I have been working in the home health arena since 1975. In those early days, home care aides were pretty much used as glorified maids who did primarily home making chores and some personal assistance services. They were assigned two hour shifts per client and did a maximum of 5 clients a day. Home health was not required to do any special training and in some cases, none was provided. Over the years the role of the aide has evolved so let’s take a look at where the role can really go.
The Evolution Of The Aide:
In the early 90’s it was recognized that the home care aides needed special training to care for the Medicare home health populations. CMS issued a rule that all aides caring for Medicare client required 80 hours of classroom and hands-on education by the state in which they resided and provided services. The training was and continues to be about fundamentals of care such as bathing, ambulation, turning, dressing, eating, etc. and is primarily acute care focused. Not much has changed since the initial curriculum development. In the home, the home care aide provides all the acute type of care plus meal preparation, light housekeeping, companionship, and medication “reminders”. The biggest departure from the acute arena is “medication reminding”. Home care aides may remind or “tell a client when it is time to take their medications”. Both Oregon and Washington state passed legislation allowing “Nurse Delegation” for aides to draw up and give insulin to select insulin dependent diabetics. Other states are beginning to explore the expanded use of these very valuable members of the home care team.
I believe it is time we did a serious reassessment of all the members of the home health team and look at how to best use them. I believe it is time all home care aides were required to have course work on medications, common uses, side effect 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 in the past that they did not even want a medication list left for the aide to follow as they are not allowed to know anything about the medications. Their only role is in the reminder. I have never followed that rule because I wanted my home care aides to know what meds were to be given. For example, it was not uncommon for me to make a list taped with the pink pill that was to be taken at breakfast and bedtime. If it was not in the cup, then the home care aide knew to report it to me.
Since that time in the field as a practicing home care nurse, I have become even more of an advocate for the aides and the patients we serve. I always want both the aides and the clients to fully understand the medications they take. No longer does a typical home care patient have 2 to 3 drugs but more commonly now 9 to 12 on average. The statistical chances of the client/patient having an interaction of some sort or a side effect is almost a certainty. Most interactions or side effects are mild, but some of them are very serious and lead to bad outcomes. Why would we not want the home care aides to be able 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. I think it is time to rethink our use of home care aides and what they have to bring to the table in terms of comprehensive care for our patient/client. Think of how valuable it would be to the patients/clients/ families if they knew the person who spends the most time with them was specially trained to recognize drug side effects and interactions. This allows early interventions which could prevent problems associated with drugs, side effects and interactions. I wonder how many repeat hospitalizations could be prevented. I wonder how better the quality of life would be if we fully used the eyes, ears, and noses of those very valuable home care aides?
Kenyon Home Care Consulting:
I welcome any thoughts on this subject. 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? If you have questions or are in need of assistance with your home health, hospice or home care private
duty agency, please call Kenyon Homecare Consulting at 206-721-5091 or contact us online to see how we can help you reach your goals.