Several months ago, I wrote in this column about how the roles of home health aides (HHAs) are expanding as they use new skills and technology to help older Americans age safely in their own homes. There are currently about one million people working as HHAs in the U.S., either in the homes of individual clients or in group homes or residential communities such as assisted living facilities. While their pay is modest—the average salary for an HHA is around $22,000 a year—the contributions of this dedicated group to American society are invaluable. If you have an elderly family member or friend, knowing there is a reliable caregiver available to check on that person daily, providing companionship, making sure they are eating properly and taking needed medications, and that their home is hygienic and safe, is literally priceless. For the many older Americans dealing with a chronic medical condition, the daily assistance of an HHA can be more important still—even lifesaving in some cases.
An Essential—and Challenging—Job
The job of a home health aide is as challenging as it is essential: Aides typically travel on their own each day into the homes of people with a variety of pressing needs. Not infrequently, they care for two or more individuals on the same day, working several hours at each stop. My own agency, Visiting Nurse Service of New York (VNSNY), employs nearly 11,000 HHAs through our Partners in Care division. Supporting our aides so that they can deliver consistently high quality care to their patients and clients is one of our top priorities. The same is true for other home health care agencies across the nation. As America’s elderly population continues to grow, maintaining a thriving HHA workforce will be one of the keys to helping our older generations age safely in place.
Similar to other home care companies, Partners in Care supports our HHAs in four basic ways: 1) We give our aides comprehensive skills training, both when they first begin their position, and on an ongoing basis thereafter; 2) we supply our aides with the up-to-date technology and administrative support they need to be effective in their daily work; 3) we focus on scheduling each aide’s assignments in a way that optimizes their earning potential; and 4) we offer our HHAs avenues for advancing their careers through advanced training and opportunities for new professional roles.
1) Arming HHAs with the Skills They Need
In the U.S., every state has its own training requirements for home health aides. New York State mandates that new HHAs receive 75 hours of training, but home care companies are free to go beyond this minimum requirement. We currently provide our newly hired aides with 114 hours of education and skills building, including in-depth training in topics like body systems, nutrition and communication skills, and hands-on practice with essential equipment like the Hoyer lift.
States typically require ongoing refresher courses as well. New York mandates two in-service (continuing education) courses for HHAs each year, which Partners in Care supplements with additional targeted training sessions. “In addition to the twice-yearly brushups, we offer specialized training in specific disease conditions such as Alzheimer’s and MS, and will bring in aides for additional training if we see they are on a case that requires additional skill refreshers,” says Jennifer Rajewski, Senior Vice President of Partners in Care. “Our HHAs are also welcome to come in on their own any time for extra training. We have a group of RN instructors who are always available to support our staff.”
With the ongoing nationwide push to avoid preventable hospital readmissions, HHA training programs have also become more focused on teaching the warning signs that may indicate worsening in a client’s medical condition. Since our HHAs spend more time with clients than any other caregiver, we want them to get on the phone immediately to a nurse or care coordinator if they see anything in a client’s status that alarms them. By helping to catch any health issues early on, HHAs at our agency and elsewhere are playing a key role in helping their clients manage their health successfully at home.
2) Providing HHAs with the On-the-Job Tools They Need
There are now a variety of software tools available to help home care agencies efficiently schedule and deploy their home health aides each day. At Partners in Care, we’ve devoted significant resources to upgrading our IT systems in recent years, including our HHA scheduling process. As assignments come in, we use this technology to map out a daily schedule for each aide that is as convenient as possible in terms of time and travel distance. We also provide detailed directions and travel instructions to go with each daily schedule, and maintain an office hotline that aides can call into as needed if they have questions or concerns during the day. Our aides also check in regularly with their supervisors, and provide feedback to Partners in Care through a separate channel to confirm that the supervision they’re getting is adequate and effective. “We know that it can be challenging to be on your own out in the field,” says Rajewski, “so we work to keep our aides linked into the organization through a variety of means.”
To provide additional tech support for HHAs, the software firm Sandata Technologies had developed a new “mobile visit verification” smartphone app for home health aides, which assists with record-keeping and navigation. The app, which Partners in Care is now piloting, is already in use at several other large home care companies, and is getting high marks from the HHAs who use it. Among other things, it contains each aide’s schedule for the week, and can instantly provide directions via Google Maps to every client’s home. The app also uses the phone’s GPS signal to automatically record when an HHA arrives at a client’s residence, eliminating the need for an arrival call-in, and has a client-specific display that lets the aide swiftly review and confirm all components of the client’s care plans with the touch of a finger. There’s also a page where HHAs can input any comments or questions they may have related to that day’s visit and can even attach photos of wounds or other medical issues, with all information transmitted securely and automatically to their supervisors.
“In addition to making life easier for a home care company’s HHAs and office staff, this app will let the company compile and analyze information about each visit in a more comprehensive way,” says Rajewski. Partners in Care expects the app to be rolled out to our full HHA workforce by the end of 2017—a step that will include supplying aides with smartphones where needed.
3) Optimizing Income for HHAs
Because home health aides are typically paid by the hour and may have multiple shorter assignments on any given day, it’s incumbent on home care companies to make sure that those HHAs who wish to work full time are able to put in a consistent 40-hour week. Being based in New York City, Partners in Care can take advantage of our large and concentrated client base to ensure that aides who complete one shorter assignment can be assigned another one that’s close by, so that their workday isn’t fragmented. “We always try and look for multiple shorter hour assignments that are in a similar geographic area, so we can ensure that aides are consistently working,” notes Rajewski. “And if a patient’s care episode ends, we try to give the aide a new one immediately, so there’s not a lapse in working time. We also compensate our aides for all travel costs incurred between their first and last assignments of the day.”
At times the needs or personal requests of clients mean also that an aide ends up working overtime, in which case they get the appropriate extra hourly wage for that additional time worked. “We’re very ready to pay overtime wages as needed, with the aim of maximizing efficiency so that aides are working a good amount of hours without being overworked,” says Rajewski.
Paying HHAs for both extended travel time and overtime are regulatory requirements, although the specifics of these rules have been a subject of political debate, as I’ve noted in previous columns. As I’ve also noted previously, a number of states, including New York, have legislated increases in their minimum wage, which benefits a significant portion of the HHA workforce. The minimum wage in New York City for large employers was recently raised to $11 per hour, and will go up incrementally to $15 per hour by the end of 2018. It’s essential that Medicare and other insurers take these wage increases into account as well, however, so that home care companies are reimbursed adequately for the care our aides are providing. A home care agency that has to close its doors because it’s losing money is no help to anyone, including its former patients and employees!
4) Offering HHAs New Career Opportunities
This aspect of the home health aide profession is perhaps the most interesting in terms of recent developments. The health care industry has come to recognize that HHAs have a unique insight into the daily lives of their patients and clients. This, combined with the skills of a good HHA—including their specific training, their interest in health and well-being, and their ability to connect with others—have led to a proliferation of new HHA roles. At Partners in Care, many of our aides have been trained to serve as health coaches, using motivational interviewing and other techniques to encourage patients to make healthy changes in their lives. We have other specialized training programs that teach HHAs the skills needed to work in a hospice setting and to assist in carrying out physical therapy programs with patients. New York State also just passed a bill creating the new position of Advanced Home Health Aide, a position that includes HHAs with additional training to administer pre-filled medications and perform other health-related tasks.
HHAs often leverage their skills into other health-related professions as well—something we strongly encourage. “It’s not uncommon for HHAs to attend nursing school while working as aides, and some of these former aides are now employed by VNSNY as nurses,” says Rajewski. “We’ve also been able to move a good number of our aides into office support roles over time, as HHA supervisors or instructors.” In addition, a new position called a Health Navigator is now being widely established as part of New York’s DSRIP (Delivery System Reform Incentive Payment) program to enhance the health of Medicaid recipients. This role, which involves helping patients access needed resources in the community, has great potential as a career ladder for HHAs, and we are actively pursuing that possibility.
Respect for an Important Job, Performed with Grace, Humor and Skill
Despite the competition from other fields, these collective steps are helping home care agencies overcome the obstacles to recruiting and retaining a strong HHA workforce. The response we’ve gotten from our own aides around these various efforts has been consistently positive. “Based on the feedback we’re receiving, our aides feel VNSNY is investing time and resources in them, and that we’re giving them the skills they need to be successful in working with patients and their families,” reports Rajewski.
HHAs across America support the health of the nation’s elderly and infirm every day, with grace, good humor and a range of skills. As I know from my own experience, all successful home health care agencies understand and respect the importance and value of what HHAs are accomplishing. At Partners in Care, we are fortunate to have a large number of aides who have been with us for many years. At the same time, notes Rajewski, “we are always looking for new qualified candidates.” For all of these reasons, and because the health of our nation’s seniors depends on it, America’s home care companies must continue to do all we can to support our home health aides across the country and the essential work they’re doing.