How to measure age-specific competencies
Written standards aid in appropriate measurement
By Patrice Spath, ART
Brown-Spath & Associates
Forest Grove, OR
Age-specific competencies are abilities and skills a clinician must have to provide appropriate care for patients in a given age group. Age-specific competencies fall into three categories:
• cognitive abilities, such as the ability to make a correct decision about the skin care needs of a geriatric patient;
• technical skills, such the appropriate techniques for drawing blood for patients of different age groups;
• interpersonal skills, such as the ability to interpret nonverbal communication from children or to recognize the need to afford the adolescent with as much independence as possible.
According to Joint Commission standards, age-specific competencies should be defined for all caregivers who assess, treat, or provide care to patients of different ages. This includes case managers and social workers as well as other clinical staff. Case managers must have knowledge of the principles of growth and development over the life span, assess clinical data relative to the patient’s age, interpret the information needed to identify patient requirements relative their age-specific needs, and provide patient care for different age groups. Listed below are examples of various case manager skills and abilities that are age-specific. These are merely examples and would not apply to all case managers. The population of patients served by the case manager and the scope of the case manager’s duties would determine the skills and abilities he or she needs to possess.
Cognitive Abilities
• Assesses skin considerations in the elderly.
• Assesses for changes in cognitive abilities in elderly patients.
• Assesses for difficulties with hearing or vision impairment with the elderly.
• Recognizes an elderly patient’s fears by repeating information often.
• Assesses resources for discharge (elderly).
Interpersonal Skills
• Uses firm direct approach with toddler.
• Uses play as a means of communication with toddlers.
• Uses visual aids when teaching a child (age 6-12).
• Empathizes with geriatric patient about losses.
• Addresses elderly patient using last name.
To meet the Joint Commission’s standards, case managers must first identify the age-specific patient populations they serve. In a general hospital this usually includes infants, children, adolescents, and the elderly. The case management department may choose to stratify their age groupings more narrowly, i.e., differentiating between premature and full-term newborns. If the case managers do not provide services for a particular patient group served by the organization, it is not necessary to develop competencies for that patient group.
Next, educate case managers about the human growth and development stages relevant to each population they serve. The education should demonstrate how case managers can apply the information to their assessments and intervention activities with patients in various age categories. For example, geriatric patients whose core body temperature ranges between 95 degrees F and 96 degrees F are at high risk for hypothermia. Case managers should use this knowledge to develop an appropriate discharge plan for these patients. To minimize the threat of hypothermia for these patients, the discharge plan should include interventions such as high-protein diets with warmed evening snacks and additional clothing or blankets and foot coverings during transport. One way to reinforce this education is to develop clinical scenarios that address the age-related patient care issues that case managers are likely to encounter.
Identify and integrate age-specific skills
Then, identify the necessary cognitive abilities, technical skills, and interpersonal skills required of case managers to care for the different age groups. These abilities and skills may relate to assessment and interpretation of age-specific data, provision of age-specific patient care, and age-specific communication and decision-making techniques. Integrate these requirements into the case management policies and procedures as well as the case managers’ job descriptions. An example of an age-specific competency matrix that can be incorporated with the job description is illustrated in the chart on p. 56. The Joint Commission standards also require job descriptions to reflect that the age-specific needs of patients were considered when determining the qualifications and skills that case managers must bring to the position. The surveyors will not look for a specific statement in the job description that delineates the ages of patients served; rather, they will expect to find evidence that the organization’s leaders considered the unique growth and development needs of patients when they defined the qualifications, duties, and responsibilities of case managers.
To evaluate case managers’ age-specific competencies, leaders must do more than provide education to staff members and test them after the educational session is over. Attendance at an educational session and completion of a written test only evaluates the case manager’s knowledge of age-specific considerations, not the ability to use the necessary skills. Staff evaluations must include an assessment of the person’s proficient execution of the appropriate cognitive abilities, technical skills, and interpersonal skills relevant to the patients in the age group(s) they are serving. The case management policies and procedures and job descriptions that reflect age-specific care provide the foundation for these competency assessments. The performance evaluation, based on the defined responsibilities for case managers, should clearly indicate whether or not the case manager has the knowledge and abilities to perform the tasks necessary to care for each unique patient population.
The Joint Commission expects that the case manager’s ability to apply age-specific competencies be evaluated at the time of the individual’s orientation to his or her job responsibilities. Their continued competence must be evaluated at each performance review, with the judgement of competence based on their application of age-specific policies/procedures, standards of care, and standards of practice. Observation of the case manager’s daily work is a perfectly acceptable and objective way to measure these competencies. Also, in the absence of staff error, competence can be assumed. However, to position the case management department for a Joint Commission survey, it is necessary to define the methods by which case manager competence is assessed, i.e., observation in daily work, objective performance appraisal, demonstration feedback, etc. The method of assessment for each competency should be clearly documented.
The critical issue in meeting the Joint Commis sion’s age-specific competency standards is that the case management department has ways of measuring an individual’s competency with age-specific abilities and skills for the age group(s) they are serving. With written standards and policies/procedures that reflect age-specific care, the organization has a means to measure case managers’ performance and criteria that serve as a foundation for the competency determinations.
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