Those of us in the home care arena know that the HHA is one of the backbones of our service provision (for purposes of this article, HHAs will be called aides hereafter). Unfortunately, the pivotal contribution this member of the home care team makes is often unrecognized by reimbursement entities and, at times, the healthcare arena as a whole. Subsequently, aides are an often underrecognized and underappreciated workforce when truly they are a crucial component of the spectrum of care that allows older adults to age in place.
There has been a continuing shift to community-based services and, where possible, avoiding unnecessary institutionalization. This shift in conjunction with the aging population has only increased the demand for competent and qualified aides. The number of people needing personal assistance and home health services is expected to more than double from 13 million in 2000 to 27 million in 2050 (Kaye et al., 2006, p. 1113). To attempt to meet this need, recruitment and retention of these workers will need to improve.
In New York City, it is estimated that one of seven low-income workers is a home or community-care worker, which includes aides. These jobs lack affordable benefits, training, regular schedules, supervision, and career paths to higher-paying work. In addition, the industry suffers from a 40% to 50% annual turnover rate (Seavey et al., 2006).
HAPI is a home care aide agency that has developed a Peer Mentor Aide program in order to provide a career path to higher paying work for aides. The organization wanted to develop its work force for the identified growing care need, and also positively impact on retention for experienced aides. The concept was developed by the Paraprofessional Healthcare Institute (2006), and then modified and applied to this organization.
What Is a Peer Mentor Aide?
A peer mentor aide is an individual who has expertise that can help another individual (mentee). According to the Centering on Mentoring, "mentors guide, train, advise and promote the career development of the mentee" (Centering on Mentoring, 2006, p. 5). Some research has found that people who are mentored are more satisfied and committed to their professions, than nonmentored individuals (Wanberg et al., 2003, as cited in Centering on Mentoring).
At this organization, mentors are reliable, clinically competent, and qualified aides who have been with the organization for more than 1 year. Peer Mentor Aides are identified by their Client Service Manager/Service Coordinator or Field Nurses. Nominees are then interviewed by the Associate Director of Training and Certification, Registered Nurse (RN), and/or Nursing Secretary. The interview process comprises situational and behavior-based questions to assess interpersonal skills. An example of an interview question is: Your aide mentee calls you because her client with diabetes is eating candy. Your client gets angry when you mention that it is not part of his care plan. How do you respond to her?
All newly hired aides since 2008 and aides who need special assistance are mentees. Aides who may have received disciplinary action, or their Client Service Manager/Service Coordinator identifies as needing extra help, are also provided mentors.
Peer Mentor Training
The peer mentor training program started with an extensive literature review as well as conversations with the Paraprofessional Healthcare Institute. A work group was formed comprising members of the aide-training program, Client Service Managers who work with the aides on a regular basis, some experienced "Senior Aides," Nurses, Social Workers, and administrative personnel.
The organization wanted to establish this mentoring program to provide a pay increase to more experienced aides in efforts of improving retention for both new and more experienced aides, and to develop a cohort of aides that might be able to service more challenging cases. The work group identified key areas that made cases more challenging to service and required a higher level of expertise, which then led to the development of the Peer Mentor Aide curriculum.
The Peer Mentor Aide curriculum includes classes on the following topics:
- Peer Mentoring and Communications
- Cultural Diversity
- Servicing the Private Pay Population
- Psychiatric and Mental Health Disorders
- Palliative Care
The length of the program was designed as two 7-hour learning days with 10 participants per class (Table 1). Lunch was provided to all participants. Classes are taught by staff members with expertise in the topics listed above. In addition to the didactic sessions, case scenarios and role-playing were also incorporated, which was thought to enhance the training experience.
Program evaluation consisted of successful completion of each posttest, aide satisfaction evaluation, and an annual competency test (Table 2), including questions from each class topic. If an aide successfully completes the training, he or she receives certificates that qualify him or her as a "Peer Mentor Aide" (Table 3).
Once the initial training is complete, Peer Mentor Aides are paired up with "Aide Mentees." Mentors have contact with the newly hired aide mentees for 1 year, and special assistance mentees for 3 months. Mentors are required to make contact with their mentee on the following schedule: first week, second week, and then monthly thereafter. Mentees may initiate calls whenever they would like and as they feel necessary. Currently, the Mentor:Mentee ratio is about 1:4; however, we hope to restrict this to no more than a 1:10 ratio.
The aide mentors are also required to maintain a written journal about their conversations with mentees, which are reviewed by the Associate Director of Training and Certification, RN. These journals allow the organization to understand the type of relationship the mentor and mentee are growing, as well as to be aware of any unusual circumstances. The majority of conversations focus on the challenges that new aides confront on a day-to-day basis and strategy sharing that the more experienced aides can provide. These conversations may include discussions on policies and procedures, human resource–related questions about the union or vacation time, or hours worked. If information is shared regarding a serious issue, such as a client fall or an aide mentee wanting to quit, mentors are instructed to call the office immediately to consult with their Client Service Manager.
The Associate Director of Training and Certification, RN, and Nursing Secretary are responsible for ensuring the success of the program. Among other responsibilities, they follow up on recruitment, interviewing, scheduling classes, coordinating mentor--mentee relationships, ensuring receipt of documentation, and reviewing and following up with any mentor--mentee needs. As of February 2010, the organization had 97 mentor aides and 330 mentee aides.
In New York City, there is a significant population of Spanish-speaking aides. To meet this need, a Peer Mentor Aide training was conducted in Spanish that would allow Spanish-speaking aides to be mentored by a Spanish-speaking Peer Mentor Aide. Spanish-speaking aides, like the other aides, have the benefit of having a mentor who truly understands them and subsequently they can call for support and clarification.
Being a Mentor Has Its Benefits
Mentors receive a promotion, an hourly wage increase, and a monthly cell phone stipend. Peer Mentor Aides must initiate regular outreach to their mentees as described above. They also provide their mentees with their cell phone number and a block of time during which they are accessible.
An external grant provided for a part-time coordinator and staff time to develop the curriculum and handout materials. It also pays for the Peer Mentor Aides during their training time, annual competency time, and the time needed to meet their mentees face to face for the first time. The hourly wage increase and the costs of monthly cell phone stipend are part of the operating budget of the organization, which views these dollars as well-spent recruitment and retention dollars.
Impact of Peer Mentor HHAs
According to a U.S. Department of Health and Human Services (2007) report, aide hours worked is one of the most significant predictors of job retention—the more hours worked, the more likely one is to remain at the job. In comparison to all other aides at the organization who work an average of 28 hour/week, the Peer Mentor Aides work an average of 40 hour/week. The Peer Mentor Aide is now becoming recognized as a well-trained and experienced aide, and some Nurses are specifically asking that a Peer Mentor Aide be assigned to their more challenging clients.
The Peer Mentor Aide program began in May 2007 with the projected goal of promoting 40 aides each year, for 3 years. The retention rate among Peer Mentor Aides is currently 87%. The organization's aide retention rate in 2008 and 2009 was 49% and 57%, respectively.
In November 2008, Judy graduated from the organization's Aide Training Program, but still had concerns that she would not be able to fulfill the responsibilities of being an aide. She immediately expressed her concerns to her Peer Mentor Kettly. Kettly quickly put Judy's mind at ease, letting her know that any time she had questions or problems she could call her. The two are frequently in touch. Judy stated that she would have not been able to handle her job without this support. Almost a year later, Judy is a strong aide and is still working with the organization.
Our Peer Mentor Aides are recognized as an elite group of aides. They have received a promotion within the home care aide agency. Often times, sadly, the next career advancement opportunity for an aide might be in a different organization. The Peer Mentor Aides are afforded the opportunity for a career ladder and pay increase within the same organization, which also improves recruitment and retention.
Special thanks to Rachel Nathaniel, BSN, RN, and Dana Calvey, BFA who oversee and ensure the success of the Jewish Home Lifecare, Home Assistance Personnel Inc. Peer Mentor Aide program.