Home And Community-Based Workforce For Patients With Serious Illness Requires Support To Meet Growing Needs

Abstract

Home health and personal care aides are one of the largest groups of health care workers in the US, with nearly three million people providing direct care for people with serious illness living in the community. These home care workers face challenges in recruitment, training, retention, and regulation, and there is a lack of data and research to support evidence-based policy change. Personal care aides receive little formal training, and they experience low pay and a lack of respect for the skill required for their jobs. High turnover and occupational injury rates are widely reported. There is little research on the factors associated with higher-quality home care, the extent to which worker training affects client outcomes, and how regulations affect access to and quality of home care. Health care leaders should seek to fill these gaps in knowledge, support the establishment of training standards and programs, implement Medicaid reimbursement strategies that incentivize improvements in pay and working conditions, reform regulations that now prevent the full utilization of home care workers, and create sustainable career pathways in home care policies.

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

“…Nurse aides are often described as special groups with low social status, lower education level, insu cient training, and poor wages. Other countries face the same problem [19] [21] [22] . Policies should be designed to ensure that nursing homes are adequately staffed and that infection control protocols are implemented with high quality [14] .…”

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

“…Nurse aides are often described as special groups with low social status, lower education level, insu cient training, and poor wages. Other countries face the same problem [27,29,30]. Policies should be designed to ensure that nursing homes are adequately staffed and that infection control protocols are implemented with high quality [17].…”

The Impact of Nurse Delegation Regulations on the Provision of Home Care Services: A Four-State Case Study

“…According to these home care workers, appropriate delegation of care tasks would allow them to support clients who want to remain at home, and also would improve access to care by allowing nurses to focus on clients with the greatest needs (Bittner & Gravlin, 2009; Institute of Medicine, 2008). Expanded delegation of health maintenance tasks through the nurse practice acts, coupled with increased training opportunities for home care workers, may improve access to care in the home and be less costly (Spetz et al, 2019). For example, a pilot study in New Jersey revealed no adverse health outcomes, higher quality of life for consumers, and improved satisfaction among home health workers when nurses were authorized to delegate medication administration to certified home health aides (Young et al, 2016).…”

“…However, if the client relies on an agency to employ an aide—whether with private funds or through Medicaid—the scope of practice of aides is controlled by state nurse practice acts. The nurse practice act can permit or prohibit licensed nurses from delegating health maintenance tasks to personal care aides and/or home health aides (Dower et al, 2013; Spetz et al, 2019). A study of delegation to home care workers conducted by AARP in 2016 found that 16 states allowed delegation of all 16 tasks inventoried, including feeding via gastrostomy tube, inserting suppositories, performing intermittent catheterization and ostomy care, administering oxygen therapy, and administering oral medications, insulin, intramuscular injection medications, enemas, and glucometer tests (AK, CO, ID, IA, KY, MN, MO, MT, NE, NM, NC, OR, TX, UT, VT, WA).…”

“…A study of delegation to home care workers conducted by AARP in 2016 found that 16 states allowed delegation of all 16 tasks inventoried, including feeding via gastrostomy tube, inserting suppositories, performing intermittent catheterization and ostomy care, administering oxygen therapy, and administering oral medications, insulin, intramuscular injection medications, enemas, and glucometer tests (AK, CO, ID, IA, KY, MN, MO, MT, NE, NM, NC, OR, TX, UT, VT, WA). In contrast, home care workers were not allowed to perform any of these tasks in Florida, Indiana, Pennsylvania, and Rhode Island (Spetz et al, 2019).…”