When hiring a Home Health Aide (HHA), there is often an expectation that they will provide a level of care similar to that of a family caregiver, encompassing tasks like housekeeping, running errands, assisting with personal care, cooking, feeding, dressing changes, and even administering medications. However, administering medications (or lack thereof) tends to raise concerns and frustrations among families.
Administering medications is a skill that requires careful consideration to prevent costly mistakes. Despite its seemingly simple nature, medication administration is a task with significant risks. Shockingly, over 100,000 medication errors are reported to the USDA each year in the United States alone, leading to 7,000 to 9,000 deaths annually. The total cost of care for patients with medication-associated errors exceeds $40 billion annually.
Families may wonder why, despite giving permission and training, an HHA may still be unable to administer medications. The reasons are multifaceted, often involving state regulations, agency policies, required training and oversight, and the comfort level of the HHA.
State regulations play a pivotal role in determining whether an HHA can administer medications. States vary in their mandates, with some strictly prohibiting HHAs from administering medications in any form, while others may allow limited assistance, often termed "hand-over-hand" assistance.
Some states have "nursing delegation" or "permitted delegation" that allows HHAs with advanced training to administer most medications (exceptions are those considered hazardous or require nursing assessment before and after administration). For more details on what your state allows, you can look up your state's administrative code on the matter or contact your state's Department of Health.
NOTE: In nursing or permitted delegation states, the doses, times, and processes of administration for every single drug to be administered should be carefully outlined in the service agreement.
The policies of the home care agency also play a significant role. Even if state regulations permit medication administration, the agency may choose not to implement it for various reasons, such as legal considerations, compliance complexities, financial factors, or staffing issues.
REQUIRED TRAINING AND OVERSIGHT
Required training and oversight are crucial components. Not every medication can be administered by an HHA, and not every HHA has the advanced training and nursing oversight necessary for such tasks. Nurses must adhere to state laws and national guidelines, ensuring that the HHA can manage the entire administration process effectively.
The HHA may have advanced training, but your loved one may be particularly complex, there may be special considerations or concerns around a given medication or its administration, or the HHA may simply be too inexperienced to accept delegation specific to your loved one. If medication administration by an HHA is allowed in your state, and it is a service your loved one requires, then you will want to work with a home care agency that can verify they have the appropriate staffing available to meet that need.
The comfort level of the HHA is another factor. Even with advanced training, an HHA may not feel sufficiently familiar with a particular medication or your loved one to administer it confidently. This discomfort is not a sign of incompetence but rather a recognition of the need for practical experience. In some cases, the nurse may accompany the HHA for additional training and education.
*There is typically an additional charge for nurse visits.
Held to a different standard
The expectation for HHAs to administer medications may stem from the belief that they are as qualified as family members. However, HHAs are held to a higher standard. While family members are forgiven for mistakes, the HHA is hired to perform specific tasks with the unspoken expectation that they are safe and proficient. Expecting an HHA to administer medications goes beyond their hired duties and places them in a role for which they may not be qualified.
Trust is crucial in the caregiver-patient relationship. While you may trust your HHA as much or more than you do your family, trust alone cannot guarantee the safe administration of medications. If an issue arises, trust turns to blame, as HHAs are held to an expert standard and are not expected to make mistakes in medication administration.
In conclusion, without proper training and documented oversight by a registered nurse, confidence in the HHA's ability to safely administer medications is compromised. Disregarding established rules and regulations further diminishes confidence in the event of harm to your loved one. It is essential to be aware of these complexities and work within the legal and regulatory frameworks to ensure the safety and well-being of those under the care of an HHA.