HHA Training Site Application

HHA Training Site Application

Below are the requirements to be a training center for the HHA Track of the Pennsylvania Homecare Associations' Training and Mentorship program funded through the Department of Labor and Industry's Job Quality Grant. HHA training programs should follow requirements found in Section 484.80 Conditions of Participation Home Health Aide Services Code of Federal Regulations.

Training Content
Are your training classes overseen or taught by a registered nurse who possesses a minimum of 2 years nursing experience, at least 1 year of which must be in home health care?*

YesNo

Please confirm that your organization's training program addresses each of these required training areas:

	Our training includes this
Communication skills, including the ability to read, write, and verbally report clinical information to patients, representatives, and caregivers, as well as to other HHA staff.
Observation, reporting, and documentation of patient status and the care or service furnished.
Reading and recording temperature, pulse, and respiration.
Basic infection prevention and control procedures.
Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor.
Maintenance of a clean, safe, and healthy environment.
Recognizing emergencies and the knowledge of instituting emergency procedures and their application.
The physical, emotional, and developmental needs of and ways to work with the populations served by the HHA, including the need for respect for the patient, his or her privacy, and his or her property.
Appropriate and safe techniques in performing personal hygiene and grooming tasks that include: 1. Bed bath 2.) Sponge, tub, and shower bath 3. Hair shampooing in sink, tub, and bed 4. Nail and skin care 5. Oral hygiene 6. Toileting and elimination
Safe transfer techniques and ambulation
Normal range of motion and positioning
Adequate nutrition and fluid intake
Recognizing and reporting changes in skin condition;
Any other task that the HHA may choose to have an aide perform as permitted under state law.
The HHA is responsible for training home health aides, as needed, for skills not covered in the basic checklist, as described in paragraph (b)(3)(ix) of this section.

Do you offer CPR and First Aid Certification. (Preferred, but not required)*

	Yes, we offer	No, we do not offer
CPR Certification
First Aid Certification

Please confirm that your training program will conclude with a written exam verifying satisfactory competency in each training area.*

Agree.Our training course cannot support this

Training Facility
Our agency agrees to host trainings face to face in a classroom setting with class sizes a minimum of 1, but no more than 20 per class*

AgreeOur training course cannot support this
Our classroom size is 500 square feet in size or greater.*

Greater than 500 square feetLess then 500 square feet

Our agency agrees to maintain the following DME items for hands-on classroom training

	We currently have this DME equipment and confirm it's in working order	We agree to purchase in advance of initiating this program
Wheelchair
Hoyer Lift
Gait belt
Oxygen tank and/or compressor
Walker
Nebulizer
Hospital bed w/mattress
Mankin
Commode chair

Please upload image(s) of your training facility*

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Post Course Completion Job Placement & Success Tracking
We agree to issue a certificate upon course completion with full name of organization deeming certification, indication of successful home health aide certification, name of trainee, Date completed, Signature of Registered Nurse who performed or oversaw the training program*

We agreeWe cannot support this
Please confirm that your agency can offer employment and/or job placement with a home health, home care or hospice organization? (required for training site approval)*

YesNo
Please confirm that your agency will track HHA's who completed the training program for 30 days following placement with a position at a home based care organization OR following completion of this training coursework with existing employment. The following metrics are required: Number of job interviews, # of HHAs hired/placed, # of HHAs that worked their first shift, # of HHAs that completed the required training, # of training hours completed, # of terminations, # of call offs & no call/no shows.*

Yes we agree to provide details metrics to PHAWe cannot support this
Provide the full name(s), title, phone number & email address of the person(s) responsible for providing the metrics to PHA. *

Agency Attestation
We would be interested in joining the Pennsylvania Homecare Association's Grant Taskforce overseeing this project. (Not required)*

Yes, we are interestedNo, we're not interested
Please review the Federal Regulations for Home Health Aides.

Below you will be asked to attest that your agency has not experienced the the below statements:
1. Was out of compliance with the requirements of paragraphs (b), (c), (d), or (e) of this section; or
2. Permitted an individual who does not meet the definition of a “qualified home health aide” as specified in paragraph (a) of this section to furnish home health aide services (with the exception of licensed health professionals and volunteers); or
3. Was subjected to an extended (or partially extended) survey as a result of having been found to have furnished substandard care (or for other reasons as determined by CMS or the state); or
4. Was assessed a civil monetary penalty of $5,000 or more as an intermediate sanction; or
5. Was found to have compliance deficiencies that endangered the health and safety of the HHA's patients, and had temporary management appointed to oversee the management of the HHA; or
6. Had all or part of its Medicare payments suspended; or
7. Was found under any federal or state law to have:
  1. Had its participation in the Medicare program terminated; or
  2. Been assessed a penalty of $5,000 or more for deficiencies in federal or state standards for HHAs; or
  3. Been subjected to a suspension of Medicare payments to which it otherwise would have been entitled; or
  4. Operated under temporary management that was appointed to oversee the operation of the HHA and to ensure the health and safety of the HHA's patients; or
  5. Been closed, or had its patients transferred by the state; or
  6. Been excluded from participating in federal health care programs or debarred from participating in any government program.
Attestation*

My agency has NOT experiences any of the above defined deficiencies/sanctions in the past two (2) yearsMy agency has experienced issues defined above within the last two (2) years
Training Site Application Submission:*

I attest that the above Training Site Application responses are true and accurate. We agree to adhere to these requirements for all candidates utilizing our training coursework for the purpose of the Pennsylvania Homecare Association's Training and Mentorship Program funded by the Department of Labor and Industry Job Quality Grant.

Form W-9
Please complete the IRS W-9 Form and upload the completed form below. This will allow us to reimburse you for Trainer Fees.
Please upload your completed IRS W-9 Form*

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Agreement
Signature

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