Quality Improvement for Long-term Services and Supports

The Opportunity

Many people with complex health needs, such as intellectual, developmental, and/ or physical disabilities, require long-term services and supports (LTSS). While the majority of LTSS are provided by unpaid caregivers, direct support professionals (DSPs) provide a range of important services such as bathing, shopping, homemaking, running errands, and light housekeeping. Due to an aging population and an increasing number of individuals with intellectual, developmental, and/or physical disabilities living longer and receiving in-home care, there is a growing need for DSPs. However, the DSP role can often be isolating and emotionally taxing, with high turnover rates and unfilled positions due to a lack of available and qualified candidates. Research conducted in 2019 by non-profit PHI National found that nearly 2.3 million home care workers earn a median hourly wage of $11.52 and about $16,200 annually.¹ In addition, despite the importance of DSP services to patient health and well-being, training requirements vary by state and are often are limited.² To help increase quality of care and quality of life for those receiving long-term services and supports through Tennessee’s LTSS programs — CHOICES and Employment and Community First (ECF) CHOICES — the Division of TennCare supported the development of The QuILTSS (Quality Improvement for Long Term Services and Supports) Institute. QuILTSS is an independent nonprofit whose mission is to build a more competent DSP workforce

The Innovation

UnitedHealthcare partnered with The QuILTSS Institute to support a new comprehensive approach to improving patient experience and the health of the LTSS population. A core component of the approach is the development and implementation of a competency-based training program. UnitedHealthcare, in partnership with enterprise partner Optum Bank®, supported this initiative by providing a $500,000 line of credit for development and start up costs. 1in4 Americans will be aged 65 and older in 2060 Home care will add more than1M jobs between 2016 and 2026 Turnover in this sector generally ranges from 40-60% ¹ UnitedHealthcare Community & State – Professional Care-Giving in the United States ² PHI National – U.S. Home Care Workers Key Facts 2019 Visit UHCCommunityandState.com to learn more. Working to build healthier communities. The program is designed by national subject matter experts and offers a micro-credentialing system so students can advance by demonstrating proficiency in skills such as communication, cultural competency, and patient-centered practices. Two unique features of the QuILTSS program are that it will be offered through local colleges and provide credit toward associates or bachelor degrees in fields such as nursing, health care administration, or other related disciplines; and that the program requires DSPs to demonstrate the expected knowledge, skills and abilities, and intellectual behaviors before earning their credential. QuILTSS will maintain a registry of individuals who have partially and fully completed the program, which will reduce the need for retraining across sites.

The Outcomes 

The QuILTSS training program is in the final stages of development. The program is currently available through a partnership with 50 nursing facilities and will be available through QuILTSS directly in early spring 2020. The program will be available for individuals wishing to pursue the college credit pathway by fall 2020. More than 12,000 individuals have participated in the QuILTSS Orientation video to date. QuILTSS and UnitedHealthcare are aligned on the importance of improving quality and satisfaction for individuals receiving LTSS care, and also improving job satisfaction, wages, and retention for DSPs. QuILTSS aims to credential more than 25,000 DSPs by 2021. For more information, visit UnitedHealthcare at uhc.com or visit quiltss.org

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