	Home Care and Support Services: Home Health Aide Services, Personal Care Aide Services, and Homemaker Services

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

HCS 11: Training and Support

Care providers receive the training and support needed to demonstrate the required competencies for providing in-home services.

Interpretation: Organizations meet applicable state regulations for determining competency of home care providers, which can include passing a written examination. In some states, these occupations are open to individuals with no formal training, and on the job training is usually provided. The Federal Government has enacted guidelines for home health aides whose employers receive reimbursement for Medicare that require home health aides to pass a competency test.

Research Note: Insufficient training and supervision have been noted as factors that generally contribute to in-home direct care staff performance and job satisfaction issues and high turnover.

HCS 11.01

As appropriate to the service, the training program includes and is not limited to:

recognition of and procedures for emergency response;
maintenance of a clean, safe and healthy home environment;
physical, psychological, emotional and developmental characteristics of the service population;
reading and recording vital signs;
communication of client information, needs, and status;
observations and documentation of client status and care or service provided;
universal precautions and basic infection control procedures;
provision of aid with activities of daily living for personal care aides and health care aides; and
provision of appropriate medical/rehabilitative procedures, safe transfer techniques, normal range of motion, and medication management for home health care aides.

HCS 11.02

The organization provides an educational program for direct service personnel who work with individuals with special needs that emphasizes:

attention to the physical, mental, social, economic, and emotional needs of the service population;
recognition of problems and response to impending emergencies or crises;
communication skills;
knowledge of appropriate community resources; and
provision of preventive and supportive services to ensure maximum participation and self-determination.

Interpretation: Organizations serving populations such as individuals with HIV/AIDS, Alzheimer’s disease, developmental disabilities or youth and families will provide training specific to that population.

Research Note: An interdisciplinary review of state agency policies and practice supportive of client functional independence found a lack of aide training and authorization to promote gradual assignment of more responsibility to the care receipt reflected in home health aide self-report data. This model development and program improvement project addresses the critical role of home health aide duties and planning for successful integration of personal care and medical treatment.

NA The organization does not work with individuals with special needs.

HCS 11.03

Within three to six months of employment, care providers successfully complete a supervised practical training, overseen by a qualified professional, and receive an evaluation that states:

preparation to be an in-home care provider;
interest in receiving peer support in on-going training; and
need for and means of seeking on-going support to meet job responsibilities.

Interpretation: Supervised practical training should be preceded by 16 hours (minimum) of classroom training, as noted in 42CFR§484.36. Supervised practical training is here defined by Centers for Medicare and Medicaid Services, DHHS, as training in a “laboratory,” field, or other practice setting in which the trainee demonstrates knowledge while performing activities under the direct supervision of a registered nurse or a licensed practical nurse.

Interpretation: For personal care aides, training overseen by a 'qualified professional' can mean an individual qualified by experience, training, education, and/or certification to meet those designated job responsibilities.

NA The organization does not provide home health aide or personal care services.

HCS 11.04

Home health and personal care aides do not provide services without a supervisor or trainer present until they have:

completed supervised practical training; or
met exemption requirements through demonstrated competence.

Interpretation: The organization is responsible for ensuring that individuals who provide home health aide services on its behalf meet competency requirements described in Public Health Code of Federal Regulation 42 CFR§484.36, which sets content and duration of training expectations. Home health aides are not permitted to provide service without the presence of a supervisor until training is completed.

NA The organization does not provide home health aide or personal care services.

HCS 11.05

All care providers receive continuing in-service education following completion of initial training requirements to ensure personnel are confident in their ability to provide quality support and assistance.

HCS 11.06

An organization may exempt care providers from completing the full training requirement, based on the following criteria:

full exemption may be granted to home health care providers who demonstrate competence in the delivery of services and hold a certificate of completion for a training program offered by an accredited program, or by a state or governmental organization meeting the Medicare Conditions of Participation;
partial exemption may be granted to home health care providers who have completed training or partial training at a non-accredited program and can demonstrate competence in the subjects covered; and
partial exemption may be granted to experienced personal care aides and homemakers who demonstrate competence in the service areas that are covered in training.

NA The organization does not exempt care providers from training.

HCS 11.07

A home health aide training program can be offered by a home care services organization, except one that has been found within the previous two years to:

permit unqualified, untrained individuals to provide services;
have been subject to a review and found by the State to provide substandard care;
have been assessed monetary penalties as a sanction;
have had all or part of its Medicare payments suspended;
have been found to have compliance deficiencies that endanger the health and safety of care recipients and has had temporary management appointed to oversee management; or
have met, under any Federal or State law, within the two year period beginning October 1988, any of the five conditions enumerated under Part (2), Conduct of Training – (i) Organizations, 42 CFR§484.36, p. 580.

NA The organization does not provide home health aide services or does not provide a training program.

QUICK JUMP TO


	PURPOSE: Individuals who receive Home Care and Support Services obtain a maximum level of independence, functioning, and health, and extend the time it is possible to live safely at home and in the community.

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	TRAINING Instruction so as to make fit, qualified, or proficient in a skill or body of knowledge.


	SUPERVISION Assumption of responsibility for directly overseeing and evaluating the work or work products of personnel within an organization. Also includes inspecting the act or process of accomplishing a function or activity.


	PERFORMANCE A measure of how well an organizational system provides services to consumers. Performance is often based on key indicators, such as rates of service, cost per consumer, degree of satisfaction with services, and extent of consumer access to services.


	PROGRAM A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.


	SERVICE POPULATION A group or target population that the organization's services are designed to serve in accord with its mission, and which includes the organization's service recipients. An organization's service population may be defined by geographic location, specific problems or needs, religion, ethnicity, culture, or other factors.


	MEDICATION MANAGEMENT Ongoing review and oversight of a client's use of prescribed or over-the-counter medications by a physician or other prescribing clinician.


	PERSONNEL The body of employees and/or volunteers that carries out the organization's tasks under the organization's administration and/or supervision. This definition does not include foster parents who are specifically referenced in relevant standards


	SPECIAL NEEDS A designation used in reference to conditions or characteristics of a person that reflect a need for special care, services, or treatment. When the term is used in the context of adoption services, special needs refers to conditions that make a child harder to place for adoption. This includes children who are members of sibling groups, older children, children with disabilities, children of certain racial /ethnic backgrounds, etc. When the term is used in the context of foster care it refers to the need for a higher degree of specialized case services and attention due to mental and physical disabilities. When the term is used in the context of out-of-school time services, a child or youth may have special physical, behavioral, medical, emotional, or cognitive needs that should be addressed or accommodated. The term is also used in other contexts. See also DEVELOPMENTAL DISABILITIES.


	CLIENT See service recipient.


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.


	PLANNING The process of specifying objectives, evaluating the means for their achievement, and exercising deliberate decision making about appropriate courses of action.


	CERTIFICATION Assurance from a state or professional association that a person or organization possesses certain attributes, knowledge, or skills.


	QUALIFIED PROFESSIONAL An individual licensed by the state in which the organization operates to perform duties outlined in the regulation requirements. Similar terms include: qualified health practitioner, qualified clinician, and qualified medical practitioner.


	EVALUATION The review and assessment of organizational operations, programs and services.


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	CRITERIA Systematically developed, objective, and quantifiable statements used to assess the appropriateness of specific decisions, services, and outcomes.