Field of Work: home health care
Problem Synopsis: Many Medicaid beneficiaries with disabilities or chronic conditions who require health care services, such as medication and managing catheters, prefer to receive them at home rather than having to move to a nursing home. Barriers to receiving such care include the nursing shortage, the high cost of nursing care and concerns of home care agencies about whether home health aides can safely provide these services.
Synopsis of the Work: The New Jersey Department of Human Services, Division of Disability Services conducted a Nurse Delegation Pilot Program in which registered nurses delegated specific health care tasks performed in the homes of some Medicaid beneficiaries with disabilities or chronic conditions to certified home health aides. The pilot received a process evaluation and a cost evaluation.
Key Results & Findings: The pilot program enrolled 226 Medicaid beneficiaries and 70 nurses and 86 home health aides from 19 home health agencies. Giving medication was the most common task delegated by nurses to home health aides. Other tasks commonly delegated were blood sugar monitoring, tube feeding and wound care.
Evaluators from the Rutgers Center for State Health Policy reported that the program had significant positive effects in improving the health and quality of life of participating Medicaid beneficiaries. The evaluation supports modifying the New Jersey Nurse Practice Act to allow certified home health aides working under nurse delegation to give medication.
Evaluators from Mathematica Policy Research reported that the average annual cost of nurse delegated services was $551 per beneficiary, slightly less than the cost of four days in a nursing facility. The treatment and control groups had similar rates of hospitalizations, number of days spent in the hospital, number of emergency room visits and number of physician visits.