Medical and Non-Medical Home Care

In the last couple of postings, I have talked about technology associated with telehealth, telemedicine, remote patient monitoring.  That theme is going to reappear quickly, as it is so important to our elders, including the clients of Support For Home.

At this time, however, since technology does not pervade patient care to the extent that it not only diagnoses but provides care, directly, there is a disconnect between the medical providers (whether in the clinic, hospital or rehab center or in home health) and non-medical home care providers.

There are many logical restrictions on professional caregivers, as opposed to RNs, Physical Therapists, and so forth, in the home setting.  Even Certified Nurse Assistants (CNAs) and Certified Home Health Aides (HHAs), who comprise the majority of our caregiver employees, are clearly not trained or licensed as medical professionals.

At the same time, some of the restrictions on them really need to be revisited, not for their sake, but for the sake of our elders and others who need support in order to live safely and well at home.

For example, think of a diabetic who needs to have his blood sugar measured three times per day.  No problem, except that he is blind and there is no family.  Can that person afford to have an RN come in three times per day to perform that very simple test?  No. 

Similarly, the individual with dementia who may need that test and / or others, but cannot possibly handle those tasks by her- or himself, is not going to have an RN showing up multiple times per day – including, perhaps, in the middle of the night.

But, at least in California, nurses maintain that such testing cannot be done by a CNA or HHA in a non-medical home care agency.  Why?  Because to administer a test means you need to be trained as to the action required by the results of the test.  Frankly, communicating results to a nurse or doctor, with our without telehealth technology assisting, seems to me to be an appropriate action, but …

At the same time, members of the family are authorized to do many of these things, without any real experience or having passed any kind of State Board exam, as CNAs must. 

Do we want our Home Care Aides acting as medical professionals?  No.  Do we want our clients to receive better care and the services that will allow them to maintain their dignity and fulfill their desire to age in place, at home?  Absolutely.

It is past time for a serious dialogue on this topic.  I would love to hear your comments.

Best wishes, Bert


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