Current through Register Vol. 46, No. 12, March 20, 2024
The governing authority shall ensure for all health care
services that:
(a) sufficient numbers of
appropriately trained and oriented supervisory staff are available to ensure the
quality of patient care services provided by the agency. Such supervision shall
include:
(1) ongoing review of cases and
delegation of assignments by appropriate health care professionals;
(2) in-home visits to direct, demonstrate and
evaluate the delivery of patient care;
(3) provision of clinical consultation;
and
(4) professional consultation on
agency policies and procedures;
(b) all staff delivering care in patient homes
are adequately supervised. The department shall consider the following factors as
evidence of adequate supervision:
(1) staff
regularly provide services at the times and frequencies specified in the
patient's plan of care and in accordance with the policies and procedures of
their respective services;
(2) staff
are assigned to the care of patients in accordance with their licensure, and
their training, orientation, and demonstrated skills;
(3) clinical records are kept complete and
changes in patient condition, adverse reactions, and problems with informal
supports or home environment are charted promptly and reported to supervisory
staff; and
(4) plans of care are
revised as needed and changes are reported to the patient's authorized
practitioner, other staff providing care to the patient, and other agencies which
authorize payment for services, as appropriate and necessary;
(c) home health aides or personal
care aides are supervised, as appropriate, by a registered professional nurse ,
or a therapist if the aide carries out simple procedures as an extension of
physical therapy, occupational therapy or speech/language pathology;
(d) in-home supervision by professional staff
of home health aides and personal care aides occurs:
(1) to demonstrate to and instruct the aide in
the treatments or services to be provided with successful re-demonstration by the
aide during the initial service visit or where there is a change in personnel
providing care, if the aide does not have documented training and experience in
performing the tasks prescribed in the plan of care;
(2) where any of the conditions set forth in
paragraph (3) of subdivision (b) of this section occur, to evaluate the condition
and initiate any revision in the plan of care which may be needed; and
(3) to instruct the aide as to the observations
and written reports to be made to the supervising nurse or therapist;
and
(e) direct supervision
of an advanced home health aide is conducted by a registered professional nurse
who:
(i) provides training, guidance, direction
and oversight, and evaluation related to the performance of advanced tasks by the
advanced home health aide;
(ii)
assigns advanced tasks to be performed by the advanced home health aide after
completing a nursing assessment to determine the patient's current health status
and care needs;
(iii) provides case
specific training to the advanced home health aide to verify and ensure the
advanced home health aide can safely and competently perform the advanced tasks
for the patient;
(iv) provides
written, patient specific instructions for performing advanced tasks, including
the criteria for identifying, reporting, and responding to problems, errors or
complications;
(v) conducts a
comprehensive medication review including evaluation of the patient's current
medication use, and prescribed drug regimen and identifies and resolves any
discrepancies prior to assigning the advanced home health aide to administer
medications;
(vi) determines direct
supervision of the advanced home health aide based on the complexity of advanced
tasks, the skill and experience of the advanced home health aide assigned to
perform the advanced tasks, and the health status of the patient for whom the
advanced tasks are being performed;
(vii) while on duty is continuously available
to communicate with the advanced home health aide by phone or other
means;
(viii) conducts home visits or
arranges for another qualified registered professional nurse whenever necessary
to protect the health and safety of the patient;
(ix) performs an initial and ongoing
assessments of the patient's needs; and
(x) conducts a home visit at least every two
weeks and more frequently as determined by the registered professional nurse, to
observe, evaluate, and oversee services provided by the advanced home health
aide;
(f) a process is in
place to document the limitation or revocation of the assignment of advanced
tasks by an advanced home health aide when deemed appropriate by a supervising
registered professional nurse and to ensure that such information is available to
other registered professional nurses that may supervise such aide; and
(g) any failure by a supervising registered
professional nurse to comply with the requirements of paragraph (e) of this
subdivision shall be reported to the department.