Friday, October 21, 2011

Health Tasks Delegated to Personal Care Community Workers.

Health Tasks Delegated to Personal Care Community Workers. Information Bulletin #343 (10/2011).

Many persons with disabilities require various health maintenance tasks to survive. States vary tremendously regarding who can legally perform these tasks. Depending on what State a person resides in, and therefore what health maintenance tasks can be delegated, often determines whether a person is unnecessarily institutionalized.

In Information Bulletin #342, we discussed the recent AARP “Raising Expectations – A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caretakers.” The AARP report analyzes “Nurse Delegation” as one indicator of community integration.

Here are the 16 health maintenance tasks reviewed State by State to determine whether or not they are delegated: (1) administer oral medications; (2) administer medication on an as-needed basis; (3) administer medication via pre-filled insulin or insulin pen; (4) draw up insulin for dosage measurement; (5) administer intramuscular injection medications; (6) administer glucometer test; (7) administer medication through tubes; (8) insert suppository; (9) administer eye/ear drops; (10) gastrostomy tube feeding; (11)administer enema; (12) perform intermittent catheterization; (13) perform ostomy care including skin care and changing appliance; (14) perform nebulizer treatment; (15) administer oxygen therapy; and (16) perform ventilator respiratory care.

Many persons with disabilities are lucky enough to have a family member/other nonpaid caretaker, partner or friend who performs these tasks. Persons with disabilities are fortunate enough to live in a State which permit them to direct their own paid personal care workers to perform these tasks as part of consumer direction.

However, many states have “nurse delegation” requirements that prohibit anyone to be paid, other than nurses, to perform these tasks. In these States, the cost of hiring nurses to perform these tasks can be extremely high. Also, hiring a nurse to perform these tasks, many of which must be done several times a day, increases the community-based costs significantly.

The consequences are important to understand. States permit family members/unpaid caretakers to perform these tasks but do not allow paid trained personal care workers (non-nurses) to perform them, even when the persons with disabilities want their personal attendants to perform these taks. Why should a family member or other non-paid caretaker be permitted to perform these tasks but a paid personal attendant worker – with the permission and under the direction of the person with a disability – not be permitted?

This contradiction cannot be based on the difficulty or health risk of the task because then all States would require only nurses perform these tasks and no States would permit any non-nurses to perform the tasks. Nor is it based on a State’s professed concern about saving money because personal care attendants are much less expensive than nurses. We also know that with proper training and supervision all of these 16 tasks can be AND ARE performed safely and regularly by non-nurses.

Here’s a breakdown by State and number of health maintenance tasks delegated.

The AARP reports notes that five states (AZ, GA, IN, NM, and PA) did not provide information to the survey.

Of the remaining 46, the best five States (CO, IA, MO, NE, and OR) permit all 16 tasks to be delegated.

Ten States (AK, NV, HI, MD, TX, WA WI, ID, MN, ND) authorized the delegation between 13 and 16 tasks.

There were 12 States (AL, CA, CT, DE, IL, MA, MS, SC, TN, UT, VT, and VA) that permitted only 4 or fewer tasks to be delegated.

There were five States (FL, MI, MT, OK, RI and WV) that permitted no delegation of any of the health maintenance tasks – yes, they prohibited the delegation of all 16 health maintenance tasks.

We are confident that those States that permit delegation of all or most of these health maintenance tasks require proper training and supervision. We are also confident that advocates could and should address this historical anomaly. Nurse delegation prohibitions should not be a barrier to residing in the community.

Steve Gold, The Disability Odyssey continues

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