Fw: Health Tasks Delegated to Personal Care Community Workers

[Guest guest]

Another thing that Illinois is not doing so well...

Ellen

Ellen Garber Bronfeld

egskb@...

Health Tasks Delegated to Personal Care Community Workers.

From: steve gold <stevegoldada1@...>

stevegoldada@...

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 delegationrequirements 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

Back issues of other Information Bulletins are available online at

http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog

located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to

stevegoldada1@... <stevegoldada@...> or call 215-627-7100.

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