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

Optimizing the Role of the Home Health Aide to Improve Patient Outcomes. Carol Rodat New York Director Paraprofessional Healthcare Institute. Paraprofessional Healthcare Institute. National organization dedicated to improving the quality of jobs in long-term care through: Workplace practice

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

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  1. Optimizing the Role of the Home Health Aide to Improve Patient Outcomes Carol Rodat New York Director Paraprofessional Healthcare Institute

  2. 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

  3. 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

  4. 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, 48:1086-1091, 2000) • Evaluation of Better Jobs/Better Care found relationship between job satisfaction and resident satisfaction and therefore retention

  5. 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

  6. 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)

  7. 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?

  8. 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?

  9. Designing an Intervention • Analyze process • Identify transition points • Analyze communication patterns • Identify education needed • Design and test intervention • Gather data and provide feedback

  10. 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)

  11. Getting Ready "Where are we going?" Clarify purpose and values Continuing the Journey: "Where do we go from here?" Celebrate achievement And keep going! Implementation: "What are we changing?" Align practices/behavior With purpose and values Evaluation: "How are we doing?" Analyze qualitative and Quantitative information

  12. 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

  13. Bigger Picture – Policy Change • What’s 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

  14. PHI’s 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

  15. PHI’s 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

  16. More Information: • www.paraprofessional.org • www.directcareclearinghouse.org • www.coverageiscritical.org • crodat@paraprofessional.org • (518) 461-9563

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