Home Health Care Aides as Extenders of Therapy Services: A Managed Care Pilot Program

Abstract

The purpose of this project was to examine the feasibility of utilizing the home health care aide as extender of therapy services. The pilot was conducted over a one-year period involving four Kaiser home health agencies. A scope of practice analysis was completed. A resource manual and training program for home health care aides were developed. Data were collected using questionnaires, tracking logs, chart audits, and telephone case conferencing. A case study approach was used to evaluate the feasibility and cost-effectiveness of this program in lieu of skilled nursing home rehabilitation. The findings of this study showed that therapists' attitudes, perceptions, and practice patterns are critical to successful implementation of this practice. Furthermore, management buy-in and leadership were also found to have a significant impact on the use of home health care aides. Recommendations included documentation and competency testing procedure redesign. Overall, this study concluded that there is opportunity to increase the therapist to home health care aide skill mix with positive clinical outcomes, but that further study is needed to identify optimum skill mix and appropriate case mix indicators.