How to create the best possible care team – November 18, 2019



Gary Barg, Editor-in-Chief

Caregiver Bookclub
Tina Marrelli,
Author – Home Health Aide: Guidelines for Care: Instructor Manual

Gary Barg: I would think that organizations who really want to provide the best care for their clients are going to treat their home care aides and CNAs correctly. Why doesn’t that always happen?

Tina Marrelli: As you can imagine, that’s a complex question. Medicare has certain rules for coverage. Aides are one of those important services. They found that aide related education and training were the most commonly cited deficiencies.

The vast majority were based on failures cited to demonstrate compliance with training and education requirements; so, knowing that, and knowing we really want to develop all of our people, and our home care aides, it’s time that we really take care of them. The demographics alone support that we should. As you know, we have 64 million people just in Medicare and Medicare is the largest payer for home care and hospice services.

As the boomers age, all of us at some point might need help with personal care and activities of daily living. This care is so personal. Hopefully, they’ve been competency assessed and educated on certain aspects of care, and oriented, and onboarded. Then, they’re going to give you a bath or help you in your home with some other really personal kind of care.

Gary Barg: It’s also, honestly, a market differentiator for home care companies, and for facilities. The fact that they sometimes have a closer relationship, after a while, with our loved ones than we do. The home health aides need to be treated as the experts that they are.

Tina Marrelli: When I was in high school, I was an aide. Then, I got bit by a mosquito that had viral encephalitis. I went into a coma. When I woke up, all I remember is how people took care of me. How their touch was. To me, it really made me understand how important aides are in any healthcare system.

Gary Barg: How does an organization best utilize your new book, Home Health Aide: Guidelines for Care: Instructor Manual?

Tina Marrelli: I tried to make this really comprehensive. Aides are so foundational to really good care. There are foundational lesson plans and patient populations. If you like, I can just give you a couple of examples?

Gary Barg: Yes, please.

Tina Marrelli: The whole first part is the lesson plans. There are 11 of these that are administrative.  It’s an overview of a very important role. What are the special and valued skills needed in home health and hospice? What are key components?  What does that aide need to understand the glossary of home health and hospice? What’s the team concept? How do you work together to help patients? What are the documentation requirements? Because even for aides, they’re very specific. What’s the role in infection control and prevention?  Administrative responsibilities such as their documentation, calling in, staying home when you’re very sick because we don’t want to give anything to our patients that might be elderly and immunocompromised. It goes all the way down to urinary catheter, incontinence care, and wound care, all alphabetical.

Gary Barg: It occurs to me that, being an organization, facility, or a corporation who hires home health aides, to not have this book, you’re putting yourself at risk. If you’re not training your home health aides correctly, you’re at risk.

Tina Marrelli: Absolutely and from an operational perspective, who do they report to? Is there one person? Do they feel like they’re part of a team? Is their input heard? How do we support these important members of the healthcare team?

Gary Barg: The professionalization of the home health aide is extraordinarily important.

Tina Marrelli: And what are we doing to maintain the folks we have? If they are happy and they stay. It’s not all about money.

Gary Barg: No. It’s about respect and dignity.

Tina Marrelli: Absolutely. I always tell people that it doesn’t pay or cost anything to say, “Thank you for a job well done.”

Gary Barg: Let’s get to the nitty gritty. What are some of the titles for aides and what kind of care do they provide?

Tina Marrelli: Some of the titles can be home health aides, hospice aids, home care aides, certified tested nursing assistants, personal care aides, depending on what the states call them. We also have community health workers now that are a specialized kind of aide. Sometimes, I think, as you said, they are, the unsung team member who really needs to be valued.

Gary Barg: Can you talk to me about ADL assistance?

Tina Marrelli: Activities of Daily Living are those things we do without even thinking about them. Getting up in the morning, brushing our teeth, washing our face, getting dressed, washing our hair, our personal care, putting on our clothes, washing our clothes, going into the kitchen, being able to prepare a meal. It’s every aspect of what happens each day that we take for granted. But, when you can’t do them all of a sudden, you see all of those consecutive steps that have to happen. That’s where the aides come in. If the aide is coming through a Medicare certified organization, the nurse provides an aide plan of care. On the plan will be things such as individualizing the patient’s care based on the assessment that was done for their particular need.

I can give you an example from a safety perspective. Oftentimes, older adults who’ve maybe had a stroke in the past might be on blood thinners. On the aide plan of care, it might say, “Watch for bleeding.”  When they’re doing oral care, or helping them brush their teeth; or checking their urinary catheter bag, is there blood? Or, is there bruising on their arms?  Then, the aide calls the nurse to and says, “This is happening with my patient,” who, in turn, will call the doctor. Aides have really important roles in observation, reporting, and documenting of patient status.

Gary Barg: What are some of the things organizations can do to retain aides?

Tina Marrelli: As you know, that’s the million-dollar question.  Like all jobs and employers, aides need to be and feel a part of the team.    First, I always think from a how do we improve things perspective. From a performance or process improvement, has the real turnover rate been identified?  What were the three or four top reasons that aides said they left? It’s usually not one thing. Ranking those things can be really important.  Of course, we know retaining aides and employees that really want to be on our team is much cheaper than that churn of orientation, onboarding, and then them leaving. I always like to think that aides should have mentors. Sometimes that can be an experienced aide. Is there one person they connect with, especially when they’re new? Across time, if they have questions, can they get them answered?

Imagine another job where you’re just sent out to people you’ve never met. And every house is so different.

Gary Barg: It sounds to me like one of the first things we need to do as caregivers, or as employers is learn how to communicate. Learn how to listen, learn how to hear what the aides are really saying as equal members of the care team; and, react to what you’re hearing. I think communication is such a big challenge.

Tina Marrelli: Yes, people really need to hear the aide’s input. Sometimes they spend more time with the patients than anyone else. Either way, those aides get to spend that time with a patient and family and are often the experts on their daily care regimen. The aides I know really want to take care of people. They want to do the right thing. But, it’s up to the organizations to bring them into the workforce in a thoughtful, planned way, and looking more towards a long-term vision than, “How do I fill this shift today or tomorrow?”