North Carolina
Personal and Home Care Aide
State Training Grant
(PHCAST)
Curriculum Overview and
Orientation to Phases I & II
Grantee: NC Department of Health and Human Services
PHCAST is funded by the US Department of Health and Human Services,
Health Resources and Services Administration (HRSA)
Welcome and Purpose
Barbara Boyce
PHCAST Management Team
Kathy Turner, RN, PHCAST Project Director, Division of Health Service Regulation
Jan Moxley, PHCAST Grant Administrator, Division of Aging and Adult Services
Donna White, RN, Elder Rights/In-Home Aide, Division of Aging and Adult Services
Susan Harmuth, Senior Program Manager, NC Foundation for Advanced Health Programs
Phyllis Daw, PHCAST Program Coordinator, NC Foundation for Advanced Health Programs
Kathie Smith, RN, Associate Vice President of State Relations, Home & Community-Based Care,
Association for Home and Hospice Care of NC
Cherie Rosemond, Research Scientist, UNC Center for Health Promotion & Disease Prevention
Tara Green-Royster, Program Manger, UNC Center for Health Promotion & Disease Prevention
Jennifer Craft Morgan, Assistant Professor, Gerontology Institute, Georgia State University
Margaret Roberton, Director, Continuing Ed-Training & Standards, NC Community College System
Barbara Boyce, Assoc. VP, Continuing Ed & Workforce Initiatives, NC Community College System
Community College
Pilot Sites
Community
College
Phase I Phase II
Asheville-Buncombe
Central Carolina
Phase
III
*
*
*
*
Central Piedmont
Coastal Carolina
*
*
*
Forsyth Technical
Mitchell
Phase
IV
*
*
*
*
Roanoke-Chowan
*
*
*
Sandhills
*
*
Southeastern
*
*
Stanley
*
*
*
Tri-County
*
*
*
Wake Technical
*
*
*
Includes both pilot years
*
*
Excludes Halifax CC & Cape Fear CC/Elder House
Overview of PHCAST
Susan Harmuth
Reasons PHCAST
Was Funded Nationally

Increasing demand for direct care workers

Personal Care Aides and Home Care Aides are
the fastest growing occupations

Plus, Nurse Aides are in the top 11 jobs in terms
of largest job growth

Trained, competent workers are essential to
quality care

Create a “Gold Standard” for minimum training
Key Concepts of NC PHCAST

Builds on prior Direct Care Worker Initiatives

Creates 4-phased framework for training and
competency to better prepare new and
incumbent workers

Training Venues:


Community Colleges
High Schools
Overview of NC’s 4-Phase Approach

Phase I – Introduction to Direct Care Work

Phase II – Direct Care Basics
(pre-Nurse Aide level)

Phase III – Nurse Aide I

Phase IV – Advanced NA training/competency




Home Care Nurse Aide
Geriatric Nurse Aide
Medication Aide
Option for in-service use across settings
Key Impacts





Better matching/redirecting of prospective
workers to job
Competency based – certificate or credential at
each phase
More consistent Pre-NA training
NA I training more realistic
Enhanced career paths, employability and
responds to employer need (4-phase approach
– specialties)
Key Impacts - Continued

New and incumbent workers can enter at
various points

Expands state recognized career path options;
supports workers; responds to employer need

Broad based support for model

Integration with other training & QI initiatives

Builds on prior direct care initiatives in NC
Key Impacts - Continued

More efficient use of NA I training programs

Employer recruitment of workers more focused

Reduces some barriers to training

High School students – job ready (NA I and
Phase IV)
Sustainability

Framework makes sense for NC

Phase I, II, linked to HRD programs

State recognized job categories

Responds to employer need (employer
participation)

Integration with other quality improvement
efforts

Potential to add new modules in future
Questions
Human Resource Development
and PHCAST
Margaret Roberton
Human Resource Development
Governance

SBCC Code – HRD Program Continuation
Each college shall operate a Human Resources Development
(HRD) program to provide assessment services, employability
training, and career development counseling to unemployed and
underemployed individuals. FTE shall be generated from HRD
programs. Each college shall provide HRD instruction and support
necessary for unemployed and dislocated workers to be served
within the college service areas.

Vision and Mission Statement
HRD is a dynamic and vital workforce development program with
proven economic, social, and educational success. The purpose
of the HRD program is to educate and train unemployed and
underemployed individuals for success in the workplace.
HRD Program Goals

Provide program outreach and student
recruitment activities to targeted populations

Assist students in accessing meaningful
training and/or employment opportunities

Enhance and develop the student’s
employability skills

Develop and promote the student’s ability to
move towards economic self-sufficiency
1D SBCCC 300.3
Program Classifications
Human Resources Development

Core Services



Skill assessment services
Employability skills training
Career development
counseling

Core Components

Assessment of an
individual’s assets and
limitations

Development of



Target Groups


Unemployed adults
Underemployed adults



a positive self-concept
employability skills
communication skills
problem-solving skills
Awareness of the impact
of Information Technology
in the workplace
HRD Fee Waiver Guidelines

Eligibility Requirements

HRD courses are not free… Fees are waived

Waiver is based on the individual’s income

Unemployed

Underemployed*

Notification of pending lay-off
HRD Eligibility

For HRD purposes, underemployed is defined
as individuals…

working and is eligible for the Federal Earned Income
Tax Credit (FEIT); or

working and earning wages at or below two hundred
percent (200%) of the federal poverty guidelines.
PHCAST Needs Aligned
to HRD Core Services

Assessment

Ability to appropriately identify individuals prepared
to enter healthcare fields



Introduce occupational requirements to maximize
success of students progressing into Nurse Aide I
Introduce workplace realities of personal/home care
environments vs. residential/institutional settings
Outline pathway alternatives for health care fields

Personal Home Care Aide

Recognized & standardized curriculum
PHCAST Needs Aligned
to HRD Core Services

Employability Skills

Concepts contextualized for
healthcare field


Communication, listening skills,
teamwork, and time/stress
management
Career Development


Ability to problem solve
independently
Decision-making and
management skills
Specific HRD PHCAST Courses

Phase I – Introduction to Direct Care Work
(Focus on job readiness skills, literacy, numeracy,
keyboarding, and realistic job previewing)

Career Exploration

Self-Assessment

General soft skill requirements

CPR (lay person)
Specific HRD PHCAST Courses

Phase II – Direct Care Basics
(Focus on non-nurse aide personal care tasks and soft
skill development; 3) expanded nurse aide (NA-1) skills)

Introduction to base skills

Introduction to functional concepts within role

Enhanced soft skills training

Career counseling
Questions
Importance of PHCAST
to Employers and
Personal Care Clients
Donna White
Importance of PHCAST to
Employers & Personal Care Clients

Growing need for Continuum of Care

Rising cost of care & shortage of trained workers

Greater efficiency in healthcare delivery
(lowering cost while improving delivery)

Promote quality care for increasing numbers of
older adults and persons with disabilities
Employer Quote

My PHCAST trained employees expressed joy
in going to the classes. They were excited
about what they were learning and they created
a tremendous bond with each other. We had a
special ceremony for them at our last meeting
and they were given pins. Based on what I have
heard from them, it was worth going through the
class. They enjoyed it. I believe PHCAST will
help with caregiver retention.
Vice President/ Home Care Agency
Statistics and Projections

In the next 20 years the number of persons 65
and older will almost double from 1.3 million to
2.3 million

North Carolina is 10th nationally in size of total
population, we are 9th in those 60 and older.

By 2025, 86 of the NC’s 100 counties are
projected to have more people over age 60
than age 17 and under
Statistics and Projections

In 2025, one in four North Carolinians will be 60
and older

Over the next two decades, the 75-84 age
group will be the fastest growing of those ages
65 and older

The number age 85 and older will grow fastest
beginning in 2030,when the oldest of our 2.4
million baby boomers near their 85 birthday
Statistics and Projections

NC currently has more than 17,000 older adults
with Alzheimer’s or other types of dementia
most of whom are being cared for at home or
by family and friends. By 2030, the total number
is projected to rise to nearly 300,000

For those age 75 and older, 13% live below the
federal poverty level and 30% live at or
between 100-199% of the FPL
Demographics

Status of North Carolinians 65 and older:






Living alone
29%
Veterans
22%
Have a disability
38%
Median household income
27%
Income below poverty level
10% ($10,778)
Income is between 100-199%
of the federal poverty level
25%
Employer Quote

I saw a client today whose caregiver went
through the program. After speaking with the
client and his guardian, I understood that they
are really impressed with the caregiver and the
improvement they have seen. She is being very
thorough, she is noticing different things in the
home, and she is alerting the office. I think
PHCAST is going to help aides improve the
relationships and the care they are providing.
The client was thrilled with the care.
RN Clinical Supervisor/Home Care Agency
NC Home Care Licensure

10A NCAC 13J allows for two levels of home
care aide, limited and extensive

There are multiple funding sources that fund
these two levels of care need
Limited Assistance

Limited Assistance: Care to a client who
requires hands-on care involving guided
maneuvering of limbs with eating, toileting,
bathing, dressing, personal hygiene, selfmonitoring of medications or other tasks
assigned that require weight bearing assistance
half the time or less during the activity
Extensive Assistance

Extensive Assistance: Client is totally
dependent or requires weight-bearing support
more than half the time while performing part of
an activity, such as guiding or maneuvering of
limbs, and meets one of the following criteria:



Requires extensive assistance in more than two
activities of daily living (ADLs) or
Needs an in-home aide to perform at least one task
at the nurse aide II level; or
Requires extensive assistance in more than one
ADL and has a medical or cognitive impairment that
requires total care more than 50% of the time
PHCAST Role

PHCAST Phase II prepares limited
assistance aides for the workforce
Employer Quote

As a supervisor, I have noticed that PHCAST
graduates are giving me more pertinent
information.
Nurse Supervisor/ Home Care Agency
Questions
Recruitment and Marketing
of PHCAST
Margaret Roberton
Recruitment / Marketing:
Getting Their Attention

Program Outreach

External Agencies

Internal Resources

Community
Recruitment / Marketing:
Getting Their Attention

Program Outreach

External Agencies







JobLink Career Centers
Division of Workforce Solutions (ESC)
Social Services
US Committee for Refugees and Immigrants
Shelters
National Guard/Family Employee Assistant Center
Community-based Organizations
Recruitment / Marketing:
Getting Their Attention

Program Outreach

Internal Resources

HRD classes





Introduction to Healthcare Occupations
HRD Strategies for Success
CE Healthcare classes
Back-to-Work intake sessions
Basic Skills Plus
Recruitment / Marketing:
Getting Their Attention

Program Outreach

Community





Flyers and brochures
College catalogues
College website
Social Media
Email



Past HRD students (Phase I and Phase II)
Current and Past NA I students (Phase IV)
Local home care facilities
Recruitment / Marketing:
Challenges

Communication of value

Home care agencies



Benefit of contextualized training
Benefit of advanced standardized training (Phase IV)
Participants



Benefit of credential for hiring
Benefit of commitment to entire pathway
Program schedule/mix
Questions
Curriculum Availability
PHCAST Phases I and II
Kathie Smith
PHCAST Phases I and II

Phase I – Includes job readiness skills, literacy,
numeracy, keyboarding, realistic job previewing

Phase II – Includes personal care tasks and
soft skill development for non-nurse aide level

An aide not listed on the NC Nurse Aide Registry as
a Nurse Aide I (CNA) but may provide personal care
to client’s with limited assistance needs in Home
Care and in other settings where a Nurse Aide I is
not required
PHCAST Phases I and II

NC PHCAST addresses the following objectives:

Help prospective workers have an understanding of
educational and training requirements for each long
term care sector pathway

Provide a uniform pre-nurse aide training program
through community colleges that covers essential softskills, basic home management and personal care
skills (non-nurse aide level providing limited assistance
to clients)
Phase I and II Curriculum

Curriculum must be followed as written but
instructors may develop creative ways to
disseminate the information, adding as needed,
activities that are learner-centered focused

Student attendance requirements are up to the
individual college; this includes how classroom
information is mastered, with flexibility for
making up absences as allowed by the college
Phase I and II Curriculum

At its core, adult learner-centered training
assumes learning is active, not passive.


Trainers using a learner-centered approach rely
heavily on role plays, case scenarios, small group
work, and other forms of interactive learning
The curriculum includes instructor guides and
interactive lesson plans
Phase II- Skills

The skills portion of Phase II curriculum (module
10) must be taught by a Registered Nurse (RN)

The RN also observes the correct demonstration
of the skills by the student
Phase I and II- Slide Presentation

Where the curriculum calls for a pre-written flip
chart, a PowerPoint presentation can be
developed and used in its place
Phase I and II – Role plays

Not every student will be comfortable with
performing role plays

Let students know that role play is a learning
tool and it may be helpful to practice before
they are actually faced with the scenario

The de-brief and discussion that occurs after
the role play is just as valuable to the learning
as the role play itself - be sure to leave enough
time to de-brief
Phase I and II – Duplication

There is some duplication of subject matter in
both phases to ensure that regardless of which
Phase the student enters, pertinent information
about Direct Care Work is covered

Activities and information vary between the two
phases to avoid exact duplication for students
who attend Phase I and Phase II training

Instructor should adjust accordingly if the same
students attend Phase II that attended Phase I
Phase I and II Guest Speakers

Guest speakers for both phases:


Invite local guest speakers as appropriate for the
material being taught.
Examples




Workers in the industry of personal care
Law enforcement to talk about gangs and drugs
Fire department to demonstrate fire safety
Alzheimer’s disease and dementia specialists
Phase I and II Resources

Instructor should review and update, as
needed, handouts, slides, and other information
contained in the PHCAST modules related to
statistics and standards of practice to ensure
information is current and accurate
Phase I and II Facilitator Guide

A Phase I and II facilitator (instructor) tutorial is
included with the PHCAST curriculum materials
Questions
Competency Skills Check List
Donna White
Use of Competency Skills
Check List

North Carolina Home Care Licensure 10 A
NCAC 13J .1110 Supervision and Competency
of In-Home Aides…

Each licensed home care agency shall document that
its in-home aides are competent to perform client care
tasks or activities to which they are assigned

Such individuals shall perform delegated activities
under the supervision of person authorized by state
law to provide such supervision
Licensure Rule Continued

In-home aides who are not subject to occupational
licensing laws, shall only be assigned client care
activities for which they have demonstrated
competency, the documentation of which is
maintained by the agency

Meeting competency includes a correct
demonstration of tasks to an appropriate
professional. Each agency shall document that its inhome aides demonstrate competence for all
assigned client care tasks or activities
PHASE II Direct Care Basics
Skills Check Lists

Module 9 “Home Management Skills” and
Module 10 “Personal Care Skills” includes
competency skills check list

Each skill check list includes the required
number of steps in order to meet competency in
that skill
PHASE II Direct Care Basics
Skills Check Lists

The steps for each skill are numbered

Each step has to be dated based on learner’s
date of demonstrated competency

Dated signature is required by the competency
evaluator and the In-Home Aide
Module 9 Check List

Home Management Skills Competency Check
List includes:

Housekeeping for clients

Nutrition and meal preparation

Food storage and safe food handling

Budgeting and spending
Module 10 Check List

Personal Care Skills Competency Check List
includes assisting:

client with a tub bath/shower

client to wash hair

with hair and scalp care

client with mouth care

with normal skin care

a man to shave
Module 10 Check List-Continued
Assisting:

client to care for hands & fingernails

with care of toenails for clients without
Diabetes/Peripheral Vascular Disease

the client to dress

with elastic stockings

the client to move up in the bed
Module 10 Check List-Continued
Assisting:

client from bed to chair using limited assistance

client to walk

client with toileting

with applying and removing eyeglasses, contact
lenses, hearing aids and artificial body parts.
(Optional demonstration)
Module 9 Check List Example
Module 10 Check List Example
Questions
Pilot Experiences-Panel Discussion

Crystal McIver & Joy McPhail
Central Carolina Community College

Alan Duncan
Sandhills Community College

Lynn Kavcsak
Wake Technical Community College
Wrap-Up
Margaret Roberton