Home Care Aides Expert Article

Home care needs and services are increasing as individuals with disabilities are consistently receiving services in a manner that allows them to remain in their home. This article explores aspects of home care services that are relevant to litigation involving claims of abuse, neglect, and professional negligence.

Home Care Aide Services – Safety, Standards of Care, and Role Delineation

Defining Home Care Aides:

The National Institute on Aging describes home care as:

Care that allows a person with special needs to stay in their home, which might be for people who are getting older or individuals who are chronically ill, recovering from surgery, or have a disability.

Home care encompasses a broad range of services that may include:

• Personal care, such as help with bathing, hair washing, or getting dressed
• Household chores, such as cleaning, yard work, and laundry
• Cooking or meal delivery
• Money management, to include help filling out forms and paying bills
• Health care, such as monitoring vitals, administering medication, and dressing wounds

Home Health Aides vs. Personal Care Aides

Within the home care system, there is a distinction between home health aides and personal care aides, the main difference being established through the word health.

Home health aides monitor the health status of an individual with a disability or illness and address their health-related needs. This health-related work is usually performed under the supervision/direction of a licensed nursing or therapy provider.

Examples of health-related activities can include taking blood pressure, changing bandages, or dressing wounds. Home health aides, in addition to health-related assistance, can also help with activities of daily living (ADLs) such as feeding, bathing, dressing, toileting, and ambulation; and instrumental activities of daily living (IADLs), which include meal preparation, light housekeeping, or laundry as needed.

In contrast, personal care aides typically do not address health-related issues directly. For example, they will not take blood pressure, or administer medication. Personal care aides do provide personalized assistance to individuals with disabilities or illnesses, with a focus mainly on ADLs. Additionally, they may also assist with some IADLs.

State Regulations for Home Care Providers

There are many areas in which the duties of the home health and personal care aide overlap. A thorough investigation into state/federal regulations and organizational policies, procedures, and practices will need to be conducted when incidents occur in the home and involve these care providers.

For example, some states limit the amount of physical assistance a personal care aide can provide when moving someone from one surface to another (transferring).

This means that if the client requires moderate assistance or more, (the individual is not able to physically provide half of the effort during the transfer), then the personal care aide should not be attempting the transfer on their own. Rather, physical assistance should be provided with additional caregiver staff, a mechanical lift, or not at all.

A Framework for Home Care Expert Witness Investigations

When investigating incidents involving home health and personal care aides, several factors may need to be considered to resolve issues surrounding liability.

Examples include, but are not limited to:

• What action/service caused the negative outcome?
  • Was this action/service appropriate for the individual?
  • Was there an established plan of care (POC) for the individual, and what did it contain?
• Was the care provider qualified to provide the service linked to the outcome?
  • What were the job duties being carried out by the home caregiver?
  • What is the job description of the home caregiver?
  • What are the educational and onboarding practices/requirements of the home care employer?
• What rules and regulations apply to caregivers within the jurisdiction?
  • Under what license is the home care employer operating?
  • What are the state requirements for licensure, certification, and/or education of the job definition?

Home care aides are an integral member of the interdisciplinary team providing services to individuals in their homes. Aides play a part in many components of the Continuum of Care model shown below.

A forensic investigation will typically include an assessment of the plan of care for the individual being served within the home care setting, the type and number of trainings provided to the aide that allow them to successfully perform their job duties, and the communication tools utilized by the home care agency between frontline care staff and management.

These are just a few examples of utilizing components within the continuum of care model to investigate matters.

Home Care Expert Witness Investigations

Mixing the increasingly complex care needs of the elderly and disabled with a job that has little or no formal education and training, can lead to negative outcomes. The hiring home care organization is expected to provide its employees with training, education, resources, support, and equipment required to provide care safely. There are also responsibilities on the part of the care provider, as they are often alone with the individual in their home, including communication, plan adherence, and identification of changes.

The health care experts at Robson Forensic are well versed in the applicable standards of care that apply to home care services.

For more information, submit an inquiry or call us at 800.813.6736.

Featured Expert

Joseph Muniak, MS, OTD, OTR/L

Doctor of Occupational Therapy & Health Care Administration Expert

Joseph Muniak, MS, OTD, OTR/L has trained therapists, registered nurses, certified nursing assistants, nursing aides, therapy aides, home care providers, and volunteers in aspects of home care skills within the inpatient hospital, academic and home care environments. Dr. Muniak works as a treating per diem occupational therapist in the home care field.