Expanding the Role of the Caregiver in Delaware.

As the population in Delaware ages, research and advocacy groups like the Multi-Professional Consortium on Gerontology, the AARP of Delaware, and the Alzheimer’s Association are seeking solutions to the very complex issues associated with longer lifespans and the care of adults living with chronic or age-related conditions. How can we help older adults continue to enjoy a high quality of life as they age? Who will care for them, and at what cost? As the population of older adults expands, so too must the population of medical and care providers. Now is the time for Delaware to create a licensed caregiver role, where licensed caregivers are eligible for nurse delegation of medication administration and other important, skilled care roles.

One very important group in the assessment of the quality of life for older adults is State Long-Term Services and Supports (LTSS). On their most recent scorecard (2014), they found that Delaware is rated rather low when it comes to care and quality of life for the aging population. Those of us who are invested in the care of our aging adult population must ask what the difference is between Delaware and the states at the very top of the list. One major difference is that states like Washington license their caregivers.

A new, licensed role for caregivers in Delaware would dramatically improve the care and quality of life for elderly, handicapped, and ill Delawareans, decrease family caregiver fatigue, and improve the competency and upward mobility of licensed caregivers. Expanding the role of caregivers in Delaware is a win-win.

Currently, Delaware does not require training for caregivers. States in the upper echelon of the scorecard, like Washington, require minimum standards for those being paid to provide care, whether they are paid by a family, a HMO or PPO, or by a care facility.

In Washington, a licensed caregiver (called a HCA) must be CPR certified, finger printed,  pass a background check and drug screen, and complete a 75 hour training program. Upon completion of the 75 hours, student caregivers are mandated to attend an in-person skills training, where students learn how to safely and effectively provide hands-on care to patients who are immobile or with limited mobility. After training is completed, approximately 80 hours in total, student caregivers are eligible to sit for a licensing examination and a skills test-out.

To maintain their license, Washington mandates that caregivers complete continuing education credits on topics like skills and medication training, and other extremely applicable and helpful topics.

Once licensed as a caregiver by Washington, a caregiver can then become nurse-delegated to perform specific tasks, like medication administration. Nurse delegation of any task requires further training, examinations, and skills test-outs. By the time a caregiver is licensed and nurse delegated to administer medication, they have completed at least 100 hours of training, examinations, and skills tests. They are educated and ready to take on an important role in the medical community.

Currently, licensed medical professionals in Delaware, such as Registered Nurses (RNs), are not allowed to delegate medication administration to “unlicensed” assistive personnel, which includes caregivers.

It is unclear if RNs are prohibited from delegating medication administration to caregivers because the caregivers are not formally trained, or if there is other reasoning behind the decision. If Delaware caregivers were mandated to receive training, like they are in Washington, Delaware caregivers could be qualified to receive nurse delegation. Washington is a good model for Delaware to follow.

Further, nurse delegation for any task, from medication administration to wound care to catheter care, would lessen family caregiver strain and fatigue. Imagine this: an adult child hires a caregiver to care for her elderly father while she is at work. The father has diabetes, and part of his care routine is to have his blood sugar checked before lunch and appropriate insulin to be administered. This is a very common practice in diabetic care. Because the caregiver is not permitted to give medication under any circumstance, the daughter must use her lunch time everyday to drive home and provide care to her father. If her father is having a particularly bad day, the daughter may have to drive home more than once to provide medication to her father. This kind of scenario occurs in Delaware every single day and it involves thousands of Delaware residents. The toll on caregivers is immense, and caregiver strain could be lessened if the State of Delaware expanded nurse delegation access to include the delegation of medication administration to caregivers.

Caregiver training could be an economic and employment opportunity for Delawareans. In states like Washington, caregivers are upwardly mobile in the workforce. After a period of employment, licensed caregivers are eligible to attend a 24 hour bridge program to nursing assistant (called a NA-C in Washington, which is the equivalent of a CNA in Delaware). Once a NA-C, it’s easier and faster to be admitted to Washington RN programs, and then it’s a quick 1-2 year online bridge to a Bachelors in Nursing (BSN). They may start their career as a caregiver, but they may end their career as someone who is in the upper echelon of the medical field. Young adults who did not have education opportunities coming out of high school and working adults who are seeking a new career field will find a caregiver licensing program to be a door of opportunity, where they can look ahead to a bright, unlimited future.

I am a licensed caregiver in Washington, and I worked as a nurse delegated medication aid and supervisor at a lock-down memory care facility; I loved my work, and I only left because I was accepted into the University of Delaware Accelerated BSN program. As a nursing student, I find the program manageable thanks in large part to my time as a caregiver. Before beginning this program, I had already spent years administering medications and providing care. My caregiving experience allowed me to hit the ground running.

I am a prime example of the upward mobility of caregivers that are trained, certified, and treated as a trusted member of the healthcare team. If I wasn’t here, I would still be there. I had a high level of career satisfaction and I was paid a living wage in a field that enabled me to be upwardly mobile. The sky was the limit — and here I am, working toward the sky.

I hope that you are inspired to join together with healthcare workers, research organizations, advocacy groups, and families across the state in urging Delaware to expand the role of the caregiver and create a new, better system of caregiver training.

Educated and trained caregivers are enabled to give excellent and effective care. Educated and trained caregivers promote a high quality of life for aging adults. Educated and trained caregivers provide families with respite and a high quality of life for ALL family members. And, in the long run, educated and trained caregivers are upwardly mobile, and will contribute great things to all levels of the medical profession.

For further reading:

Delaware State Plan on Aging

Resources for Caregivers in Delaware

Delaware Care Act

Caregivers in Delaware – AARP

About the Author:

Rebecca Ivory is an Accelerated BSN student at the University of Delaware and the undergraduate research assistant to Dr. Bowen. She is a licensed caregiver in Washington State, where she worked as a medication aid and supervisor at a memory care facility; she previously worked as a hospice aid in New Jersey and taught English medical terminology and therapeutic communication to medical staff in Japan.

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