Should Aides be Allowed to Give Medications to Frail Seniors?

Frail seniors, as well as adults with disabilities, often need help with routine medical care such as taking pills, receiving injections, getting oxygen, or managing catheters. Traditionally, this assistance has been provided only by nurses. But, especially for people living at home or even in assisted living facilities, having a nurse provide this routine care is prohibitively expensive and can lead to long delays in getting assistance. As a result, states are increasingly permitting home health aides or certified nursing assistants to take on these responsibilities.

While the change is controversial, especially among some nurses, it is an important step forward.  It can save money, free-up RNs to do more skilled work, and make it possible for many frail seniors to stay at home rather than having to move to a nursing home.

Most important, there is growing evidence that as long as aides receive proper training and supervision, they can improve the quality of the care their patients are receiving. Why? In part because where only nurses are legally allowed to, say, administer medications, aides often give pills anyway, only they do it off the books and without proper training. Or seniors and their well-meaning but unskilled family caregivers may try to manage on their own–an effort that often leads to tragic mistakes.

The math is pretty compelling. An RN costs $40-$50/hr in many parts of the country. There is simply no way many people can pay that much. By contrast, a home health aide hired through an agency costs $20. Just as important, with shortages of primary care doctors in many areas, nurses ( as well as physician assistants and nurse practitioners) have a lot more to do these days. Is it really the best use of their time to drive to a house deep in the suburbs to give someone a pill.

This shift of responsibility from RNs is called nurse delegation. And while it is catching on, many states remain extremely reluctant to permit aides to handle this routine care. A recent AARP scorecard of state long-term care supports and services reported that whether you can receive this care from aides depends a lot on where you live. For instance, in states such as Michigan, Oklahoma, Florida, and West Virginia aides are not permitted to provide this assistance at all. By contrast, states such as Missouri, Arkansas, and Colorado permit aides to perform a wide-range services.

Interestingly, in a recent New Jersey survey, patients and their families were highly satisfied when aides provide this care. Aides themselves were also pleased with the arrangement but not as much as consumers. Nurses and administrators, however, were much less comfortable with the change.

In the new world of health care, RNs will have many more responsibilities, including managing cases of patients at risk of hospitalization. It is inevitable that aides will be performing routine health maintenance. It is far better for them and their patients that they do it legally, safely, and under good supervision. More states need to get on board with these reforms.

By | 2011-10-14T15:32:45+00:00 October 14th, 2011|Aging, aging in place, family caregivers|13 Comments


  1. Glenda Hynes, RN, RAC-CT October 14, 2011 at 4:36 pm - Reply

    While I agree that an RN is not needed for routine medications at home or in a LTC facility, I believe extensive training & nurse oversight beyond the regular CNA training should be provided. If the photos of the correct pills and dosage are available to the aide this helps too. When an elder takes 11 + medication/day it is easy for errors to me made. Many LTC facilities {in states where this is allowed}have aides graduate from a Medication Technician Training Program & their competency in medication administration is checked regularly by a nurse.

    The best payoff for the nurse is the opportunity to assess and plan for the patients care – rather than just being a “pill pusher” Nurse job satisfaction improves!

  2. Joan Millet October 15, 2011 at 2:32 am - Reply

    I believe that administering meds is not routine and particularly with dock frail elderly there could be BP monitoring etc We are looking a cost vs quality to much!

  3. Ann-Marie Walsh October 16, 2011 at 7:10 pm - Reply

    This especially hits home with me as my sister-in-law has ALS and her primary caregiver is exhausted – almost to the point of risking himself! He would treasure having a trained aide to help with the machines, feeding and medications.
    Since we forecast such an extreme shortage of skilled nurses and doctors, we need to proactively address new ways to meet the demands.
    Also note that the legal landscape has forced volunteers of hospitals and hospice to be completely hands-off. If a volunteer is the only person available and a patient falls or needs water, we cannot assist or even touch the patient. Strict instructions to call 911 and wait. The patients and families suffer.

  4. sue October 19, 2011 at 10:55 am - Reply

    I thought you might be interested in this read.

  5. Agnes Pelosa RN October 21, 2011 at 3:50 am - Reply

    Home Health aides in FL may not administer medications, but often remind and place a pill planner filled by thier supervising Nurse on the table at meal times or bed time. This help alone improves compliance with daily meds. This is no more dangerous than leaving a pill planner in the home for any client. Medications that require BP or other assessments can not be taken safely by the elderly with or without the help of the Caregiver, and should be given after a Skilled visit. I care for my 87 year old mother in law and without a med planner and reminder she would miss or over use her medications. The disabled may need help opening a planner or putting a pill in thier mouth. Currently home care aides can not assist them, leading to the need for ALF or even SNF care. I feel allowing well trained aides with prepared medications could meet thier needs at home.

    • Alan April 9, 2014 at 2:41 pm - Reply

      The problem in Florida is how low is the payment of HHA. I think some of these Haitians coming are not even HHA’s. They are bath givers. They cannot even read English and can barely speak and understand it. There’s a story about computer help desk caller says computer is dead. Help desk says is it plugged in? Caller says no. Plugs it in … it works. Help desk tells to put computer back in box and send it back to store … you are too stupid to own a computer. This is why they can’t give medication … they are too stupid to handle a medication.

      Say my mothers House Call doctor prescribes an antibiotic pill 2 x a day for 10 days. They are not coming back until way past that 10 days is over with. It’s ok that her son gives the pills … but home bath aide says “I don’t give medications”. Shit if I open the capsule and pour it on the food … you’ll give the d amn food. Or put in the juice or other drink.

      • Tina May 8, 2014 at 3:32 am - Reply

        HHA are NOT allowed to administer meds. A pt relative may choose to give the med but as an employee, an HHA must not give any medication to a pt under any circumstances. Plus, there’s is no need to call anyone “too stupid to give meds…” It makes you sound like the douche bag that you probably are.

        • Alan May 7, 2015 at 6:03 pm - Reply

          Unless I know from direct experience … The HHA’s and their company not being able to handle communicating their schedule – so they don’t show up. So I have to manage the HHA’s and the HHA company for my mother myself. Cut her arm which is retracted and disabled with the T-shirt the other day. Neither of 2 HHA’s admits they did it. Turn off the air conditioner to do the bed bath – but don’t turn it back on. So when I come back from working on a job site all day and it’s 83 degrees in moms room. So you tell me who’s the douche bag. (There’s an index card “Did you leave on mom’s Air Conditioner?” at 5’4″ eye level on the inside of the front door. But this one HHA continues to often FORGET that.)

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  8. Marlyn April 16, 2012 at 9:46 am - Reply

    i agree with this reforms, aide with proper training or certified can give better service

    • Alan April 9, 2014 at 2:53 pm - Reply

      Aide with half a brain and command of the English language can give medication – because they could understand to read the bottle and understand the bottle and follow the da mn instructions. But these supposed HHA they send do not have that faculties and command of the English language. They must have took HHA school in another language, didn’t go at all, or got a forged documentation of it.

      There’s no reason for people to be running around with less than a High School education especially working in health care. Especially these health care aides in their late 30’s and 40’s.

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