Over the years the role of the home care aide has evolved. When I began working in the home health arena in 1975, home care aides were used as glorified maids who did primarily home making chores and some personal assistance services. They were assigned to two hour shifts per client and did a maximum of 5 clients a day. Home health was not required to make special training available and in some cases, none was provided.
In the early 90′s it was recognized that the home care aides needed special training to care for the Medicare home health populations. HCFA (now CMS) issued a rule that all aides caring for Medicare clients, whether in the hospital, nursing home or home health had to be Certified Nursing Assistants with the requisite 80 hours of class room and hands on experience. They also needed to be licensed as a CNA by the state in which they resided and provided services.
The training was, and continues to be, focused on the fundamentals of care, such as bathing, ambulation, turning, dressing, eating, etc. and is primarily acute care focused. In the home, the home care aide provides all the acute type of care plus meal preparation, light housekeeping, companionship and can remind a client/patient of the time to take their medications. Not much has changed since the initial curriculum development. The biggest departure from the acute arena of care is in the area of “medication reminding”.
Home care aides may, “tell a client when it is time to take their medications”. In the last decade, both Oregon and Washington State passed legislation allowing for “Nurse Delegation” to home care aides to draw up and give insulin to selected insulin dependent diabetics. Other states are exploring the expanded use of these valuable members of the home care team. I believe it is time for a serious reassessment of all the members of the home health team to see how best to use the team members including the home care aides.
I believe it is time all home care aides were required to have course work on medications, common uses, side effects and medication interactions. I do not know if it is ego or clinical arrogance that has prevented the full use of our “aide colleagues”, but we can no longer afford to keep them in the dark and our clients/patients at risk.
I have been told by surveyors that they did not even want a medication list left for the aide to follow as they were not allowed to know anything about the medications other than to remind when it was time. I have never followed that rule because I wanted my home care aides to know what pills were to be given. It was not uncommon for me to make a list and tape one of the pills with the name of the drug next to it and the times of day each of them was to be taken. I wanted the home care aides, at the very least, to know that the ‘blue pill was taken at breakfast and bedtime’ and if it was not in the cup, they should report it to me.
Since being in the field as a practicing home care nurse, I have become even more of an advocate for the home care aides and the patients we serve. I want the home care aides and the clients to fully understand the medications they are dealing with. No longer does a typical home care patient have two to three drugs but more commonly now an average of 9 to 12 different medications. The statistical chances of the client/patient having an interaction or experiencing side effects is almost a certainty. Most interactions or side effects are mild and not something to worry about, but some are very serious and lead to bad outcomes. Why would we not want the home care aides to recognize and inform us immediately when one of the bad events occurs?
Over the last 10 years I have had several occasions to act as an expert witness for home care aides who have been accused of wrongful deaths as a result of drug interactions. In the last two cases, the charges were eventually dropped against the aides because the states they worked in did not allow them to know or understand the medications. The laws were followed, but the clients died. It’s time to rethink our use of home care aides and what they bring to the table in terms of comprehensive care for our patient/client. Think of how valuable it would be to the patients/clients and their families if they knew that the person who spends the most time with them or their loved one was specially trained to recognize drug side effects and interactions and report them so early interventions could prevent problems associated with drugs, side effects and interactions. I wonder how many repeat hospitalizations could be prevented and how better the quality of life would be if we fully used the eyes, ears, and noses of those very valuable members of our team, the home care aides.
We are in the middle of a paradigm shift in health care in this country. Why not go all the way and make it quality for all, patients, clinical staff and our home care aides? I welcome your thoughts on this subject. If you have questions or are in need of assistance with you home health, hospice or home care private pay agency, please contact Ginny Kenyon. We are here to help.