The issue of caregivers and medications within home care can be very confusing. It’s such a hot and misunderstood topic that recently we were told the wrong information about caregivers and medications by someone who works in a state regulatory agency.
She stated, “home care aides can’t even open pill bottles.”
It was a puzzling statement regarding caregivers and medications as personal care attendants, or caregivers, routinely help elderly or disabled clients by opening pill bottles or medication organizers. This is especially true for clients who have sight issues, arthritis or dementia. Those clients are the most at risk to open and take the wrong medication.
Recently, At Home Nursing Care spent some time reviewing policies and fact sheets for caregivers and medications to re-educate ourselves. Turns out, home care aides can open pill bottles. It’s specifically allowed.
A fact sheet distributed by the California Department of Social Services regarding caregivers and medications in November of 2023 reads as follows:
The following list contains examples of nonmedical services a Registered Home Care Aide may provide when assisting with medications that a client self-administers.
Opening the client’s medication bottle/canister/blister pack
Reminding the client to take medications
Reminding a client to refill medications
The Cambridge University Press defines self-administration as “the act of taking a drug yourself.” This implies by mouth, when conscious or awake. Someone being cared for by hospice who is unconscious and receiving morphine through a syringe under the tongue would not be self-administering, for example. In that case, a licensed nurse would be administering a medication. A caregiver assisting would not be appropriate.
Clients must be able to take the medications themselves but can be reminded by the caregivers about when to take the medications, and caregivers can open the pill box or bottle to assist the client. This is important, especially with clients who have cognitive impairment. There is also no rule against recording when the medications were self-administered by the client.
When charting completion of daily activities, caregivers should not use terms such as “gave” or “administered” regarding medications, a common language oversight. “Gave” or “administered” might imply that the caregiver is working outside of the normal scope for caregivers and medications.
A better term would be “reminded” or “assisted” client with self-administration.
There are times when a care plan is written in a way that makes it seem like caregivers are making dosing decisions or administering medications, and when errors are found they should be changed. A care plan for a non-medical caregiver should read something like “remind/assist client with medications that the client self-administers.”
Other examples of medication services that a home care aide/personal care attendant may not provide include:
Diabetic insulin shots (or any injections), including preparing syringes for clients or even disposing syringes for clients. Our agency can assist with setting up safe and proper disposal services.
Pushing medications or nutrition through tube feedings, such as a G or J Tube.
IV Insertions or pushing any medications or even water through an IV.
Assistance with medications that the client self-administers that would otherwise require administration or oversight by a licensed health care professional. (This is a long sentence in the CDSS Fact Sheet, and it is admittedly vague. My thought is that this relates to someone who could take a syringe of morphine independently when conscious but is now unconscious. Therefore, only a family member, friend or licensed nurse with a doctor’s order can give the morphine.)
As our annual compliance training dictates, a family member, colleague or hospice nurse should not ask a home care aide/personal care attendant to perform a nursing skill outside of the caregiver scope. This does happen as many private families and clients are confused by the issue of caregivers and medications.
Over many years we’ve had family members asking caregivers to insert medicated suppositories, to “administer” morphine to someone who can’t self-administer, to help with the feeding through a G-tube, to provide prescription medications on a wound (way beyond first aid), or to have a caregiver fill and set up a pill box.
None of those activities should be performed by someone without a medical license, or a family member, and the office and supervisors are here to support caregivers and educate families when needed. If a caregiver/homecare aide, or personal care attendant notices an error in a care plan or if a family member requests a nursing skill be performed, this is a reminder to always let a supervisor know.