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How We’re Helping Massachusetts Home Care Aides Manage our Seniors’ Mental and Behaviora

By Hayley Gleason, MSW, MS Assistant Director, Home Care Aide Council

Your 88-year-old mother has been getting help in her apartment from a home care aide. At first, it went OK, but now Mom’s very agitated. The first aide quit after mom screamed at her repeatedly. Now Mom insists that the next-door neighbor is looking through the walls into her bedroom at night. The second home care aide is threatening to leave, and you fear her agency won’t be able to find a replacement.

Sound familiar?

A dramatic increase in homebound seniors with dementia, depression and other mental and behavioral health conditions is straining the capacity of professional home care workers and putting their caregiving families at wit’s end.

As a gerontologist, educator, former assisted living facility manager and staff member of Massachusetts leading home care industry association, I know that home care clients with mental or behavioral health issues are very challenging to work with. Because of their difficult behaviors, these clients will often go through multiple aides. The home care agency may end up saying to the case manager we can no longer care for this client. When difficult-to-manage clients bounce from one agency to the next, home care workers experience burnout, the agency loses its client, families have no one to turn to and our industry suffers.

The federal government requires home health aides (HHAs) to have 75 hours of initial training and 12 hours of in-service training per year. But there are no exact requirements for training on mental health diagnoses.

Here in Massachusetts, our home health aides have the opportunity to receive 12 hours of additional training to become an advanced aide, called a Supportive Home Care Aide (SHCA), in one of the two areas: Alzheimer’s disease and/or mental health. But while the Alzheimer’s Association has updated their training curriculum, our mental health training protocols are woefully out of date. The training curriculum for Massachusetts Mental Health Supportive Home Care Aides (SHCAs) has not been updated in 20 years.

The board and executive team at the Home Care Aide Council of Massachusetts decided it was time to act. In 2014, we began a pilot study to help us re-design and update the mental and behavioral health training program for home health workers. The goal? To arm the state’s supportive home care aides with updated knowledge and tools to help them effectively deal with their clients’ mental health challenges.

The Council felt it was critical to provide a new mental health training to our member agencies and their home care aides. To work with low-income clients served by the Massachusetts Executive Office of Elder Affairs, home care agencies are required by the state to provide initial and ongoing training for their aides. However, home care agencies aren’t paid for the time they invest in training their workers, and most are too focused on the day-to-day challenges of serving clients to develop the curriculum themselves. Therefore, a big part of the Council’s role is to provide the best and most current resources and education.

Before updating the mental health training curriculum, we wanted to understand the needs of home health aides who work with these clients. We received a planning grant from the Commonwealth Corporation’s Healthcare Workforce Transformation Fund to figure out what should go into the new training. What should it include? What new information should be taught? Refined? Discarded?

In 2014, we conducted focus groups and interviews with home care aides, home care supervisors and managers, and other key stakeholders to determine what’s happening (and not happening) in the field. Then we received a second round of funding to develop a series of evidence-based training programs that include follow up and assessment of our results.

We developed a pilot curriculum and conducted first-phase training in May (2015) with 49 supportive home care aides at five home care agencies. This fall, we’re in the second phase of training with a goal of reaching over 80 home care aides at eight agencies.

Two-day pilot training for 10 home health aides at Best of Care

Photo: Home Care Aide Council Assistant Director Hayley Gleason, MSW, MS, recently presented a two-day pilot training for 10 home health aides at Best of Care Inc.’s Quincy, Mass. Office. Upon completion, each aide received a certificate to work as a Mental Health – Supportive Home Care Aide. In addition to the mental health training, the Council also offers home care agencies an ADRD (Alzheimer’s and Dementia Related Diseases) training track.

We’ve received great feedback from the home care aides in our pilot program. Between pre- and post-test surveys of the aides who attended our training, comprehension improved nearly 25% and participants rated the trainings on a 4.35-out-of-5 points scale.

After training a group of home care aides with a particularly difficult resident of a senior housing complex, the aides told us they were able to make huge strides in working with that client. The workers’ case manager was so excited about the positive impact of their training, she asked to attend our supervisors training session!

In early 2016, we will distribute the curriculum and conduct a regional train-the-trainer program, which will be available to member home care agencies across the state. Thanks to the grant we received from the Healthcare Workforce Transformation Fund, the curriculum and train-the-trainer sessions will be free to our Council’s member agencies, which can use it for existing and new staff.

Massachusetts Office of Elder Affairs and the state’s 27 Aging Services Access Points (ASAPs) have actively supported us from the beginning; they’ve been great partners along the way. In every pilot training session we’ve connected with that regions ASAP. We want them to know they will soon have access to home care workers who are specially trained to deal with their clients mental health issues.

In developing this critical training program, the Home Care Aide Council is giving our state’s home care professionals much-needed tools to manage really tough cases. We’re also shining a light on the important work our home health aides do, day in and day out, to keep our seniors safe and healthy in their homes.


Hayley Gleason, MSW, MS is Assistant Director of the Home Care Aide Council, managing grants, training program development and research/evaluation. A doctoral student of gerontology at UMass Boston with a strong knowledge of long-term care issues, Gleason formerly managed an assisted living facility. Working for the Home Care Aide Council allows her to apply her academic expertise, business background and her concern for our aging population to support people working on the front lines of home care.

Note: This post draws from Mental and behavioral health conditions among older adults: implications for the home care workforce, a May 2015 paper written by Hayley Gleason and Caitlin Coyle for the Journal Aging and Mental Health


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