Frail seniors, as well as adults with disabilities, often need help with routine medical care such as taking pills, receiving injections, getting oxygen, or managing catheters. Traditionally, this assistance has been provided only by nurses. But, especially for people living at home or even in assisted living facilities, having a nurse provide this routine care is prohibitively expensive and can lead to long delays in getting assistance. As a result, states are increasingly permitting home health aides or certified nursing assistants to take on these responsibilities.
While the change is controversial, especially among some nurses, it is an important step forward. It can save money, free-up RNs to do more skilled work, and make it possible for many frail seniors to stay at home rather than having to move to a nursing home.
Most important, there is growing evidence that as long as aides receive proper training and supervision, they can improve the quality of the care their patients are receiving. Why? In part because where only nurses are legally allowed to, say, administer medications, aides often give pills anyway, only they do it off the books and without proper training. Or seniors and their well-meaning but unskilled family caregivers may try to manage on their own–an effort that often leads to tragic mistakes.
The math is pretty compelling. An RN costs $40-$50/hr in many parts of the country. There is simply no way many people can pay that much. By contrast, a home health aide hired through an agency costs $20. Just as important, with shortages of primary care doctors in many areas, nurses ( as well as physician assistants and nurse practitioners) have a lot more to do these days. Is it really the best use of their time to drive to a house deep in the suburbs to give someone a pill.
This shift of responsibility from RNs is called nurse delegation. And while it is catching on, many states remain extremely reluctant to permit aides to handle this routine care. A recent AARP scorecard of state long-term care supports and services reported that whether you can receive this care from aides depends a lot on where you live. For instance, in states such as Michigan, Oklahoma, Florida, and West Virginia aides are not permitted to provide this assistance at all. By contrast, states such as Missouri, Arkansas, and Colorado permit aides to perform a wide-range services.
Interestingly, in a recent New Jersey survey, patients and their families were highly satisfied when aides provide this care. Aides themselves were also pleased with the arrangement but not as much as consumers. Nurses and administrators, however, were much less comfortable with the change.
In the new world of health care, RNs will have many more responsibilities, including managing cases of patients at risk of hospitalization. It is inevitable that aides will be performing routine health maintenance. It is far better for them and their patients that they do it legally, safely, and under good supervision. More states need to get on board with these reforms.