Connecticut Considers Allowing Non-Nurse Home Care Aides to Administer Drugs

The federal demonstration program, Money Follows the Person, is encouraging the transition of patients from nursing home facilities back into their homes and communities. In addition to bettering a patient’s quality of life, care provided in home settings and community-based care centers tends to be much cheaper. In order to qualify for participation in the program, the cost of community care must meet particular thresholds that are comparatively less than institutional costs. One factor standing in the way of many patients meeting this threshold is the high cost of medication administration.

Under Connecticut law, home health aides are not permitted to administer medication to their patients, making it one of the few states to restrict that task to nurses only. At an average of $54 per visit, nurses cost twice as much as home health aides, and cost the state $128.28 million last year for medication administration to Medicaid patients. Since many patients need 2 or 3 visits per day for help taking their prescriptions, the costs can add up quickly, disqualifying patients from the Money Follows the Person program and resulting in their confinement to institutions. Out of the 44 states participating in the demonstration program, Connecticut recently accounted for 30 percent of the cases where patients were ineligible to transition out of institutions because of cost.

Connecticut Governor Daniel Malloy is joining home care advocates in pushing for more flexibility in medication administration in order for more patients to be free to transition to home-based and community-based long term care. His proposed plan contains four objectives:

  • To allow medication administration by agency-based personal care attendants;
  • To reduce medication administration rates paid to nurses by 10 percent;
  • To allow nurses to delegate medication administration to trained and certified home health aides; and
  • To cover assistive technology that allows patients to self-administer medications

Malloy’s plan estimates that these measures would save the state $20.5 million in the next year and $28.6 million per year subsequently.

Not surprisingly, nurses and their affiliated associations have their reservations about the Governor’s proposals. Mary Jane Williams, an official in the state’s nursing association, raised common concerns that “the administration of medications…requires skill and judgment related to the assessment of the patient…[The proposed change] separates the individual who administers the medicine from the individual who is responsible for the assessment and outcome.”

State Senator Toni Harp pointed out that the proposal would not take away the right of a doctor to require that a nurse handle the administration of medications for more fragile patients. Even if a patient would benefit from the daily visitation of a nurse, advocates contend that it still is not necessary for a nurse to visit several times a day simply to administer pills.

The Connecticut legislature is currently taking the plan under consideration.