Allied Health Advisory Group

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

Introductions Welcome Please say your Name Title Organization 2

Updates from DHE 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) 3

Sub-Committee Updates 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) 4

Sub-Committee Updates 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. 5

Sub-Committees Update Nurse Assistant Certification sub-committee Thanks to all that signed up First meeting will be 6/19/17 Members: 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 6

Sub-Committees Update Scalable Projects Sub-Committee Thanks to all that signed up First meeting will be 6/21/17 Members: Braithwaite, Janice Brodeur, Lynne Gutman, Rebecca Jacobsen, Tammi Kronopolus, Carol Smith, Kevin Winchester, Leanne Yu, Patricia Zhavoronkova, Marina 7

Special Guest Presentation New changes coming from CMS on training requirements of HHAs Tim Burgers, Associate Director, Home Care Alliance of Massachusetts 8

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/som10 7ap_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 selfadministered. 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 onsite 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_hh a.pdf

QUESTIONS? Timothy Burgers, Associate Director Home Care Alliance of MA tburgers@thinkhomecare.org 617/482-8830

AHAG Planning Looking Back Looking Ahead 29

Goals of the Direct Care Workforce Plan Create Career Preview Opportunities Offer or increase the length of clinical experiences Offer one day direct care previews Develop recruitment screening tools Increase Career Awareness 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 Change Policy June 2014 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 Build the Business Case for Investing in the Direct Care Workforce 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 Invest in the Development of Core Competencies 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 Provide Employer Support Develop and pilot a case manager model Offer post placement coaching Offer supervisor/staff management training 30

Looking Back 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? 31

Where Are We Now? 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 32

Where Are We Now? Step 2: Organizing Thoughts 5-7 minutes Transfer those answers and ideas to the sticky notes 33

Where Are We Now? 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! 34

Focused Goals for the AHAG Create Career Preview Opportunities Offer or increase the length of clinical experiences Offer one day direct care previews Develop recruitment screening tools Increase Career Awareness 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 Change Policy June 2015 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 Build the Business Case for Investing in the Direct Care Workforce 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 Invest in the Development of Core Competencies 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 Provide Employer Support Develop and pilot a case manager model Offer post placement coaching Offer supervisor/staff management training 35

Focused Goals for the AHAG Create Career Preview Opportunities Offer or increase the length of clinical experiences Offer one day direct care previews Develop recruitment screening tools Increase Career Awareness 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 Change Policy June 2015 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 Build the Business Case for Investing in the Direct Care Workforce 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 Invest in the Development of Core Competencies 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 Provide Employer Support Develop and pilot a case manager model Offer post placement coaching Offer supervisor/staff management training 36

AHAG Focused Goals 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! 37

Predicting the Future 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? 38

Next Meetings Friday, September 29 th, 9:30 11:30am, Worcester State University Friday, December 8 th, 9:30 11:30am, Worcester State University Looking for topics and presentations! 39

Summer Tours Arranging 1-3 tours of college campus healthcare sim centers July and early August College volunteers? Contact Geoff 40

Thank you sincerely for your time and dedication!!! 41