I have several friends in the home care industry—top administrators within their own agencies—who privately admit that they have hired a “self-employed” home care aide when faced with the need for a family member’s care.
The issue isn’t just money, it’s scope of practice. “It’s crazy that an aide in my agency can’t legally administer meds or give an insulin shot. And now with my Mom, I can’t deal with that foolishness. She needs a higher level of service, but I sure can’t afford to hire an RN eight hours a day…”
So, ironically, my industry friends have turned to the private market, managing the aide’s care as a family member, rather than hassling the legal constraints of a home care agency. Very telling.
In these troubled days of ever-increasing budgetary constraints, I believe that our industry can no longer insist on unnecessary programmatic constraints. Of course, scope of practice limitations are absolutely necessary—but not ones so restrictive that we ourselves aren’t willing to abide them.
Fortunately, the emerging new world order of episodic payments and global capitation offers our industry a new set of opportunities. Once freed from fee-for-service restrictions, what will remain will be scope of practice restrictions. Therefore, now is the time to engage in a thoughtful redesign of the role of the home care aide: How can we make the highest and best use of the aide in our care teams? What training and support will she need to help the rest of the team provide genuine person-centered care?
We may not fully realize it until our own family members are in need, but the answer to greater person-centered, cost-effective care is standing before us. The home care aide is already right there, at the side of our loved ones—let us give her the new tools she needs to “practice at the top of her ‘license.’”
Steven Dawson, President
PHI
Steven Dawson, president of PHI, has worked for over 19 years to secure quality care by championing quality jobs for our nation’s direct-care workforce. PHI, with a staff of 43, works with more than 30 home care and nursing home providers to improve the skills necessary to create relationship-centered organizations. In addition, Steven co-convenes the national Eldercare Workforce Alliance. He is also a member of CHAMP’s Advisory Council and served on the Framework Initiative’s National Advisory Council.
I understand the frustration that is occuring across the board. In the State of NE, there are regulations that prohibit a nursing assistant from providing more than hands on care. If a person is “employed” as an aide, then they are to only provide services as an aide. There is a fine line to draw when employing outside help. Hiring caregivers to do insulin and medication management works for some familes very well and is a great alternative for patients wishing to remain at home. Please check with the licensure unit in your state before hiring a certified aide for these duties. You may unknowingly cause that person to lose their certification. If the agency chose to use Medication Aides, there are many states, such as NE, that are able to use this individual in the homes, but must have a policy and procedure for their use. Using a MA, providing medications and giving insulin is a matter of showing competency and following the regulations of the state and the agencies policies and procedures.
I tend to agree with Steve. As a nurse, I am well aware that it is often my profession that baulks at scope of practice changes for aides. With appropriate training and support, home care aides are clearly capable of so much more. By helping aides practice at the top of their scope, we actually free up nurses to function at the top of their practice. It is a new world now and time to challenge the traditional mindset.
Joanne Handy RN,MS, CEO, Aging Services of California