Although home-care providers are the ones who spend the most time with complex, critically ill patients, they usually receive little formal training before they are certified by a state or federal government.
Federal law mandates 75 hours of training for providers working for Medicare-certified agencies and just a handful of states go beyond that for their Medicaid programs.
The demand for home-care providers—usually a layperson with no healthcare background—is projected to grow rapidly as baby boomers retire and more care moves to the home setting. In-depth training is essential to ensure complex patients are well cared for but also to decrease unnecessary readmissions and to keep patients in the home longer, said John Baackes, CEO of Medicaid insurer L.A. Care Health Plan.
“We recognized (the home-care provider) could be a viable part of our team because many (members)—if they are frail enough to have a home support worker, have many issues,” he said.
Since 2017, L.A. Care has invested in training home-care providers for its members. California already pays these providers caring for Medicaid beneficiaries $13 to $14.75 an hour depending on the county as part of its In-Home Supportive Services Program, but training isn’t required. Because the program involves Medicaid members selecting their own providers, it’s often family members with little healthcare knowledge.
L.A. Care has partnered with the California Long-Term Care Education Center to offer 10 weeks of training, which costs about $2,000 per person. A little over 3,000 providers have completed it over the last three years, and Baackes said the cost is worth it because of the impact on outcomes. The health plan found that during the 20 months after completion of the training, members with those providers saw a 42% decline in emergency department visits and hospitalizations dropped by 60%.
The curriculum, taught in six languages, covers various aspects of home care such as infection control, cardiopulmonary resuscitation, nutrition and diet, home safety and checking vital signs. Prior to COVID-19, participants would meet in person for the weekly course, which lasts 3½ hours. The classes successfully transitioned to online. Of the roughly 300 students participating, only 27 dropped out, said Corinne Eldridge, CEO of the California Long-Term Care Education Center.
For Sandra Owens Taylor, the training has improved her confidence on the job. A home-care provider for more than 20 years, she said it was helpful to be refreshed on core skills and to learn new topics. For instance, she didn’t know L.A. Care would pay for handrail installation and personal protective equipment. “My understanding has been heightened,” she said.
The program concludes with a graduation, which is a special affair, Baackes said. Participants rent caps and gowns, and family members often bring balloons and flowers for the ceremony.
“I can’t tell you how moving this is. They really think this is a big deal and it is a big deal,” he said. With COVID-19, the graduations have transitioned to a virtual ceremony.
L.A. Care is the only payer the California Long-Term Care Education Center partners with now for the training, but Eldridge said she’s looking to expand through changes in state policy. The state is currently drafting a strategic plan on how to improve health for aging residents; one of the preliminary recommendations is to include training as part of the In-Home Supportive Services Program. The plan is set to be finalized by the governor in October.
“Having it baked into state policy, it would be really amazing to have these results and career pathways within home care accessible to all (In-Home Supportive Services) caregivers across the state,” Eldridge said.