Teaching in-home caregivers to provide more expert care pays off
A study has found that elderly and disabled low-income Californians were less likely to need to be hospitalised after their in-home caregivers were trained in an intensive 73-hour course covering infection control, first aid, medications and other areas. Rates of emergency-room admissions under these caregivers fell by 24% after one year of training and 41% after two years of training. Healthcare professionals are now hoping to gain financial support from Medi-Cal health plans for these training programs.

SAN FRANCISCO — Low-income Californians who are elderly and disabled were less likely to go to the emergency room or be hospitalized after their in-home caregivers participated in an intensive training program, according to a report.

Under a pilot program, nearly 6,000 aides in Contra Costa, Los Angeles and San Bernardino counties were trained in CPR and first aid, as well infection control, medications, chronic diseases and other areas. All were workers of the In-Home Supportive Services program, who are paid by the state to care for low-income seniors and people with disabilities, many of them relatives.

Researchers at the University of California, San Francisco based their analysis on the results in Contra Costa County, which they said produced the most complete and reliable data.

UCSF professor emeritus Bob Newcomer said they compared insurance claims on 136 at-risk elderly and disabled residents whose caregivers were trained with the claims from more than 2,000 similar residents whose caregivers did not receive the training. Though the sample was small, Newcomer said he was encouraged by the findings.

“Training shows a lot of promise,” he said.

The rate of repeated emergency room visits declined by 24 percent, on average, in the first year after caregivers were trained and 41 percent in the second year, according to the UCSF analysis.

The demand for in-home caregivers is rising as the population ages. But most caregivers, including those paid by the state, are not required to receive formal training even though many are looking after people who have chronic diseases, dementia or mental illness.

California’s supportive services program pays caregivers to help about half a million elderly and disabled people stay in their homes rather than be placed in institutions. To qualify for the care, seniors must be eligible for Medi-Cal, be 65 or older, and be blind or disabled.

The goal of the pilot program was to determine whether educating IHSS caregivers and integrating them into the medical team would improve the health of their patients. The training was conducted by the California Long-Term Care Education Center under a three-year, $11.8 million grant from the federal Centers for Medicare & Medicaid Services. The center, which released the report on the results of the pilot program, worked in conjunction with UCSF.

The caregivers in all three counties, 44 percent of whom did not have a high school education, voluntarily attended about 60 hours of classes and completed 13 hours of related work at home. The people they cared for also took part in some of the classes, which were conducted in several languages.

Caregivers who were trained told researchers they felt better equipped to do their jobs and communicate with clients and their doctors, according to the report.

Andrew O’Bryan, said he was especially happy to learn CPR in case his mother has an emergency. For more than eight years, he has been paid by the state to care for his 67-year-old mom, Anabelle O’Bryan, who he said has diabetes, congestive heart failure, arthritis and high blood pressure.

O’Bryan, who lives in Oakley, said he also learned what to ask when he accompanies her to the doctor and how to decide if she needs to go to the hospital.

“Now I am more equipped to spot things” before they get worse, he said.

For example, O’Bryan said he knows to elevate her feet when they get swollen rather than immediately take her to the ER. And Annabelle O’Bryan said she is more confident in her son’s abilities after he took the class, and she knows that he is helping her stay healthier.

“He is really on top of me not eating the sugar,” she said. “He is really careful about that.”

Newcomer said that because the caregivers are in the patients’ homes for hours, they can be the “eyes and the ears” for physicians and other medical providers. They can tell the doctors “if the person is more confused, or is refusing to eat, or that the status is changing,” he said.

The results of the study show that caregivers play a pivotal role in helping keep people out of the hospital, said Corinne Eldridge, executive director of the California Long-Term Care Education Center. The nonprofit center was founded in 2000 by members of the Service Employees International Union, which represents many IHSS workers.

During the training sessions, Eldridge said, the caregivers learned skills such as how to read medication labels or provide the best diet for a diabetic patient. Like Andrew O’Bryan, they also became more confident about handling worrisome situations, such as deciding when to call a doctor or dial 911.

Eldridge said the center is now hoping to gain support from Medi-Cal health plans to help pay for the training as a way to reduce health care costs.

“We really see training as part of the solution in order to provide better care … and frankly as a way to invest in the workforce,” she said.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.