10_12_09 Humphrey REVISED Formal Caregivers Slide Presentation by dopdm303

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									Formal Caregivers

  Carolyn Humphrey
 Paula Milone-Nuzzo
        Outline of Presentation
• Overview of the evolution of home and community based
  formal caregivers
• Composition and competencies of formal caregivers
   – Professionals
   – Direct-care workers
• Issues affecting formal caregivers
   – Care recipients demographics
   – Formal caregivers demographics
• Cultural issues
        Outline of Presentation
• Context and human factors affecting formal caregiving
   – Practice Issues
   – Environmental Issues
   – Technological Issues


• Strategies for addressing human factors to improve safety
  and quality
                 Definitions
• Formal Caregiver
    Clinicians and trained non-professionals who
    provide intermittent or continuous in-home
    services
• Context of Care
    These services can be provided by a traditional
    home care agency, community and social
    service agency, or for–profit providers
  Evolution of Home and Community
      Based Formal Caregivers


• Early home care providers—a brief history
   Composition and Competencies of
         Formal Caregivers

• Professionals
    Nurses, physicians, therapists, dietitians and
    social workers
• Direct-Care Workers
    Home health aides, homemakers, companions
    and patient care attendants
Composition and Competencies of
      Formal Caregivers
• Other Providers
  – Durable medical equipment, oxygen, medical
    supplies
  – For-profits providing housekeeping, personal
    care, rehabilitation, companion care
  – Community based programs: Meals on Wheels,
    care management, well baby care
      Professional Caregivers
• Nurses
  – Predominant discipline in home care
  – Home care roles
  – Educational preparation
     • AD, Diploma, BSN, Advanced Practice Nurses
• Therapists, Dieticians, Social Workers
  – Home care roles
  – Educational preparation – One path for entry
    into practice
        Direct-Care Workers
• Homemakers, home health aides
  companions and personal care attendants
    Traditional roles and competencies
    Consumer driven models of care
    Independently hired direct-care workers
       Changing Care Recipient
           Demographics
•   Aging of the population
•   Increase in chronic illnesses
•   Viability of low birth weight infants
•   Viability of severely disabled adults
**All want to remain in the least restrictive environment
    – Fewer informal caregivers
   Changing Demographics of
      Formal Caregivers
• Professional
  – Aging of the nursing and allied health
    population
  – Early retirements due to physically strenuous
    and technically challenging work
  – Professional health care workforce shortage
Source: HRSA, National Sample of Registered Nurses, 2004
Number of PT and OT Graduations 1998-2004
   Changing Demographics of
      Formal Caregivers
• Direct-Care Workers
  – Characteristics
     •   High school education or less
     •   Half are non-white
     •   Most are unmarried with children
     •   20% live below the poverty line
     •   47% on public assistance
 Culture and Formal Caregivers
• Cultural V alues
  – Ethnic, racial, socioeconomic and income
• Cultural Competence
  – Educational programs
  – Recruitment of diverse populations into home
    care
    Human Factors Affecting
      Formal Caregivers
• HF focuses on understanding interactions
  among humans and all elements of a work
  system.
• Consideration of Human Limitations
  – Physical
  – Cognitive
  – Organizational
The Smith and Canyon work system model
          Human Factors
       The Formal Caregiver
• Practice Issues
  – Formal caregiver autonomy
     • Professional isolation
     • Professional identity
  – Quality & availability of support from other
    sectors of the healthcare establishment
  – Coordination of care
         Human Factors
       Job Responsibilities
• There are no OSHA Ergonomic Guidelines
  for home care
• Transport of equipment & supplies
• Heavy lifting
• The movable office
• Violence in neighborhoods & homes
          Human Factors
           Technologies
• Technology
  – Clinical documentation systems, smart care
    plans, point of care devices
  – Use of medical devices
  – Telemedicine remote monitoring of recipients
    in the home
  – Formal caregiver & care recipient anxiety
         Strategies & Recommendations
Inadequately Addressed            Steps to Close Gaps
• Professional education          • Examine formal caregiving
  across disciplines re: formal      curricula content.
  caregiving in the home          • Work with education
                                     accreditation bodies to
                                     change requirements.
• Direct-Care Worker              • Systematic review of
  Education                          training requirements &
                                     roles across states
   Strategies & Recommendations
Inadequately Addressed         Steps to Close Gaps
• Formal caregiver education      – Ethnogeriatrics
  for special populations         – Lesbian, gay and
                                  bisexual persons
                                  – Interdisciplinary team
• Use teaching content &
                                  training
  models from Aging in
  America: Building the
  health care workforce
   Strategies & Recommendations
Inadequately Addressed       Steps to Close Gaps
• Time lacking for CE, in-   • Email/voicemail in-services
  services, communication,   • Interactive, web-based
  team building.                education
                             • Web-based live meetings
                                with archive availability
   Strategies & Recommendations
Inadequately Addressed        Steps to Close Gaps
• Redesign formal caregiver   • HF approach to
  home care agency work          documentation systems
  processes                   • Mandate minimum
                              intake information
                              • Restructure home visit
                              • Delegate
                                 – Older workers
                                 – Direct-care providers
                                 – LPN
    Policy Recommendations
• Entry into practice for nurses at the
  baccalaureate level
• Improve the role of the direct-care worker
• FDA to work with manufacturers and
  formal caregivers on medical device use in
  the home.
    Action Recommendations
• OSHA Home Care Guidelines
• HF consciousness raising within HC
  community and recipients of care
• Explore formal relationships with HC
  providers and nursing education
• Identification of HF engineers in HC
  technology manufacturers
  Research Recommendations
• Effective strategies to educate formal
  caregivers on strategies to improve care
  delivery and outcomes.
• HF and HC research conducted in the field
  optimizing shared goals.
• Develop HF approaches for vulnerable care
  recipients and formal caregivers.

								
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