REAL Health Care Reform: Allow In-Home Caregivers To Give Medications

Paid caregivers should be allowed to perform the same medication tasks in a home care setting that family members are allowed to perform. Currently they are not allowed to do so, but that should be changed. Health care reform can take place in big, sweeping movements or in small but sensible ways. This is one of those small but helpful steps.

Summary

Paid caregivers should be allowed to perform the same medication tasks in a home care setting that family members are allowed to perform.  Currently they are not allowed to do so, but that should be changed.

Health care reform can take place in big, sweeping movements or in small, sensible ways.  This is one of those small but helpful steps.

Introduction

Under current law, in California only licensed nurses may perform “pass or administer” medications in a home care setting…

…EXCEPT:

Any non-nurse third party else can legally perform certain medication tasks IF that non-nurse is NOT being paid for performing them, under the correct circumstances.  Those circumstances include being properly instructed in how to do it.

Thus, any third party, including family members, friends, neighbors, even convicted felons may do it so long as they’re not being paid to do it.  If they ARE being paid, they cannot do it.  This means that paid in-home caregivers cannot legally perform those same tasks that family members can perform, even though the paid caregivers stand in for family so that the family members can go to work, school, and so forth.

Why Are Family Members Allowed To Administer?

It is difficult to know the “legislative intent” for this exception for non-paid third parties, for this provision has been in the law for almost forty years.  However, it is reasonable to speculate that the reason for the provision was to make it possible for families to care for their loved ones.

That was particularly appropriate back in the day of one-earner households when one spouse could work and earn a living to support the family while a non-working spouse or partner stayed home to care for a loved one who lived under the same roof.   Today, however, almost all households have both adult members of the family working in order to make ends meet.

In today’s world, one of the currently-working spouses or partners must quit their job or work only part time in order to care for the loved one who needs care if that loved one cannot take their own medications.  There is no legal option to hire in-home caregivers to care for that loved one so that both spouses or partners can continue to work if that loved one requires administration of medications.  This is just one of the many challenges facing members of the “sandwich generation”.

The Question Is, Why Is This Law Still On The Books?

If there’s pay involved, a nurse must be doing it.

But wait a minute.  Ask yourself this:  what is the justification for making this all depend upon whether or not pay is involved?  Is this all just a ploy to make sure that there is a protected income stream for nurses?

I think not.  I think that this is merely an example of part of the law that no longer works in our modern times, one that should be changed.

A Modest Proposal

The purpose of this message is to make the following modest proposal for California non-medical in-home caregiver services:

  • Paid non-medical in-home caregivers should be allowed to pass or administer drugs in a home care setting under very specific circumstances while being paid to do so as part of their normal duties, whenever it would be legal for unpaid third parties to do so, such as family members, because such caregivers perform tasks normally performed by family members.

The required specific circumstances would include, but not necessarily be limited to, these:

  1. The medication task involved must be one that would be legally allowable if it were being done by an unpaid family member
  2. The caregiver must be trained by a nurse in the same way and to the same degree that a family member would be required to be trained.
  3. The caregiver must be employed by a certified home care company, so that there is appropriate supervision and legal responsibility for the acts of the caregiver.
  4. The caregiver’s employer home care company must prepare and maintain a written plan of care for every client for whom medication tasks will be performed.  Each plan of care must include specific descriptions of, instructions regarding, the medication tasks to be performed for that client.
  5. The caregiver must keep records of the medication tasks performed.
  6. The caregiver’s employer home care company must adopt and enforce appropriate policies and procedures regarding the medication tasks.
  7. The client (or client’s authorized representative) must give informed consent for the medication tasks that will be performed by the paid caregiver.
  8. The caregiver’s employer home care company must carry appropriate general and professional liability insurance with at least $1Million/$3Million limits that includes coverage for medication tasks.


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Tim Colling

Tim Colling is the founder and President of A Servant's Heart In-Home Care, which provided in-home caregiving services in San Diego County, and also of A Servant's Heart Geriatric Care Management, which provided
professional geriatric care management services and long term care placement services in San Diego County. Tim has more than 30 years of experience in management in a variety of industries. He held a Certified Care Manager credential from the National Academy of Certified Care Managers. Tim is also a Certified Public Accountant (retired), and received his Bachelor’s Degree in Accounting from California State University at San Diego. In addition to writing blog posts here for the Servant’s Heart blog, Tim also is a regular contributor to HealthLine.com and to FamilyAffaires.com as well as blogs of other eldercare services provider companies. Finally, Tim is also the president of A Servant's Heart Web Design and Marketing, which provides home care marketing as well as website design and online marketing for those who serve the elderly and their families.

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