Do You Utilize Clinical Staff To Full Potential? Home Health Aides Can’t Be In The Shadow In PDGM. Position Yourself For Your Future Success!
Kenyon HomeCare Consulting • March 16, 2021
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.
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Surveys are heavily focused on data to serve as evidence of your agency's practices. Create a "Survey Book" containing all required documents for immediate access.
For home health agencies, a regulatory survey is not just an inspection—it's a high-stakes assessment of your commitment to patient safety, quality care, and operational compliance. Since repeat surveys are unannounced, the goal is to cultivate a culture of "survey readiness every day." Preparing your agency for a successful survey requires proactive planning, meticulous documentation, and full staff engagement. Below are the steps to build for continuous compliance. 1. Develop a Survey team: Preparation starts with designating a core team responsible for the survey response. Clear roles ensure a calm, organized, and efficient process when a surveyor walks through the door. Each person needs to know exactly what they are responsible for and what metrics they need to track to be sure the agency is always ready for a survey. The Administrator/Survey Lead: Must be present for the entrance conference. This person is the main point of contact, handles high-level questions, and maintains a professional atmosphere for the organization with the agency staff and with any surveyors. Director of Clinical services/ Supervisor: This team member is responsible for assuring all documentation is reviewed and appropriate. This includes OASIS accuracy, that the plan of care matches the OASIS findings, and visit documentation follows the plan of care. ICD-10 Coders: This team member reviews the OASIS and matches it with the discharge summary to assure accuracy of OASIS (along with DCS or Supervisor). The coders also verify the ICD-10 code accurately reflects findings of the OASIS. Clerical Support: Staff is responsible to all personnel records monthly review for required documents and all new employees for same while reporting any missing documents (e.g. updated license, auto insurance, driver’s license etc.). Create plans and have operations in place to communicate at least a month in advance to employees when items need updated. This person is also responsible for managing the logistical needs when the surveyors are on site (e.g., Wi-Fi password, workspace, etc.) to create a buffer for management. They also discreetly communicate critical questions to the Survey Lead. The team member acting as Survey Lead is considered the survey readiness team leader. Promoting survey readiness should include regular monthly meetings with all of the survey readiness team members. Each team member should be ready to report on the status of their responsibilities and any data to support their findings. These findings include: a. Status of OASIS accuracy and any staff who need training. b. Planned OASIS training that provides regular updates on areas where staff continue to struggle. c. Plan of care with matching visit notes d. Personnel files and any updates when employees are not responding to the request for documents e. Status of continuing education per state or federal requirements f. Yearly evaluations with supervisory visits to support evaluation. Supervision needs to pay particular attention to hand washing according to policy and standard infection control procedure when getting in an out of bag, with client contact, or coming in and out of the home. This remains one of the primary findings by surveyors. g. Evidence of yearly required continuing education such as: • Infection control • Patient Rights and Advocacy to uphold dignity and autonomy • Emergency Preparedness with response protocols; evidence of bi-yearly practice drills for a potential emergency • Medication Management and safety to prevent errors • Updated relevant health care regulations and policies • Cultural competency to enhance communication and care for diverse populations. All data collected by the team members may need to be sent to the compliance manager and may become part of a plan of correction for the Quality Assurance program. Should you need assistance with survey readiness, please continue to part 2 of this series and call Kenyon Homecare Consulting at 206-721-5091 to help you get there!
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