On December 3rd home health care nurses from all over the state of Connecticut converged at Central CT state University to further fine tune the application of the new law taking effect next year regarding nurse delegation of medication administration to non licensed home health care agency personnel. Beginning January 1 all home care agencies will need to have in place policies regarding the delegation of this duty to med-certified home health aides. At present there are no medication certified home health aide in home care. The state is still working on the training aspect of the certification program for the aides so it does not appear that med admin will be delegated in the near future but we are one step closer to this regulation being put into practice. It is clear that the program is targeted to those patients (mostly psychiatric) now receiving nursing visits by licensed home care agencies for medication administration.

The state spends close to 20 million dollars annually on nurse medication administration visits through home health care agencies. By delegating this duty to an aide within the home health care agency they expect to realize significant cost savings. The state hopes that by making medication administration by aides available to patients through home heath care agencies that there will be a significant number of nursing home patients who will be eligible to transition out to the community.

In other words these patients are residing in nursing homes mainly because they need medications given to them daily and they are not responsible enough to taken them on their own. We can assume that most of these patients also have a psychiatric illness and require medication monitoring. We can then expect that the psychiatric population in the community will grow rapidly in the next couple of years. Has the state of Connecticut thoroughly assessed the impact of moving these patients out into the community?

The fact that these patients may be stable on their current medication regime while in an instituition does not mean they will remain so once they are subjected to the stress and temptations of community living. One can only hope that this policy change is not being driven solely by financial factors ( state deficits) and that additional support services needed for that population will also be provided. Thirty years ago the State of Connecticut transitioned psychiatric patients from the state hospitals out into the community with nothing less than disastrous results for both patients and the communities in which they were located. No one as yet is addressing this issue.

Most of the feedback in the room from the nurses who will be instituiting these changes at the agency level was less than positive. Change is often hard to embrace and particularly when it may involve increased agency liability, scheduling headaches and the uncerainty that this is safe practice. Couple this with the potential increase in the number of Medicaid patients transitioning into the community as a result of the new regulation and the next couple of years could see a serious shortage of nurses and aides qualified to supervise these patients at home and take responsibility for their medication management as well as supportive services in the community.