Agencies Should Involve Aides as Part of their Interdisciplinary Team

Educate home health aides about skin condition changes. That’s one step your agency could take immediately to prepare for the revised aide services condition included within the proposed Home Health Conditions of Participation (CoPs).

CMS is expected to finalize the CoPs in the coming months, and agencies that don’t comply could be cited on surveys.

Agencies should work with aides to ensure they recognize and report changes in skin condition, including pressure ulcers. Due to the personal care they provide patients, aides are more likely to be the first to notice skin condition changes and early stage pressure ulcers. This then could allow early intervention by clinicians in order to treat or reverse the changes.

Some requirements in the new condition involving aides, §484.80, will be more stringent than what’s currently expected of aides. But CMS’ expectations also are more practical and help promote an interdisciplinary approach.

The proposed CoPs include the aide as part of the interdisciplinary team, allow therapists to supervise aides, enhance aides’ skills and increase options for an aide to be qualified for home health. With revisions of policies and procedures, education to staff, revisions to content of competency evaluations and supervisory visits, agencies can be prepared for these upcoming changes.

CoPs Enhance Communication Skills

CMS has recognized aides often see patients more frequently than clinicians and therefore are in a position to observe the changes in a patient’s status. Under the proposed CoP, aides must report changes in the patient’s condition to an RN or other appropriate skilled professional, and they must be taught to identify any changes that may need to be reported.

Communication skills and recognizing and reporting changes in skin condition will be part of the aide training and included as skills evaluated in the competency program.

Although the current CoPs state that communication skills are part of aide training, this has been expanded to include the aide’s ability to read, write and verbally report clinical information to patients and caregivers, as well as to other agency staff. Since aides are part of the interdisciplinary team, the aide must communicate effectively to the team as well as the patient. Therefore, communication is to be enhanced in aide training, and subsequently in the agency.

Although many aides report clinical information — such as if the patient has more pain — to the RN, by adding this enhanced portion of training and competency evaluation, all aides will understand the importance of communication and their role in the interdisciplinary team.

Reporting Change in Skin Condition is Required

The proposed CoPs also include a new requirement for the aide to recognize and report a change in the patient’s skin condition, including pressure ulcers.

Reporting on these changes to the RN or appropriate professional staff must now be a part of the aide care plan.

The aide must have completed training and competency evaluation prior to being deemed competent to work independently on patients.

Current CoPs do not include this specific skill. However, an agency can assign other tasks, such as checking the patient for pressure ulcers, to the aide. Now all agencies and aides must comply with this change.

Changes Include Training, Evaluations

The new CoPs also make it acceptable to conduct aide training on a mannequin and to conduct competency evaluations on a “pseudo-patient,” such as a volunteer whose age is representative of the primary population served by the agency.

This will enable agencies to more easily complete skills competency for the aide. However, the tasks on pseudo-patients must be completed as if on an actual patient, thus restricting the ability to complete all skills competency with a pseudo patient.

RNs must supervise these evaluations as well as follow-up evaluations if the aide is deemed unsatisfactory on a task. Such a task must be performed again under an RN’s supervision until the aide achieves a “satisfactory” evaluation.

Steps to Prepare for the New CoPs

  • Update your aide job description. You’ll want to hire someone with effective oral and written communication skills for reporting and recording clinical findings to other interdisciplinary team members, patients, caregivers and/or representatives.
    The job description also should include: Ability to make observations for a change in patient status including skin condition changes for pressure ulcers; ability to coordinate with other professional staff when there is a need to revise the aide care plan; and ability to participate in interdisciplinary case conferences.
  • Change your policies and forms. The supervisory visit policy should be updated to include that if a deficiency is noted, an on-site visit with the aide present would be made by an RN.   Also update your competency testing checklist, aide care plan, aide visit note and supervisory visit note to include observations in patient status, including changes in skin condition for pressure ulcers. Also add a communication section to report to professional staff.
  • Update training and competency evaluations. Training should be updated with observing, reporting and documenting the patient’s skin for changes, development of pressure ulcers and changes in patient status. There also should be training to ensure aide’s communication skills are compliant to verbally and in writing report clinical information to patients and caregivers, as well as appropriate professional staff.   Competency testing, meanwhile, should include direct observation of the aide to include the aide’s ability to observe, report and document changes in patient status and skin condition.
  • Revise your aide competency evaluations to include age appropriate pseudo-patients for the aide to complete certain tasks. This may be another member of your agency, or a volunteer.

The last change to CoPs was in 1997. However, stay tuned for updates coming your way this November. Our expert team at 5 Star Consultants is always current on changes in the industry. We can help to keep your team up-to-date too with our onsite or virtual education programs. Contact us today at [email protected] or (866) 428-4040 to learn more.

Source:  Home Health Line, Decision Health, September 26, 2016

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