Assistant Professor Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois, United States
Background: Children with medical complexity (CMC) face challenges accessing home healthcare services due to workforce shortages, leading to difficulties for families to provide care at home while staying employed themselves. To address this, some states such as Colorado have created programs to pay family caregivers as employees to provide some or all of a child’s home care if family members undergo certified nursing assistant (CNA) training. Little is known about the characteristics of patients and family employees who utilize family CNA programs compared to traditional home healthcare models.
Objective: To characterize patients and employees in Colorado’s Medicaid-based paid-family CNA home healthcare program, compared to non-family CNA care.
Design/Methods: We conducted a three-year retrospective review (1/1/21017-12/31/19) of a national home healthcare agency’s (TeamSelect) patient and employee electronic records. Patient inclusion criteria were age <21 years at enrollment, any receipt of CNA care, and Colorado residence. Employees of the agency were included if they provided CNA care to the included patients. Descriptive and bivariate statistics were performed on both patients and employees, stratified by patient’s relationship to employee (i.e., family CNA employee versus non-family CNA employee).
Results: N=861 patients met inclusion criteria of which, 680 (79%) received any family CNA care and 181 (21%) received only non-family CNA care. N=864 employees were included, of which N=608 (70%) were related and N=256 (30%) were unrelated. Patients receiving family CNA care had similar characteristics to those who received non-family CNA care, except that patients receiving family CNA care were less likely to also be receiving nursing-level services (42% versus 60%, p<0.01) (Table 1). Family and non-family employees also had similar characteristics (Table 2), except that family employees were slightly older and much more likely to be actively employed with the agency at the end of the three-year span (82% versus 9%, p<0.01). Conclusion(s): For CMC receiving in-home CNA care, paid family caregivers had lower turnover compared to non-family caregivers. This model may help address workforce shortages in pediatric home healthcare while improving family financial health through income replacement. Further investigation will explore cost and health outcomes in such models.
Authors/Institutions: Carolyn C. Foster, Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Soyang Kwon, Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Christy S. Blakely, Family Voices Colorado, Denver, Colorado, United States; Sarah A. Sobotka, University of Chicago, Chicago, Illinois, United States; Denise M. Goodman, Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Rishi Agrawal, Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Mark Brittan, Children's Hospital Colorado, Aurora, Colorado, United States