Several factors play into caregiver versus a nurse

It’s very common for potential clients of At Home Nursing Care to ask if they need a caregiver versus a nurse to meet their needs at home.  Most members of the public know very little of the difference between home care and home health, until they are looking for care for themselves or someone they love.

Rules may the choice of caregiver versus nurse more clear

In California, the rules about scope of practice for a caregiver versus a nurse are very clear.  A caregiver, also known as a personal care attendant or home health aide, can assist with activities of daily living such as bathing, dressing, toileting, ambulating, transfers, medication reminders and feeding. 

Young nurse helping patient with cane in his home.  Activities needed help determine if someone needs a caregiver versus a nurse.
Deciding if a caregiver versus a nurse is the right option

Incidental activities of daily living that a caregiver can provide include help with errands, doctor’s appointments, incidental transportation, light housekeeping, companionship, and other household activities.  When potential clients need help with activities of daily living, a caregiver is more practical and affordable compared to a nurse.

Activities that require a nurse

When medical needs are present, such as wound care beyond first aide, help with a G-tube for feeding or help with injections, or assistance with a ventilator, then a nurse is needed versus a caregiver.   A licensed vocational nurse, LVN, is an appropriate match for most in home care patients, unless the medical services fall exclusively under the prevue of an Registered Nurse, RN, such as medication infusions such as IVIG or those involving a port to the heart.

Only an RN can admit clients to home health services, and the RN is charged with supervising LVN’s who provide nursing care in the home under a plan of care signed by the client’s primary care physician. The RN will visit at least every 60 days or if there is a change of condition with the patient. LVN level of care is typically 40% more expensive per hour than caregiver level of care, based on the education and licensing of the care provider.

One area that leads to some confusion involves medication assistance, most often called “reminders.” A caregiver can provide medication assistance so long as he or she is helping a client with medications normally self-administered.   That means it’s appropriate for a caregiver to help with medications pre-sorted into a pill box and to remind clients when it’s time to take those medications. 

Medication limitations with caregivers

But caregivers are not appropriate to measure dosing, and they should not be filling the pill box.  That should be done by an RN or LVN or family member.  And caregivers should not be expected to evaluate interaction risk or to diagnose or treat a medical condition.

One question we hear often is that the hospital will train a family member how to help a patient with a G-tube, so why can’t a paid caregiver be trained?  The answer involves California law and liability.  A G-tube includes a feeding schedule, food that needs to be measured, along with water to be flushed, and residuals to be measured.  Those activities fall within the scope of an LVN or RN.   

The commonsense conclusion is that family members will not often sue themselves if they make a mistake with a G-tube that ends in a bad outcome for the patient.  But a licensed home care or home health agency can be sued or even have their license revoked by the California Department of Social ServicesHome Care bureau or California Department of Public Health.  A caregiver who handles a G-tube can be accused of practicing medicine without a license.

At Home Nursing Care is both a provider of non-medical in home care or caregiving services, along with Medicare Certified and private duty home health.  Whether you need a caregiver versus a nurse, we will evaluate your situation and create the appropriate plan of care to legally and professionally meet your in home care needs.

Watch our video on the same topic here.