How Providers Can Adapt to Shifting Role of Home Care Aides

Private duty home care companies face an ongoing challenge in knowing what services their aides are allowed to perform, but they can stay compliant—and successfully coordinate with other types of in-home caregivers—through smart hiring, rigorous training and a commitment to being informed.

New Jersey is one of the flashpoints for this issue: The Garden State is considering a set of rule changes that would allow home care aides to perform many tasks that currently can only be done by licensed nurses, including helping patients with injectable medications.

The push for change has come as federal and state health care policy is shifting to make it easier for people to receive in-home care, NJ Spotlight reported Monday. This means an increasing number of people are receiving in-home services from a variety of caregivers; a single patient might receive care from an unpaid family member, a privately paid aide from one agency, and a nurse from a different agency that receives Medicare reimbursements.


Under these circumstances, it is imperative for the care providers to know their specific roles—which are largely defined at the state level.

Focus on state law

While New Jersey is pushing to expand the role of home health aides, this does not hold true in other states, highlighting the need for private duty agencies to know the rules in their particular service areas.


“We are primarily governed by state regulations, and each state is different,” said Sheila McMackin, founder of private duty agency Wellspring Personal Care, at last week’s Illinois HomeCare & Hospice Council annual conference. “If you can imagine, there are 50 states where there are 50 types of private duty home care agency regulatory requirements. It’s a very fragmented industry.”

When it comes to the services that non-nurse, private duty home care aides can provide versus what requires a licensed nurse, McMackin touted the clarity of the rules in Illinois. They were developed with input from private duty providers—which has not always been the case in other states.

For example, Illinois care aides are not allowed to administer medication, meaning they cannot place it in a client’s mouth, inject it, apply it via the skin or through eyedrops, or otherwise facilitate its entry into the body.

While this rule is not ambiguous, private duty aides still might find themselves pressured to administer medications by a client’s family members or even nurses working with Medicare-certified agencies, noted Teresa Fitzgerald, RN, executive director of product development at VNA Healthtrends Home Healthcare.

Specifically, there is an issue “across the country” with nurses asking care aides to administer morphine to patients at the end of life, she explained.

Private duty agencies must train their workers about what to do in these situations to stay on the right side of the law, Fitzgerald and McMackin agreed.

While there are some unscrupulous providers that will ask home care aides to perform tasks they are not qualified to do, the complexity of the rules also can lead to confusion. And sometimes, this confusion means that care aides actually are not performing tasks that are allowed.

In New Jersey, nurses already have the authority to delegate certain tasks, such as administering a feeding tube, to aides. But providers often are not aware that this is allowed, driving up costs of care and making it more difficult for patients to receive timely services, according to NJ Spotlight.

Set the bar high for hiring

While keeping current on applicable laws and training workers accordingly are key tips, compliance in some ways starts with the hiring process, McMackin emphasized.

While acknowledging that home care providers face difficulties in attracting and retaining workers, she stressed that lowering hiring standards is not the answer.

In addition to commonsense practices like drug screens, she has seen that hiring certified nursing assistants is a successful strategy, she explained.

Even though the CNA credential means that these workers might have the skill set to perform more sophisticated tasks than home care aides are allowed to do, these workers have proven adaptable and, after being trained in what they can do for home health clients, reliably stick to those parameters, McMackin said.

“CNAs are good hires in terms of keeping the lines from blurring,” she said.

Fitzgerald agreed that hiring knowledgable and skilled workers like CNAs is a good idea for private duty agencies. CNAs also do not necessarily have to be paid at a higher rate just because they have the credential, she and McMackin added, although competitive compensation is needed to establish a high-quality staff.

Written by Tim Mullaney

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