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A new joint publication of PHI and the Pioneer Network details how Partners in Care (PIC), the country’s largest home health agency, changed its culture, increased staff morale, and lowered turnover.

The profile (pdf) explains how PIC’s decision to participate in the PHI Center for Coaching Supervision and Leadership (CCSL) affected the entire agency.

“Coaching Supervision has transformed the culture of this organization,” said PIC president Marki Flannery. “Relationships between office-based supervisors and home health aides are much more positive.”

Based in New York City, PIC employs more than 9,500 home health aides and serves more than 20,000 clients each year.

Coaching Training Gets Results

PIC’s culture-change journey began in 2006, when it agreed to participate in CCSL. Several managers were trained in the core skills of PHI Coaching Supervision^SM, which include active listening, collaborative problem solving, and nonjudgmental communication.

Later, those managers trained several hundred of PIC’s supervisors, instilling the lessons of coaching throughout the organization. Currently, PIC is trying to train all 9,500 of its home health aides in the communication skills involved in the PHI Coaching Approach^SM.

The infusion of PHI Coaching Supervision into the organization has produced clear benefits, detailed in the case study.

Supervisory staff turnover has dropped dramatically to around 14 percent, down from more than 32 percent in 2006, the year PIC began its involvement with CCSL.

Home health aides are also experiencing stronger relationships with their supervisors, according to both survey data and anecdotal evidence. “Supervisors now listen to you more,” said Pauline Smith, a home health aide who has been at PIC for 12 years. “You’ll have a complaint, and the supervisors are more attentive to you and what you have to say. That way, we get better results.”

Supervisors at PIC also say that aides have been able to deliver better care to clients, due to both their enhanced communication skills and the newfound sense that they are truly valued by PIC management. “If the aides feel more valued…their whole approach with their clients is going to be [changed], and the clients are probably having a better experience,” Flannery said.

– by Matthew Ozga

New York City Council Speaker Christine Quinn

New York City Council Speaker Christine Quinn outlined her vision for how the city can both create jobs and build long-term economic security in an October 18 speech.

Among the initiatives intended to help recent immigrants and low-income workers improve their job prospects is an expansion of training for home care workers to help them get jobs in the growing health care sector.

The City Council is working with PHI and 1199 SEIU to train an additional 200 New Yorkers per year in home health care and to also address stabilization efforts across the home care sector.

“PHI thanks Speaker Quinn and the City Council for investing in the home care workforce to ensure quality jobs for low-income workers and better care for elders and people with living with disabilities in New York City,” said PHI President Steven Dawson.

Increase in Demand for Home Care Workforce

Quinn says that the following recent state changes are expected to have a large impact on the home care workforce, making it an ideal time to support this vital industry:

• As the population ages, there will be an increased demand for health professionals who care for disabled or home-bound individuals.
• New York State has mandated that all home care workers serving Medicaid recipients within geographic areas that have local living wage laws be paid a living wage (to be phased in beginning in 2012).
• New Yorkers who need more than 120 days of home and community-based long term care services — mostly dual eligibles — will be required to enroll in Managed Long Term Care (MLTC) plans beginning in April 2012, pending federal approval. Most MLTC plans will likely employ home health aides to ensure compliance with federal regulations and because these workers can perform health-related tasks.

“An enormous amount of upgrade training will be necessary to ensure that tens of thousands of personal care aides do not become unemployed due to these changes,” Quinn said.

Initiative Specifics

The City Council’s partnership with PHI will fund a RN-certified trainer to make it possible for PHI and its affiliate, Cooperative Home Care Associates (CHCA), to train new home health aides and help transition personal care aides who might not otherwise retain their jobs.

CHCA guarantees a job to any trainee who successfully completes the entry-level training.

Through the City Council’s partnership with 1199 SEIU, the 1199 SEIU Bill Michelson Home Care Education Fund will provide additional training and education services to support all home care workers — including individuals from CHCA — to achieve higher levels of education and employment by providing extensive ESL training, preparation for college enrollment, and other skill-building initiatives.

“By partnering with 1199 SEIU and PHI, the City Council is supporting a field that will see increased growth due to demographic shifts, and an agency that is committed to improving the quality of the profession and the stabilization of this field,” Quinn said.

– by Meghan Shineman, PHI New York Policy Analyst

Three brief stories on direct care:

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Consumer Voice Launches Home Care Survey

Consumer Voice

In an effort to improve the quality of home care, the Consumer Voice is conducting a survey of:

• consumers who have received home care services and supports in the past year or two, and
• families and friends who have arranged these services for others.

The survey is available online. The deadline to complete it is September 1.

The Consumer Voice represents consumers in issues related to long-term care, helping to ensure that consumers are empowered to advocate for themselves.

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Book Examines Home Care Workers’ Lives

A new book explores the deep, often profound impact that the daily routine of caregiving has on the lives of home care workers.

Clare L. Stacey, an assistant professor of sociology at Kent State University, drew upon interviews with home health aides and personal and home care aides to write The Caring Self: The Work Experiences of Home Care Aides.

The book examines the meaningful ties that many home care workers make with the elders and people with disabilities for whom they provide care.

It also details the difficult and often unfair conditions under which home care workers must work, and the emotional and physical toll those conditions can take.

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New York State Person-Centered Care Initiative to Expand

The Western New York Alliance for Person-Centered Care (WNYAPCC) has created a membership program in an effort to expand its person-centered care initiative.

The program is designed to enhance collaboration and synergy among organizations and health care professionals that provide long-term care and geriatric services in an eight-county region in New York State.

More information on the membership program is available on the WNYAPCC website.

– by Deane Beebe and Matthew Ozga

NY Capitol Building in Albany

Recently the New York State Department of Health (DOH) announced the members of some of the workgroups for Governor Andrew Cuomo‘s Medicaid Redesign Team (MRT) effort.

The MRT was charged with identifying the best ways to reduce costs and improve the health delivery system in the state. Most of the team’s 79 recommendations were incorporated into the 2011-2012 New York State budget, which passed on March 31.

The budget included sweeping legislation that will dramatically alter the way the state pays for and delivers Medicaid services, particularly in home- and community-based settings.

PHI Role within Reform

PHI New York Policy Director Carol Rodat and Marilyn Saviola, director of advocacy at Independence Care System (ICS) — the PHI-affiliated managed long-term care organization — were both named to the MRT Managed Long Term Care (MLTC) Implementation and Waiver Redesign Workgroup.

The MRT Managed LTC Workgroup is charged with, among other things, the task of advising DOH on:

• the development of care coordination models to be used in the mandatory enrollment;
• processes to ensure patient protections and access;
• continuity of services; and
• avoidance of nursing home placement and hospital stays.

PHI and ICS have been active proponents for wage improvements for home health aides, as well as for the greater use of care management models. Both of these provisions were in the blueprint (pdf) they presented to the MRT.

Profound Impact of MLTC Reforms

Included in the New York State budget is a proposal to expand the use of capitated care management models, which — combined with reimbursement cuts — has the potential to change the landscape of home care.

Beginning with New York City residents in April 2012, all adults over the age of 21 covered by Medicaid — or “dually eligible” for Medicare and Medicaid coverage — who need community-based long-term care services for more than 120 days will be required to enroll in a MLTC plan or another care coordination program. New York State will first need the federal government’s permission to implement its plan.

DOH anticipates transitioning approximately 2,000 clients a month into a MLTC plan over a period of three years. A MLTC plan is a term that applies to New York’s Medicaid Managed Long Term Care plans, Medicaid Advantage Plus, or the Program of All-inclusive Services for the Elderly (PACE).

The New York State MRT website contains a list of members and meeting dates for three of the nine MRT workgroups, as well as additional information.

– by Meghan Shineman, PHI New York Policy Analyst

Jed A. Levine

A guest column by Jed A. Levine, executive vice president and director of programs and services at the Alzheimer’s Association, New York City Chapter.

Alzheimer’s disease (AD) is the public health crisis of the 21st century. An estimated 5.4 million people have AD in the United States, and that number is projected to increase to 13 million by mid-century unless we find a way to prevent, delay, or cure the disease.

We spend $183 billion annually caring for persons with AD.

The disease affects not only an individual’s memory, but all areas of thinking, function, and behavior. Persons with AD become progressively dependent on others for all their activities of daily living (ADLs). There is no cure, and only modest treatment for the symptoms of the disease. The disease can last up to 20 years, with a mean of 8-10 years.

For many families, home care workers are a lifeline. With the help of these workers, family members who would otherwise need to provide full-time care can continue working and providing for spouses and children.

For persons with dementia, quality of life depends on quality of care and their relationships with their care providers. In the early and middle states of the disease, persons with dementia can still experience pleasure and meaning in their lives. The quality of the assistance and support they receive is critical. Even when the disease is advanced, the person with dementia can experience comfort and does not have to suffer.

Valuable, Practical, and Proven

Dementia care is hard work; it takes specialized skills that can be learned by caregivers.

Since 1989, the Alzheimer’s Association, New York City Chapter (AANYC), has provided in-depth training on dementia care for home care workers, through agencies and for individuals.

This 50-hour training builds skills such as:

• communication;
• understanding and responding to “behavioral symptoms”;
• engaging the person with dementia;
• understanding the family’s experience; and
• self-care, such as meditation and yoga.

A recent formal evaluation of the 50-hour dementia care training showed that the person with dementia showed greater improvement in behavior and emotion when cared for by a trained aide. The person with dementia was also found to be “communicating more,” “less agitated,” and “more cooperative with ADLs.”

Family caregivers also rated trained aides positively, including overall satisfaction with the aide.

The study also found that trained aides were more likely than their non-trained counterparts to stay in the field of dementia home care.

As the population of persons with dementia, including AD, grows, so too will the demand for trained home care workers. AANYC has developed a model of training that is valuable, practical, and proven.

More Information

To learn more about the training evaluation, contact Edward Cisek, Ph.D., AANYC.

To inquire about the dementia training, contact Matt Kudish, LMSW, AANYC.

For more information about AANYC, or any of the 78 local chapters, visit the website, or call the national 24-Hour Helpline at 1.800.272.3900.

Some information in this article was taken or adapted from the following publications published by the Alzheimer’s Association:

• 2011 Alzheimer’s Disease Facts and Figures (pdf)
• The Shriver Report
• Alzheimer’s Association Quality Care Guide, Dementia Care Practice Recommendations for Professionals Working in a Home Setting (pdf)

A new report from the Long Term Care Community Coalition (LTCCC) examines the current state of the quality of care and life in New York’s assisted living facilities, as well as the ability of the state Department of Health (DOH) to oversee this system.

The May 2011 report, Care and Oversight of Assisted Living in New York State, analyzed DOH survey data from 2002 to 2011 and ombudsmen complaint data from 2006 to 2011.

LTCCC authors Cynthia Rudder, Richard Mollot, and Lucia Caltagirone highlight examples of continued poor quality of care in assisted living facilities — including adult homes, enriched housing, assisted living residences, and the state’s Medicaid-funded assisted living programs (ALPs) — and recommend ways in which the state legislature and DOH could improve oversight and enforcement. All of these assisted living options are licensed under New York’s adult home regulations.

The LTCCC’s report was supported by a grant from the Robert Sterling Clark Foundation.

Significant Findings

The report concludes that more than two-thirds of adult homes and assisted living residences are violating the state’s care rules, and are either harming their residents or putting them at risk for harm. This conclusion is based on the following findings:

• Few violations cited led to enforcement actions unless they were “endangerment” violations.
• Approximately three-quarters of the facilities found to have endangered their residents have been sanctioned or fined. However, many of the cases have yet to receive a final disposition, including eight from more than three years ago.
• “Impacted homes” — a term that is applied to adult homes with 25 percent or more mentally disabled residents — have twice as many violations as the “non-impacted” homes.

Continued Non-Compliance

The three areas most cited by DOH have remained the same for nine years — resident care, medication, and environmental issues. In fact, almost one-quarter of the medications citations are repeats from previous years.

Some of the reasons listed for non-compliance include:

• The state recommends a training program for direct-care staff, but does not require residences to train their care staff with a mandated training curriculum;
• Administrators are not licensed as required; and
• Facilities are only required to give 3.75 hours of personal care per week to each resident. According to the authors, this is insufficient time for staff to care for residents on multiple medications.

Policy Implications

“This report makes a valuable contribution to understanding the provision and oversight of assisted living in New York — an area that is still relatively unknown,” said PHI New York State Policy Director Carol Rodat. “These findings should encourage policymakers to pursue better training across all care settings.”

As a result of their findings, the LTCCC authors recommend two important changes in enforcement policy:

• Revise the current state law which does not permit a fine if the facility corrects the violation, and
• Increase the number of DOH agency staff to facilitate effective and timely enforcement.

– by Meghan Shineman, PHI New York Policy Analyst