I have several friends in the home care industry—top administrators within their own agencies—who privately admit that they have hired a “self-employed” home care aide when faced with the need for a family member’s care.
The issue isn’t just money, it’s scope of practice. “It’s crazy that an aide in my agency can’t legally administer meds or give an insulin shot. And now with my Mom, I can’t deal with that foolishness. She needs a higher level of service, but I sure can’t afford to hire an RN eight hours a day…”
So, ironically, my industry friends have turned to the private market, managing the aide’s care as a family member, rather than hassling the legal constraints of a home care agency. Very telling.
In these troubled days of ever-increasing budgetary constraints, I believe that our industry can no longer insist on unnecessary programmatic constraints. Of course, scope of practice limitations are absolutely necessary—but not ones so restrictive that we ourselves aren’t willing to abide them.
Fortunately, the emerging new world order of episodic payments and global capitation offers our industry a new set of opportunities. Once freed from fee-for-service restrictions, what will remain will be scope of practice restrictions. Therefore, now is the time to engage in a thoughtful redesign of the role of the home care aide: How can we make the highest and best use of the aide in our care teams? What training and support will she need to help the rest of the team provide genuine person-centered care?
We may not fully realize it until our own family members are in need, but the answer to greater person-centered, cost-effective care is standing before us. The home care aide is already right there, at the side of our loved ones—let us give her the new tools she needs to “practice at the top of her ‘license.’”
Steven Dawson, President
Steven Dawson, president of PHI, has worked for over 19 years to secure quality care by championing quality jobs for our nation’s direct-care workforce. PHI, with a staff of 43, works with more than 30 home care and nursing home providers to improve the skills necessary to create relationship-centered organizations. In addition, Steven co-convenes the national Eldercare Workforce Alliance. He is also a member of CHAMP’s Advisory Council and served on the Framework Initiative’s National Advisory Council.