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Best Practices in Training the Home and Community-Based Services Workforce

Best Practices in Training the Home and Community-Based Services Workforce

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Best Practices in Training the Home and Community-Based Services Workforce

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  1. Best Practices in Training the Home and Community-Based Services Workforce Elyse Perweiler, MPP, RN UMDNJ-School of Osteopathic Medicine Associate Director, New Jersey Geriatric Education Center Director New Jersey AHEC Program Strengthening the HCBS Direct Service Workforce May 8-9, 2008 Baltimore MD

  2. Objectives • Discuss the social and policy context for training direct service workers (DSWs) to care for the elderly • Identify best practices for training DSWs in the Geriatric Education Center network • Describe the role of Community Health Workers (CHWs) in minority and underserved communities • Identify models for training CHWs through the AHEC network

  3. What do we know about today’s older Americans? • Older adults are 12% of our population • 26% of physician office visits • 35% of all hospital stays • 34% of all prescriptions • 38% of all emergency medical service responses • 90% of all nursing home use • Have multiple chronic conditions and experience more mental health conditions • Over 60% living in the community obtain LTC services (e.g., personal care, household chores) • 70-80% of care to older adults receiving long term care services is provided by direct care workers Institute of Medicine, Retooling for an Aging America: Building the Health Care Workforce, 2008, accessed at

  4. What about the future? • Demographic characteristics will differ • More health care provided through technology • Different expectations and preferences for care • Financial realities will change Medicare benefits • Greater need for health care services • Older adults will become more active partners in managing their health

  5. Institute of Medicine ReportRecommendations • Enhance competence of all individuals in delivery of geriatric care • Increase recruitment and retention of geriatric specialists and caregivers • Redesign models of care to increase flexibility • Increase state and federal minimum training standards for all direct care workers from 75 to 120 hours • Include demonstration of competencies in caring for older adults as a certification requirement • Provide training to informal caregivers and integrate them into the formal health care team Institute of Medicine, Retooling for an Aging America: Building the Health Care Workforce, 2008, accessed at

  6. Addressing Workforce Issues in Caring for the Elderly • Health care workforce is not sufficient to meet needs of the elderly • Education of the formal health care workforce remains inadequate • All health care workers need to be trained to care for older adults • The reality – Majority of care provided to the elderly is given by direct service workers or informal caregivers • Between 2006-2016, personal and home care aides will represent the 2nd and 3rd fastest-growing occupations • Little is done to increase competence of direct care workers to care for the elderly

  7. Direct Service WorkersStrengthening a Vital Link • Focus on improving health care and access to minority and underserved communities • Establishing key linkages in underserved areas • Building a strong network • Strengthening the health care team • Increasing awareness of the role of Community Health Workers (CHWs)

  8. Geriatric Education Centers (GECs) • 48 GECs • Partnerships and collaborations • Leveraging funds • Support agencies that target paraprofessionals • Provide in-service training to nursing homes • CE activities and summer institutes • Train Direct Service Workers through “train the trainers” models • On-line learning and distance education models

  9. Best Practices in GECs • Minnesota GEC • Career Caregiver Leadership Program (CCLP) • 6 month education and empowerment program for direct care staff • Supports system changes and quality of life of staff and residents they serve Contact: Lisa Edstrom, Phone: (612) 624-3904 • Montana GEC • Online Geriatric Education and Certificate Program • 4 options: personal use, CE, 45 hour geriatric training certificate, academic credit Contact: Phone: (866) 506-8432

  10. Best Practices in GECs • Nebraska GEC • Interdisciplinary training of nursing home providers via delivered over Statewide Telehealth Network • 6-month curriculum on dementia and mental illness • Downloadable Tip Sheets • Blog format for Q & A • Listserv for participating facilities Contact: Lisa Bottsford, Phone: (402) 559-8421 • New Jersey GEC • Train the trainers dementia curriculum for CNAs and Home Health Aides • 7 modules with variable agendas for full days or half-day trainings • Utilizes activities, games and audiovisuals to reinforce conceptual learning, overcome cultural and health literacy barriers • Recommended by NJ Dept. of Health & Senior Services as a model curriculum for dementia training in NJ long term care facilities Contact: Elyse Perweiler, Phone: (8456) 566-7082

  11. Best Practices in GECs • Wyoming GEC • Foundations of Dementia Care • Two 4-day trainings per year (dementia basics, meals, communications, pain, behaviors) • Scholarships for family caregivers • Wyoming Care with Confidence Curriculum • 2-day train the trainer workshop for mental health professionals to train CNAs in LTC • Will conduct 1 to 3 4-hour trainings in their regions Contact: Jennifer Durer, Coordinator, WyGEC, Phone: (307) 766-3441

  12. Best Practices in GECs • GEC of Greater Philadelphia (GEC-GP) • Teaching and Learning to Care for Caregivers in LTC (“TLC for LTC”) – dissemination to direct care staff in personal care and adult day health agencies serving minority populations Contact: Sangeeta Bhojwani, Phone: (215) 573-7293 • Alaska GEC • Collaboration resulted in Trust Training Cooperative • LTC Apprenticeship Program – 3 year pilot project • Direct Service Specialist Occupational Endorsement • Goal = create a credentialing program for Alaska DSPs that will become the industry standard Contact: Sheila Wright, Phone: (907) 264-6228

  13. Area Health Education Centers (AHECs): Building Best Practice Models in Underserved Communities • 54 AHEC Programs, 208 AHEC Centers in 48 states • Partner with academic institutions, community-based agencies, professional groups, state and federal government • Leverage funds from other sources • Implement competency-based and basic entry level core curriculum for Community Health Workers (CHWs) • Promote CHW leadership • Address requirements for certification • Support and develop CHW preceptors and placement sites

  14. Community Health Workers (CHWs): A New Look at Direct Service Workers • Indigenous to and representative of the communities they serve • Break down language and cultural barriers • Have unique skills • Known by many names • Non-traditional students • Not recognized as a “profession” by the U.S. Department of Labor

  15. AHEC Best Practice Models • Arizona AHEC • Community Health Worker National Education Collaborative (CHW-NEC) • Establish “promising practice” educational program delivery strategies, instructional materials/methods, provide technical assistance • 6 core Technical Assistance Institutions • 15 Adapter Institutions • National Advisory Council • Expert consultants • Evaluator Contact or www.chw-nec-org

  16. AHEC Best Practice Models • Gulfcoast South AHEC • Community Health Partnership Project • Florida AHEC Network Cardiovascular Initiative funded by FDOH (2001-2002) • 2003 – Trained CHWs statewide in CVD prevention • Leverages funds and provides stipends and incentives • CHW Training Model (8-10 hours) • Definition, role, rationale, confidentiality, adult learning & presentation skills, community resources, evaluation, data collection, etc. • Information on specific health topics (CVD, breastfeeding, diabetes) with resources and materials • Each CHW trained presents at least 2 educational programs Contact: Ansley Mora, Community Education Coordinator,

  17. AHEC Best Practice Models • DC AHEC • Community Health Navigator Project • 2005 partnership between a parent advocacy group and DC AHEC Program • Uses community participatory model of engagement • 2006 – initial curriculum redesigned and program formalized • Guides or “navigates” underserved residents through service maze • Provides health education and promotion workshops and training sessions to improve health outcomes • Peer to peer training model (30-32 hr.) • Paid a stipend • Quarterly in-service training • Annual recognition celebration Contact: Kim Bell, Executive Director, kbell@dcahec,org Phone: (202) 574-6994

  18. AHEC Best Practice Models • NJ AHEC • NJ Community Health Worker Institute • Educational experiences for health professionals working with CHWs • Pilot projects to show value of CHWs as part of the interdisciplinary team • Course content on working with/supervising CHWs • CHWs as instructors • Career development for CHWs • Core curriculum to standardize skills and competencies • Standardized CHW job description for NJ Dept. of Labor • Establishment of a CHW “cluster” infrastructure to provide training, technical assistance and support Contact: Dwyan Monroe, BA, Director, NJ Community Health Worker Institute, Phone: (856) 566-6024

  19. Additional Contact Information • Elyse Perweiler, MPP, RN Director, NJ AHEC Program Associate Director, NJGEC National Association of Geriatric Education Centers (NAGEC) representative (856) 566-7082