Eldercare Voices: Home Care Workers on the Interdisciplinary Care Team: A Win for Consumers and Clinicians

Corinne Eldridge

Home care workers play a critical role in keeping older adults and people with disabilities healthy in the comfort of their own home. Home care workers are in the unique and pivotal position of spending many hours with the consumer they care for, often on a daily basis, and therefore can serve as the eyes and ears of the consumer. A home care worker, observing changes to the health baseline of the consumer, can act upon those observations swiftly. When a consumer consents for their home care worker to be included as a member of the consumer’s interdisciplinary care team (ICT), the central role of the home care worker is validated in a crucial way that reinforces this important model of care.

An ICT is a dedicated team of health care professionals and other individuals closely involved with the consumer’s care who come together to ensure that the full range of the consumer’s health and personal care needs are met. A well-functioning ICT provides the consumer with greater oversight of his or her care, and regularized interaction between all of the consumer’s providers helps assure that needs are met in the most coordinated and beneficial way. Given the philosophy of this model, it is clear that the inclusion of the home care worker in the ICT is crucial to its success. As noted above, a home care worker is in a key position – along with any additional family caregivers, when involved – to relay critical observations and information back to the clinical care team, helping provide the best-informed support to the health of the consumer.

Given the frequency of visits and the length of time the consumer and home care worker spend together, these providers can generally be seen as a trusted voice on the ICT, intimately familiar with the consumer’s habits and needs. As part of the ICT, home care providers can help implement care plans and monitor and communicate how modifications to the plan may result – positively or adversely – in changes in consumers’ health. Because home care workers generally take care of consumers in their own homes, they are in the best position to make observations on conditions in the home that may affect the health of the consumer, such as issues with being able to stay in the home safely, observations related to medication adherence and prescriptions, access to care or medical supplies, changes in appetite and diet, or severe and sudden changes in the consumer’s health status. They can also help navigate the medical system, helping to ensure consumers get necessary appointments and equipment and ensuring the voice of the consumer is heard through the health care process. They are also able to observe first-hand over continuous spans of time, changes in mental status or moods, and report falls or other incidents that may occur in the home.

“Without integration, we will not receive the respect that we need to have to represent [the] consumers, from anyone else on the care team. [Integration] is so important. Once you understand how the system works, your integration into the system becomes a much smoother process to help the consumer. We are literally becoming the lynchpin in the whole medical process and making it easier for the doctors and nurses to do their jobs.”

–Percy Tolton, Jr., In-Home Supportive Services Provider

Home care workers can also respond to, and report back on, enquiries made by other care team members. This type of increased interaction and communication with the clinical care team helps build a dynamic of respect across all disciplines of caregivers responsible for providing care for a consumer. Breaking down barriers between professions and roles allows for increased respect for, and actual understanding of, the role a home care worker plays. This kind of team-based inclusion and cooperation can have a major impact in bringing about deeper health care system change. Clinical members of the ICT are highly educated and empowered in their roles as health providers. Often, a home care worker may initially be timid about raising his or her voice to share observations out of fear of being dismissed for a variety of reasons including educational level, level of English proficiency and perceptions of power directed toward the clinical staff. Once a home care worker is formally seated on an ICT and the clinical staff is oriented to and helped to understand the vital role of that provider, his or her contributions and the observations about the consumer can be heard in more meaningful manner.

When given the opportunity to bridge their quality in-home care provision with the health care delivery system, home care workers are able to be even more valuable and effective members of consumers’ care teams. Meaningful collaboration between the consumer, the home care worker, any additional unpaid family caregivers and the rest of the care team can have demonstrable effects on the health care system and – most importantly – provide the right care, at the right time, in the right setting.

Corinne Eldridge is Executive Director of the California Long-Term Care Education Center, a non-profit educational institution dedicated to providing educational opportunities as tools of empowerment for long-term care workers to build better lives, provide quality care, and meet and invest in the critical needs of the long-term care workforce. Serving as Project Director for CLTCEC’s most notable pilot project, Care Team Integration of the Home-Based Workforce, which was funded by an $11.8 million Health Care Innovation Award from the Centers for Medicaid and Medicare Innovation, she led the successful completion of the 3-year project to train over 6,000 home care workers and In-Home Supportive Services consumers pairs in a program taught in six languages across three California counties. Corinne continues to develop and execute training program partnerships with a spectrum of educational institutions, joint labor and management training and trust fund for nursing home workers, and long-term care stakeholders.