Assistance & Caregiving - UCSF
  • College of Recovery & Community Inclusion - Temple
slide44

Every lesson is designed to give DSPs the knowledge, skills and attitudes they need through innovative, engaging and interesting training.

slide45

CDS Instructional Design

  • Competency-Based
      • Accredited by NADSP
  • Evidence-Based
      • Best Practices in HCBS
      • Research translation (e.g. self-determination, social inclusion, community living, employment)
  • Adult learning
      • Highly interactive and multi-media
      • Reflective exercises
      • Used in combination with classroom and mentoring
  • Self-paced, asynchronous, just in time
  • Various Assessments Methods
  • Moving toward pad and handheld
contact information
Contact Information

Annie Johnson Sirek, MSW

[email protected]

(612) 626-0535

Research and Training Center on Community Living

Institute on Community Integration,University of Minnesota

discussion

Discussion:

What are your goals

for preparing our workforce

to better meet individuals’ needs?

reasons to collaborate
Reasons to Collaborate
  • Collective voice is needed to bring attention and solutions.
  • Efforts to improve financing, reimbursement, and regulatory structures should benefit all sectors.
  • We do not have the resources to duplicate efforts.  
  • Must share innovative solutions across sectors.    
  • State agencies & providers are increasingly cross-sector.
  • States are seeking cross-sector solutions & efficiencies.
  • In many ways, it is the same workforce.
  • Health and quality of life of individuals served is not organized by silos.
strategic areas for collaborative planning and action1
Strategic Areas for Collaborative Planning and Action
  • Training and education
  • Retention
  • Wages and benefits
  • Payment rate and procurement structures
  • Data collection, research and evaluation
  • Status and awareness
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