Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model

Paying Family Medical Caregivers for Children's Home Healthcare in Colorado: A Working Medicaid Model

Foster C; Kwon S; Blakely C; Carter K; Sobotka SA; Goodman DM; Agrawal R; Brittan M

The Journal of Pediatrics

2023

children with medical complexity; Medicaid; children with special health care needs; Colorado; Caregiving

OBJECTIVE: To compare the characteristics and healthcare utilization of children with medical complexity (CMC) who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional non-family member (non-family CNA). STUDY DESIGN: This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017-2019 by a home healthcare agency. We compared patient characteristics between the family CNA and non-family CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. RESULTS: Of 861 patients, 79% (N=680) received family CNA care and 21% (N=181) received non-family CNA care. Patient demographics and hospitalization did not differ between the groups, although family CNA patients were less likely to receive additional nursing-level care (42% versus 60%, p<0.01). Family and non-family CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% versus 9%, p<0.01) despite lower average hourly pay ($14.60 vs. $17.60 per hour, p<0.01). Hospitalizations were rare (<10% of patients). In the adjusted model, family CNA patients experienced 1 more hospitalized day per year, compared with non-family CNA patients (p<0.001). CONCLUSIONS: Paid family caregivers provided CNA level care to CMC with a greater employee retention compared with non-family CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.

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