By Debbie Savage, Responsive Home Care
Just before beginning this article, I received my very own personal AARP magazine in the mail –– and I have to admit that is still hard to believe! Who would have ever thought that I (moi) could/would receive any magazine that was not Vogue or Glamour?
Yes, like most of us, I have been denying my age for a few years, but I see the writing on the wall so clearly now! We need to formulate a comprehensive plan (soon, like quickly) that will allow people, older people –– like me and perhaps you –– to age in place…and do it safely and as independently as possible. As a diagnosed problem solver, I have been trying to come up with a creative way to help us all have the aging result we want. It certainly is not easy –– there are too many pieces to this puzzle.
We, as providers, have significant obstacles to overcome in all areas of home care, but specifically in private home care. My belief is private home care is the future and a fundamental necessity for assisting in safe and healthy aging in place and preventing rehospitalization!
Private home care agencies work as a compelling complement to Medicare home health care by ensuring the patient is eating, bathing, dressing, taking his/her medications, and hydrating –– but perhaps the most significant element in all this is communication! By following up with The Medicare Team, creating this communication bridge for sharing change in condition, we, as private home care agencies, have indispensable value for everyone involved. Keeping people safe, independent at home, and out of the hospital is our shared goal.
To make a positive difference, we must streamline our statutes and rules in order to set up an infrastructure that not only protects people, but also gives them choices. In order to do this we have to agree there is an inherent mutual risk, particularly in home care that must be addressed and agreed upon between the provider of care, the family and the recipient of the care.
Over the past several months, I have had the good fortune to speak to the leaders and staff of HCAF about the following recommendations. They have kindly agreed to let me share these ideas. Some of you may or may not agree with them, but at least we have a starting point for discussion purposes.
The following initiatives will make a meaningful difference:
Nurse Delegation. Texas passed nurse delegation legislation many years ago. Certified nurse assistants (CNA) and home health aides (HHA) can be trained to apply ointments, provide simple wound care, apply ointment for hemorrhoids, Fleet enemas, nebulizer treatments, etc. With the nursing shortage and the high cost related to sending a nurse to individual homes, nurse delegation is common sense. If Medicare nurses are required by the Centers for Medicare & Medicaid Services to teach and train family members or caregivers in the home, why can’t it be done in private home care? A licensed nurse traveling house to house for nebulizer treatment three times a day, carries an exorbitant cost and the market cannot afford it, now or in the future. Nurse delegation in Florida must happen.
Separate Chapter 400 Part III: Home Health Agencies. Surveyors, consumers, and providers are confused by the regulations. This statute and rule needs separation and clarification. Only licensed home care agencies should be listed under Home Health Agencies. Administrative code should be separated by Certified (Medicare/Medicaid) and state licensed only (Private Duty).
Move Nurse Registries to Chapter 400 Part IX – Health Care Services Pool. Nurse Registries provide CNA and HHA placement; many do not place nurses. The patient or client is the employer and responsible for payroll taxes, benefits, etc. Nurse registries are not employers and should not be listed within the home health agencies statute.
Stop the fake news Nurse Registries! False advertising must be stopped and appropriate disclosures in nurse registry advertising must be enacted to protect the consumer and fully disclose their role as a placement/staffing service, not a home care agency. Nurse registries refer caregivers to patients/clients to employ directly; registries do not employ, train, insure, coordinate, supervise, evaluate, or pay payroll taxes. Recently, the U.S. Department of Labor Wage & Hour Division updated specific guidance for field staff on this topic dated July 13, 2018.
Require E-verify for Nurse Registries and All Licensed Home Health Agencies. E-verify is a program that verifies the legal eligibility of workers to work in the United States. All employers are required to maintain I-9s on their employees, but they do not always verify the information. Governor Rick Scott made a campaign promise to stop illegal immigration and make sure illegal immigrants in Florida were not taking jobs. One of his first recommendations, which was supported overwhelmingly by the Republican base and the Florida Constitution Revision Commission, was E-verify. This safety measure was suddenly taken off the ballot for this November’s vote after complaints from the agriculture industry. Migrant workers who work in agriculture should not be comparable to home health aides providing personal care in an individual’s home. We owe it to our elderly patients/clients and our community to ensure we are employing workers who are legal to work in the United States, along with 20 other states. E-Verify would do this in Florida.
Amend Chapter 400.476(3), Florida Statutes. Under employment law and Workers’ Compensation agreements an employee is oriented, trained, and evaluated. The client/patient should not be charged an additional fee for this supervision. Supervision, training, and evaluation is a minimum business standard for any employer.
Home Health Aides Are Not Independent Contractors. The state of Georgia enacted legislation several years ago stating clearly that home health aides are not independent contractors, they are employees. Florida should do the same.
In addition to HCAF’s year-round advocacy activities in Tallahassee and Washington, D.C., the Home Care Political Action Committee (PAC) exists to support candidates for state political office who are home care champions. Contributing to the PAC is an investment in our profession and can help us collectively achieve the aforementioned policy goals. HCAF leadership has shown an interest in broadening their legislative initiative for private pay home care agencies. In order for this to happen, they need our help and financial support! By contributing to the Home Care PAC, attending legislative days in Tallahassee, and visiting your local elected officials to share your views, we all can make a difference in the future of home care in Florida.
Debbie Savage, RN, BSN, is President of Responsive Home Care. For more information, visit Responsive-HomeCare.com.
Originally posted at https://www.homecarefla.org/, reprinted with permission.