Under the proposed Home Health Conditions of Participation (CoPs), your interdisciplinary team will determine if the RN or therapist is more appropriate for assigning duties and performing aide supervisory visits.
That differs from the existing CoPs, which require RNs to be the clinicians solely responsible for aides (unless patients only received therapy).
Therapists will be able to work closer with aides on areas such as ambulation, transferring, activities of daily living (ADLs) and independent activities of daily living (IADLs). This may be useful in, among other things, keeping patients in their homes and increasing agencies’ star ratings.
These are welcome additions expected in the CoPs. The additions will enable interdisciplinary teams to better function as a whole to improve patient outcomes.
CoPs Tweak How Assignments Can Work
Since aides are required to be competent in all tasks assigned, the proposed CoPs indicate it is important to have an aide’s skills matched to the patient’s needs and provide continuity when possible.
Therefore, the agency can identify aides with training and experience or educate them in the areas in which therapists have primary focus. For example, if a patient is dependent for bathing, the therapist can work with the aide to increase the patient’s independence.
Agencies must provide in-service training to therapists to ensure that when implementing and revising aide assignments, the therapists are knowledgeable of regulations, laws and policies for aides.
Right now, frequent deficiencies are noted in which aides don’t follow assignments. For instance, the plan might indicate the need for an aide to document shower and oral care every visit, but the aide only documents the shower. Another example: the aide documents tasks and procedures not listed on the aide assignment.
Since these can be vulnerable areas for deficiencies, agencies should ensure therapists are educated on the appropriate method to complete the aide assignment and what the aide is required to follow and document.
Supervision of the Aide Changes too
In the proposed CoPs, supervisory visits of aides remain on the same timeframe — no less frequently than every 14 days, and the aide does not have to be present. But unlike the current CoPs, the aide’s supervisor may be a RN or a therapist.
If a potential deficiency in aide service was noted during the supervisory visit, an on-site visit is required to be made with the aide present. This would be performed by the same RN or therapist, who will observe and assess the aide while performing the patient care duties. This will allow agencies to re-teach and reassess skills in which the aide was deficient — and to determine the aide’s competency.
The proposed CoPs add that supervision must ensure aides furnish care in a safe and effective manner. This includes, but is not limited to following the patient’s plan of care for completion of tasks assigned to an aide by the RN or other appropriate skilled professional; maintaining an open communication process with the patient, 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.
The proposed CoPs don’t have a specific requirement for how to document the supervisory visit. Therefore, agencies can update their own supervisory visits to meet these requirements.
Prepare for the Aide Services Condition
When the new CoPs are finalized, your agency will need to:
- Educate therapists about their expanded role with aides. Therapists will need to understand the condition on aide services including the revised aide assignment plans, that they need to make supervisory visits no less frequently than every 14 days and to make on-site visits with the aide if there is a deficiency noted.
- Make sure therapists understand the level of detail required in the aide assignment and that the aide can only do what is on the assignment. For example, the aide cannot make choices between items such as bed, bath or shower. Also, the aide must complete every item on the aide assignment. In addition, the therapist will have to understand that as the patient’s needs change, the aide assignment sheet must be revised and reviewed with the aide.
- Add skills to the aide competency evaluation related to the therapy tasks. For example, add patient-specific directions for things such as range of motion and home exercise program. Before, RNs might have placed these items on an aide assignment, but not provided patient-specific directions.
Also, note that the increased detail of items on the aide care plan could be used in order to give the aide more direction. For example: ambulation with walker within the first floor, or allow the patient to wash her face and arms. This could lead to improved patient outcomes.
Experience the 5 Star Difference
5 Star’s senior managing partner and co-founder, Sharon Litwin, offers over 30 years of experience in the home healthcare industry. Sharon and the 5 Star team can train your staff on quality outcomes as well as on many other home healthcare and hospice topics. To learn more about our services, please contact us at (866) 428-4040 or [email protected]
Source: Home Health Line, Decision Health, November 14, 2016