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