to know about . . .
If your "care" has to be overseen by a registered nurse, a "professional," the hourly cost skyrockets. If you hire a neighbor or friend -- or college student -- to do the same thing part time, you can do it for less money.
Both federal and state regulations are full of requirements that "professionals" handle what they call "health care" -- when often what you need is some help getting dressed or using the bathroom. The regulations are written that way because professional groups -- nurses' groups, medical groups -- lobby to make them that way. Plus, bureaucrats want to make sure everything is "professional."
In most states, laws called "nurse practice acts" list a large range of tasks that, by state law, only a registered nurse can do -- even if these are tasks someone without medical training can also do.
That's why state laws often need to be changed to make in-home services a reality.
The success of Oregon's home and community-based programs is due in part to "nurse delegation" legislation passed in 1987, directing the state board of nursing to adopt rules to allow registered nurses to "delegate" to unlicensed personnel things that the state's Nurse Practice Act had required be done by a nurse.
It is not unusual for nurses to delegate a wide range of tasks to attendants and family members in the performance of their practice . . .
And all states permit nurses to use wide discretion in teaching and delegating. Requirements for specific nurse oversight or firm requirements that the persons to whom tasks are being delegated have particular credentials, or that they be closely supervised at regular intervals drives up costs of care and reduces flexibility.
Assisting consumers with medications is a particular problem, as are catheter care, ostomy care, and wound care. . . .
Currently, Federal Medicaid home health agency definitions and certification requirements are tied to Medicare. . . . Medicaid home- and community-based service programs provide primarily non-medical assistance to people. . . . It is important for HCFA [the Health Care Financing Administration, which sends the Medicaid money to the states] to revise the Medicaid home health regulations, as the aims of the two services differ substantially. The current regulations . . . create a "medical model" for personal assistance services that is costly, inappropriate, and unnecessary.
Several states have clarified their nurse practice acts to permit delegation to uncertified, qualified individuals with no untoward effects. Requiring long-term care providers to have professional certification in order to provide 'low-tech' services increases the cost of long-term care programs substantially with no discernible impact on the quality of services delivered.
Training requirements should be flexible in order to accommodate the range of needs and resources of service recipients. Training packages required at the state level are unlikely to meet the needs of any long-term care consumer from the diverse population of individuals who need those services, and are likely only to increase program costs. The consumer of long-term care services is the expert when it comes to determining her/his needs, and should be allowed to direct and provide the individualized training of her/his assistant(s).
If a minimal level of training is required for personal care providers at the state level, these programs should be administered by the consumer if desired, and should include information on consumer-directed approaches and descriptions of how to maximize the independence of individual consumers.
From Consumer Choice and Control: Personal Attendant Services and Supports in America: Report of the National Blue Ribbon Panel on Personal Assistance Services, August, 1999