An Advanced Home Care Role Benefits Workers — and Clients

If the career ladder for home care workers was an actual ladder, it would be difficult to climb. You’d see entry-level titles near the base: personal care aide and home health aide certifications are within reach for many job seekers, with few barriers to entry and with training that can be completed in weeks or months, depending on the state.

But above those positions, the ladder becomes uneven. There is a significant gap between a home health aide job and the next formalized title, licensed practical nurse, which requires one to two years of academic training. Few employers provide alternative advancement options to fill that gap for home care workers, even for those who have excelled in their jobs for years and are ready to gain new skills and responsibilities.

In 2014, PHI began building a new rung in the home care career ladder. We provided 13 weeks of advanced training to eight New York City home health aides who were promoted to higher-paying, salaried positions known as Care Connections Senior Aides. With a focus on improving care transitions and reducing adverse health outcomes, the Care Connections Senior Aides were deployed to client homes following a hospitalization or other disruption in care. There they supported the client’s primary home care workers, helping them recognize and report changes in client conditions. Care Connections Senior Aides were also integrated into clients’ interdisciplinary care teams, drawing on observations from the home environment to inform decisions about treatment.

The promising results of the Care Connections Project have drawn attention to the potential of advanced roles and care team integration for home care workers. Building on this success, PHI is now developing similar advanced positions in other states. To inform these interventions, I spoke to a home care worker trained in the original pilot.

Marisol Rivera was a home health aide for 16 years before becoming a Care Connections Senior Aide at Cooperative Home Care Associates in the Bronx. (This April, she received an additional promotion at the agency.) I asked Marisol about the years she spent as a Care Connections Senior Aide and what these types of roles could mean for the home care field.

Angelina Drake: Tell me how you first learned about the Care Connections Senior Aide position.

Marisol Rivera: In 2014, I had just come home from working with a client, and a nurse from Cooperative Home Care Associates called me.  She asked if I was interested in training for a new program. In the past, I’d always been the type to think, “Oh no, that’s not me, I don’t think I’ll be good at that.” But this time the nurse convinced me.

When this opportunity came along, I thought, “I’ve been a home health aide for so many years. Instead of just helping one person, as a Care Connections Senior Aide, I’d be able to do more for more people.” And I did.

AD: What about this opportunity gave you a different level of confidence?

MR: The training instructors were awesome. They made sure we had a chance to practice, to role-play our skills. The training helped me recognize that this role was building on what I did every day as a home health aide. It was about getting used to doing that job for more than one client and bringing back reports to the care team to better assist them with the client’s care.

AD: How did you feel when you first entered the field in an advanced role?

MR: In the beginning, I was nervous because aides in the home now saw me as a supervisor. I would always assure them that, no, I was not a supervisor, I told them: “I am a home health aide just like you, and because I’ve been in the field for so long, I’m here to give you support.”

The workers were very pleased with that support. I’d speak calmly and make sure not to sound like I was judging or accusing workers of doing something wrong. “We’ll do it together,” I’d say. “This is why I’m here.”

AD: That speaks to the importance of entry-level aides seeing you as a peer. How do you think you were able to build their trust?

MR: The moment I would tell them I was a home health aide there to support them, I could see their tension fade away. They were able to open up and explain what they were going through because I knew how difficult the job could be.

A lot of workers get worried that if they call their employers to ask for assistance, they might be judged. That’s why we go out into the home to let these aides know we are there to provide additional training. We let them know it’s okay, we’ve got you, and we’re not going to leave you on your own unless you feel 100 percent confident that you’ve got this.

AD: Were there conditions in the home that you were able to observe and help address as a Care Connections Senior Aide?

MR: There have been multiple visits where I noticed that clients needed help moving between locations around the home but did not have assistive equipment. I’d recommend a lift or other device and explain why it was important: an unsuccessful transfer might put them or their worker at risk of fall or injury. I looked for unfilled equipment prescriptions as well because clients very often do not know the process to go through to get equipment approved by insurance and into the home. I trained aides on how to connect with the client’s care plan to report missing equipment, or I’d work with the nurse to address equipment prescriptions that had not been filled.

Often, clients come home from the hospital with new needs that are not explained to the home care worker, so I’d show workers what to look out for — it might be repositioning the client every few hours or cleaning equipment more regularly, for example. Urinary tract infections also cause a lot of problems that could be prevented. If I went to a home and noticed that the client’s catheter had not been changed regularly, or that the placement of the drainage bag was incorrect, I’d show the home care worker what should be done and what to look out for in the future.

AD: What type of support is important for home care workers to succeed in their jobs?

MR: One of the main challenges of working in a client’s home is that client family members can misunderstand the home health aide’s role. Some people think the role is a maid or that we have to care for everyone in the home. So each time I’d visit as a Care Connections Senior Aide, I’d show the client and family members the plan of care and what it specified were their home care worker’s responsibilities. This would help reduce complaints and keep the aides with their clients longer.

Support from employers when conflicts with the family occur — because there are conflicts — can help workers feel like they are not alone. When an advanced aide comes out to the home to address an issue, everyone there can feel supported.

I think the role of the home health aide should be considered just as important as any other role. We are a part of the client’s health care team. Some clients don’t have family members around every day but do have a home care worker. When she reports something, it should be listened to and not disregarded because of her title. Sometimes the aide knows more about the client’s health than a physician or family member. As aides, we know that we are not a doctor or a nurse, but the home care role can be just as important in what it provides for the client.

AD: How do you think your role has helped family caregivers?

MR: Many family members are grateful for what Care Connections Senior Aides have done to stabilize their loved one’s home care. If they have a well-supported worker, the family member can go back to work, live in their own home, and know that the client is taken care of. That’s part of why home care workers are important: they are there to relieve some of the responsibility that the family caregiver has in caring for their loved one.

AD: Would you recommend an advanced position to other home care workers?

MR: Yes, I would definitely recommend it. Being an extra set of eyes in the field is great. I know how overwhelmed workers can feel when they’re on their own, but when they know they have someone in a role like this to support them, it helps them to do their job and follow up on client issues. I think every agency should have these roles. They will prevent a lot of hospitalizations.

AD: There’s long been a perception that home care does not offer a career pathway for its workers. Do you feel like your experience has changed that?

MR: Oh yes. That’s why, in the field, the first thing I’d do is let workers know I was a home health aide, too. Even today, I maintain my certificate, I go to in-services just like them. When they ask me how I got an advanced role, I tell them my story and to look for an opening at their agency. “You’re qualified,” I tell them, “so apply for it.”

I believe in this type of role because, again, home care workers spend the most time with clients. They know their clients. And as home care workers who have advanced, we know what it is to work out challenges every day in the home. We know that by supporting workers and bringing information from the home to the care team, our roles help deliver better service.