The Evolution of Continuing Care Assistance

The evolution of Continuing Care Assistants began in the late 1970’s when an education program was developed for the Personal Care Worker. With the introduction of Home Care Nova Scotia in the 1990’s, a similar program was developed for Home Support Workers. Private courses also developed independently to serve this emerging frontline healthcare worker. While there were similarities within the various curricula, students graduated with differing titles and skill sets making it difficult for employers to know the competencies associated with each course. Graduates found themselves restricted to working in one sector, or asked to complete a second course to secure employment in a different field of continuing care. As Nova Scotia moved toward integration of health care services, it became obvious a standard was necessary. In the absence of a governing body, Nova Scotia Department of Health (DOH) oversaw the development of a standardized CCA educational program and certification process. Under DoH direction, continuing care providers and Nova Scotia Community College collaborated to developed one curriculum to meet the needs of continuing care. By September 2000, the new standardized Continuing Care Assistants program was introduced, officially replacing all other similar programs as the recognized educational program for frontline healthcare workers in Nova Scotia, whether they work in home care or nursing homes. This program combined all material and skills taught in the Personal Care Workers, Home Support workers, and Home Health Aid courses plus additional components. This standardized provincial CCA program offers graduates more employment options, and clients the assurance that qualified individuals are assisting them.

The CCA program includes an outcomes based curriculum and is comprised of 436 hours of theory and lab time, and 3 field placements totaling 100 hours in home care and 230 hours in nursing homes, for a total of 766 hours minimum. Graduates must additionally obtain certification in the NS Alzheimer Disease and Other Dementias Care Course, Food Handlers course, First Aid and CPR, Workplace Hazardous Material Information System (WHMIS), Introduction to Occupational Health and Safety Act and the CCNS Palliative Care Frontline Education to be eligible for CCA certification. All components must be successful completed within 2 years through an approved educational provider and each student must achieve a mark of 75% in a provincial examination set by the CCAPAC, to become certified.

The CCA Program Advisory Committee (CCA PAC) was established by DoH to assist with activities of this developing program and to coordinate daily operations. The CCA PAC consists of key stakeholders, including representatives from Nursing Homes, Home Care, Acute Care, Educators, and CCAs. Through a “Request for Proposal” process, Nova Scotia Association of Health Organizations (NSAHO) was contracted by DoH to provide the business function to maintain and operate the CCA PAC.

The CCA PAC sets standards for the CCA program including 1) curriculum standards, criteria for admission to CCA programs and qualifications for educators; 2) approving educators for CCA program delivery; 3) certifying graduates of the CCA educational program; 4) ensuring that CCA educational programs comply with established curriculum standards; and 5) ongoing evaluation and revision of CCA curriculum.

In April of 2006, with the standardized provincial CCA program well established, DoH made provincial CCA certification the educational requirement for “Entry to Practice” for all new employees of nursing homes, homes for the aged and home support agencies. In response to industry’s concern regarding the availability of certified CCAs, a phased in approach was developed, allowed for the hiring of non-certified staff provided they had four basic modules to enable safe practice and a commitment the new hire would achieve CCA certification within 2 years for hire. Also included was an option to hire nursing/medical students provided they had training equivalent to the four basic modules.

The CCA program availability is critical. Many prospective CCAs are older, with family commitments and find the full-time classes difficult. Others cannot afford the required 6 to 9 months without income. To accommodate interested candidates while maintaining the standard, the CCA PAC developed a number of course delivery options. The CCA program can be delivered across the province, by participating Nova Scotia Community College, private career colleges, licensed nursing homes/ homes for the aged, home support agencies, and NS work activity programs. It can be offered as a core or customized program, full-time, part-time or through self-directed learning. Equivalency modules are available for previously certified PCWs and HSWs who chose to become CCA certified. There is also a blended delivery option that can include on-line lessons, self-directed learning modules and some classroom attendance.

Prior Learning Assessment and Recognition (PLAR) is another initiative of CCA PAC supported by NS DoH, to obtain CCA certification. The CCA PLAR process evaluates an individual’s past experiences and education (formal and on-the-job) and gives credit toward CCA certification. PLAR Assessors, trained by CCA PAC, assist interested individuals identify past experiences and education equal to the CCA program. Together they identify the best methods of demonstrating this knowledge and the students work on their own to prove that knowledge as well as identifying knowledge gaps and the best options to fill them.

Course Recognition was identified as another need as the PLAR process was being refined. While the PLAR process works, it is quite time consuming and labour intensive, and therefore somewhat frustrating for those who have completed a similar program in another province and are seeking employment in Nova Scotia. To meet this need CCA PAC, supported by NS Department of Health, is currently assessing similar courses across Canada, comparing the various curricula to the CCA curriculum. It is anticipated that by fall 2008, a minimum of 15 courses will be evaluated and graduates will receive automatic course recognition for the components equivalent to the NS CCA program and will therefore not have to undergo the complete PLAR process.

Recruitment of CCAs is an increasing concern throughout health care in Nova Scotia. By 2010, Nova Scotia will have an additional 1848 new and replacement longterm care beds, all requiring significant numbers of CCAs. The Home Care program is also expanding, requiring additional CCAs. The district health authorities are now hiring CCA for hospitals, particularly in restorative and alternate level of care units, creating additional demand for certified CCAs. This is occurring at a time when the province’s changing demographics is decreasing the availability of both certified and prospective CCAs. Consequently, recruitment of CCAs is a priority with NS Department of Health.

CCA recruitment initiatives are underway. A provincial CCA human resource strategy is being developed, including both long and short-term initiatives. Integrated with the provincial Health Human Resource strategy, this strategy includes the development of a human resource forecasting model for CCAs. To facilitate forecasting a database to track CCAs was developed by CCA PAC, and a supply and demand study was contracted out to the Health Care Human Resource Sector Council to get a documented picture of the current situation as of 2008.

A second and farther reaching CCA advertising campaign was launched in the spring of this year, building on last year’s provincial campaign that include newspapers, TV, and transit advertisements, adding web-sites and “street team” visits to high schools. The continuing care sector is encouraged to be actively involved, participating on several CCA human resource strategy working groups. District level committees were initiated by the CCA PAC to coordinate the recruitment and education of CCAs in each of the nine provincial health districts, so resources could be pooled for efficiencies.

CCA bursaries are a significant recruitment initiative, now being offered for the 4th year to assist prospective CCA students. This year the Department of Health is providing $4,000,000 to be offered as “return-for-service” bursaries by nursing homes and home support agencies to new recruits into the CCA program. Each recruit is eligible for up to 70% of tuition costs to a maximum of $4000 and in return must agree to work for their sponsoring agency for 1 year following graduation. To date this initiative has had a 95% success rate, and encouraging employers to pursue additional student recruits.

The Scope of Practice for CCAs has been in question as their options for employment has been expanding. After considerable cross-jurisdictional research, no consistency in the scope of practice for this role was apparent. The Department of Health supported the CCA PAC in the development of a CCA scope of practice and the scope of practice document is now ready for final approval.

The development of the CCA program in Nova Scotia is still unfolding. We are proud of the professionalism that has been introduced to this role through the standardization of the CCA program and its delivery. Today, the CCAs’ role and value in health care is growing. Our challenge now is to ensure this career option is, and will remain, an attractive choice, one that provides a work-life balance for the individual and safe and professional care to the Nova Scotians requiring continuing care.