1. The Home Care Aide Specialty A Phase IV (Advanced) PHCAST Curriculum September 26, 2013 Kathie Smith, Associate VP of State Relations, Home and Community Based Care Association for Home and Hospice of North Carolina Kathy Turner, Assistant Chief, Health Care Personnel Registry, NC Division of Health Service Regulation

2. Home Care Aide Program Approval Process All Nurse Aide I training programs must obtain DHSR approval to offer the Home Care Aide training course. (available via web or by emailing Brenda Sanders) The 2-page application must be completed and faxed to Brenda Sanders, Center for Aide Regulation and Education Instructor should be a registered nurse with an unencumbered license with a minimum of one year of home care/home health experience.

3. Major Program Requirements Use the state-approved Home Care Aide Specialty curriculum and teach, at a minimum, 100 hours of content - to include all modules. Students must be listed on the Nurse Aide I Registry prior to attending the course. Programs must require a minimum numerical grade of 75 as the final theory grade and a lab/activity grade as pass/fail.

4. Program Approval Process Once the program application is received: Application will be processed Faculty will be reviewed for minimum requirements Program number will be assigned Program coordinator will be notified via email Certificate of Completion template will be sent with approval email

5. Program Review/Renewal Home Care Aide programs will be reviewed by the Education Consultant at the time of the Nurse Aide I Training program renewals

6. Home Care Aide Listing Process Upon completion of the HCA course, the program coordinator/instructor will: Complete Certificate of Completion for successful students Fax Certificate of Completion to Kathy Turner at 919- 733-9764 Retain copy of certificate in records Give original certificate to student Regardless of certificate type presented to student, this specific Certificate of Completion must be faxed to DHSR. Incomplete certificates will be returned.

8. Listing Process Upon receiving faxed certificate, staff at the Center for Aide Regulation and Education will: Ensure student completer is currently listed on the Nurse Aide I Registry Add the aide to “Home Care Aide Specialty Training” listing document, found on https://www.ncnar.org/verify_listings1.jsp

9. Sample Listing Page

10. Listing Verifications Once the DHSR’s web technology project is completed, the listing will be found on the Nurse Aide Verification page as do the other registry listings. It will be modeled after the Geriatric Aide listing.

11. Resources To obtain copy of the HCA program application send email to Brenda.Sanders@dhhs.nc.gov. (applications will soon be available on agency web site)Brenda.Sanders@dhhs.nc.gov To inquire about HCA curriculum and/or site reviews, contact your NAI Education Consultant (see web site for contact information) or Kathy Turner (Kathy.Turner@dhhs.nc.gov).Kathy.Turner@dhhs.nc.gov To inquire about listings, contact Kathy Turner

12. PHCAST Phase IV – NUR 3218 Home Care Nurse Aide Home Care Nurse Aide Recommended Hrs: 100 Max. Hrs: 120 Tier 2 Description Provides advanced training for the Nurse Aide I Focuses on enhancing specific skills needed when working in the home care setting Includes: person-centered care, nutrition/hydration, patient and personal safety, mental health, dementia, behavioral challenges, pain management, palliative care and stress management

13. Where are the enrollees? Community employers Employment agencies Division of Workforce Solutions CE Healthcare classes (NA I & ll) Back-to-Work intake sessions Student Recruitment

14. Turn Key Curriculum

15. Integration of Adult Learning Principles

16. Reality-Based Education Application of learned knowledge “Real world” experiences A meaningful learning experience

17. Curriculum Content Topics with Time Guidance Scripts, PowerPoints Activities, Handouts, PDFs, Resources Instructor Tutorial/How to Use

18. Laboratory Element Setting up a home simulated laboratory

19. Phase IV- Sample Comments (student) This course has started me on the path to reaching my career goals. (100% agree) I know about career options that I did not know about before the completing this course. (93% agree) This course has put me further along in reaching my education goals. (89% agree) I am considering career options that I was not considering before the course. (72% agree) This course has made me more satisfied with my direct care job than I was before. (92% agree) This course has made me a better direct care worker.(100% agree) I would recommend this course to my coworkers.(96% agree)

20. The Industry Connection -Relevance- Kathie Smith, RN

21. Emerging programs and payment delivery methods Care transitions Bundled payments ACOs Focus on non clinical type services to keep people at home

22. Persons 65 years or older 41.4 million in 2011 Represented 13.3% of the U.S. population, 1+ of 8 Americans Number of older Americans increased by 18% since 2000, compared to an increase of 9.4% for the < 65 population Number of Americans 45-64 who will reach 65 over the next two decades – increased by 33% during this period. (DHHS AOA) A look at Older Americans

23.  Number of people with chronic conditions is rapidly rising. Between 2000 and 2030, the number of Americans with one or more chronic conditions will increase 37%, an increase of 46 million people.  About 28% of Americans have two or more chronic conditions and they are responsible for two-thirds of health care spending.  In the Medicare program over two-thirds of the expenditures are for beneficiaries with five or more chronic conditions. ( Chronic care -making the case for ongoing care- Robert Wood Johnson) Chronic Condition Management

24. Reducing Hospital Readmissions October 2012 CMS began ranking hospitals based on 30 day readmission rate for heart attacks, pneumonia, heart failure In 2015 the program will expand to include COPD and other conditions Poor performing hospitals will have all Medicare payments reduced by an amount equal to value of payments for excess readmission. (MedPac 2012) Hospitals Are Being Penalized for Certain Readmissions

25. PHCAST and Home Care Aide Courses: An Industry Perspective Growing need for continuum of care Rising cost of care & shortage of trained workers Greater efficiency in healthcare delivery (lowering cost while improving delivery) Promote quality care for increasing numbers of older adults and persons with disabilities ( Division of Aging and Adult Services)

26. Home Care Aide Training How It Can Be Used Assisting agencies in the professional development of current staff Give agencies a “raise the bar” level of staff when partnering with care transition entities by having aides that have more than minimum training requirements Prepare a potential employee to enhance their resume by having increased knowledge specific to Home Care

27. Employer Feedback from Pilots: Home Care Nurse Aide Increased overall skills, helped build confidence Dementia portion most interesting and helpful Format was pleasing and open discussions encouraged Learned more from the instructor than the PowerPoint presentation (by design) Sparked interest in education Disease processes most applicable

28. Employer Feedback from Pilots: Home Care Nurse Aide Overall very pleased with the class Received more compliments from workers who were PHCAST trained Reports to nurse/supervisor were more pertinent Emphasis on critical thinking and communication with office staff, therapists, and family members to enable them to give the best care possible with confidence Knowing how to prioritize the care plan Great tips on recognizing, avoiding and dealing with caregiver burnout

29. Outreach – Make it Real! Work with your local home care, home health and hospice agencies Agency listings by county (DHSR) http://www.ncdhhs.gov/dhsr/reports.htm Agency listings at Association website at: www.homeandhospicecare.orgwww.homeandhospicecare.org (go to locate a provider and click on home care or hospice and can search by county Ask to speak with agency owner, director or supervisor

30. Suggestions for Utilizing Community Agencies Aide supervisor may visit the class to discuss supervisory visits to the home Request agencies to share different types of aide logs and notes to use when teaching documentation Ask agencies to share orientation topics and hiring requirements and include the information in various lessons Owner or directors can serve as guest speakers to talk about home care in general and how it fits into the care continuum Ask the agencies for a list of the types of ongoing in- services they provide for their aide staff, such as continuing education and training

31. Suggestions for Utilizing Community Agencies Enlist their assistance in setting up home care lab (ideas, type of supplies/equipment) Ask them to write real-life scenarios to use for role-playing and additional activities Bring them in to assist with mock interviews

32. Questions/Sharing Questions and Sharing