By Geralyn Magan
Two recent journal articles, co-authored by LTSS Center researchers, address the opportunities and challenges presented by the home care workforce.
Two prominent journals in the health care field published articles on the home care workforce this spring. Robyn Stone, co-director of the LeadingAge LTSS Center @UMass Boston, and Natasha Bryant, the LTSS Center’s managing director/senior research associate, wrote one article and served as co-authors on the second.
The Journal of the American Geriatrics Society (JAGS) published “The Future of the Home Care Workforce: Training and Supporting Aides as Members of Home-Based Care Teams” by Stone and Bryant in its May 2019 edition.
Health Affairs published “Home and Community-Based Workforce for Patients With Serious Illness Requires Support to Meet Growing Needs” in June. Joanne Spetz from the University of California San Francisco (UCSF) was the lead author on the Health Affairs article. Stone, Bryant, and Susan A. Chapman, also from UCSF, were co-authors.
INCLUDING HOME CARE WORKERS ON HOME-BASED TEAMS
In their JAGS article, Stone and Bryant make a strong case for why clinicians should include home health, home care, and personal care aides as active members of home-based care teams.
Members of this workforce “are often the eyes and ears of the health system, observing subtle changes in condition that can provide important information for clinical decision making and therapeutic intervention,” write the authors. “Despite this fact, the growing number of team-based home care initiatives have failed to incorporate this workforce into their programs.”
Aides belong on home-based teams because they are a major source of emotional support for many patients with serious illness and are likely to have the most interaction with family members, write Stone and Bryant. In addition, these aides often play a pivotal role in maintaining continuity for health consumers who see multiple providers or experience multiple care transitions.
Despite their importance, however, aides are often not included on care teams because their work is undervalued, investments in their training and education are inadequate, and state laws often limit their ability to work effectively in teams and to advance in their careers.
To address these barriers, Stone and Bryant call on federal and state policy makers, educators, and health systems and providers to take 3 steps.
Standardize competency-based training requirements. These requirements should be designed to ensure the development of a quality home care workforce and to address the skills and knowledge that aides need to operate effectively as part of a team. Team-related competencies for aides should cover such skill areas as:
- Observation.
- Documentation and reporting.
- Participation in care planning and implementation.
- Effective communication with other team members.
Expand nurse delegation consistently across states. Home care aides are more likely to be included as team members if they are allowed to expand their jobs beyond personal care tasks, write Stone and Bryant. Nurse delegation laws, which allow aides to engage in skilled nursing tasks under the supervision of a nurse, create opportunities for aides to become specialists in areas that will help them serve as “confident, effective team members and even team managers,” they write. Such specialties might include:
- Medication management.
- Wound care.
- Dementia care.
- Pain management.
- Health coaching.
Support evaluation, dissemination, and replication of successful programs. Stone and Bryant call on federal and state policy makers to support demonstrations and evaluations that rigorously test the benefits associated with adding aides to home-based care teams. Those demonstrations could explore:
- The best strategies for integrating aides into the teams.
- Financial incentives that would motivate payers and providers to formally include aides as team members.
- How aides should be compensated for their teamwork.
- How successful programs could be disseminated and scaled to support wider adoption.
CARING FOR PEOPLE WITH SERIOUS ILLNESS
The Health Affairs article addresses the recruitment, training, retention, and regulatory challenges facing the nearly 3 million people providing direct care for people with serious illness who are living in the community. These personal care aides receive little formal training, and experience low pay and a lack of respect for the skills required to do their jobs.
While the authors make note of the dearth of data available to inform good policy and practice decisions regarding the home care workforce, they also suggest several opportunities for change, recommending that policy makers:
- Implement reimbursement strategies that incentivize improvements in pay and working conditions for home health and personal care aides.
- Follow the Institute of Medicine’s 2008 recommendations calling for the implementation of federal training standards for home care workers across all settings, an increase in the minimum required training hours for nursing assistant and home health aide from 75 to 120, and the introduction of required training hours for personal care workers.
- Reform regulations that now prevent the full utilization of home care workers, and use health care policies to create sustainable career pathways for these workers.
- Develop demonstration programs in communities with high unemployment rates or higher-than-average concentrations of older adults to address the need for new jobs and the demand for services to assist frail older adults and their family caregivers.