Why Home Care Costs Too Much

Regulations often require that nurses do simple tasks like administer eyedrops

By Paul Osterman in The WSJ. Excerpts:

"There are two million home health aides in the U.S. They spend more time with the elderly and disabled than anyone else, and their skills are essential to their clients’ quality of life. Yet these aides are poorly trained, and their national median wage is only a smidgen more than $10 an hour.

The reason? State regulations—in particular, Nurse Practice Acts—require registered nurses to perform even routine home-care tasks like administering eyedrops. That duty might not require a nursing degree, but defenders of the current system say aides lack the proper training. “What if they put in the cat’s eyedrops instead?” a health-care consultant asked me. In another conversation, the CEO of a managed-care insurance company wrote off home-care aides as “minimum wage people.”

But aides could do more. With less regulation and better training, they could become as integral to health-care teams as doctors and nurses. That could improve the quality of care while saving buckets of money for everyone involved."

"Then, with improved training, aides could take on some tasks now done by nurses, such as giving patients those eyedrops or other prepackaged medicines. It’s just a matter of scaling up existing curricula. A monthlong program, developed by the nonprofit Paraprofessional Health Institute, teaches aides about chronic diseases, handling clients with dementia, and performing simple medical tasks. New York state has created an “advanced aide” classification to recognize such training."

"Yet the potential cost savings are considerable. There are 2.3 million Medicaid patients receiving long-term care at home. Imagine if even half of them replaced one hourlong nurse’s visit a month with a stop by a trained aide. Assuming the nurse makes $35 an hour and the aide $15, that’s an immediate savings of roughly $275 million a year."