Rules Limit Tasks for Home Aides

By Sarah Hollander

Soon after Mary Relotto moved her 90-year-old mother into her Columbus home last fall, she realized she would need help.

While family members can perform nursing tasks for a loved one at home, state regulations restrict the tasks that hired caregivers can provide. Home health aides can assume many tasks, but nurses must perform others, including the administration of medications.

Relotto, a 52-year-old business consultant, said she wanted more flexible options.

“If I’m the responsible party, then why couldn’t I give authority to an aide I’ve vetted?” Relotto said, adding that it was important for her mother, who died in November, to be at home, rather than in a nursing facility.

AARP Ohio agrees that family caregivers would benefit from expanding the types of services nurses—but not family members—can delegate. It plans to highlight the issue this year in the General Assembly and advocate for new rules that allow nurses to delegate tasks to aides, including the administration of shots, pills and other medications.

Aside from the potential cost savings to families in not having to hire a nurse for these tasks, such a change also would help family caregivers who now need to leave work to care for their loved ones, said Trey Addison, AARP Ohio associate state director.

“If you broaden the scope of what home health care aides can do, you won’t need to dispatch nurses all over the place,” Addison said. “Plus, that aide already has a relationship with the patient.”

Rules vary greatly by state. Some states allow home health aides to give injections and tube feed, for example, while others ban them from dispensing an aspirin.

Delegation is voluntary
Ohio ranks below average in delegating tasks, according to an AARP survey. Nurses cannot delegate the administration of medications to unlicensed people, with few exceptions, said Lisa Emrich, program manager with the Ohio Board of Nursing.

Home health aides may administer over-the-counter topical medications, eye and ear drops, foot soaks, suppositories and enemas with a nurse’s approval. They can also help a mentally alert person take their medications by bringing them a pill bottle, for example, or removing a lid.

If a task requires nursing skills and judgment, and results aren’t reasonably predictable, the nurse cannot delegate that task and an aide cannot perform it, Emrich said.

AARP offices across the country have fought for additional tasks, with recent success in New Jersey, West Virginia and Kentucky. In all cases, extra delegation is voluntary, said Susan Reinhard, an AARP senior vice president, director of the AARP Public Policy Institute and a nurse.

If an aide doesn’t want to take on the extra duties, or a nurse feels they aren’t capable, delegation is never mandated. You can’t force someone to do this,” Reinhard said. “Nobody wants that.”

Also this year, AARP Ohio will:

• Push for a caregiver tax credit for expenses such as home improvements, assistive equipment or technology, respite care or a personal care aide. Such legislation will likely be income-based, Addison said.
• Continue fighting utility company requests that could lead to rate hikes, such as any First­Energy Corp. requests for subsidies to cover losses at the Davis-Besse and Perry nuclear power plants.

AARP Ohio urges members to contact their state legislators at 800-282-0253 to support caregiver initiatives and oppose utility subsidies, Addison said.

Sarah Hollander is a writer living in Cleveland.