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In an article published in the January-February 2012 issue of AgingToday, a publication of the American Society on Aging, PHI proposes developing an “advanced aide” position that could play a critical role on care teams to improve outcomes and cost efficiencies.

“Making the Most of Direct-Care Workers with a New Role on the Care Team” (pdf) explains that with delivery system reforms moving toward managed care and the Affordable Care Act‘s emphasis on testing new coordinated care models, this is an ideal moment to “engage in a thoughtful redesign of the role of the direct-care worker.”

One of the specific opportunities the authors mention is the recent request for proposals for the Center for Medicaid and Medicare Innovation “Health Care Innovation Challenge” grant.

Well Worth the Investment

The creation of an advanced aide position “would be well worth a substantial investment in training, support and compensation,” write the authors, PHI Policy Analysts Gail MacInnes and Meghan Shineman.

“Advanced aides could support health promotion, improved chronic care management and better care transitions — resulting in less institutionalization, fewer re-hospitalizations, and decreased emergency room visits.”

Employers could determine how advanced aides “could play a stronger role in a more integrated care team,” suggest the authors, who add that it is “too early to articulate a precise portable definition” of the Advanced Aide position but the time is ripe for experimentation.

Enhancing the role of direct-care workers is the intent of a bill recently introduced by Senator Robert Casey (D-PA) to establish demonstration projects that focus on care coordination and service delivery redesign for older adults with chronic illnesses, or those at risk of institutional placement.

– by Deane Beebe

The Centers for Medicaid and Medicare Services (CMS) and Administration on Aging (AoA) have been hosting webinars on applying for the new federal Health Care Innovation Challenge grant.

The webinar will be held on Thursday, Dec. 8 at 1 p.m. EST.

To view the webinar, register online.

Visit the CMS Innovation Center’s Events Archive to view a recording of the first webinar — an overview of the grant — and check back for the other webinars.

PHI recently published its own online guide to developing a strong Innovation Grant proposal.

The Health Care Innovation Challenge, which will provide up to $1 billion in grants from the Center for Medicare and Medicaid Innovation to “test creative ways to deliver high-quality health care services and lower costs,” was launched by the Department of Health and Human Services (HHS) on November 14.

“The Innovation Challenge is an exciting opportunity to design creative care models that expand the role of direct-care workers in an array of long-term care settings,” said Steve Edelstein, PHI national policy director. “It also signals the importance of HHS’s commitment to models that integrate these frontline workers into the care team to improve the care outcomes for elders and people living with disabilities.”

Grants ranging from approximately $1 million to $30 million for a three-year period will be awarded to applicants proposing the most compelling new ideas to deliver better health, improve care, and lower costs for people enrolled in Medicare, Medicaid, and CHIP — particularly those with the highest health care needs.

New Models of Workforce Development and Deployment

The Innovation Center will give preference to proposals that include “development and/or deployment of health care workers in new, innovative ways.” For example:

• new roles and skills for an existing workforce,
• new types of workers to support core transformation of the health care delivery system, and
• team-based models as better methods to serve a particular population.

Successful proposals, according to the grant guidelines, must include an innovative, explicit workforce development plan, one that requires new roles for all staff engaged in the new models of care and new skills to manage team building and care coordination.

“Training and educational experiences will be needed” to develop the skills required for the “health care workforce of the future,” states the announcement, which also notes that “preference will be given to projects that implement their care improvement activities faster than six months.”

The Innovation Center was created under the Affordable Care Act as part of the Centers for Medicare and Medicaid Services (CMS).

More information on the Health Care Innovation Challenge is available on the CMS website.

Important Health Care Innovation Challenge Dates

• Letter of intent: due December 19, 2011
• Applications: due January 27, 2012
• Awards Granted: March 2012

– Originally published at PHInational.org by Deane Beebe

A Centers for Medicare and Medicaid Services (CMS) memorandum (pdf) issued on September 30 lists the categories of approved uses of Civil Money Penalty (CMP) funds by state.

Topping the list of nine “categorically permitted uses” — which do not require prior approval from CMS — is the use of CMP funds to promote “culture change” in projects that involve multiple nursing homes.

“This announcement provides an important opportunity for state culture change coalitions to tap into CMP monies to support training and culture change initiatives in their states,” said Susan Misiorski, PHI national director of training and organizational development services.

“There are currently 36 states with culture change coalitions, fueled largely by volunteers,” Misiorski added.

CMS describes culture change in the memo as “the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity, respect, self-determination and purposeful living.”

The memorandum lists examples of culture change initiatives in several states, including:

• a culture change project that focuses on achieving staff stability in nursing homes in Louisiana;
• projects that facilitated implementation of culture change in New York State nursing homes; and
• the development of web-based training modules on culture change principles and practices for ombudsman staff and volunteers in Georgia.

Training Initiatives Approved

Training for facility improvement initiatives that are open to multiple nursing homes is also on the CMS list of categorically permitted uses of CMP funds.

One example provided in the memorandum is the joint training of surveyors and facility staff from multiple nursing homes committed to implementing effective fall-prevention programs.

Under the Affordable Care Act, a portion of collected federal CMP funds may be used to support activities that promote quality care and the well-being of nursing home residents in certified nursing homes.

– by Deane Beebe

The Centers for Medicare & Medicaid Services (CMS) has endorsed an adult abuse and neglect prevention training program designed for direct-care workers.

The 12-module curriculum — developed collaboratively by BEAM (Bringing Eden Alternative to Michigan), Michigan State University, and PHI with leadership from the Michigan Office of Services to the Aging -– is available as a free download at the PHI Training and Organizational Development Services website.

The adult learner-centered curriculum “includes highly interactive trainings that focus on actively building person-centeredness and self-management skills within individuals and organizations,” said PHI training and organizational development specialist Maureen Sheahan, who supported the curriculum design.

Kari Sederburg, director of the Michigan Office of Services to the Aging, added that the Michigan State evaluation of the training found that “almost every staff person who used the skills reported that it helped to prevent abuse or neglect.”

CMS’s endorsement came in an August 12 memorandum (pdf) to State Survey Agency directors recommending several training resources that deal with abuse prevention and dementia care.

Section 6121 of the Affordable Care Act mandates enhanced training on each of those subjects for nurse aides working in nursing homes.

– by Matthew Ozga

Three brief stories on direct care:

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CMS Proposes Guidelines for State Balancing Incentive Payments Program

The Centers for Medicare & Medicaid Services issued a “State Medicaid Directors Letter” (pdf) on September 12 to provide guidance for establishing the State Balancing Incentive Payments Program, a provision of the Affordable Care Act.

The new program, created to serve more people in home- and community-based settings, will assist states in “transforming their long-term care systems” by:

• improving systems performance and efficiency;
• creating tools to facilitate person-centered assessment and care-planning; and
• enhancing quality measurement and oversight.

The Balancing Incentive Program offers a targeted increase in the Federal Medical Assistance Percentages (FMAP) for non-institutional long-term services and supports (LTSS) to states that undertake structural reforms to increase access to home- and community-based LTSS.

On October 7, the Friday Morning Collaborative, a coalition of national aging and disability organizations, is hosting a webinar on the Balancing Incentive Payments Program. Registration is free, but space for the webinar is limited.

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State Direct-Care Worker Associations to Hold Annual Meetings

The Arizona Direct Care Worker Association (ADCWA) is holding its 4th Annual Conference and Celebration in Tucson on October 5 to honor and educate certified nursing assistants, home care workers, and professional caregivers in the state. To learn more about the event and register, visit the ADCWA website.

The Florida Professional Association of Care Givers is sponsoring its 16th Annual Caregivers Convention entitled, “Building a Quality Direct Care Workforce for Tomorrow’s Demands!” The all-day educational meeting will take place in Altamonte Springs on October 20. A registration form and more information is available at the association’s website.

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Des Moines Register Editorializes on Better Rewards for Caregivers

The Des Moines Register published an editorial in late August arguing that to ensure an adequate supply of direct-care workers to care for aging Iowans, those workers must have better wages, health coverage, education and training, and be valued in the medical field for the critical work they perform.

The editorial also explains that worker turnover is costly to employers, Medicaid, and consumers.

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