New Roles for Home Care Aides Considered at DC Forum

Home care stakeholders, Capitol Hill staff, and government officials convened in Washington, DC on March 1 to take a fresh look at the expanded roles that home care workers could play to improve care and lower health care costs.

The forum, entitled Innovations in Care Coordination: Rethinking the Role of Home Care Workers, was co-sponsored by PHI and SEIU.

Health policy experts who spoke at the briefing called this an ideal time — an historic opportunity — to consider advanced roles for home care workers because of the Affordable Care Act‘s mandate to deliver coordinated, quality person-centered care that is also cost effective.

The speakers concurred that home care workers could play a key role on coordinated care teams that provide health and support services to people with both serious chronic diseases and severe physical limitations. They discussed several existing program models in which aides are integral to the multi-disciplinary teams of doctors, nurses, social workers, and other professionals.

Spectrum of Roles

PHI President Steven Dawson launched the discussion (pdf) by explaining that there was not one, but a “spectrum” of roles that an “advanced” aide could play on the team. The training and support required for the job would vary depending on where a particular role falls on the spectrum.

For example, the roles could range from an aide who provides information and education to clients, to an aide who assists individuals with taking medication, or one who specializes in dementia or end-of-life care. On the more advanced end of the spectrum, aides could serve as assistant trainers, peer mentors, and/or have a distinct, in-person role within the care coordination team.

Dawson noted that, since home care aides work in individuals’ homes and have frequent in-person contact with the individual receiving care, they are in a prime position to help improve the quality of long-term services and supports while lowering costs, but noted that there were significant challenges to be addressed.

Bruce Vladeck, former director of the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services), said that coordinated — or integrated — care models could help bridge the major disconnect between acute and long-term care. He noted that care workers, who have the day-to-day personal relationships that lead to the kind of trust that allows clients to share their concerns and symptoms, are critical to the care team.

The aides should be “empowered to play the role they are capable of playing and to be most effective,” Vladeck said.

Coordinated Care Models Incorporate Aides on the Team

Several models of coordinated long-term care that target people with complex medical conditions, severe physical limitations, and behavioral issues (in some programs) were featured, including:

• Independence Care System, a Medicaid managed long-term care organization sponsored by PHI, is piloting a program that employs a “Senior Aide” to 1) help the team more effectively and efficiently identify clients’ underlying health issues and improve care quality, and 2) support the aides who are working in the home.
• VA Home-Based Primary Care (pdf) and Medical Foster Home Programs (pdf), successful models reported on (pdf) by Thomas Edes, M.D., of the U.S. Department of Veteran Affairs (VA), who said that these programs have plans to incorporate home health aides into the care teams.
• Commonwealth Care Alliance, which offers a full spectrum of medical and social services for people with Medicaid and dual eligibles, as explained by Robert Master, M.D., the organization’s president and CEO.

Master said that with training, home care aides can do much more for their clients: for example, injection therapy, which provides significant cost savings and is well worth the investment.

During the event, Senator Robert Casey, Jr. (D-PA), the Senate sponsor of the event, discussed the bill (pdf) he recently introduced to test using advanced roles for direct-care workers to improve efficiency and quality of care for frail elders.

Judy Feder, a professor of public policy at Georgetown University, presented on the Compound Costs of Chronic Illness and Functional Impairment: Why Long-Term Services and Supports Matter (pdf). She recommends that people who need of assistance in ADLs/IADLs and have functional impairments be targeted for coordinated care regardless of the payment source.

Such programs will potentially give the “biggest bang for the buck,” noted Feder.

At the end of the half-day event, a forum participant remarked, “We need to make sure that some of the savings that we are talking about goes to direct-care workers.”

More Information

For more information on the forum, including the complete list and bios of the presenters, handouts, and the white paper by PHI and SEIU entitled Innovations in Care Coordination: Rethinking the Role of Home Care Workers (pdf), visit the event website or contact PHI Policy Analyst Gail MacInnes.

— by Deane Beebe