Time To Rethink Our Stance On Home Care Aides And Medications

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 to 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. In the early 90’s it was recognized that the home care aides needed special training to care for the Medicare home health populations and, 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 and 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. 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 can remind a client/patient of the time to take their medications.

The biggest departure from the acute arena of care is in the area of “medication reminding”. Home care aides may remind, “tell a client when it is time to take their medications”. In the last decade or so, both Oregon and Washington state passed legislation allowing for “Nurse Delegation” of the drawing up and giving of insulin by home care aides to selected 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 best to use all of 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 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 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 and the times of day each of them was to be taken. I wanted them at the very least to know for example 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 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 by wanting both the aides and the clients to fully understand the medications that they are dealing with. No longer does a typical home care patient have two to three 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 and not something to be worried about, 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 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 that 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?

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 you home health, hospice or home care private pay agency, please call Kenyon Home Care Consulting at 206-721-5091 or contact us online . We can help!