Running head: POLICY ACTION PLAN 1

Policy Action Plan: Private Duty Nursing

Crystal Parks

Delaware Technical Community College

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Private duty nursing across the country is challenging for individuals, families, private

hires, agencies, private health insurance companies, Medicaid, and Medicare. Private duty

nursing carries many different definitions. PDN is a service that provides an individual in need of

physical, mental, cognitive, or a combination of help stay in their home. PDN services are

available through several different methods including private pay (out of pocket), private health

insurance, Medicaid, or Medicare. Unfortunately, private duty nursing is expensive, and most

individuals or families do not have the means to pay out of pocket for needed help. If the

individual or family is fortunate to have private health insurance, they are still at a disadvantage

having to follow the policies coverage for PDN, if their policy even covers this service at all.

This leaves the state and federal funded programs of Medicaid and Medicare to provide services

to individuals that need assistance to stay in home versus being placed in an institution. Medicare

is a federal funded health care program which was established in 1965 under the Social Security

Act as health insurance for the aging whether disabled or not. Medicaid also was established in

1965 under the Social Security Act to supplement the inadequacy of welfare medical care and is

now the main source for disabled individuals under the age of 65 years old and older than 18

years old. (Mason, Gardner, Leavitt, Chaffee, & O’Grady, 2015, p.151). Both supplemental

health insurances are funded by the Federal Government while Medicaid is a split funded

program also being funded by State Government. This leaves Medicaid to have specific federal

guidelines and freedom of the state to implement and adopt their own qualifications and

programs. In the state of New Jersey Medicaid has two programs that can offer PDN which are

MLTSS and DDD. MLTSS has no individualized budget while DDD evaluates the individual

requesting services and determines an individualized budget that is used for specific qualified

services. Sadly, PDN in the State of New Jersey per Medicaid waiver description uses a specific
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qualification form called the NJ Choice Assessment System. Within this system individuals are

evaluated by a state hired nurse who enters the home asking questions to individuals regarding

their ADL capabilities, cognitive assessment, and memory. If a person can perform ADL’s, pass

the cognitive assessment and memory assessment within the one-hour time frame of the visit

they may not be qualified for Medicaid to provide PDN. This is disastrous specifically for the

traumatic brain injured patients. TBI’s can leave individuals with hidden physical, cognitive, and

memory loss disabilities that are not always visible or recognized by a person who asks specific

questions within an hour time frame. When the person who has suffered a TBI is not qualified for

PDN the family or themselves may be deprived from having the best recovery scenario due to

the lack of direction and resources available. This leads to individuals who cannot maintain a

full-time job, depression, peer pressure paths that lead to criminal charges, and worse case

individuals seek street drugs for help.

NJ has 12 congressmen. Jefferson Van Drew is the U.S. Representative for our district in

N.J. who would be the last person to introduce an idea of changing the qualifications needed by

NJ Medicaid to provide proper PDN services specifically in TBI individuals. U.S. Representative

Van Drew would proceed in taking the idea and implementing it into a Bill to be introduced to

Congress. Prior to involving U.S. Representative Van Drew, Adam Taliaferro N.J. State

Assembly member would be the individual who would have the most education, knowledge, and

direction to help the idea be refined giving a better chance of creating a bill. Assemblymen

Taliaferro is the best choice due to the TBI injury he suffered in a high school football accident.

The struggles he and his family faced encouraged him to begin a foundation to help provide

additional support ranging from financial to physical for injured athletes in N.J. With his

expertise in lawmaking, introducing ideas and bills, connections with the proper chain of
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command for local, state, and federal government, and his knowledge of the ongoing PDN issues

for TBI survivors, Assemblyman Taliaferro can guide individuals and groups lobbying to change

the current Medicaid guidelines. Currently there are no definitive ideas or bills in the State of

New Jersey to change the way Medicaid Waiver programs qualify TBI individuals for PDN.

When presented to have the opportunity face to face with decision-makers to address the

idea of changing the law for qualifying TBI survivors to receive PDN three major categories are

in the forefront of the topic. First and foremost, education and knowledge presented about how

Traumatic Brain Injuries can present in people differently and within different circumstances

they are faced with in everyday living. Evaluating a TBI person for one hour of their day does

not give an evaluator the real lifetime experienced challenges they face in daily activities. Asking

the evaluated person to remember 5 words for 10 minutes does not show that a person in a crisis

cannot remember life changing procedures leading to criminal charges, more bodily harm, or

even death. Examples of memory for a TBI individual: a leak under their sink occurs. They take

a trip to the hardware store forgetting their wallet being so focused on fixing the leak. They go to

purchase a wrench reaching for their wallet now realizing they forgot it at home. Grapping the

wrench they proceed to tell the attendant they will be right back with the money. They leave with

the wrench, attendant calls the police, police arrest TBI individual for shop lifting. After many

hours of explanation and begging for forgiveness TBI individual is upset, ranging with anger

within themselves and at the policy system and charges are dropped. TBI individual now feels

more of a failure and the leak never got fixed. Secondly, physical assessment is not all whether a

person can dress or not dress themselves. Can a TBI individual physically escape from a burning

house? Does the TBI person physically stay balanced the third time up and down the steps verse

the one time the evaluator sees them do it? Thirdly, cognitive function deficits are not always
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seen in an hour of someone’s time. Can the TBI individual calm them selves and reason when

angry in a store because they cannot find the item them came for? Will they rage out of the store

not look both ways and cross the front of the store with oncoming traffic getting injured again?

Will they lash out uncontrollably on a sales attendant not meaning or even realizing they are

doing it? All three topics can be assessed, addressed, and overcome in time with a PDN. Time

given with a PDN can change the outcome of lifestyle for a TBI individual. The PDN would

work closely helping their patient learn new ways to remember, change emergency thoughts and

practice plans for stressful situations, and even redirect the rage and anger to help them cope and

learn to function in a different capacity being more socially accepted and successful.

Giving traumatic brain injured people a voice for better support and advocating for more

proper in-home assistants is a top priority and goal. Private duty nursing in home will allow the

individual to stay within society and their own environment helping to successfully lead an

independent lifestyle up to their own capacity. To provide PDN even for short intervals daily to

provide the proper assessments and direction needed to help prevent TBI individuals from

seeking wrong paths and self-medicating. These goals are currently being worked on with the

help of a Medicaid representative for the current county along with Assemblyman Adam

Taliaferro to complete the idea with all aspects of a traumatic brain injury to ensure an individual

of all capacities and level of injury have full advantage of the changes suggested to be made into

law for the State of New Jersey. When the ideas are finalized, Assemblyman Taliaferro will lead

and set up the face to face time with Senator Sweeny of New Jersey to help create a bill which

then will be presented to U.S. Representative Van Drew.

Traumatic brain injured individuals and families deserve the proper and utmost care for

as long as needed to encourage and help full recovery up to the person’s capacity. TBI’s are not
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always visually noticeable or recognized particularly in an hour evaluation time. TBI suffers are

entitled to PDN who can help recognize, document, advocate, and create changes to help that

person develop and live as independently as possible. Time frames and limits on rehabilitation

and PDN qualification is unjust. The brain is a unique organ that is still on the top of the list on

research and understanding by the highest medical professionals specializing in the brain. They

themselves can not give an answer on at what level or capacity a brain can re gain function so

how can it be fair that our government gives limits on an individual to have the proper care to

equip them with the best outcome they can achieve. That is the accomplishment when NJ

Medicaid provides a more proper and guided assessment for PDN and resources specifically for

TBI people.

References
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Retrieved from https://www.horizonnjhealth.com/securecms-

documents/610/MLTSS_Non_Med_Prof_Provider_Manual.pdf

Retrieved from https://www.state.nj.us/humanservices/doas/documents/ltc_guide_6.pdf

Actions - H.R.647 - 116th Congress (2019-2020): Palliative Care and Hospice Education and

Training Act. (2019, October 29). Retrieved from https://www.congress.gov/bill/116th-

congress/house-bill/647/all-actions?q=%7B%22search%22%3A%5B

%22healthcare+nursing%22%5D%7D&r=2&overview=closed&s=1#tabs

Adam Taliaferro Foundation. (n.d.). Retrieved from https://www.taliaferrofoundation.org/about-

us

Mason, D. J., Gardner, D. B., Leavitt, J. K., Chaffee, M. W., & O'Grady, E. T. (2015). Policy &

politics in nursing and health care (7th ed.). Elsevier Health Sciences.

New Jersey. (n.d.). Retrieved from

https://www.govtrack.us/congress/members/NJ#representatives

Private duty nursing - CPP-IX-F-3-1135. (n.d.). Retrieved from

https://www.nj.gov/dcf/policy_manuals/CPP-IX-F-3-1135_issuance.shtml