allied health advisory group - mass.edu health advisory... · allied health advisory group june 9...

Allied Health Advisory Group

June 9th, 2017 9:30-11:30am Framingham State University Campus Facilitator: Geoff Vercauteren Director of Healthcare Workforce Development

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Welcome

Please say your Name

Title

Organization

Introductions

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Updates from David Cedrone

N&AH is in both the House and Senate budgets for $200k

▪ Thank you for your advocacy!

TRAIN is in the Senate budget at $1.1M.

▪ Will go to conference committee.

The overall state budget is still tenuous so we have to anticipate the possibility of 9c action in the fall

We should be prepared to move forward aggressively once the final budget is approved (later in July)

Updates from DHE

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Curriculum Design and Alignment

Completed focus groups

▪ Springfield/Greenfield area; South Coast; Greater Lowell; Greater Cape and Islands; North Shore

Themes Very favorable impression of CC grads

Many AH DCWs struggle with technology

Increase soft skills training; Substance abuse training; Behavioral health training

Lose many CC grads to nursing programs

Next steps Publish findings

Updated C.N.A./HHA sheet (posted online)

Sub-Committee Updates

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Legislative Outreach and Policy sub-committee No new members – future in question

Scope and Role Definition Patti-Ann Collins - White paper writing progressing

Working title: “Did you know? Clarifications on the Scope and Role of the Nursing Team.”

Sub-Committee Updates

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Nurse Assistant Certification sub-committee Thanks to all that signed up

First meeting will be 6/19/17

Members:

Sub-Committees Update

Adams, Alena Burgers, Tim Chernow, Harneen

DiFiore, Kristine

Hayward-Jansen,

Elizabeth

Kronopolus, Carol

Pepin, Angel Philie, Pauline

Pietre, Theresa Shack, Karen Smith, Kevin Winchester, Leanne

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Scalable Projects Sub-Committee Thanks to all that signed up

First meeting will be 6/21/17

Members:

Sub-Committees Update

Braithwaite, Janice Brodeur, Lynne Gutman, Rebecca

Jacobsen, Tammi Kronopolus, Carol Smith, Kevin

Winchester, Leanne

Yu, Patricia

Zhavoronkova, Marina

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New changes coming from CMS on training requirements of HHAs

Tim Burgers, Associate Director, Home Care Alliance of Massachusetts

Special Guest Presentation

MEDICARE TRAINING

REQUIREMENTS

FOR HOME HEALTH

AIDES

Proposed changes in the federal requirements effective January 13, 2018

Tim Burgers, Associate Director

Home Care Alliance of MA

The Medicare Conditions of Participation (CoPs)

for Home Health Agencies:

• Define the qualifications for a Home Health Aide

• Establish standards for the content and duration of training

programs

• Outline competency evaluation standards

• Include in-service training requirements

• Set qualifications for instructors

• Define what entities are eligible to train HHAs

• Describe the duties of the HHA

• Establish standards for supervision of HHAs

The Medicare CoPs are being updated

this year for the first time in 18 years.

Home Health Aide services are currently

defined in

42 CFR 484.36

Under the proposed new CoPs effective

1/13/2018, Home Health Aide services are

defined in 42 CFR 484.80

CURRENT DEFINITION OF A

HOME HEALTH AIDE:

A person who has successfully completed

a State-established or other training

program that meets the requirements of §

484.36(a) and a competency evaluation

program or State licensure program that

meets the requirements of § 484.36 (b) or

(e),

or a competency evaluation program or

State licensure program that meets the

requirements of § 484.36 (b) or (e).

NEW DEFINITION OF A HOME

HEALTH AIDE:

A qualified home health aide is a person who has successfully completed:

(i) A training and competency evaluation program as specified

in paragraphs (b) and (c) respectively of this section; or

(ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or

(iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of § 483.151 through § 483.154 of this chapter [the Nurse Aide standards for Skilled Nursing Facilities], and is currently listed in good standing on the state nurse aide registry; or

(iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section.

42 CFR 484.80(a)(1)

MAINTAINING HHA

CERTIFICATION

No substantive change to this requirement: A home

health aide or nurse aide is not considered to have

completed a program, as specified in paragraph (a)(1)

of this section, if, since the individual's most recent

completion of the program(s), there has been a

continuous period of 24 consecutive months during

which none of the services furnished by the individual as described in § 409.40 of this chapter were for

compensation. If there has been a 24-month lapse in furnishing services for compensation, the individual must

complete another program, as specified in paragraph

(a)(1) of this section, before providing services.

42 CFR 484.80 (a)(2)

CONTENT AND DURATION OF

TRAINING -- WHAT HASN’T

CHANGED

The new CoPs still require 75 hours of training, of

which at least 16 hours must be practical

training.

The trainee must receive at least 16 hour of

classroom training before the practical training

can begin.

Agencies must maintain documentation that

demonstrates that the requirements of the

standard have been met.

CONTENT -- WHAT HASN’T

CHANGED (i) Communication skills, including the ability to read, write, and verbally report clinical information to

patients, representatives, and caregivers, as well as to other HHA staff.

(ii) Observation, reporting, and documentation of patient status and the care or service furnished.

(iii) Reading and recording temperature, pulse, and respiration.

(iv) Basic infection prevention and control procedures.

(v) Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor.

(vi) Maintenance of a clean, safe, and healthy environment.

(vii) Recognizing emergencies and the knowledge of instituting emergency procedures and their application.

(viii) The physical, emotional, and developmental needs of and ways to work with the populations served by the HHA, including the need for respect for the patient, his or her privacy, and his or her property.

……………………………….

(x) Safe transfer techniques and ambulation;

(xi) Normal range of motion and positioning; (xii) Adequate nutrition and fluid intake; ………………………………

(xiv) Any other task that the HHA may choose to have an aide perform as permitted under state law.

CONTENT -- WHAT HAS

CHANGED Important wording changes:

(ix) Appropriate and safe techniques in performing

personal hygiene and grooming tasks that include—

(A) Bed bath;

(B) Sponge, tub, and shower bath;

(C) Hair shampooing in sink, tub, and bed;

(D) Nail and skin care;

(E) Oral hygiene;

(F) Toileting and elimination;

CONTENT -- WHAT HAS

CHANGED Two new items added to the list of skills:

(xiii) Recognizing and reporting changes in skin

condition;

…………………………

(xv) The HHA is responsible for training home

health aides, as needed, for skills not covered in

the basic checklist, as described in paragraph

(b)(3)(ix) of this section.

42 CFR 484.80 (b)(3)

COMPETENCY EVALUATION

The Competency Evaluation standard has been reorganized but with no substantive changes.

Note that both the current and proposed CoPs require that competency be evaluated by observing an “aide’s performance of the task with a patient.”

The current Surveyor Interpretive Guidelines allow

competency be “evaluated with the tasks being performed on a pseudo-patient such as another aide or volunteer in a laboratory setting. The tasks must not be simulated in any manner and the use of a mannequin is not an acceptable substitute.”

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/som107ap_b_hha.pdf









IN-SERVICE TRAINING

The in-service training standard has been

reorganized with just one minor change.

In-service training must be supervised by a

registered nurse; however, the requirement that

the supervising RN have two years of nursing

experience and one year of home health care

experience has been removed.

42 CFR 484.80(d)

INSTRUCTOR

QUALIFICATIONS

No Change: Classroom and supervised

practical training must be performed or

supervised by an RN who possesses a minimum

of two years nursing experience, at least one

year of which must be in home health care.

ORGANIZATIONAL

QUALIFICATIONS

One small change to which entities can train HHAs.

ANY organization can train HHAs EXCEPT Home Health Agencies that within the last two years:

Have been found to be out of compliance with this Standard; Employed unqualified individuals as HHAs; Was subject to an extended or partially extended survey for

substandard care; Was assessed a civil penalty of $5000 or more as an intermediate

sanction; Had deficiencies that endangered patients and had temporary

management appointed by DPH; Had all or part of its Medicare payments suspended; Had its Medicare participation terminated;

NEW: Been excluded from participating in federal health care programs or debarred from participating in any government program.

42 CRF 484.80(f)(7)

HHA ASSIGNMENT AND

DUTIES Duties include provision of hands-on person care;

performance of simple procedures as an

extension of therapy or nursing services; assistance

in ambulation or exercises; and assistance in

administering medications ordinarily self-

administered.

NEW: Home health aides must be members of the

interdisciplinary team, must report changes in the

patient’s condition to a registered nurse or other

appropriate skilled professional, and must

complete appropriate records in compliance with

the Home Health Agency’s policies and

procedures.

42 CFR 484.80(g)(4)

SUPERVISION OF HOME

HEALTH AIDES Basic requirement: If the patient is also receiving skilled services, on-site

supervision at least every 14 days.

(NEW: Supervision can be performed by a “registered

nurse or other appropriate skilled professional [PT, OT, or SLP] who is familiar with the patient, the patient’s plan of

care, and the written patient care instructions…” Clarification: “The home health aide does not have to be present during this visit.”

If the patient is not receiving skilled services, on-site

supervision by an RN at least every 60 days [CHANGE from 62 days] “while [the HHA] is performing care.”

42 CFR 484.80(h)

SUPERVISION, CONTINUED…

NEW: If an area of concern is noted by the supervising

professional during a supervisory visit when the aide is not present, then the supervising individual must make an on-site visit in order to observe and assess the aide while he or she is performing care.

A registered nurse or other professional must make an annual on-site visit to the patient’s home to observe and assess each aide while performing care.

If a deficiency in aide services is verified during an on-site visit, then the agency must conduct, and the home health aide must complete a full competency evaluation.

42 CFR 484.80(h)(1)(ii) and (iii); and 42 CFR 484.80(h)(3)

SUPERVISION, CONTINUED…

NEW elements of supervision (to be documented in supervision note):

Following the patent’s plan of care for completion of tasks assigned;

Maintaining an open communication process with the patient, representative, caregivers, and family;

Demonstrating competency with assigned tasks; Complying with infection prevention and control

policies and procedures; Reporting changes in the patient’s condition; and Honoring patient rights.

42 CFR 484.80(h)(4)

REFERENCES

Current Medicare Home Health Conditions of Participation: https://www.gpo.gov/fdsys/pkg/CFR-1999-title42-vol3/pdf/CFR-1999-title42-vol3-part484.pdf

Proposed New Medicare Home Health Conditions of Participation Effective January 13, 2018: https://www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf (pp. 80-82 for Home Health Aide Standards)

Current Medicare Interpretive Guidelines -- State Operations

Manual Guidance to Surveyors: Home Health Agencies: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf

https://www.gpo.gov/fdsys/pkg/CFR-1999-title42-vol3/pdf/CFR-1999-title42-vol3-part484.pdf















https://www.gpo.gov/fdsys/pkg/FR-2017-01-13/pdf/2017-00283.pdf









https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_b_hha.pdf






QUESTIONS?

Timothy Burgers, Associate Director

Home Care Alliance of MA

[email protected]

617/482-8830

mailto:[email protected]

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Looking Back…Looking Ahead

AHAG Planning

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• Offer or increase the length of clinical experiences

• Offer one day direct care previews

• Develop recruitment screening tools

Create Career Preview Opportunities

• Build direct care worker pathways

• Create recognized transferrable training

• Develop a direct care job website

• Invest in an information campaign for students (including financial aid awareness)

• Offer partial scholarships for students

Increase Career Awareness

• Staff a cross-secretariat task force to identify barriers

• Launch an advocacy campaign to improve reimbursement and wages

• Create an innovation fund to support new, untested, promising ideas

Change Policy

• Convene an education, employer and policy collaborative

• Articulate the business case for investing in the DCW

• Create regional data sets through the WIBs

• Launch a campaign to educate people on the value of the DCW in the healthcare system

Build the Business Case for Investing in the Direct Care Workforce

• Align core competencies across jobs and build consensus for support

• Pilot core competencies curriculum and offer statewide core competency courses

• Inform DCW curriculum with the employer needs

• Incorporate life/soft skills into direct care curriculum

• Align job descriptions and standards of practice

Invest in the Development of Core Competencies

• Develop and pilot a case manager model

• Offer post placement coaching

• Offer supervisor/staff management training

Provide Employer Support

Goals of the Direct Care Workforce Plan

June 2014

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Thinking back to June 2014, how would you characterize that time for the Allied Health Direct Care Workforce?

Are things better, same, or worse now? Why or why not?

Looking Back

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Step 1: Brainstorming 5-7 minutes

Write down as many projects, changes, collaborations or any other activity that has happened or is currently happening, that is making an impact on the training, recruiting, hiring, or promoting of the Allied Health-DCW.

Some things to consider: What partnerships have you developed?

What activities do you know of, or have you been involved with, that effect the allied health direct care workforce?

Have occurred roughly in the last 2 years

Where Are We Now?

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Step 2: Organizing Thoughts 5-7 minutes

Transfer those answers and ideas to the sticky notes

Where Are We Now?

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Step 3: Categorizing 15 mins

Put those sticky notes in whatever goal category you think they belong in

Use leftover time to view other people’s work!

Where Are We Now?

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Change Policy
















Focused Goals for the AHAG

June 2015

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Change Policy
















Focused Goals for the AHAG

June 2015

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Looking at your responses to the previous exercise, how would you quantify our progress on the goals that we said we would focus on (see previous slide) in June 2015? Have we moved the needle?

Are those goals still relevant? Do we need to change our focus and revisit the priorities ?

If so, what should they be?

Small groups to discuss

Report out!

AHAG Focused Goals

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What changes in the AH DCW workforce (PCA, HHA, CNA, MA) do you see coming in the next 12 – 24 months that we should be watching?

What about longer out from there?

What do you want to hear about at upcoming AHAG meetings?

Predicting the Future

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Friday, September 29th, 9:30 – 11:30am, Worcester State University

Friday, December 8th, 9:30 – 11:30am, Worcester State University

Looking for topics and presentations!

Next Meetings

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Arranging 1 -3 tours of college campus healthcare sim centers

July and early August

College volunteers? Contact Geoff

Summer Tours

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Thank you sincerely for your time and dedication!!!

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