North Carolina

Personal and Home Care Aide State Training Grant

(PHCAST)

Curriculum Overview and

Orientation to Phases I & II

Grantee: NC Department of Health and Human ServicesPHCAST is funded by the US Department of Health and Human Services,Health Resources and Services Administration (HRSA)

Welcome and Purpose

Barbara Boyce

PHCAST Management TeamKathy Turner, RN, PHCAST Project Director, Division of Health Service Regulation

Jan Moxley, PHCAST Grant Administrator, Division of Aging and Adult Services

Donna White, RN, Elder Rights/In-Home Aide, Division of Aging and Adult Services

Susan Harmuth, Senior Program Manager, NC Foundation for Advanced Health Programs

Phyllis Daw, PHCAST Program Coordinator, NC Foundation for Advanced Health Programs

Kathie Smith, RN, Associate Vice President of State Relations, Home & Community-Based Care, Association for Home and Hospice Care of NC

Cherie Rosemond, Research Scientist, UNC Center for Health Promotion & Disease Prevention

Tara Green-Royster, Program Manger, UNC Center for Health Promotion & Disease Prevention

Jennifer Craft Morgan, Assistant Professor, Gerontology Institute, Georgia State University

Margaret Roberton, Director, Continuing Ed-Training & Standards, NC Community College System

Barbara Boyce, Assoc. VP, Continuing Ed & Workforce Initiatives, NC Community College System

Community College

Phase I Phase II Phase III

Phase IV

Asheville-Buncombe *

Central Carolina * * *

Central Piedmont *

Coastal Carolina * * *

Forsyth Technical *

Mitchell * * *

Roanoke-Chowan * *

Sandhills * * *

Southeastern * * *

Stanley * * *

Tri-County * * *

Wake Technical * * *

Community CollegePilot Sites

Includes both pilot years Excludes Halifax CC & Cape Fear CC/Elder House

Overview of PHCAST

Susan Harmuth

Reasons PHCAST Was Funded Nationally

Increasing demand for direct care workers

Personal Care Aides and Home Care Aides are the fastest growing occupations

Plus, Nurse Aides are in the top 11 jobs in terms of largest job growth

Trained, competent workers are essential to quality care

Create a “Gold Standard” for minimum training

Key Concepts of NC PHCAST Builds on prior Direct Care Worker Initiatives

Creates 4-phased framework for training and competency to better prepare new and incumbent workers

Training Venues: Community Colleges High Schools

Overview of NC’s 4-Phase Approach Phase I – Introduction to Direct Care Work

Phase II – Direct Care Basics (pre-Nurse Aide level)

Phase III – Nurse Aide I

Phase IV – Advanced NA training/competency Home Care Nurse Aide Geriatric Nurse Aide Medication Aide

Option for in-service use across settings

Key Impacts Better matching/redirecting of prospective

workers to job Competency based – certificate or credential at

each phase More consistent Pre-NA training NA I training more realistic Enhanced career paths, employability and

responds to employer need (4-phase approach – specialties)

Key Impacts - Continued New and incumbent workers can enter at

various points

Expands state recognized career path options; supports workers; responds to employer need

Broad based support for model

Integration with other training & QI initiatives

Builds on prior direct care initiatives in NC

Key Impacts - Continued More efficient use of NA I training programs

Employer recruitment of workers more focused

Reduces some barriers to training

High School students – job ready (NA I and Phase IV)

Sustainability Framework makes sense for NC

Phase I, II, linked to HRD programs

State recognized job categories

Responds to employer need (employer participation)

Integration with other quality improvement efforts

Potential to add new modules in future

Questions

Human Resource Development and PHCAST

Margaret Roberton

Human Resource Development Governance

SBCC Code – HRD Program Continuation Each college shall operate a Human Resources Development

(HRD) program to provide assessment services, employability training, and career development counseling to unemployed and underemployed individuals. FTE shall be generated from HRD programs. Each college shall provide HRD instruction and support necessary for unemployed and dislocated workers to be served within the college service areas.

Vision and Mission StatementHRD is a dynamic and vital workforce development program with proven economic, social, and educational success. The purpose of the HRD program is to educate and train unemployed and underemployed individuals for success in the workplace.

HRD Program Goals Provide program outreach and student

recruitment activities to targeted populations

Assist students in accessing meaningful training and/or employment opportunities

Enhance and develop the student’s employability skills

Develop and promote the student’s ability to move towards economic self-sufficiency

Human Resources Development Core Services

Skill assessment services Employability skills training Career development

counseling

Target Groups Unemployed adults Underemployed adults

Core Components Assessment of an

individual’s assets and limitations

Development of a positive self-concept employability skills communication skills problem-solving skills

Awareness of the impact of Information Technology in the workplace

1D SBCCC 300.3Program Classifications

HRD Fee Waiver Guidelines Eligibility Requirements

HRD courses are not free… Fees are waived

Waiver is based on the individual’s income Unemployed

Underemployed*

Notification of pending lay-off

HRD Eligibility For HRD purposes, underemployed is defined

as individuals…

working and is eligible for the Federal Earned Income Tax Credit (FEIT); or

working and earning wages at or below two hundred percent (200%) of the federal poverty guidelines.

Assessment Ability to appropriately identify individuals prepared

to enter healthcare fields Introduce occupational requirements to maximize

success of students progressing into Nurse Aide I Introduce workplace realities of personal/home care

environments vs. residential/institutional settings

Outline pathway alternatives for health care fields Personal Home Care Aide

Recognized & standardized curriculum

PHCAST Needs Aligned to HRD Core Services

PHCAST Needs Aligned to HRD Core Services

Employability Skills Concepts contextualized for

healthcare field Communication, listening skills,

teamwork, and time/stress management

Career Development Ability to problem solve

independently Decision-making and

management skills

Specific HRD PHCAST Courses Phase I – Introduction to Direct Care Work

(Focus on job readiness skills, literacy, numeracy, keyboarding, and realistic job previewing)

Career Exploration

Self-Assessment

General soft skill requirements

CPR (lay person)

Specific HRD PHCAST Courses Phase II – Direct Care Basics (Focus on non-nurse aide personal care tasks and soft

skill development; 3) expanded nurse aide (NA-1) skills)

Introduction to base skills

Introduction to functional concepts within role

Enhanced soft skills training

Career counseling

Questions

Importance of PHCASTto Employers and Personal

Care Clients

Donna White

Importance of PHCAST to Employers & Personal Care Clients 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

Employer Quote My PHCAST trained employees expressed joy

in going to the classes. They were excited about what they were learning and they created a tremendous bond with each other. We had a special ceremony for them at our last meeting and they were given pins. Based on what I have heard from them, it was worth going through the class. They enjoyed it. I believe PHCAST will help with caregiver retention.

Vice President/ Home Care

Agency

Statistics and Projections In the next 20 years the number of persons 65

and older will almost double from 1.3 million to 2.3 million

North Carolina is 10th nationally in size of total population, we are 9th in those 60 and older.

By 2025, 86 of the NC’s 100 counties are projected to have more people over age 60 than age 17 and under

Statistics and Projections In 2025, one in four North Carolinians will be 60

and older

Over the next two decades, the 75-84 age group will be the fastest growing of those ages 65 and older

The number age 85 and older will grow fastest beginning in 2030,when the oldest of our 2.4 million baby boomers near their 85 birthday

NC currently has more than 17,000 older adults with Alzheimer’s or other types of dementia most of whom are being cared for at home or by family and friends. By 2030, the total number is projected to rise to nearly 300,000

For those age 75 and older, 13% live below the federal poverty level and 30% live at or between 100-199% of the FPL

Statistics and Projections

Demographics Status of North Carolinians 65 and older:

Living alone 29% Veterans 22% Have a disability 38% Median household income 27% Income below poverty level 10% ($10,778) Income is between 100-199%

of the federal poverty level 25%

Employer Quote I saw a client today whose caregiver went

through the program. After speaking with the client and his guardian, I understood that they are really impressed with the caregiver and the improvement they have seen. She is being very thorough, she is noticing different things in the home, and she is alerting the office. I think PHCAST is going to help aides improve the relationships and the care they are providing. The client was thrilled with the care. RN Clinical

Supervisor/Home Care Agency

NC Home Care Licensure 10A NCAC 13J allows for two levels of home

care aide, limited and extensive

There are multiple funding sources that fund these two levels of care need

Limited Assistance Limited Assistance: Care to a client who

requires hands-on care involving guided maneuvering of limbs with eating, toileting, bathing, dressing, personal hygiene, self- monitoring of medications or other tasks assigned that require weight bearing assistance half the time or less during the activity

Extensive Assistance Extensive Assistance: Client is totally

dependent or requires weight-bearing support more than half the time while performing part of an activity, such as guiding or maneuvering of limbs, and meets one of the following criteria: Requires extensive assistance in more than two

activities of daily living (ADLs) or Needs an in-home aide to perform at least one task

at the nurse aide II level; or Requires extensive assistance in more than one

ADL and has a medical or cognitive impairment that requires total care more than 50% of the time

PHCAST Role PHCAST Phase II prepares limited

assistance aides for the workforce

Employer Quote As a supervisor, I have noticed that PHCAST

graduates are giving me more pertinent information.

Nurse Supervisor/ Home Care Agency

Questions

Recruitment and Marketing of PHCAST

Margaret Roberton

Recruitment / Marketing: Getting Their Attention

Program Outreach External Agencies

Internal Resources

Community

Program Outreach External Agencies

JobLink Career Centers Division of Workforce Solutions (ESC) Social Services US Committee for Refugees and Immigrants Shelters National Guard/Family Employee Assistant Center Community-based Organizations

Recruitment / Marketing: Getting Their Attention

Program Outreach Internal Resources

HRD classes Introduction to Healthcare Occupations HRD Strategies for Success

CE Healthcare classes Back-to-Work intake sessions Basic Skills Plus

Recruitment / Marketing: Getting Their Attention

Program Outreach Community

Flyers and brochures College catalogues College website Social Media Email

Past HRD students (Phase I and Phase II) Current and Past NA I students (Phase IV)

Local home care facilities

Recruitment / Marketing: Getting Their Attention

Recruitment / Marketing: Challenges

Communication of value Home care agencies

Benefit of contextualized training Benefit of advanced standardized training (Phase IV)

Participants Benefit of credential for hiring Benefit of commitment to entire pathway Program schedule/mix

Questions

Curriculum Availability

PHCAST Phases I and II

Kathie Smith

PHCAST Phases I and II Phase I – Includes job readiness skills, literacy,

numeracy, keyboarding, realistic job previewing Phase II – Includes personal care tasks and

soft skill development for non-nurse aide level An aide not listed on the NC Nurse Aide Registry as

a Nurse Aide I (CNA) but may provide personal care to client’s with limited assistance needs in Home Care and in other settings where a Nurse Aide I is not required

PHCAST Phases I and II NC PHCAST addresses the following objectives:

Help prospective workers have an understanding of educational and training requirements for each long term care sector pathway

Provide a uniform pre-nurse aide training program through community colleges that covers essential soft-skills, basic home management and personal care skills (non-nurse aide level providing limited assistance to clients)

Phase I and II Curriculum Curriculum must be followed as written but

instructors may develop creative ways to disseminate the information, adding as needed, activities that are learner-centered focused

Student attendance requirements are up to the individual college; this includes how classroom information is mastered, with flexibility for making up absences as allowed by the college

Phase I and II Curriculum At its core, adult learner-centered training

assumes learning is active, not passive. Trainers using a learner-centered approach rely

heavily on role plays, case scenarios, small group work, and other forms of interactive learning

The curriculum includes instructor guides and interactive lesson plans

Phase II- Skills The skills portion of Phase II curriculum (module

10) must be taught by a Registered Nurse (RN)

The RN also observes the correct demonstration of the skills by the student

Phase I and II- Slide Presentation Where the curriculum calls for a pre-written flip

chart, a PowerPoint presentation can be developed and used in its place

Not every student will be comfortable with performing role plays

Let students know that role play is a learning tool and it may be helpful to practice before they are actually faced with the scenario

The de-brief and discussion that occurs after the role play is just as valuable to the learning as the role play itself - be sure to leave enough time to de-brief

Phase I and II – Role plays

Phase I and II – Duplication There is some duplication of subject matter in

both phases to ensure that regardless of which Phase the student enters, pertinent information about Direct Care Work is covered

Activities and information vary between the two phases to avoid exact duplication for students who attend Phase I and Phase II training Instructor should adjust accordingly if the same

students attend Phase II that attended Phase I

Guest speakers for both phases: Invite local guest speakers as appropriate for the

material being taught. Examples

Workers in the industry of personal care Law enforcement to talk about gangs and drugs Fire department to demonstrate fire safety Alzheimer’s disease and dementia specialists

Phase I and II Guest Speakers

Instructor should review and update, as needed, handouts, slides, and other information contained in the PHCAST modules related to statistics and standards of practice to ensure information is current and accurate

Phase I and II Resources

A Phase I and II facilitator (instructor) tutorial is included with the PHCAST curriculum materials

Phase I and II Facilitator Guide

Questions

Competency Skills Check List

Donna White

Use of Competency Skills Check List

North Carolina Home Care Licensure 10 A NCAC 13J .1110 Supervision and Competency of In-Home Aides… Each licensed home care agency shall document that

its in-home aides are competent to perform client care tasks or activities to which they are assigned

Such individuals shall perform delegated activities under the supervision of person authorized by state law to provide such supervision

Licensure Rule Continued In-home aides who are not subject to occupational

licensing laws, shall only be assigned client care activities for which they have demonstrated competency, the documentation of which is maintained by the agency

Meeting competency includes a correct demonstration of tasks to an appropriate professional. Each agency shall document that its in-home aides demonstrate competence for all assigned client care tasks or activities

PHASE II Direct Care BasicsSkills Check Lists

Module 9 “Home Management Skills” and Module 10 “Personal Care Skills” includes competency skills check list

Each skill check list includes the required number of steps in order to meet competency in that skill

The steps for each skill are numbered

Each step has to be dated based on learner’s date of demonstrated competency

Dated signature is required by the competency evaluator and the In-Home Aide

PHASE II Direct Care BasicsSkills Check Lists

Module 9 Check List Home Management Skills Competency Check

List includes: Housekeeping for clients

Nutrition and meal preparation

Food storage and safe food handling

Budgeting and spending

Module 10 Check List Personal Care Skills Competency Check List

includes assisting: client with a tub bath/shower

client to wash hair

with hair and scalp care

client with mouth care

with normal skin care

a man to shave

Module 10 Check List-ContinuedAssisting: client to care for hands & fingernails

with care of toenails for clients without Diabetes/Peripheral Vascular Disease

the client to dress

with elastic stockings

the client to move up in the bed

Assisting: client from bed to chair using limited assistance

client to walk

client with toileting

with applying and removing eyeglasses, contact lenses, hearing aids and artificial body parts. (Optional demonstration)

Module 10 Check List-Continued

Module 9 Check List Example

Module 10 Check List Example

Questions

Pilot Experiences-Panel Discussion Crystal McIver & Joy McPhail

Central Carolina Community College

Alan Duncan Sandhills Community College

Lynn Kavcsak Wake Technical Community College

Wrap-Up

Margaret Roberton