2:17pm

Tue March 13, 2012
Shots - Health Blog

Connecticut Considers Letting Health Aides Give Medicines To Homebound

Originally published on Thu March 15, 2012 11:44 am

Connecticut, like every state trying to reduce health care spending, is looking closely at how it cares for people with chronic conditions.

Gov. Dannel Malloy has promised to move more than 5,000 poor and disabled patients out of nursing homes in five years.

But the Democratic governor says there's an expensive obstacle in the way. Connecticut law says nurses have to give medications to people in the Medicaid system living at home, and that costs a lot of money.

Jane Counter is one of those nurses. On a recent weekday near Hartford, Counter had already seen a dozen patients before 9 a.m.

The psychiatric nurse arrives at the apartment of Frank. (We are identifying him by first name only to protect his privacy).

Counter gives Frank his extensive series of daily medications. But she says she's doing a lot more than delivering pills from a lock box. She's assessing Frank — asking about his blood sugar, his diet, his sleep medications and about any bruising or bleeding that could give her pause.

She's not technically paid to assess him, but she does, because it's what nurses do. "And it's helpful because we build a rapport and, and that, over time, they become more comfortable with us and will report more symptoms to us, which is really important for us to know," Counter says.

But now the state of Connecticut is asking the question: Could someone other than a nurse do that same job, or part of it, for less money?

"The cost of medication administration is a significant barrier to getting people out of nursing homes and keeping people out of nursing homes," says Anne Foley, the governor's undersecretary for policy and planning.

So Connecticut is thinking of changing its approach and letting non-nurses administer drugs. "There are a few states that allow home health aides to do almost nothing in terms of medication administration, and Connecticut is one of them," says Howard Gleckman, a resident fellow at the Urban Institute who studies elder care.

The state legislature is now considering a plan to allow trained home care aides — who now cost half what nurses do — to administer medications while working under a nurse's supervision. Foley says that and other changes could eventually save the state millions.

Nurses like Counter would still go out to assess the health and safety of their clients, but they would clock less time traveling between patients. "It just means that they're not going two times a day, every day, three times a day, every day, to [give medications]," Foley says

The Urban Institute's Gleckman says there's some logic in giving home health aides more responsibility. Nurses have more important things to do than hand out pills.

And home health aides are on the front line. "So, in fact, if something changes with the patient — she's not eating at much as she was, she's having incontinence problems — it's much more likely that a home health aide will notice that than a nurse who spends five minutes in the house," Gleckman says. "This does require some training, but a well-trained aide can absolutely do this."

Now, it's up to the state's legislature, which is holding a hearing on the governor's proposal Tuesday.

This story by Jeff Cohen is part of a reporting partnership that includes WNPR, NPR, and Kaiser Health News.

Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

Transcript

ROBERT SIEGEL, HOST:

Now, one state's effort to reduce health care spending and the obstacle that it's facing: state law. Connecticut's governor has proposed moving more than 5,000 poor and disabled patients out of nursing homes and into home care.

But Connecticut law requires that people in home care only receive medication from nurses. And that costs a lot of money, as Jeff Cohen of member station WNPR reports.

JEFF COHEN, BYLINE: It's just before nine o'clock, and psychiatric nurse Jane Counter has already seen a dozen patients as she walks up to the apartment of her next one.

(SOUNDBITE OF KNOCKING)

JANE COUNTER: Hi, Frank.

FRANK: Hi.

COHEN: We're not using Frank's full name because of his condition, but Counter says she comes to visit him five days a week, once a day.

COUNTER: You're still really not using your Ambien, right?

FRANK: No.

COUNTER: So you're not needing that for sleep?

FRANK: No.

COHEN: Counter's job here is to give Frank his extensive series of daily medications. But she says she's doing a lot more than delivering pills from a lockbox. She's assessing Frank, asking about his blood sugar, his diet, his sleep medications, and about any bruising or bleeding that could give her pause. She's not technically paid to assess him, but she does, because it's what nurses do.

COUNTER: And it's helpful because we build a rapport, in that, over time, they become more comfortable with us and will report, you know, more symptoms to us, which is really important for us to know because it affects their plan of care, their medication regimen, and it's important information that we can give back to their providers.

COHEN: So here's the question: Could someone other than a nurse do that same job, or part of it, for less money? Connecticut officials say yes. They say they spend far too much money for nurses to give prescription drugs to Medicaid patients living at home.

Anne Foley is the governor's undersecretary for policy and planning. She says the high cost also means some patients don't have the option of leaving an institution.

ANNE FOLEY: The cost of medication administration is a significant barrier to getting people out of nursing homes and keeping people out of nursing homes.

COHEN: So, Connecticut is thinking of changing its approach and letting non-nurses administer drugs.

Howard Gleckman is a resident fellow at the Urban Institute who studies elder care. He says that Connecticut is one of the most restrictive states in the country.

HOWARD GLECKMAN: Overall, only about half of states allow home health aides to administer these medications. There are a few states that allow home health aides to do almost nothing, in terms of medication administration, and Connecticut is one of them.

COHEN: The state's legislature is considering a plan to allow trained home health aides, who now cost half what nurses do, to administer medications while working under a nurse's supervision. Foley says that and other changes could eventually save the state millions. And nurses would still go out to assess the health and safety of their clients.

FOLEY: It just means that they're not going two times a day, every day, three times a day, every day to do that.

COHEN: But what makes sense to Foley makes for a complicated problem for Tracy Wodatch. She's a vice president with the Connecticut Association for Home Care and Hospice. Her organization is working with the governor on his bill. Still, she says there are serious concerns on the minds of nurses and the agencies that hire them - from affordability to liability to figuring out which patients are best suited for the change. So, for example, an unstable psychiatric patient wouldn't be a good fit.

TRACY WODATCH: One that has changes on a daily basis, one that may have outbursts, may have significant mood swings on any given day, not be safe with a home care aide who's trained just in giving medications and not really recognizing symptoms, side effects, interventions that could be put in place to avoid further problems.

COHEN: Still, the Urban Institute's Howard Gleckman says it makes sense to give home health aides more responsibility. Nurses have more important things to do than hand out pills. And home health aides are on the front line.

GLECKMAN: So, in fact, if something changes with the patient - she's not eating at much as she was, she's having incontinence problems - it's much more likely that a home health aide will notice that than a nurse who spends five minutes in the house. This does require some training but a well-trained aide can absolutely do this.

COHEN: Plus, Gleckman says the limited research done on the issue suggests that outcomes for patients are at least as good. Now, it's up to Connecticut's legislature. Its session ends in early May.

For NPR News, I'm Jeff Cohen in Hartford.

SIEGEL: And that story comes to us as part of a collaboration of NPR, member station WNPR, and Kaiser Health News. Transcript provided by NPR, Copyright NPR.