Integrating home health aides into the patient care team may be new for some agencies, but it’s a positive step toward having the full interdisciplinary group work to improve patient outcomes.
The requirement to have aides as members of the interdisciplinary team is one of the major changes included for aides within the revised Home Health Conditions of Participation (CoPs). As a part of the team, aides must be diligent in reporting any patient changes to clinicians, including a new item — changes in skin condition. Agencies should note that the final CoPs deleted the portion of the proposed rule requiring aides to report changes in the condition of pressure ulcers. CMS recognized this would exceed an aide’s normal scope of practice.
The training program as well as competency evaluations for the aides will now include teaching an aide to recognize and report all changes in skin condition.
CNA training may be considered as an appropriate qualification for an individual to be a home health aide beginning with the new CoPs, in addition to the training and/or competency program and/or state licensure program for home health aides currently in the CoPs.
In these programs, aides also will learn many of the items, such as recognizing skin changes. Agencies must ensure all in-service training occurs for current aides and new hires.
These new requirements for aides are effective July 13, 2017 and agencies in non-compliance could face a standard-level deficiency — or worse — during a survey.
Expand Aide Competencies for CoPs
The revised CoPs add areas that must be included within competency evaluations for each aide.
One new area is communication skills. This includes the ability to read, write and verbally report clinical information to patients, representatives and caregivers, as well as to other agency staff.
Per the final rule, “Aides should be able to communicate clinical information to patients that is within the aide’s licensure requirements (for example, blood pressure).”
Another new area to include within competency evaluations is reporting changes in skin condition.
Communication skills must be evaluated by observing an aide’s performance of the task with a patient. The skin condition requirement can be evaluated that way or via other means such as testing.
Act if you see Communication Issues
If during a supervisory visit of an aide your agency identifies an area of concern — such an issue with communication skills — your agency should do the following:
- Conduct a home visit with the aide present.
The supervising clinician must make an on-site visit with the aide to observe the aide performing care.
Among the things, a supervising clinician should look for when observing an aide’s communication skills: Is the aide communicating appropriate information within her scope to the patient and caregiver? Is the aide communicating information received to the RN or therapist?
- Have the RN conduct a competency evaluation of the aide.
This should be performed if a deficiency is verified during an on-site visit. A full competency evaluation by an RN is necessary rather than just remedially checking the one task the aide was unsatisfactory in performing. A deficiency in one skill may indicate deficiencies in other areas.
- Educate the aide.
Education must include the contents of the aide supervisory visit: Following the patient’s plan of care (aide assignment sheet) for completing the assigned tasks; maintaining an open communication process with the patient, representative (if any), caregivers and family; demonstrating competency with assigned tasks; complying with infection prevention and control policies and procedures; reporting changes in the patient’s condition; and honoring patient rights.
If an aide is found to lack competence in communication, an agency should provide in-service training on appropriate communication to patients and caregivers.
After teaching the aide, conduct role-playing scenarios on this. Have the aide document results of patient communication during a mock visit and then call the nurse to discuss.
Preparation is Key
We can help ensure your team is ready for the July 13 CoPs implementation date. Sharon Litwin, founder and senior managing partner at 5 Star Consultants, is giving a four-part webinar series. It details every condition and standard in the new CoPs related to home health. The pre-recorded version of part one is available now to purchase. However, you can still join the remaining three live webinars or in the future purchase these pre-recorded sessions on DVD also. If you are looking for a high-level overview instead, Sharon also has a pre-recorded 90-minute session available on DVD that you can view at your convenience. If you would like further information about either education option, please contact us at [email protected] or 314-952-8392.
Source: Home Health Line, Decision Health, March 13, 2017