Healthy Aging and Care for Older Adults – Aligned Strategies Framework

1. Increase the supply, diversity and distribution of qualified workers to meet target demand

A. To meet the need of 200,000 additional direct care workers by 2030 with a cultural and linguistic match across all regions, establish and gain widespread adoption of a new universal home care worker job family with entry, mid and advanced levels (e.g., level based on acuity level of older adult. For example, advanced level may perform paramedical tasks with appropriate training, certification, observation and RN or NP oversight for older adults with Dementia and functional limitations)
B. Provide sufficient sources of funding through public and private payers and elevate the universal home care worker as a viable member of the multidisciplinary care team, inclusive of Health Homes and ACO structures
C. Promote the benefits of careers focused on caring for older adults and individuals with serious illness through increasingly meaningful exposure to and experience with aging related careers starting in middle and high school; explore infusion of curricula around aging careers in high school health academies with priority targets for underrepresented populations
D. Expand workforce by creating new and flexible job opportunities for previously overlooked workers to care for older adults
E. Establish and expand home-related health care roles that can be provided by older adults seeking post-retirement careers and retired health workers. Roles may include “tuck-in” calls, in-home visits, advocacy, navigation, care coordination, including SDOH, coaching, etc. to address social isolation and associated health risks. Provide sufficient training support and compensation to meet demand.
F. Target recruitment efforts aimed at under-tapped groups: older adults, re-entry populations, service industries where position are phased out due to automation, robotics, gig-economy. Provide meaningful work opportunities to support aging in place
G. Strengthen and expand career ladder pathways and training opportunities for current health workers to advance into priority aging-related and hospice and palliative care careers. Provide support for advising, mentoring and training program assessment preparation and entry.
H. Sustainable, publicly and privately funded financial incentives are available for scholarships, stipends, and loan forgiveness for aging-related careers. Include priority professions, underrepresented candidates and underserved communities.

2. Align education and training program content and modalities with changing roles and requirements to prepare workers with the competencies to secure and succeed in emerging roles

A. Establish clear and meaningful standards for training and certification of the new universal health care worker job family
B. Education and support RN/LVN/NP supervisors through technology enablement to respond to the universal health care worker’s needs, particularly in crisis situations and to ensure quality of delegated paramedical tasks
C. Establish formal training programs / blended learning and technology solutions for PCPs, NPs, PAs, RNs, LVNs, SWs, Pharmacists, Chaplains and Universal Health Care workers in hospice and palliative care.
D. Establish a universal set of hospice and palliative care competencies for interdisciplinary health workers across the continuum and distribute through all health sciences
E. Promote widespread adoption of existing baseline and role-based competencies in geriatrics for all health care professionals across the continuum
F. Promote interdisciplinary team-based education across the continuum with inter-professional faculty, and promote teaching/education as a value role for all health care team members, including family and hired caregivers (universal health care worker job family), with recognition and pay/bonus for excellence in teaching
G. Develop an understanding of best practices in IPE education and faculty development and what can be introduced to CA and adapted to the local environment.
H. Consider how to provide community mentorship and family support models
I. Maintain and obtain dedicated geriatric and hospice/palliative care flexible funding mechanisms for fellowship, advance preparation training and workforce training across the continuum at the state level
J. HPEIs and employers coordinate strategy to enrich curricula from middle/high school to post- secondary.
K. Expansion of the California Long-Term Care Education Center through a potential waiver for further evaluation of IHSS workers and outcomes (reduced hospitalizations, ED visits, worker and consumer satisfaction. Applies to the universal health care worker job family.
L. Support residencies and clinical placements for NP and PA students in settings caring for older adults.

3. Strengthen the capacity, effectiveness and retention of the current workforce through changes in the roles, functions and configuration of workers and teams

A. To enable new models of care, establish and implement interdisciplinary team-based roles with knowledge and/or credentials to enable high-quality, technology-enabled and person-centered care with a focus on aging in place for seriously ill older adults
B. To enable new models of team-based care, prepared professionals with geriatric and hospice and palliative care expertise with interdisciplinary leaders in these fields serve as faculty, coaches and mentors to increase competencies and develop interdisciplinary team- based approaches to meet the complex medical and unmet social needs of the aging population
C. Conduct pilot demonstration project(s) of nurse delegation towards a plan of widespread stakeholder adoption followed by legislative action (e.g., RN/LVN delegation of paramedical tasks, such as administering eye drops) to the universal health care worker job family based on level, competencies and corresponding training requirements, certification, observation and RN or NP oversight
D. Grant full practice authority to Nurse Practitioners, including Geriatric NPs and Adult Acute Care NPs to the full extent to which their education and training has prepared them in order to improve access, contribute to health disparities reduction efforts and lower the cost of providing such care
E. Reimbursement strategies for team-based care by private and public payers
F. Develop and expand internship programs and/or clinical placement within the community with an emphasis on priority career options and underserved regions. Require rotations in older adult care and hospice and/or palliative care and clinical site engagement in professional schools as part of the general training.
G. Develop new roles, advancement opportunities and educational programs to train members of home care teams who work with data and population health monitoring, assessments and interventions.

4. Accelerate innovations in technology, process, payment and collaboration to cost effectively achieve access, outcome and equity goals

A. Align population needs and team-based roles with necessary funding sources and regulatory structures to support care of older adults.
B. Prepare a prevention-oriented workforce with understanding of the importance of integrating medical and and social determinants of health. Promote expansion of community-based medical services (clinic and home-based care) to minimize avoidable acute care medical services.
C. Develop/expand education and training so all health care workers are able to engage actively in patient hand-offs, coordination and navigation across the continuum to improve care and the experience for older adults. Empower all workers to view themselves as central to coordination.
D. Propose an optimal regulatory framework around technology to either “loosen up” regulations and introduce or “tighten up” regulations where none or few exist or were older adults benefit from protections its affords. Evaluate sound ethical standards, especially around technology deployment
E. Outcomes achieved from value-based care (medical + social + behavioral) are rewarded through higher levels of team-based care
F. Establish use of patient/family input, biometric data, home/point of care laboratory data, and medication use data to predict medical crises early to intervene virtually or send care team to the patient
G. Support policies and reimbursement for community-based palliative care teams for older adults with serious illness.
H. Support innovative insurance models for LTC or home care
I. With a focus on aging in place, advocate for a greater shift in Medi-Cal funds from Medi-Cal custodial nursing facilities to home-based care and its caregivers
J. Leverage technology and scalable training modalities to prepare healthcare workforce across the continuum
K. Reimbursement incentives in place for greater use of digital health and improved workflows