published Sunday, May 16th, 2010

Home medical care rules loosened


by Emily Bregel
Audio clip

Patricia Puckett

A change in Georgia law aims to help disabled people remain in their homes by allowing caregivers to be trained to perform medical tasks such as tube feeding, bladder and bowel care and medication administration.

The change could keep thousands of medically stable people out of nursing homes, supporters say.

"We're trying to get that middle ground here, with making sure that personal care assistants know what they're doing and can do it safely and cost-effectively," said Patricia Puckett, executive director of the Statewide Independent Living Council of Georgia. The council is an advocacy group that supported the changes to the Nurse Practice Act.

The change, advanced by Gov. Sonny Perdue's office, will save money for patients and the state Medicaid program, supporters say. It offers options between paying a nurse $30 to $40 an hour for routine care or going to a nursing home.

Requiring licensed nurses to provide such care "runs the expenses up tremendously, to where they actually end up in a nursing home when it's not necessary," said the bill's House sponsor, Rep. Jimmy Pruett, R-Eastman.

He said the bill easily passed the General Assembly.

"People are happier living at home. The longer that we can keep them at home, the better job we're doing as a state," he said.

Under the change, an unlicensed person would only be able to perform duties that patients themselves could do if it weren't for a disability. Caregivers still couldn't do things that require nursing judgment, such as starting an IV, said Mary Eleanor Wickersham, health and human services policy adviser to the governor.

CONCERNS ABOUT LEEWAY

But some in the home care industry are concerned about the implications of deregulating home-based care.

Similar proposed changes to Tennessee's Nurse Practice Act have been defeated because of such concerns, said Gayla Sasser, executive director of the Tennessee Association for Home Care.

"There is risk and danger to consumers if those skilled tasks are delegated to nonlicensed individuals," she said. "I know a lot of states are grappling with health care costs. We see that nationwide, but we have to be mindful of the risk involved."

Victor Moldovan, attorney and lobbyist for the Georgia Association for Home Health Agencies, said his organization will be involved as actual rules are written under the new Nurse Practice Act.

"We wanted to be certain any changes to the law would not impact the quality of care to patients," he said.

For example, it's "probably OK" for a caregiver to administer medicine in an already established regimen, Mr. Moldovan said. But a newly prescribed drug should require nurse oversight.

WHAT DOES THE LAW SAY?

An amendment to the Nurse Practice Act allows an unlicensed caregiver to perform certain health tasks for a disabled person in a home-care setting. Previously, the law required that a licensed health care professional perform those duties, such as tube feeding and bowel and bladder care.

Andy Wade, 48, of Rome, Ga., said he welcomes the change. A car crash left Mr. Wade an "incomplete" quadriplegic, with limited sensation in his arms and legs.

His personal care attendant comes in twice a day to help him get dressed, bathe and perform other activities. Although the attendant's assistance with his bowel needs technically is not permitted under Georgia law, his home care agency allows such help without a nurse's supervision, Mr. Wade said.

Under the new rules, Mr. Wade said, "it'll take away a lot of the stigma of, 'Will the person get in trouble for doing it?'"

"It will allow (disabled people) to have the freedom to allow their attendants to do whatever needs to be done to take care of them. For lots of people, that's a big relief."

about Emily Bregel...

Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...

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