Current through Register Vol. 24-18, September 15, 2024
The applicant or licensee must develop and operationalize
delivery of services policies and procedures that describe:
(1) Admission, transfer, discharge, and
referral processes:
(a) In order to minimize
the possibility of client abandonment, clients must be given at least a
forty-eight hour written or verbal notice prior to discharge that will be
documented in the client record;
(b) Forty-eight hour notice is not required
if home care agency worker safety, significant client noncompliance, or
client's failure to pay for services rendered are the reason(s) for the
discharge;
(c) A home care agency
discharging a client that is concerned about their ongoing care and safety may
submit a self-report to appropriate state agencies which identifies the reasons
for discharge and the steps taken to mitigate safety concerns;
(d) Home care agencies under contract with
DSHS or the AAA may follow different time frames for notice of discharge as
established in the terms of the contract.
(2) Specific nonmedical services available to
meet client, or family needs as identified in the plan of care;
(3) Home care services starting within seven
calendar days of receiving and accepting a referral for services. Longer time
frames are permitted when one or more of the following is documented:
(a) Longer time frame for the start of
services is requested by the client, designated family member, or legal
representative, or referral source;
(b) Longer time frame for the start of
services is agreed upon by the client, designated family member, or legal
representative, or referral source in order for agency to select and hire an
appropriate caregiver to meet the needs of the client;
(c) Start of services was delayed due to
agency having challenges contacting client, designated family member, or legal
representative;
(d) Home care
agencies under contract with DSHS or the AAA may follow different time frames
for the start of services as established in the terms of the
contract.
(4) Agency
personnel, contractor, and volunteer roles and responsibilities related to
medication self-administration with assistance;
(5) Coordination of care, including:
(a) Coordination among services being
provided by a licensee having an additional home health or hospice service
category; and
(b) Coordination with
other agencies when the care being provided impacts client health;
(6) Actions to address client, or
family communication needs;
(7)
Emergency care of the client;
(8)
Providing back-up care to the client when services cannot be provided as
scheduled. Back-up care which requires assistance with client ADLs must be
provided by staff with minimum credentialing or workers who meet the exemption
criteria in chapter 246-980 WAC. Noncredentialed staff may provide back-up care
only when assisting a client with IADLs or in emergency situations;
(9) Actions to be taken upon death of a
client;
(10) Actions to be taken
when client has a signed advanced directive;
(11) Actions to be taken if a client has a
signed POLST form. Any section of the POLST form not completed implies full
treatment for that section. At minimum, include: In the event of a client
medical emergency and agency staff are present, provide emergency medical
personnel with a client's signed POLST form;
(12) If the home care agency chooses to offer
assistance with taking vital signs, then relevant policies and procedures must
comply with the following minimum requirements:
(a) Assistance with taking vital signs for
informational purposes only, due to client being unable to complete tasks
independently. Home care agency workers may only assist clients in the process
of taking their own vital signs. Examples of assistance include, but are not
limited to, handing client a digital thermometer, sliding blood pressure cuff
over client's arm, turning on a device, recording digital readings and
communicating those readings back to the client, designated family member, or
legal representative. Devices used must be electronically operated with digital
readouts; and
(b) Assistance with
taking vital signs to determine when to take or exclude prescribed medications,
or what dosage of medication to take due to client being unable to complete
tasks independently. Agencies must contract with a registered nurse to
determine if nurse delegation is appropriate and train agency worker(s) on
taking specific vital signs and to understand how the readings relate to the
medications that the client needs to take;
(13) If a home care agency chooses to offer
assistance with passive range of motion exercises for maintenance purposes
only, then relevant policies and procedures must comply with the following
minimum requirements:
(a) Ensure the client
provides the agency with a copy of their passive range of motion exercise plan
established by a physical therapist licensed under chapter 18.74 RCW, an
occupational therapist licensed under chapter 18.59 RCW, or qualified
registered nurse licensed under chapter 18.79 RCW. The date of the plan must be
within twelve months of requesting assistance with passive range of motion. The
plan must clearly state that the passive range of motion is for maintenance
purposes only. Passive range of motion for purposes of restoring joint function
is outside the scope of a home care agency to provide;
(b) If the exercise plan is older than twelve
months or does not clearly state for maintenance purposes only, the agency will
direct client to get an updated or new passive range of motion plan from their
health care provider;
(c) Ensure
and document passive range of motion skills verification of assigned agency
workers, consistent with WAC
246-335-425(9),
prior to the provision of these services; and
(d) Ensure clients receiving passive range of
motion submit to the agency an updated exercise plan from their health care
provider at least annually;
(14) Nurse delegation according to the
following:
(a) Delegation is only permitted
for stable and predictable clients requiring specific nursing tasks that do not
require clinical judgment;
(b) Home
care agencies are not required to provide nurse delegation services and do not
need a policy if they do not provide these services;
(c) A licensee with an approved home care
service category only may provide nurse delegation in the following ways:
(i) Contract with a registered nurse for any
client needing nurse delegation;
(ii) DSHS or the AAA that contracts with
licensees to provide home care services to medicaid eligible clients are
responsible to establish contracts with registered nurse delegators for any
client needing nurse delegation; and
(d) Home care agency credentialed workers
must complete the core delegation training from DSHS prior to participating in
the delegation process. Home care agency workers must also comply with any
nurse delegation requirements specific to their department issued
credential.
