Personal care, home health and home care aides should be included in the team-based programs through which home- and community-based services and care increasingly are delivered in assisted living communities and homes, but several factors are impeding their inclusion, according to a study recently published in the Journal of the American Geriatrics Society.

Aides are “the eyes and the ears of the health and [long-term services and supports] systems,” according to authors Robyn Stone, DrPH, and Natasha Bryant of the LeadingAge LTSS Center @UMass Boston. Working closely with those they help with activities of daily living and instrumental activities of daily living, and their families, aides are in a position to help maintain care continuity and “observe the physical condition of the living environment…, the degree of a patient’s social isolation and depression, positive or negative family dynamics, and slight changes in medical condition or function that could help clinical teams make appropriate and timely decisions about therapeutic interventions and whether to transfer an individual to a hospital or other care setting,” they wrote.

Barriers to aides’ inclusion include a lack of understanding that they perform complex tasks, inadequate training of the aides to develop their competencies, high turnover among aides, and laws limiting what tasks RNs can delegate to aides, Stone and Bryant said.

Some organizations have incorporated aides into team-based care, however, the authors noted. Building on their experience, they wrote, “federal and state policymakers, educators, and health systems and providers should standardize competency‐based training requirements, expand nurse delegation consistently across states, and support evaluation, dissemination, and replication of successful programs.”