Home Health Care

Several forces are coming together which will expand the home health care industry in Connecticut.

Governor Malloy is expanding the MFP ( Money Follows the Person) program. This is a federal reform program that aims to reduce the number of patients on Medicaid in expensive institutional healthcare settings. It focuses on moving people out of long-term care facilities and placing them back into their homes where most elderly people prefer to reside. The Connecticut legislature has approved new regulations for the home health care industry that will allow nurses to delegate medication administration to home health aides that are working with patients in their homes. All of these changes are designed to benefit the elderly and to improve quality of life and expand the elderly population that can reside at home with assistance. These are all positive things for health challenged individuals, providing the proper community support is available. This was not the case when the state decided that mental health patients belonged in the community and not in chronic care facilities. Community support was grossly inadequate in the 1980s when the state deinstitutionalized patients from psychiatric hospitals, producing disastrous results for many communities and individuals. Hopefully this most recent plan to transition people into the community has taken into account the need for expanded home health care services.

A second shift in the state's public health policy that has started to effect the home health care industry is in the area of informed risk. Informed risk is basically a policy stating that a person who may not be deemed safe to stay at home is allowed to remain at home as long as patient and family acknowledge that the patient is at greater risk of injury at home as opposed to a facility. It is an honoring of the patient's wishes as opposed to what the agency may feel is the best plan of care for the individual. Up until recently if a person was deemed unsafe in their home environment the home care agency would not support the person remaining at home. In other words they would refuse to provide services. Now the state is promoting keeping people at risk in their homes, providing that they are mentally sound, and they have acknowledged the fact that they are assuming greater risk by staying at home.

Even with good agency oversight it is inevitable that these shifts regarding informed risk and allowing non nurses to give medications will lead to an increase in injuries, accidental overdoses, misuse of medications as well as negligence and/or abuse. Agency staff will need to carefully document risk assessment and delegation of duties. Careful monitoring and good case management will help minimize errors and limit abuse and neglect in this population however the home care industry is certain to have an increase in liability hence the possibility of increasing nursing malpractice claims.

With the first wave of baby boomers starting to retire, the number of senior citizens in Connecticut continues to expand. The need for experienced home health care experts will continue to grow as well.