1. PERSONAL AND HOME CARE AIDE STATE TRAINING (PHCAST) INFORMATION SESSION September 28, 2011 9:30-1:00PM MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES & EXECUTIVE OFFICE OF ELDER AFFAIRS PRESENTS:

2. Disclosure 2 This project is supported by funds from the Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under HRSA PHCAST Program Announcement HRSA-10-288 CFDA No. 93.512. Massachusetts PHCAST Grant Project T82HP20323 was awarded $738,993 for year 1, $744,769 for year two, with expected continued funding for year 3. The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any official endorsement be inferred by, the DN, BHPr, HRSA, DHHS, or the US Government.

3. The PHCAST Team 3 PHCAST Co-Principal Investigators  Ann L. Hartstein, Secretary, Executive Office of Elder Affairs  Rosalie Edes, Deputy Assistant Secretary of Disability Policies and Program, Executive Office of Health and Human Services Project Director  Leanne Winchester, RN, University of Massachusetts Medical School Senior Advisor  Mary Kay Browne, University of Massachusetts Medical School and EOHHS Project Coordinator  Kate Russell, University of Massachusetts Medical School PHCAST Partners  Bristol Community College  Commonwealth Corporation  MA Council for Home Care Aides  Paraprofessional Healthcare Institute (PHI)  UMMS MassAHEC Network  PCA Workforce Council

4. PHCAST Advisory Group  Association of American Retired Persons (AARP) Massachusetts  Arc Massachusetts  Association of Developmental Disabilities Providers  Boston Center for Independent Living  Department of Public Health  Department of Developmental Services  Department of Mental Health  Department of Transitional Assistance  Department of Youth Services  Executive Office of Elder Affairs  Executive Office of Health & Human Services  Executive Office for Work, Labor Development  Local 509 Service Employees International Union (SEIU)  Massachusetts Association of Behavioral Healthcare  Massachusetts Senior Care Association  Massachusetts Aging Services Association  Massachusetts Assisted Living Federation of America (ALFA)  Massachusetts Clubhouse Coalition  Massachusetts Commission for the Blind  Massachusetts Commission for the Deaf and Hard of Hearing  Massachusetts Council for Home Care Aide Services  Massachusetts Home Care  Massachusetts Community Colleges Executive Office  Massachusetts Commission for the Deaf and Hard of Hearing  Massachusetts Rehabilitation Commission  National Empowerment Center  PCA Quality Workforce Council  1199 SEIU United Healthcare Workers East  Smith College / PCA Employer  The Home Care Alliance  The Providers Council 4

5. Agenda 5 1. Background and Vision 2. PHCAST core competency curriculum development process, outcomes and objectives 3. Presentation of Skills & Knowledge Competency Training 4. Break 5. Looking ahead – open discussion 6. Break 7. Demonstration of PHCAST Core Competency Module

6. Project Context 6  Personal & Home Care Aides are among those direct care workers who play a vital role in job creation and economic growth, particularly in low-income communities.  PHCA provide an estimated 70 to 80% of the paid hands-on long- term care and personal assistance received by Americans who are elderly or living with disabilities or other chronic conditions.  The Bureau of Labor Statistics projects that PHCA will be the fourth fastest growing direct care occupations in the U.S. between 2008 and 2018, with an increase of 46 percent. Source: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES- Health Resources and Services Administration- Bureau of Health Professions -Division of Nursing

7. Background: Massachusetts Long-term / Direct Care Workforce Landscape 7  Massachusetts currently employs and/or pays for long-term support direct care workers through a number of state agencies including but not limited to:  EOEA, MassHealth Office of Long-term Care, DDS, DPH, Soldiers’ Homes, MRC, DMH, DCF, DYS, MCB  The Commonwealth spends >$4B on long term supports for people with disabilities, ~47% in community settings  These workers provide the following types of direct care supportive services:  Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)  Skills training  Cueing / monitoring & other communication & behavioral support  Other

8. Background: Workforce Landscape, cont. 8 Challenges faced by consumers, workers, agencies:  Same worker may be employed through various programs (i.e., paid by various agencies) to provide same type of care  Agencies may have different requirements for workers in each setting (often dependent on funding stream)  Needed core competencies may be the same across consumers but not required across agencies / settings  Worker titles are multiple and overlapping i.e., Direct Care Workers? Direct Support Professionals? LTC Direct Care?  Worker pay varies, not always based on competencies

9. Direct Care Workforce Turnover 9  Turnover rates are extremely high among direct care workers, almost half of workers are employed at more than one job in a 2 year period  2/3 of direct care workers surveyed reported that turnover interferes with their ability to do their job Source: U.S. Department of Health and Human Services. 2011. “Understanding Direct Care Workers: A Snapshot of Two of America’s Most Important Jobs” Washington, D.C.

10. PHCAST Core Competency Curriculum Development Time Line 10  November 2010, the team developed a cross walk of their current trainings with the Affordable Care Act core competencies  Winter 2011, the team conducted gap assessment of current curricula  Spring 2011, the team developed the first draft of four of nine core competency modules  Summer 2011, began year 1 pilots  December 2011, complete the first draft of the remaining 5 modules  January 2012, the year two pilots will begin

11. PHCAST Core Competencies 11

12. Curriculum Development 12 Goals and Objectives Assessment & Evaluation ALCT Learning Activities

13. Adult Learner-Centered Training Approach 13  Emphasis is placed on the learning process of the learner  The teacher acts as a facilitator rather than an information expert  How the Adult Learning Cycle “Works”  Facilitators refer to the learners’ prior experiences  Facilitators help the learner to focus on key points from their experience and shares ideas and reactions with others  Facilitator guides the learner to new insights; provides new information  Facilitator coaches the learner through feedback, advice and encouragement  ALCT at it’s core assumes learning is active, not passive. ALCT begins with actual experiences using multiple training methods

14. Module: Roles and Responsibilities of a Personal & Home Care Aide 14 Goal: to ensure that participants will have a basic understanding of the day to day tasks as well as the limits on what tasks they can perform; understand the importance of the position to the consumer and the health care system; and recognize differences in roles and the opportunities for career advancement in the health care field. Objectives: by the end of the session, participants will be able to:  Explain the potential benefits of the personal and home care aide can provide for the consumer;  List the various employers and employment opportunities;  Define and list ADLs and IADLs; and  Explain the limits of service/care of the personal and home care aide.

15. Module: Personal Care Skills and Nutrition 15 Goal: Participants will learn the skills necessary to assist consumers with three of the activities of daily living—bathing, dressing, and eating. They will also explore the importance of applying the principles of person-centered care and consumer direction, in order to show respect and promote the dignity of the consumer while assisting with personal care. Objectives: by the end of the session, participants will be able to:  Explain the importance of communicating with the consumer and respecting dignity, privacy, and the consumer’s preferences during bathing.  Explain how to apply basic principles of person-centered care when assisting the consumer with personal care such as bathing, pericare, mouth care and skin care.  List things to observe and report when assisting with bathing.  Explain the importance of body mechanics during bathing.  List the steps of infection control during bathing.

16. Module: Consumer/ needs-specific Training 16 Goals:  Participants will have a basic understanding of the variety and complexity of individual consumer needs they are likely to encounter in the workplace;  Participants will also learn to recognize and explore assumptions, biases and misconceptions they may hold or may encounter in the workplace; and  Participants will be able to define and understand the importance of Consumer Autonomy and Consumer Direction when providing care. Objectives: by the end of the session, participants will be able to:  Explain the range of consumer needs, including ranges in age and behaviors, cognitive and developmental abilities;  List some common assumptions about the population they will work with;  Discuss the impact these biases or assumptions can have on consumer care;  Define of Consumer Autonomy and Consumer Direction; and  Discuss the impact of Consumer Autonomy and Consumer Direction on practice.

17. Module: Gentle Touch (Basic Restorative) 17 Goal: participants will learn about providing gentle, competent, and respectful physical assistance to support consumers in the manner they prefer. Objective:  Describe strategies to maintain the consumer’s dignity while assisting with toileting ADLs.  Describe and demonstrate proper body mechanics  Demonstrate methods to safely assist the consumer to ambulate, transfer and reposition  Describe types and uses for assistive devices for ambulation and toileting  Describe healthy toileting practices

18. Module: Consumer Rights, Ethics, and Confidentiality 18 Goal: participants will understand basic consumer rights and how to protect and respect those rights. Objectives:  Define and discuss a health care proxy and how it is used  Define and understand the consumer’s right to privacy and confidentiality as defined by the Federal Health Insurance Portability and Accountability Act (HIPAA)  Explain the role the personal and home care aide has in ensuring consumers’ right to privacy and confidentiality  List the common laws protecting elders and individuals with disabilities from abuse, neglect and fraud  Define and understand their role as a mandated reporter  Recognize and respect consumer values, beliefs, preferences and directives, particularly when handling finances  Identify special circumstances in which participants will provide assistance outside of the normal routine, to enable consumer participation in group and family activities

19. Module: Interpersonal Skills 19 Goal: to ensure participants develop strategies to reduce job-related stress and improve job satisfaction through skills acquisition that strengthen their relationships with their consumers. Objectives:  Define the stress response system (fight or flight);  Recognize the impact of good and bad stress on their physical, mental and emotional health and well-being;  Describe time management strategies;  Discuss coping strategies for unplanned and unanticipated stressors, including death or dying;  Explain effective communication strategies, including perspective taking, checking understanding and active listening techniques; and  Describe basic conflict resolution techniques.

20. Module: Infection Control 20 Goal: prepare participants to practice infection control effectively and apply the principles of standard precautions appropriately in everything they do with consumers and to safeguard the consumer, themselves and their families Objectives: by the end of the session, participants will be able to:  Define universal precautions.  Explain why universal precautions are used for infection control.  Demonstrate proper hand-washing procedure.  Demonstrate application of the principles of infection control in all activities.  Demonstrate the use of standard precautions as indicated.

21. Module: Safety and Emergency Training 21 Goal:  to prepare participants to support a safe living environment for the consumer.  Recognize and address risk factors for falling by the consumer and the PCA/PCHM.  Respond to emergency situations in the home—including medical emergencies, fire, and other situations that would require evacuation.  Provide basic first aid to the consumer. Objective:  Define a support a safe, clean, and comfortable living environment.  Describe methods ways to reduce falls in and outside the home  Describe ways to avoid worker injuries  Explain emergency response procedures.

22. Module: Health Care Support 22 Goal:  ensure that participants understand their role in supporting the health and well- being of the consumer within the limitations of their role as defined by their employer; and  increase the participants’ awareness of health altering situations and events. Objectives:  Discuss the differences that exist between various employers regarding provision of care (e.g., medication administration);  Discuss the differences that exist between various employers when reporting and responding to life saving and/or threatening events;  Discuss the signs and symptoms of life threatening events such as: stroke, heart attack, and seizure; and  List signs of changing health status (e.g., decubitus ulcers (bed sores) )

23. Skills & Knowledge Testing 23  The goal of the PHCAST demonstration project is to develop a core curriculum that can effectively impart the basic knowledge, skills and attitudes required of all direct care workers.  Upon successful demonstration of skills and knowledge the participants will receive a certificate of achievement.

24. Skills & Knowledge Testing 24  The knowledge portion of the test includes 65 multiple choice questions.  The skill portion of the assessment requires students to demonstrate 8 core skills  Hand washing, putting on/taking off gloves, proper body mechanics, helping consumer with dressing, toileting, transferring, bathing, and mouth and hygiene care.  Each competency will be scored as Skilled Satisfactory Needs review

25. Skills Assessment 25

26. Sample Knowledge Test 26 1. PHCA/PCA often helps with: a.personal care b.shopping c.transferring to a wheelchair d.all of the above 2. When you need to lift a heavy object, the best way is to: a.Arch your back, take a deep breath, and lift b.Keep your knees straight; bend your back by leaning forward c.Keep your back straight, bend your knees, and then lift using your leg muscles d.Keep your arms bent and one foot directly behind the other, and then lift 3. A client/consumer’s culture influences their nutrition by: a.What foods are selected b.The methods of food preparation c.The types of spices used in cooking d.All of the above 4. A person who has had a stroke (CVA) may have the following symptoms: a.Depression b.Slurred speech c.Weakness or paralysis on one side of the body d.All of the above 5. The most common accident in the home is: a. Getting burned b. Choking c. Poisoning d. Falling 6. The consumer has a right to: a.safety b.choose c.education d.all of the above 7. The most important thing the PCA/PCHA does when communicating is: a.Giving advice b.Listening carefully c.Having your emotions influence your care d.Not making eye contact 8. The most effective method of preventing the spread of infection is: a.wearing protective eyewear b.to not touch a client/consumer who is infected c.wearing gloves the entire time you work d.hand washing 9. The very FIRST sign of a possible decubitus ulcer (bed sore) is: a.A red mark that does not go away after ten minutes b.A black and blue area c.Wrinkle marks on the body that go away within 5 minutes d.A large draining wound

27. Sample Knowledge Test 27  Results

28. Year 2 Objectives 28  Implementation  Train 260 personal and home care aides (Jan-May)  Evaluate the core curriculum  Revise new core curriculum based upon Year 1 evaluation  Integration  Integrate curriculum into existing state training venues  Identify topics for continuing education, including Alzheimer’s care-taking  Dissemination  Engage new training venues across the Commonwealth  Begin work on alternate training formats for Spanish speakers

29. Integration Steps 29  Share the curriculum with state training leads  Cross walk with existing training requirements to identify alignment with core competencies  Explore what steps may be needed by each agency to integrate the curriculum into their operations.

30. New Venues 30  Year 2 includes plans for new venues, possible considerations include:  ILCs  PCMs  Additional Community Colleges  Vocational schools  Online trainings (proposed for year 3)  Thoughts and ideas from attendees

31. Break 31

32. 30-minute Interactive Demonstration 32  Health and Safety Module  Activity: Home Safety

33. Example Core Curriculum 33

34. Contact Information 34 To remain involved please contact  Leanne Winchester, Project Director Phone: (617) 573-1823 Email: Leanne.Winchester@state.ma.us  Kate Russell, Project Coordinator Phone: (617) 573-1830 Email: Kate.Russell@state.ma.us