Each day, thousands of Delawareans serve as caregivers for family members. These family caregivers often have full-time day jobs; they return home from work to provide evening care, or dash home at lunch to check in on loved ones. They provide trusted care to those they hold most dear—an emotionally challenging, but critical, role in our society.
The challenges can be financial, too. Family caregivers often cannot afford to hire a nurse. And to paraphrase a former DHSS Secretary: Delaware could not possibly afford the costs the State would need to cover if these caregivers stopped providing care for their family members.
As we enter the holiday season—when many people take time to catch their breath from work, embrace family, and reflect on their family members’ health—we pledge to advance important legislation in 2018 that will benefit both family caregivers and their loved ones: allowing home health aides to provide more services.
Across America, how we provide care for older adults and people with disabilities is changing. Here in Delaware, we have some important catching up to do. Delaware currently ranks 41st in the United States for the number of tasks home health aides are permitted to perform. Home health aides in Delaware can help people with bathing, dressing, eating, and getting out of bed, but they cannot legally give medications. The current Delaware law does not allow trained home health aides to administer routine oral medications, eye drops, blood sugar finger sticks, and nebulizer (inhaled) treatments—all of which can be difficult for a family caregiver to provide, as these often need to be given at frequent intervals throughout the caregiver’s workday.
Ironically, Delaware law permits a family’s housekeeper to complete these tasks but prohibits trained home health aides from doing so.
To promote quality care and better health outcomes at a lower cost, we should modify Delaware’s outdated laws that limit the care home health aides are allowed to provide. We should join the many other states that have seen the benefits of these changes. As we ease the burden on family caregivers by allowing trained home health aides to do more, family caregivers will better sustain the balance between working and caregiving—an important consideration, as more and more Baby Boomers retire and as we in Delaware seek to reinvigorate our economy and enhance our workforce.
Allowing trained home health aides to provide more care will also alleviate pressures on the State budget. Under current law, the State pays for at-home nurse visits for Medicaid patients. If nurses could delegate more tasks to trained home health aides, the State could see fiscal savings while family caregivers could focus on work and their loved ones could more consistently receive medicines on-schedule and remain in their homes longer. We want caregivers to have an aide give medicines in the home. We also want to work on allowing homecare nurses to delegate medication administration to aides under their supervision. New Jersey, Connecticut and Maryland have successfully modernized their laws to allow for this, with outcomes of improved care, fewer unwarranted re-hospitalizations, and Medicaid savings.
Current fiscal constraints are not the only pressure facing Delaware. Demographic changes are daunting, too. The average age of Delaware residents is increasing rapidly, especially as more and more seniors move to Delaware for retirement. The number of Delawareans older than 60 is expected to double by the year 2030. With a sharp increase in age will come a sharp increase in the demand for health care. As they age, most Delawareans prefer to continue living at home with help from family and friends, hoping that their family caregivers will succeed with balancing work and caregiving duties, knowing all the while how difficult this juggling act can be. The only way we will be able to meet the preferences of older Delawareans for reliable care while still growing our workforce and economy is to help increase the options—and lower the costs—for family caregivers.
A recent AARP Public Policy Institute study cites a need in Delaware for improving supports for family caregivers. As we rise to meet that need, we are mindful of how important it is to ensure patient safety and maintain proper liability. To address these concerns, we can borrow from analogous frameworks in Delaware and adapt successful models that have worked in other states.
In the coming years, Delaware will need to meet the growing demand for health care, all while implementing measures to promote better care at lower costs. Allowing trained home health aides to perform more tasks should be a part of these efforts. We look forward to introducing this legislation in 2018, and to helping family caregivers and their loved ones alike.