I spent this morning at an interesting Capitol Hill conference on an important—but often ignored —topic: What role should home health aides play in the delivery of care to people with chronic disease?
Health care providers and policy experts are spending lots of time thinking about ways to better integrate medical and personal care. They are finally recognizing that people with chronic disease, especially those who also have functional limitations, need a range of supportive services to stay home. Medical treatment alone is not nearly enough.
Most everybody agrees on the goal: Keeping these people as healthy as possible, and avoiding costly and often debilitating hospital and nursing home stays. And there is also growing consensus that one way to achieve that goal is with care teams.
Often, that means physicians, nurses, and social workers. Sometimes, teams also include pharmacists, physical therapists, chaplains, and nutritionists. But these designs often leave out key players: patients and their families themselves, and home care workers.
This morning’s program looked at the role of aides in those teams. It was sponsored by the Service Employee’s International Union (SEIU) and the Paraprofessional Healthcare Institute (PHI), an organization that both trains and employs aides.
PHI president Steven Dawson made the case for the importance of aides in integrated care teams. At the very least, they can provide valuable information to medical professionals about changes in a clients’ health status. With better training, they can do much more than that, including coaching clients, formally monitoring their health, administering medications, and managing medical equipment.
But Dawson conceded that at least three barriers continue to limit the role of aides. The first is the debate over much they should be allowed to do. Would even well-trained aides be acting as unlicensed nurses? These are hot-button issues, as I learned a few months ago when I blogged on the subject.
The second problem is what Dawson called the “bias of low expectations.” Too often, doctors and nurses assume aides are incapable of doing more than basic personal care, so they don’t ask them to do more. My own sense is that teams themselves will break down this bias. As nurses and doctors learn how much aides can do, and how much they know about their patients, they will come to respect their skills.
Finally, Dawson noted the structural problems. Traditional fee-for service Medicare is not designed to pay for aides beyond very limited hours after a hospitalization. But as health systems are rewarded for keeping patients as healthy as possible—a key element of the 2010 health reform law– money may become available to build an infrastructure for quality home care. And that could include well-trained, fairly paid, aides.
Building integrated care teams in the current health and long-term care systems won’t be easy. The barriers Dawson acknowledged—and some others– are very real. But it is time we learned what aides can do if given the chance, and whether their participation in care teams can both improve patient health and save money.