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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