Section 410IAC17-14-1. Scope of services

   (a) The home health agency shall provide nursing services by a registered nurse or a licensed practical nurse in accordance with the medical plan of care as follows:

(1) The registered nurse shall perform nursing duties in accordance with the Indiana nurse practice act (IC 25-23). Except where services are limited to therapy only, for purposes of practice in the home health setting, the registered nurse shall do the following:

(A) Make the initial evaluation visit.

(B) Regularly reevaluate the patient's nursing needs.

(C) Initiate the plan of care and necessary revisions.

(D) Initiate appropriate preventive and rehabilitative nursing procedures.

(E) Prepare clinical notes.

(F) Coordinate services.

(G) Inform the physician and other appropriate medical personnel of changes in the patient's condition and needs, counsel the patient and family in meeting nursing and related needs, participate in in-service programs, and supervise and teach other nursing personnel.

(H) Accept and carry out physician, chiropractor, podiatrist, dentist, and optometrist orders (oral and written).

(I) Assist the physician, chiropractor, podiatrist, dentist, or optometrist in evaluating level of function.

(J) Direct the activities of the licensed practical nurse.

(K) Delegate duties and tasks to licensed practical nurses and other individuals as appropriate.

(2) The licensed practical nurse shall perform duties in accordance with the Indiana nurse practice act (IC 25-23). For purposes of practice in the home health setting, the licensed practical nurse shall do the following:

(A) Provide services in accordance with agency policies.

(B) Prepare clinical notes.

(C) Assist the physician and/or registered nurse in performing specialized procedures.

(D) Prepare equipment and materials for treatments observing aseptic technique as required.

(E) Assist the patient in learning appropriate self-care techniques.

(F) Accept and carry out physician, dentist, chiropractor, podiatrist, or optometrist orders (oral and written).

(G) Inform the physician, dentist, chiropractor, podiatrist, or optometrist of changes in the patient's condition and needs after consulting with the supervising registered nurse.

  (b) Any therapy services furnished by the home health agency shall be provided by:

(1) a physical therapist or physical therapist assistant supervised by a licensed physical therapist in accordance with IC 25-27-1; or

(2) an occupational therapist or occupational therapist assistant supervised by an occupation therapist in accordance with IC 25-23.5.

(3) a speech-language pathologist or audiologist in accordance with IC 25-35.6.

  (c) The appropriate therapist listed in subsection (b) of this rule shall:

(1) Make an initial evaluation visit to the patient for whom only therapy services are required.

(2) Review the plan of care as often as the severity of the patient's condition requires, but at least every two (2) months.

(3) Assist the physician, chiropractor, podiatrist, dentist, or optometrist in evaluating level of function.

(4) Help develop the plan of care (revising as necessary).

(5) Prepare clinical notes.

(6) Advise and consult with the family and other home health agency personnel.

(7) Participate in in-service programs.

  (d) In carrying out the responsibilities identified in subsection (c) of this rule the therapist may:

(1) direct the activities of any therapy assistant; or

(2) delegate duties and tasks to other individuals as appropriate.

  (e) Any social services furnished by the home health agency, shall be provided by a social worker, or a social work assistant under the supervision of a social worker, and in accordance with the medical plan of care. The social worker shall do the following:

(1) Assist the physician and other team members in understanding the significant social and emotional factors related to the health problems.

(2) Participate in the development of the plan of care.

(3) Prepare clinical and progress notes.

(4) Work with the family.

(5) Use appropriate community resources.

(6) Participate in discharge planning and in-service programs.

(7) Act as a consultant to other home health agency personnel.

(8) Accept and carry out physician orders for social work services.

  (f) This rule does not prohibit the provision of:

(1) homemaker services, including shopping, laundry, cleaning, and seasonal chores;

(2) companion type services, including transportation, letter writing, mail reading, and escort services;

(3) assistance with cognitive tasks, including managing finances, planning activities, and making decisions;

(4) attendant care services; or

(5) any other services for which an individual license, certification, registration, or permit is not required under state law.

  (g) Home health aides shall be supervised by a health care professional to ensure competent provision of care. Supervision of services must be within the scope of practice of the health care professional providing the supervision.

  (h) Home health aides must receive continuing education. Such continuing education shall total at least twelve (12) hours from January 1 through December 31, inclusive, with a minimum of eight (8) hours in any eight (8) of the following subject areas:

(1) Communications skills, including the ability to read, write, and make brief and accurate oral presentations to patients, caregivers, and other home health agency staff.

(2) Observing, reporting, and documenting patient status and the care or service furnished.

(3) Reading and recording temperature, pulse, and respiration.

(4) Basic infection control procedures and universal precautions.

(5) Basic elements of body functioning and changes in body function that must be reported to an aide's supervisor.

(6) Maintaining a clean, safe, and healthy environment.

(7) Recognizing emergencies and knowledge of emergency procedures.

(8) The physical, emotional, and developmental needs of and ways to work with the populations served by the home health agency, including the need for respect for the patient, the patient's privacy, and the patient's property.

(9) Appropriate and safe techniques in personal hygiene and grooming that include the following:

(A) Bed bath.

(B) Bath, sponge, tub, or shower.

(C) Shampoo, sink, tub, or bed.

(D) Nail and skin care.

(E) Oral hygiene.

(F) Toileting and elimination.

(10) Safe transfer techniques and ambulation.

(11) Normal range of motion and positioning.

(12) Adequate nutrition and fluid intake.

(13) Medication assistance.

(14) Any other task that the home health agency may choose to have the home health aide perform.

  (i) During a home health aide's first year on the state's home health aide registry, the number of hours of training for that aide shall be a prorated portion of the usual twelve (12) and eight (8) hours.

  (j) A home health aide continuing education program may be offered by any organization except a home health agency that has a probationary home health agency license.

  (k) The training of home health aides pursuant to a continuing education program must be performed by or under the general supervision of a registered nurse. The home health agency shall maintain sufficient documentation to demonstrate that the continuing education requirements are met.

  (l) The home health agency shall be responsible for ensuring that, prior to patient contact, the individuals who furnish home health aide services on its behalf meet the requirements of this section as follows:

(1) The home health aide shall:

(A) have successfully completed a competency evaluation program that addresses each of the subjects listed in subsection (h) of this rule; and

(B) be entered on and be in good standing on the state aide registry.

(2) The home health agency shall maintain documentation, which demonstrates that the requirements of this subsection and subsection (h) of this rule were met.

(3) If the home health agency issuing the proof of the aide's achievement of successful completion of a competency evaluation program is not the employing agency, the employing agency shall keep a copy of the competency evaluation documentation in the home health aide's employment file.

  (m) The home health aide shall be assigned to a particular patient by a registered nurse (or therapist in therapy only cases). The home health aide may not be assigned to perform additional tasks not included in the original competency evaluation until he or she has successfully been evaluated as competent in that task. The home health aide must report any changes observed in the patient's conditions and needs to the supervisory nurse or therapist.

  (n) A registered nurse, or therapist in therapy only cases, shall make the initial visit to the patient's residence and make a supervisory visit at least every thirty (30) days, either when the home health aide is present or absent, to observe the care, to assess relationships, and to determine whether goals are being met. (Indiana State Department of Health; 410 IAC 17-14-1; filed Mar 18, 2002, 3:40 p.m.: 25 IR 2487; errata filed Mar 28, 2002, 4:28 p.m.: 25 IR 2522; readopted filed Jul 14, 2008, 2:14 p.m.: 20080806-IR-410080322RFA; readopted filed Sep 10, 2014, 2:08 p.m.: 20141008-IR-410140299RFA)