Report: Advancing the Home Care Workforce

one year of experience to be eligible for the one-week intensive training, which would lead to health coaching specialization for high-risk heart failure or chronically ill older adults. Training modules focused on concepts including self-management and readiness to change, goal setting, and motivational interviewing, as well as other supportive strategies for engaging consumers in their health care. The heart failure program aimed to provide additional support to patients during the first 30 days post-hospitalization. The program for chronically ill older adults used HHA health coaches to set goals with their clients, review the client’s chronic condition, and encourage medication adherence. We found no evidence that HHA health coaches were compensated for their program participation or received higher wages. 2.1.3. Care Team Integration Home care workers play an integral role in elderly clients’ care and ability to remain at home. These workers – especially PCAs providing long-term care for Medicaid recipients - spend more time with clients’ than other members of their health care team and can help maintain care continuity for clients with complex needs and multiple providers. 22 As such, they have ample opportunity to build relationships with clients and their families, understand their medical and social needs and preferences, and observe, record, and report changes in clients’ condition or health that could prevent more serious medical problems or hospitalizations. 23 ‘Care team integration’ approaches elevate the role of HCWs by providing specialized training and opportunities that facilitate their inclusion in clients’ interdisciplinary health care teams. Beyond the potential benefits of this model to workers themselves (e.g., job satisfaction) and their clients (e.g., reduced hospitalizations), other care team members stand to benefit from listening to home care workers’ observations and understanding their contributions to consumer health. 17 We identified six programs that modeled the integration of HCWs into the care team. Two are worth describing in detail: a large demonstration program and a local pilot. In 2011, the California Long-Term Care Education Center (CLTCEC) received a CMS Health Care Innovation Award for their demonstration project, Care Team Integration of the Home-Based Workforce (CA). This large-scale project involved over 6,000 long-term care consumers participating in the state’s In-Home Supportive Services (IHSS) program and their consumer- directed caregivers. A multi-stakeholder engagement approach was used to design a competency-based, ~75-hour training curriculum for caregivers in more than four different languages. Training included advanced consumer care skills and care team integration. The training was designed to encourage caregivers to take on enhanced roles of monitor, communicator, coach, navigator, and care aide. They utilized role-playing to practice identifying problems and communicating them to the care team. A unique component of this program was that it also provided training to consumers to activate their participation in self-directed care and


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