Opinion: Regulatory Change Could Improve Care for Many of NJ’s Most Vulnerable

Jennifer Farnham, Joel C. Cantor | January 12, 2016 | Opinion
Delegating more tasks to certified aides may help reduce hospital admission rates and visits to the emergency room

Joel C. Cantor
New Year’s resolution: Make healthcare better for New Jersey’s most vulnerable. At its November meeting the New Jersey state Board of Nursing took steps to do just that. The board voted to allow state-licensed nurses to delegate more tasks to [link:http://www.njconsumeraffairs.gov/hhh/Pages/default.aspx|certified homemaker-home health aides (CHHAs).

Why, you may be wondering, would such a seemingly small regulatory change rise to the level of meeting such an ambitious New Year’s resolution?

Aides assist people who need help with activities of daily living, such as eating, bathing, dressing, mobility, and using the toilet. They also help with light housekeeping and meal preparation to allow clients to live independently in a safe, healthy environment. Without such help, people with functional limitations may need to live in a long-term care institution like a nursing home. Strong support for daily activities among people with disabilities can also help prevent negative outcomes such as hospital admissions and emergency department visits.

The importance of strong support for people with disabilities is evident in healthcare cost and use statistics. According to the Commonwealth Fund State Health System Scorecard, New Jersey ranks in the bottom quarter of states in rates of avoidable hospital use and cost as well as in successful transitions from hospital to home and from nursing facilities back to community settings. This year, 97 percent of New Jersey hospitals will pay Medicare readmission penalties, more than any other state. New Jersey also has the highest intensity in the country of hospital and specialist care at the end of life for chronically ill Medicare patients, while coming in below average for utilization of home health and hospice, according to the Dartmouth Atlas of Health Care.

Allowing nurses to delegate more responsibility to CHHAs can help turn these statistics around. In particular, helping clients adhere to their treatment and medication regimes can help them live successfully in the community and avoid trips to the hospital.

New Jersey’s CHHAs work under the supervision of nurses who assess client needs and oversee their care. If the state Office of Administrative Law ratifies the nurse-delegation changes approved by the Board of Nursing, nurses will be permitted to delegate medication administration and other tasks to licensed CHHAs if they believe it is necessary and safe to do so.

The results of a New Jersey pilot program showed that allowing nurse delegation of medication administration and other tasks to licensed aides can make clients better off and potentially save healthcare dollars. Participation in the pilot was entirely voluntary for the home health agencies, nurses, aides, and clients. Seventy nurses in 19 agencies participated, delegating one or more services for 226 clients. Nurses could delegate any task, but 62 percent delegated medication administration (74 percent of these were oral medications). The next largest category was blood glucose monitoring (22 percent). Wound care, tube feedings, respiratory assistance, and bladder and bowel assistance were most of the rest of the tasks.

Pilot program results were positive. A formal evaluation by Rutgers Center for State Health Policy found that delegation had significant positive health and quality-of-life effects for consumers, with no evidence of adverse consequences. All participants, including nurses, aides, and clients, expressed high levels of satisfaction with delegation. While the pilot was not designed to measure the impact of delegation on hospital costs, participants reported that delegation would reduce trips to the emergency department and admissions.

Nearly 25 percent of clients reported that the delegated task was either not being done at all or not being done consistently prior to the pilot program. This meant, for example, blood glucose levels going unmonitored or being inconsistently monitored, wounds that were not properly cared for, and medication inconsistently taken. These are precisely the kinds of gaps in care that lead to health crises and avoidable hospitalizations.

New Jersey’s CHHAs are key healthcare team members. They work closely with patients in their home and are best positioned to observe changes in the patient’s condition. While not without its administrative challenges, the regulatory changes approved by the New Jersey Board of Nursing giving nurses and aides more flexibility in delivering care in the home have great potential to improve care delivery, reduce avoidable hospital costs, and improve the lives of thousands of some of New Jersey’s most vulnerable residents.