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The New JerseyNurse Delegation
Pilot Project:There’s No Place Like Home
Susan Brennan McDermott, RNProject Director
Division of Disability ServicesNew Jersey Department of Human Services
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Overview of Presentation
Why In New Jersey?
Design of the NJ Pilot Program
Implementation
Program Statistics
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Why In New Jersey?
Individuals are in nursing facilities who want to be in the community or with family
Families find that home care aides cannot provide the type of service they need to maintain loved ones at home
There is a shortage of licensed nursing personnel
Demand for home care will escalate dramatically as the “boomers” begin needing LTC services
It has been effective in other states
NJ must address its “Olmstead” obligation
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Why In New Jersey (continued)
Family caregivers “burn out” or risk loss of employment because of care giving and need to perform “skilled tasks”
We are not making full use of the skills, knowledge and talent of registered professional nurses who work in the Medicaid PCA program
We know (but never acknowledge) that aides are performing skilled tasks without nursing oversight or supervision
Why In New Jersey (continued)
Home care agencies indicated that
providing “intermittent” skilled care several
times a day by licensed nurses is not
practical or realistic in the current
environment
Skilled nursing care at home identified as a
crucial element for facilitating
deinstitutionalization, by NJ Olmstead
Stakeholder Task Force (2001)
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Study Population
Study population consists of individuals eligible for Medicaid personal care assistant (PCA) services
Does not impact on (or negate) the receipt of Home Health benefit under Medicaid (short term, skilled restorative or rehabilitative services)
Intended to address the needs of individuals with relatively stable conditions who require ongoing PCA service in the community
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Design Features Board of Nursing agreed to allow medication
administration by CHHA for pilot
DDS/DHS selected 22 Home Care Agencies with 46 locations to participate in the pilot on a voluntary basis
Target is to have 200-300 individuals who will receive nurse delegated services over 2-3 year period
Participation is VOLUNTARY for everyone
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Design Features (continued)
Staff Marketed pilot project to Community Choice Counselors and Social Workers at Nursing Facilities to identify residents who could be discharged if delegated services are available
DDS/DHS applied for and received multi-year funding from the Robert Wood Johnson Foundation (RWJF) to operate the pilot for a 36 month period.
RWJF funds are matched with Title XIX (Medicaid) funding to provide adequate resources.
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Design Features (continued)
Home care agency’s delegating nurses have the “final say” in all matters related to delegation
Participants, agencies and nurses are asked to cooperate with researchers in both allowing interviews and providing data.
A unique Medicaid PCA procedure code and rate have been developed to cover the cost of the nurse delegation service.
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An Advisory Council, made up of a cross section of stakeholders, is in place to provide advice and assist with problem solving. The Advisory Council meets 2-3 times per year.
Periodic updates are issued to the homecare associations to keep them informed of the progress and outcomes of the pilot.
A quarterly report is generated for the Board of Nursing
Design Features (continued)
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A Review of the Delegation Process
PCA Pilot agency nurse, who has been oriented, reviews new referrals and current caseload and determines which consumers would benefit from delegated services
The decision to delegate or not and to rescind delegation is the sole responsibility of the nurse based on his/her professional judgment.
The RN uses triad model of delegation -- one nurse delegates tasks to one aide for one consumer. Task competency of the CHHA is not transferable from one consumer to another, even if the nurse and aide are the same for other consumers. Must be patient specific.
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A Review of the Delegation Process
(continued)
The RN has the right to refuse to delegate tasks of
nursing care if he/she believes it would be unsafe
or inappropriate to delegate or he/she is unable to
provide adequate supervision.
IMPLEMENTATION
Developed Curriculum and Gained Approval
from American Nurses Association to Award
Three Continuing Education Units, through
New Jersey Homecare Association for
Nurses who agree to participate.
Contracted and worked closely with Rutgers
Center for State Health Policy to obtain
necessary feedback from all stakeholders.
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IMPLEMENTATION(CONTINUED)
Developed procedures and forms with ad hoc
committee to document care in a succinct way
including documentation of medication
administration.
Designed data base containing relevant
information regarding participants
Provide data regarding patient participants to
Mathematic Policy Research for cost evaluation.
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IMPLEMENTATION(CONTINUED)
Designed a CD for nurses that includes
instructions for skilled tasks that could be
delegated.
Designed a CD that includes 27 commonly
prescribed medications for chronically ill
patients
Held focus groups with certified Home Health
Aides
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IMPLEMENTATION(CONTINUED)
Visited agencies and nurses for consultation and
encouragement
Conducted home visits with consumers and
families for support and problem solving
Accompanied nurses on home visits
Continued to Market the Program to key
stakeholders.
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Program Statistics
198 participants were enrolled with a target of
200 to 300.
Currently 140 participants are active
15 referrals have been received from nursing
facilities
3 participants have been moved from nursing
facilities back into the community
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Program Statistics(continued)
158 participants received medication
administration with the most common being
oral medication
52 participants received glucometer testing
9 participants received tube feeding
Other skilled tasks delegated included:
Wound care Straight catheterization
Bladder training Insulin pre-fill
Colostomy care Bowel Program/enema18
A picture is worth a thousand words
– Meet our participants
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For further information:
Contact:
Susan Brennan McDermott, RN
Project Director
NJ Nurse Delegation Pilot
609 292-1268