Any national program must direct states to review and change their Nurse Practices Acts to allow delegation of health related tasks to qualified unlicensed attendants. The most important component of an attendant services delivery system, whether individual provider or agency-based, is the attendants. Any national program must also clarify who the actual employer is. These questions are also tied to the direct payment versus agency model debate. We live in a litigious society where the FEAR of lawsuits, rather than data on actual occurrences of lawsuits, drives the delivery system we have today.
State agencies promulgate pages of rules to protect themselves from potential lawsuits.
A balance must be struck between protecting the individual and allowing people to take reasonable risks. This issue is particularly intense when health-related tasks are provided. State or federal funded liability pools may be one solution to this problem. At a minimum a study must be conducted to come up with possible solutions. Currently billions of dollars are spent on institutional care in this country.