The nursing shortage and lawsuits are prompting a growing number of states to pay family members to provide skilled nursing care at home to medically fragile children.
New Jersey and Florida are the latest states to pass laws that allow a family member to get free training as a certified nursing assistant and get paid by Medicaid to provide up to 40 hours a week of home-based care to a child with significant medical needs such as cerebral palsy, epilepsy or severe autism who needs 24/7 care.
Colorado, New Hampshire, Arizona, Pennsylvania, Indiana and Massachusetts have similar laws.
Children with complex medical conditions are eligible for home-based skilled nursing care under Medicaid, and many states are struggling to provide consistent service due to the shortage of registered nurses. There are more than 200,000 openings nationwide for registered nurses and about the same number of openings for CNAs, according to the Bureau of Labor Statistics.
New Jersey's CNA bill became law in July, while Florida's took effect in June. In July, a federal judge ruled that Florida had violated the Americans with Disabilities Act after families alleged the state failed to provide in-home care to 140 medically complex children, forcing them into institutions. Missouri settled a similar lawsuit last year by agreeing to find ways to improve in-home nursing care to children with significant medical needs.
Family CNA programs vary by state, as do their licensing requirements. Generally, most work the same way: The family member--typically a parent--completes courses and clinical work through a vocational school or home health agency, then takes a state licensing exam. Following certification, the family member is eligible to work for a Medicaid-certified home health agency to care for their child. Home health agencies pay the family member through state Medicaid reimbursements they receive. Many agencies also provide healthcare and retirement benefits, as well as paid time off to the caregiver.
Brandi Coon completed Arizona’s family licensed health aide program last year to care for her 8-year-old son, Tyson, who has epilepsy and cerebral palsy. Coon works for Aveanna Healthcare, a national provider for home health and private duty nursing services. She earns approximately $20 an hour to provide 40 hours of care a week to her son.
Coon said she decided to become a licensed health aide after home health agencies in the Phoenix area were having a hard time providing nurses to care for Tyson. She said her son is now receiving more consistent care and has avoided trips to the hospital.
“I’m able to really see his medical changes and those micro needs that he has on a day-to-day basis and that makes a big difference over the course of months and years,” Coon said.
Aveanna also trains and hires family CNAs in Colorado and plans to expand the program to other states that license family home health aides. While the company does not disclose the number of family CNAs it has on staff, CEO Jeff Shaner said the program has helped “bridge the care gap” due to the nursing shortage.
“We can’t staff enough whether it’s nurses or aides,” Shaner said. “There just aren’t enough available caregivers to fill the need on a full time basis, so these family members become crucial in bridging that gap where there needs to be a professional in the home, but there are none to be found.”
Family CNA programs were found to provide consistent care and be cost-effective, according to a study published in the Journal of Pediatrics in February. The study analyzed three years of Medicaid claims data for more than 800 children in Colorado who received home-based care from either a family CNA or a non-family nurse. Researchers found the number of hospitalizations were about the same, indicating there was not a diminished level of care under the family caregiver.