Empowering the eyes and ears of hospice: The Aide Specialist Program

Abstract

Home aides are the critical link between the goals of hospice and their implementation. They spend greater periods of time in the home than other hospice team members, and often enjoy a privileged relationship of trust and openness with the patient and family. In order to optimize the contribution hospice aides can make, The Hospice of Central New York developed a program designed to improve hospice care quality by enhancing the skills, sensitivity, and self-esteem of the home health aides who most regularly provide this care. This article describes the components of a successful hospice aide training and support program, discusses the techniques used and the evaluation measures employed, and summarizes the benefits, limitations and challenges of initiating and maintaining a program of this kind. Typically the lowest-paid and least educated of health care workers,1 the home health aide (HHA) is often the most isolated member of the hospice interdisciplinary team, and may be marginalized in the staff development and quality improvement efforts of hospice administrators.2 Yet, hospices that overlook this vital human resource miss a fundamental opportunity to assure the success of their patient and family care plans. Home health aides are the “eyes and ears” of hospice: they spend far greater periods of time in the home than any other team member, and the intimate physical care they provide frequently results in a privileged relationship of trust and openness between the aide and the patient and family.3 While the home health aide is uniquely positioned to make a significant contribution to the psychosocial and spiritual care, as well as the physical well-being, of the patient/family unit, the potential benefits of this relationship cannot be optimized unless hospice empowers the persons doing this work through a specialized program of education and support. As Kennedy-Malone4 recently observed in an article on aide staff retention, the existing research strongly indicates that factors other than compensation make a difference in the commitment home care aides feel toward their jobs: “Because ‘intrinsic’ factors such as a sense of accomplishment, feeling appreciated by their clients and the home care agency, and an affinity to their clients are related to retention, home care agencies need to reinforce these job attributes.”5 The Alethea Center—the educational division of the Hospice of Central New York in Syracuse—recently initiated an advanced training program for certified home health aides, in cooperation with three area preferred provider agencies. The purpose of this program was to create the conditions for greater quality and continuity of patient-and-family care by enhancing the skills, sensitivity, and self-esteem of those who most regularly provide this care. This article will describe the essential components of a successful hospice aide training and support program, document the techniques and activities employed, explain the methods used to evaluate the program’s outcomes and impact, and summarize the challenges, limitations, and benefits of initiating and maintaining a program of this kind.