Today, every home health agency is trying to position themselves for success in PDGM. However, one huge missing piece of the puzzle in patient care is the home health aide. As you move forward into big payment reform, make sure you realize outcomes and cost of patient care can greatly improve with proper utilization of your aides. Let’s look at how many agencies see the home health aides now and how we need to transition them as an integral part of a coordinated care.
Our “Bath Aides” Today:
The biggest mistake in the industry is to label your home health aides “bath aides”. When a care plan is developed, it is developed around personal care and bathing, so some clinicians minimize the capability of the aide. Many agencies hire only CNAs. This means we need to see the home health aide as a certified nursing assistant. This means allowing them to work completely within scope of practice and not just doing the bath. Depending upon the state, some aides are allowed to do dressing changes and draw up insulin. Now, this means the agencies need training programs in place and must determine competency of staff completing these tasks. You may feel that not every aide on staff is suited for certain tasks and this is fine. However, in a PDGM world, you will have a difficult time surviving if you do not utilize every discipline to fullest potential within scope of practice. Let’s look at what full potential for your home health aide looks like in PDGM.
PDGM and Aide Utilization:
Our aides always need to have chronic disease at the forefront of care. Considering the majority of the patient population is dealing with chronic disease, every aide needs ongoing education regarding chronic disease care. If you can work with the aides to take a blood pressure, monitor swelling, and weights on a CHF patient, then why wouldn’t you have them do it? If they have been educated and competency is met, then have them understand why these items need addressed every visit and reported on to the nurse. This also includes consideration in the rehab process. SNFs have long recognized the use and value of restorative aides and programs within the facility. Why don’t we use the aide as part of these processes in the home? ROM or assistance with exercises is so often a part of the patient care plan, but most agencies don’t have the aide complete additional ambulation or home exercises with the patient. We teach family members and neighbors to provide skilled care, so why are you having the aides do it?
In PDGM, an aide should get a plan of care with report from the nurse as to specifics of care. This means talking about specifics related to chronic disease, personal care, and therapy focus. The aides should know what specific goals are listed in the care plan. The aide should have care goals related to advancing the patient to independence with personal care and also what specifics need reported as part of routine visits. This way, the aide is engaged in what all the disciplines are working to complete. This promotes an ongoing circle of care that is continually client-focused. This allows the nurse and therapy staff to be plugged into additional data about the patient when they aren’t present in the home. Don’t minimize the role these staffers can play in positive patient outcomes. Remember that they know more about that patient and spend more time with them than all the other disciplines.
Moving Into Aide Utilization Is A Process:
At Kenyon Homecare Consulting, we recognize that a paradigm shift with clinical staff takes time. It also takes education to staff to understand the change. We can help you with the chronic disease education for staff and agencies. We can also assist with on-site training with staff as you transition to client centered coordinated care planning. Call us today at 206-721-5091 or contact us online to see how we can help you with success in PDGM.