Parents and family members can now pursue training and receive licenses through Arizona’s new Licensed Health Aide (LHA) program, allowing them to be hired to provide qualifying care for their medically fragile children under age 21. This program is open to AHCCCS Arizona Long Term Care (ALTCS) members, including those enrolled in the Division of Developmental Disabilities (DDD) and Elderly and Physically Disabled (E/PD), who receive Private Duty Nursing or skilled nursing respite, also referred to as skilled nursing. Nursing respite is not an eligible component of the LHA program.
Arizona is one of three states to offer this option to parents; Colorado and New Hampshire have similar programs. Other states have started to inquire about Arizona’s program hoping to offer something similar, said Nicolette Fidel, deputy assistant director, network operations, management and licensing with DDD.
Parent Cara Pastrana moved from Surprise to Colorado Springs four years ago with her family to participate in Colorado’s CNA (Certified Nursing Aide) program. The Colorado program allows parents with this certification to be paid as CNAs to provide qualified medical care for their children. Pastrana’s 5-year-old son has extensive medical needs including renal failure, which required dialysis and a kidney transplant. He also has pulmonary edema and developmental delays.
“When you have a medically fragile child, it can force one parent to stay home to provide or oversee care,” Pastrana said. She has three other children and left a position in property management to care for her son while they still lived in Arizona.
Once her family relocated to Colorado, Pastrana pursued certification and became a parent CNA, paid hourly by a home health agency. Pastrana clocks in and out on her phone or on a desktop application and is required to chart and document all care.
The family had access to qualified nurses over the years but also saw benefits to a parent providing this care. “Parents can never call in sick,” Pastrana said. As a Parent CNA, Pastrana also gains work experience that she can put on her resume for other career opportunities down the road.
While Arizona’s program differs from Colorado’s, it allows parents to participate in training, obtain licensure, and get paid to provide some skilled care for individuals under 21 years of age if they qualify for private duty nursing hours. AHCCCS includes a definition of private duty nursing and LHA services in its policy manual.
Other relatives over age 18, including siblings, grandparents, aunts and uncles, and foster parents who are legal guardians can also get licensed and paid to provide some skilled care for those under age 21 who qualify for nursing hours. Additional information about qualifying individuals and covered services are also available in the AHCCCS policy manual.
WHY THE LHA PROGRAM CAME TO ARIZONA
The statewide nursing shortage was a big motivator for home healthcare agencies to push the parent LHA program in Arizona. “It’s a very popular program in Colorado and many people move there for it,” said Erica Drury, director of policy and legislation with MGA Homecare. Pastrana and her family hope to move back to the Phoenix metropolitan area someday to participate in Arizona’s LHA program.
“This program can fill gaps in care where a patient is authorized for hours but can’t get them all filled,” Drury added. “Hopefully this will help patients who otherwise wouldn’t receive enough support or care.” If a caregiver calls in sick, a parent might need to manage their child’s care while trying to work, which can cause stress and lapses in care.
MGA Homecare sponsored the legislation, authored by Arizona Representative Joanne Osborne. MGA employs parents for the Colorado parent CNA program, and recently received approval from the Arizona Board of Nursing for its LHA training.
The push started before the COVID-19 pandemic, but COVID certainly added urgency. “People didn’t want to expose their medically fragile children to more people,” Drury noted. “This program gained popularity and received increased attention due to COVID.”
Unlike COVID flexibilities provided by DDD that allow parents to provide habilitation and attendant care to their minor children, the parent LHA program is not temporary or tied to the pandemic.
In Arizona, home health agencies create their own LHA training modules and submit them to the state Board of Nursing for approval. As of mid-April, four agencies had received approval for their curriculum, Fidel said. She estimated that 18 home health agencies joined an informational call during mid-April to learn more about the LHA program.
Once an agency’s training is approved, it can start onboarding parents as LHAs. Parents who want to participate can complete the training and will then need to take the state licensing exam administered by their agency. Agencies will set their own rates for the training. After completing the training and exam, the parent applies to the Arizona Board of Nursing for licensure.
Once licensed, an LHA must work under supervision of a registered nurse. LHAs can provide care in the home or community, but not when a child is hospitalized.
Team Select Homecare, who also employs parents for the Colorado Parent CNA Program, received approval from the Arizona Board of Nursing for their LHA training in March. “We recently began one individual’s LHA certification education,” said Colby Kostur, regional vice president of long-term care. “The approved training programs will fluctuate from agency to agency, but all approved programs will have met Arizona Board of Nursing’s requirements. Training usually lasts two to three days, primarily provided in-person, and is customized to the child’s specific healthcare needs.”
Parents or family members who become licensed as LHAs might also qualify for medical benefits from their agency if they work a full-time schedule.
PARENTS EAGERLY AWAITED APPROVAL
Parents in Arizona have been looking forward to Arizona’s LHA Program for some time. Marcel Martinez, community relations representative with Team Select Homecare, said the agency receives multiple calls daily from interested parents.
Jennifer Foster-Degillo lives in Queen Creek and has three children, including her 10-year-old son with cerebral palsy, epilepsy and respiratory issues. He uses a wheelchair and a communication device and requires medication and breathing treatments throughout the day. “I have a master’s degree in social work, but I haven’t been able to work outside of the home,” Foster-Degillo said. The family has had nurses, but their nurses sometimes moved on and left the family without outside care. Her husband frequently works evenings, making it even more difficult to find consistent providers.
Tricia Burke’s family lives in Tucson and her 3-year-old son has had 12 surgeries so far, along with respiratory issues. Burke juggles his care, with help from nurses and respite providers, along with her full-time job as a college professor. Burke’s family has also had a difficult time locating and retaining nurses to work with her son.
Burke teaches online for a college located in Texas. She’s been able to work remotely throughout the pandemic, but she doesn’t know if that flexibility will last. If she becomes a parent LHA, paid to provide care for her son, she could reduce her hours with her other job.
“This program will reduce stress on parents who are trying to juggle care and work full time,” Burke said, noting that parents could also change to part-time hours for their other jobs, and get paid to care for their children. “It might not be as stressful for parents as trying to keep a full-time job.”
Trudy Billy, tribal program manager for Raising Special Kids, says finding home-based nursing care for children is next to impossible in remote areas like the Navajo reservation. She encourages families with medically fragile children to look into this program. Parents or relatives who would like to become LHAs will need to locate an agency licensed in their home county that offers this program. Parents might also need to travel to a larger city to participate in LHA training and licensure.
Objectors to the LHA program include those who question whether parents should get paid to care for their own children. “Individuals unfamiliar with a program like this will say providing this care is just part of being a parent,” Kostur said. “Parents who have a medically fragile child know that it’s not a ‘typical’ parenting situation. They are providing total skilled care for their kids. The main benefit is continuity of care, which can help decrease hospitalizations for these kids and ultimately reduce costs to the state and other insurance providers.”
Becoming an LHA requires training and a license, noted Alexandra Koloskus, chief compliance officer with MGA Homecare. Parents need to document and chart the care and are supervised by registered nurses at their home health agency.
“This is not personal care or babysitting,” Koloskus added. “Parents are providing a skilled level of care that would otherwise be paid at a nursing rate.” Because the reimbursement rates for a parent LHA are lower than private duty nursing, she added, the program will offer overall cost savings to the state.
Interested parents can start by talking with their DDD support coordinators to verify their child’s nursing hours. Those parents whose children have not yet qualified for skilled nursing hours can contact their support coordinators to request a nursing assessment to determine the child’s needs.
Parents or family members can then contact a home health agency that offers the LHA program to get started on training. Parents or relatives will need to submit documentation to become licensed through the Arizona Board of Nursing’s online portal before starting a paid position as an LHA. The state licensing exam fee is $50 with an additional convenience fee of $3 for submitting online, and licensure lasts two years.
For more information about the LHA program, contact your DDD support coordinator. The Arizona State Board of Nursing has a list of frequently asked questions available on its website, and DDD will also offer additional details and FAQs on its website.
“This program has been a collaborative effort among AHCCCS, DES-DDD, ADHS, the Board of Nursing, providers and other stakeholders, and it’s been a long time in coming,” Fidel said. “We want to support families with skilled care needs, avoid gaps in care and make sure that families have more choices.”