As you know, Medicare's requirements for home health aide in-services are the following (Standard §484.80(d); Tag G774):
"§484.80(d) Standard: In-service training. A home health aide must receive at least 12 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient."
We recommend the following list of in-services (consider them for your field nurses and therapists as well) for the first year a home health aide is employed.
In order of Importance...
1. Performance Improvement - QAPI
Why? Quality Assurance/Performance Improvement is the method by which your HHA achieves excellence. Achieving excellence occurs by identifying problems and correcting them. Read our Blog on QAPI.
Aides spend more time with the patient than other disciplines. They are the 'front-line' when identifying breakdown in policies and procedures. Specifically, you want your aides to have a complete understanding of every incident type tracked by your Agency such as...
• direct exposure to patient body fluid including needlestick(s)
• hazardous waste management violation
• healthcare-acquired infection
• patient injury during care
• employee injury during care
• workplace safety violation
How? An Agency representative should explain and demonstrate how QAPI works at your Agency. It's unnecessary to purchase an on-line course.for aides to attend...
2. Infection Prevention & Control
Why? The containment challenges of the current COVID-19 pandemic demonstrate the importance of frequent infection control and prevention training.
Although this would be considered part of your Agency's orientation, additional reinforcement of infection control is necessary. Employees and patients that don't practice proper control can spread the infection exponentially. Because aides spend more time with the patient than other disciplines, thorough knowledge of when and how to perform the following infection control is mandatory:
- Hand hygiene
- Use of personal protective equipment (e.g., gloves, masks, eyewear)
- Respiratory hygiene / cough etiquette
- Sharps safety (engineering and work practice controls)
- Sterile instruments and devices
- Clean and disinfected environmental surfaces
How? Online continuing education courses are available for this subject matter.
3. Employee Safety During Home Visits
Why? Home health workers are exposed to unsafe situations because of...
- unstable home environments
- prevalence of handguns and other weapons in the home
- isolated work environment
- solo work - often in high crime areas or remote locations with no means of back-up
- poorly lit and/or isolated parking areas
- public perception that health care workers carry drugs and drug paraphernalia
- presence of gangs, drug and alcohol abusers, and presence of dysfunctional family members at home visits
- service delivery is all hours 24-7.
At a minimum the in-service should include (1) agency policies and procedures for personal safety and protection, (2) causes and reasons for violence, (3) predictors of violence, (3) appropriate reactions to violence, (5) violence-provoking behavior.
How? Online continuing education courses are available for this subject matter.
4. Emergency Preparedness
Why? Like infection prevention and control, this is already included as part of your Agency's orientation. Additional reinforcement of the Agency's process for emergency preparedness is necessary for agency staff. Training includes:
- A thorough review of the Agency's P&P for emergency preparedness
- How patients are prioritized for care
- How communication is achieved in an emergency
- How to get information on assignments during an emergency
How? An Agency representative can explain the Agency's policies and procedures on Emergency Preparedness.
5. Preventing Caregiver Burnout
Why? Health care workers experience high rates of burnout because of the nature of the profession. Burnout can result in high rates of employment turnover...in addition to impacting patient care - negatively. Agencies are well-served to address this 'head-on' and review signs of burnout: chronic fatigue, forgetfulness, pessimism, isolation, irritability, and poor performance) and solutions to preventing and managing caregiver burnout.
How? Online continuing education courses are available for this subject matter.
6. Fall Prevention
Why? Falls - a common occurrence - can put patients back in the hospital - which brings your Home Health COMPARE 5-STAR scores DOWN. Many private insurance companies select HHAs for their low readmission rates.
Safety at home is the number one objective for home health care. Strategies for eliminating risk for falls and injuries should be standard policies and procedures..
How? Invite one of your Physical Therapists to share home safety and fall prevention strategies.
7. Home Safety for Patients with Dementia
Why? Safety at home is a number one concern for patient with dementia. Just a few concerns include...
- Fire hazards such as stoves, other appliances, cigarettes, lighters, and matches.
- Sharp objects such as knives, razors, and sewing needles
- Poisons, medicines, hazardous household products
- Spoiled and expired food from the refrigerator/cupboard...
How? Invite one of your RNs to share the Agency's standard practices for home safety for patients with dementia.
8. Identifying & Reporting Abuse/Neglect
Why? As the aide spends more time with the patient than other disciplines, s/he must be ready to report actual or suspected patient abuse and neglect. Signs and symptoms include - but are not limited to - family/support system failure to provide for patient needs, withholding of patient’s resources, unnecessary confinement of patient, inappropriate touching of patient by others, unexplained injuries, verbal or physical assaults, substandard living conditions, and overcharging patient for services and housing.
How? Online continuing education courses are available for this subject matter.
9. Ethics in Healthcare
Why? Home health care presents a dangerous opportunity for violation of ethical behavior, especially for patients who are compromised physically, mentally, and emotionally. Ethical behavior includes (1) respecting patient choice, (2) protecting patient confidentiality, privacy, and security, and (3) administering health care services according to professionally-accepted standards of practice. A caregiver’s ethical behavior is critical to healing and recovery, and to the success of the Agency’s Mission.
How? Online continuing education courses are available for this subject matter.
10. Range of Motion
Why? Aides can augment physical and occupational therapy regimens by helping the patient to perform exercises during care.
How? Invite one of your PTs or OTs to share active and passive range of motion methods.
11. Patient Self-Care Strategies for Bathing
Why? Aides can augment therapy regimens by understanding the strategies used by Occupational Therapists to help the patient achieve better functionality. M1830 Bathing ability on the OASIS assessment is also a Home Health COMPARE-5 STAR outcome.
How? Invite one of your Occupational Therapists to share work simplification and energy conservation strategies for bathing/showering..
12. Safe Transfers
Why? Aides can augment therapy regimens by understanding the strategies used by Physical Therapists to help the patient achieve better functionality. M1850 Transferring ability on the OASIS assessment is also a Home Health COMPARE-5 STAR outcome.
How? Invite one of your Physical Therapists to share strategies for safe transfers.
