Current through Reg. 49, No. 38; September 20, 2024
(a) In addition
to meeting the standards in Subchapter C of this chapter (relating to Minimum
Standards for All Home and Community Support Services Agencies), an agency
holding a license with the category of personal assistance services must meet
the standards of this section.
(b)
A person who is not licensed to provide personal assistance services under this
chapter may not indicate or imply that the person is licensed to provide
personal assistance services by using the words "personal assistance services"
or in any other manner.
(c)
Personal assistance services, as defined in § 558.2 of this chapter
(relating to Definitions), may be performed by an unlicensed person who is at
least 18 years of age and has demonstrated competency, when competency cannot
be determined through education and experience, to perform the tasks assigned
by the supervisor. An unlicensed person who is under 18 years of age, is a high
school graduate or is enrolled in a vocational educational program, and has
demonstrated competency to perform the tasks assigned by the supervisor, may
perform personal assistance services.
(d) The following tasks may be performed
under a personal assistance services category:
(1) personal care as defined in § 558.2
of this chapter;
(2) health-related
tasks provided by unlicensed personnel that may be delegated by an RN, or that
an RN determines do not require delegation, in accordance with the agency's
written policy adopted, implemented, and enforced to ensure compliance with the
rules adopted by the Texas Board of Nursing in 22 TAC Chapter 225 (relating to
RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in
Independent Living Environments for Clients with Stable and Predictable
Conditions);
(3) health-related
tasks that are not the practice of professional nursing under the memorandum of
understanding between HHSC and the Texas Board of Nursing; and
(4) health-related tasks that are delegated
by a physician under the Texas Occupations Code Chapter 157.
(e) The agency must ensure that
when developing its operational policies, the policies are considerate of
principles of individual and family choice and control, functional need, and
accessible and flexible services.
(f) In addition to the client record
requirements in § 558.301(a)(9) of this chapter (relating to Client
Records), the client file must include the following:
(1) documentation of determination of
services based on an on-site visit by the supervisor where services will be
primarily delivered and records of supervisory visits, if applicable;
(2) individualized service plan developed,
agreed upon, and signed by the client or family and the agency. The
individualized service plan must include:
(A)
types of services, supplies, and equipment to be provided;
(B) locations of services;
(C) frequency and duration of
services;
(D) planned date of
service initiation;
(E) charges for
services rendered if the charges will be paid in full or in part by the client
or significant other(s), or on request; and
(F) plan of supervision; and
(3) documentation that the
services have been provided according to the individualized service
plan.
(g) In addition to
the written policies required by § 558.245 of this chapter (relating to
Staffing Policies) the agency must adopt and enforce a written policy
addressing the supervision of personnel with input from the client or family on
the frequency of supervision.
(1) Supervision
of personnel must be in accordance with the agency's policies and applicable
State laws and rules, including rules adopted by the Texas Board of Nursing in
22 TAC Chapter 225.
(2) A
supervisor must be a licensed nurse or have completed two years of full-time
study at an accredited college or university. An individual with a high school
diploma or general equivalence diploma (GED) may substitute one year of
full-time employment in a supervisory capacity in a health care facility,
agency, or community-based agency for each required year of college.
(3) The client in a client managed attendant
care program funded by HHSC or the Department of Assistive and Rehabilitative
Services is not required to meet the standard in paragraph (2) of this
subsection.
(h) Tube
feedings and medication administration through a permanently placed gastrostomy
tube (g-tube) in accordance with subsection (d)(3) of this section may be
performed by an unlicensed person only after successful completion of the
training and competency program and procedures described in paragraphs (1) -
(5) of this subsection.
(1) The training and
competency program for the performance of g-tube feedings by an unlicensed
person must be taught by an RN, physician, physician assistant (PA), or
qualified trainer. A qualified trainer must:
(A) have successfully completed the training
and competency program described in paragraphs (2) and (3) of this subsection
taught by an RN, physician, or PA;
(B) have demonstrated upon return
demonstration to an RN, physician, or PA the performance of the task and the
ability to teach the task; and
(C)
have been deemed competent by an RN, physician, or PA, to train unlicensed
personnel in these procedures. Documentation of competency to perform, train,
and teach must be maintained in the employee's or contractor's file. Competency
must be evaluated and documented annually by an RN, physician, or PA
.
(2) The minimum
training program must include:
(A) a
description of the g-tube placement, including its purpose;
(B) infection control procedures and
universal precautions to be used when performing g-tube feedings or medication
administration through a g-tube;
(C) a description of conditions that must be
reported to the client or the primary caregiver, or in the absence of the
primary caregiver, to the agency administrator, supervisor, or the client's
physician. The description of conditions must include a plan to be effected if
the g-tube comes out or is not positioned correctly to ensure medical attention
is provided within one hour;
(D)
review of a written procedure for g-tube feeding or medication administration
through a g-tube. The written procedure must be equivalent to current
acceptable nursing standards of practice, including addressing the crushing of
medications;
(E) conditions under
which g-tube feeding or medication administration must not be performed;
and
(F) demonstration of a g-tube
feeding and medication administration to a client. If the trainee will become a
qualified trainer, the demonstration must be done by the RN, PA, or physician.
If the trainee will not become a qualified trainer, the demonstration may be
done by an RN, PA, physician, or qualified trainer.
(3) The minimum competency evaluation must be
documented and maintained in the employee's file and must include:
(A) a score of 100 percent on a written
multiple-choice test that consists of situational questions to include the
criteria in paragraph (2)(A) - (E) of this subsection and an evaluation of the
trainee's judgment and understanding of the essential skills, risks, and
possible complications of a g-tube feeding or medication administration through
a g-tube;
(B) a skills checklist
demonstrating that the trainee has successfully completed the necessary skills
for a g-tube feeding and medication administration via g-tube, and if the
trainee will become a qualified trainer, the skills checklist must also
demonstrate the ability to teach another person to perform the task. The skills
checklist must be completed by an RN, physician, or PA, if the trainee will
become a qualified trainer. The skills checklist for a trainee who will not
become a qualified trainer may be completed by an RN, physician, PA, or
qualified trainer; and
(C)
documentation of an accurate demonstration of the g-tube feeding and medication
administration performed by the trainee as required by paragraph (2)(F) of this
subsection. If the trainee will become a qualified trainer, documentation of
competency to teach this task must be maintained in the file of the qualified
trainer. The person responsible for the training of the trainee must document
the successful demonstration of the g-tube feeding and medication
administration via g-tube by the trainee and the trainee's competency to
perform this task in the trainee's file.
(4) The client or primary caregiver must
provide information on the client's g-tube feeding or medication administration
to the agency supervisor. If the client is not capable of directing his or her
own care, the client's primary caregiver must be present to instruct and orient
the supervisor regarding the client's g-tube feeding and medication regime. A
copy of the current regime including unique conditions specific to the client
must be placed in the client's file by the agency supervisor and provided to
the respite caregiver. The respite caregiver must be oriented by the client,
the client's primary caregiver, or the agency supervisor. The supervisor of the
delivery of these services must have successfully completed a training and
competency program outlined in paragraphs (2) and (3) of this subsection or be
a qualified trainer.
(5) Legend
medications that are to be administered must be in a legally labeled container
from a pharmacy that contains the name of the client. Instructions for dosages
according to weight or age for over-the-counter drugs commonly given the client
must be furnished by the primary caregiver to the respite caregiver performing
the tube feeding or medication administration.
