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Catheter

Sitting on her back porch, Longview resident Heather Jacobson explains the specifics of her investigation by the State Department of Health’s Home Care Aide Program, as outlined in the document she is holding. The investigation follows Jacobson's suspension from ResCare in September of 2018 for unprofessional conduct following a shift during which she replaced a client’s catheter.

In late August, Heather Jacobson may have saved the life of one of her home care clients. But the next month her employer suspended her for the action, and she enters the new year wondering if she’ll continue to have a job.

Jacobson, 22, was suspended from Longview’s ResCare Home Care in September and is under investigation by the State Department of Health for allegedly practicing beyond the scope of her license.

The investigation stems from changing a quadriplegic client’s clogged catheter line. The client showed signs of a severe infection, including sweating, nausea, an extended stomach and bright red skin, she said. Jacobson is not allowed to drive clients, and when she suggested calling 911 the Longview-area client told her he couldn’t afford an ambulance.

The client asked Jacobson to change the catheter line even though she told him she’d never done it before, she said. The client walked her through each step and his symptoms ended.

Jacobson said she can’t legally go against a client’s wishes. However, if he had passed out and could no longer make decisions, she would’ve called 911. If she did nothing in this case, the client’s health would’ve gotten bad enough to need an ambulance, she said. (She could not name the client because of health privacy laws.)

“If you’re with any client and just sit and watch them be unhealthy, that is neglect,” Jacobson said. “You can’t just do nothing. I did what needed to be done in the moment.”

Two weeks later, though, her supervisors from ResCare Home Care suspended her. They told her she wasn’t supposed to change the line and that procedure is to “sit and watch,” she said. Jacobson thought changing the line was allowed because other caregivers with the same company and qualifications did it and the patient’s care plan included “catheter care” with no other explanation, she said.

Jacobson said she’s not mad at the company or her supervisors for suspending her.

“I’m mad at the policy because there is no right choice. You can’t just watch someone get sicker.”

State regulators need to come up with a happy medium, she said.

The rules governing home care aides and other licensed health care workers are very specific. According to the Washington Administrative Code, long-term care workers, including home care aides, help clients with daily living tasks such as eating, personal hygiene, cooking and cleaning. Home care aides can help clients take medicine, but the individual must be able to ingest or inject the medication alone and be aware they are taking it.

The code does not specifically mention catheters but says home care aides aren’t allowed to perform sterile procedures. Jacobson said changing the catheter line falls under this category, which she didn’t know at the time. However, everything was kept sterile throughout the process, she said.

State law requires every business, agency or organization employing license holders to report firing or restricting an employee for actions that may constitute unprofessional conduct, including acting beyond the scope of practice.

Barnard Baker, spokesman for ResCare, confirmed Jacobson’s suspension and said the company is cooperating with the health department’s investigation.

“ResCare HomeCare is always striving to provide the highest quality services to each individual we serve in the safest possible environment,” Baker said in an email statement.

Jacobson’s home care aide license is still active until a hearing judge makes a decision on whether discipline is applicable, according to the state Health Department. She doesn’t know how long it will take for her case to be resolved.

Home care aides must complete 75 hours of training and a certification exam to get licensed. Jacobson, who is from Longview, began working at ResCare in May after helping care for her great-grandmother.

“I try to not be like here’s the bare minimum, but try to help someone do whatever’s possible to keep someone excited and wanting to live… I would love my job back but I don’t know if that’s going to happen.”

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