Home Health Aides Take On More Tasks

By Christina Hernandez Sherwood

When Elaine Eldred’s husband, Arthur, experienced multiple health crises leading to a diagnosis of Lewy body dementia, she spent four years as his primary home caregiver. Eldred, a retired nurse with 50 years of experience, would drive her husband to doctor visits, bathe him, and handle the shopping and meal preparation.

“I understand how caregivers get burned out,” said Eldred, of Lumberton, whose husband died in 2014. “I experienced that myself.”

Eldred sought respite from certified home health aides who assisted her twice a week. The aides could relieve Eldred of most of her caregiver duties, but they were unable to administer her husband’s medications because a state regulation prohibited the practice.

“What does someone do?” she asked. “The importance of giving medications accurately is a big responsibility on a caregiver.”

That burden was partially lifted in March by the New Jersey Board of Nursing, which decided to allow nurses to delegate to certified home health aides the task of administering medication to patients, said Evelyn Liebman, AARP New Jersey associate state director for advocacy.

“They literally couldn’t, under the previous regulation, provide eye drops,” she said of the aides. “They couldn’t administer oral medication.”

Impact of regulation
That meant family caregivers were left to manage the medications, Liebman said. Under the CARE Act, enacted in 2014, hospitals have to give a designated caregiver instructions in medical tasks. But some caregivers had to leave work just to give a relative a couple of pills, because a home health aide was not allowed to do that.

“It clearly didn’t make sense in terms of our desire to have the best access to care at home,” Liebman said. “It was long past due for New Jersey to remove this prohibition.”

The change was not without some pushback. The State Nurses Association wanted to ensure that supervising nurses kept their authority over delegating the administration of medication, said CEO Judith Schmidt. “Not every certified home health aide will be capable of giving medication,” she said, and not every patient will be an appropriate candidate.

Schmidt said the association ultimately supported the regulation change, as long as health care agencies follow Board of Nursing procedures: that nurses may delegate at their own discretion and that there be an ongoing supervisory relationship between the nurse and the home health aide.

“We do support the process of delegation to certified home health aides,” Schmidt said. “We are comfortable, as long as everyone follows the proper procedures.”

Much of the opposition to the change stemmed from misunderstanding from nurses, said Susan C. Reinhard, director of the AARP Public Policy Institute and a nurse.

There’s skepticism that certified home health aides, who haven’t attended nursing school, can handle some of these responsibilities, Rein­hard said, and concern that delegating some tasks would take professional duties away from nurses.

But a pilot project overseen by the New Jersey Department of Human Services and evaluated by the Rutgers Center for State Health Policy found no adverse outcomes to consumer health. The project engaged nurses at 19 agencies in delegating administration of medication and other tasks to certified home health aides, resulting in higher levels of satisfaction for aides and consumers.

Eldred testified in favor of the change in regulation in part because of her geriatric consulting work. She taught aides in nursing homes to do procedures and monitored their performance.

“The more you delegated to them and enhanced their knowledge, the more they felt empowerment,” she said. “I thought they performed better. I always remembered that.”

Christina Hernandez Sherwood is a writer living in Collingswood, N.J.