Part 793 - Patient/Family Care Services

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 4010

Section 793.1 - Patient rights

Section 793.1 Patient rights. (a) The governing authority shall establish written policies regarding the rights and responsibilities of the patient and shall ensure the development of procedures implementing such policies to ensure that, as a minimum, the patient has a right to: 

(1) be fully informed of these rights prior to or at the time of admission, verbally and in writing, in a language and manner that the patient understands, as evidenced by written acknowledgment of receipt signed by the patient or the patient’s representative, pursuant to subdivision (b) of this section; 

(2) be given a statement of the services provided by the hospice and covered under the hospice benefit, including any limitations on those services, and of related charges including charges for services not covered by third-party payors or not covered by the hospice basic rate; 

(3) be fully informed of the patient's medical condition; 

(4) adequate, appropriate and timely care and services, including effective pain management and symptom control for conditions relating to the patient’s terminal illness, for the duration of the illness for which hospice was elected; 

(5) be involved in developing his or her hospice plan of care; 

(6) choose his or her attending physician; 

(7) refuse to participate in experimental research; 

(8) refuse medication, care and treatment after being fully informed of and understanding the consequences of such actions; 

(9) voice complaints and recommend changes in policies and services to hospice staff, the New York State Department of Health or any outside representative of the patient's choice. The expression of such complaints by the patient or his/her designee shall be free from restraint, interference, coercion, discrimination or reprisal; 

(10) express complaints about the care and services provided and to have the program investigate such complaints as specified in section 794.1(l) of this Title. The program is responsible for notifying the patient or his/her designee that if the patient is not satisfied by the response the patient may complain to the Department of Health; 

(11) be treated with consideration, respect and full recognition of the patient’s dignity and individuality; 

(12) make independent personal decisions and have knowledge of available choices; 

(13) be assured of confidential treatment of patient records in accordance with applicable state and federal laws; 

(14) be informed of the name and function of any person and/or agency providing care and services;  

(15) receive services and/or continue to receive services without regard to age, race, color, creed, gender, national origin, sexual orientation, disability or source of payment; 

(16) receive services without discontinuation or diminishment because of the inability to pay for care; 

(17) receive written information and assistance with executing advance directives as set forth in Article 29-CC of the Public Health Law and implementing regulations, as well as applicable federal regulations; 

(18) exercise his or her rights without fear of discrimination or reprisal;

(19) have his or her person and property treated with respect and to be free from mistreatment, neglect, or verbal, mental, sexual and/or physical abuse, including injuries of unknown source, and misappropriation of property; and

(20) refuse consent to advanced tasks performed by an advanced home health aide, in which case the hospice shall provide for the performance of such tasks by a registered professional nurse. 

(b) If a patient lacks capacity to exercise these rights, the rights shall be exercised by an individual, guardian or entity legally authorized to represent the patient. 

(c) The governing authority must: 

(1) ensure that all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property, by anyone furnishing services on behalf of the hospice, are reported immediately by hospice employees and contracted staff to the hospice administrator; 

(2) immediately investigate all alleged violations involving anyone furnishing services on behalf of the hospice and immediately take action to prevent further potential violations while the alleged violation is being verified. Investigations and/or documentation of all alleged violations must be conducted in accordance with established procedures; 

(3) take appropriate corrective action in accordance with state law if the alleged violation is verified by the hospice administration or an outside body having jurisdiction, such as the Department of Health or local law enforcement agency; and 

(4) ensure that verified violations are reported to State and local bodies having jurisdiction including the Department of Health within 5 working days of becoming aware of the violation. 

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete

Section 793.2 - Eligibility, Election, Admission and Discharge

793.2 Eligibility, Election, Admission and Discharge.  

The governing authority shall ensure that: 

(a) except as prohibited by Article 45 of the Public Health Law or any other law or regulation, a patient referred to a hospice may be accepted from any source; 

(b) policies and procedures for admission and discharge are developed and implemented; 

(c) any individual admitted to hospice is certified as being terminally ill consistent with state and/or federal definitions. Written certification of terminal illness is required for each election period defined in paragraph (d)(4) of this section. If the hospice cannot obtain the written certification within 2 calendar days after the election period begins, it must obtain an oral certification within 2 calendar days and the written certification before it submits a claim for payment.  

(1) Initial certification of terminal illness must be obtained from either the medical director of the hospice or the physician member of the hospice interdisciplinary group provided for in section 793.4 of this Part, and also from the individual's attending physician, if the individual has an attending physician. In connection with the initial certification, the medical director or physician designee must consider the following: 

(i) diagnosis of the primary terminal condition, along with any supporting current clinically relevant information;  

(ii) related diagnoses, if any, along with any supporting current clinically relevant information;  

(iii) current subjective and objective medical findings;  

(iv) current medication and treatment orders; and  

(v) information about the medical management of any of the patient’s conditions unrelated to the terminal illness.  

(2) Subsequent certifications of terminal illness are obtained from the medical director of the hospice or the physician member of the hospice interdisciplinary group and must be based on the certifying individual’s clinical judgment regarding the normal course of the individual’s illness. 

(3) All certifications must: 

(i) specify that the individual's prognosis is for a life expectancy consistent with applicable state and federal statutes for purposes of payment;  

(ii) include clinical information and other documentation that support the medical prognosis; and  

(iii) be filed in the clinical record.  

(d) an individual who meets the hospice eligibility requirements files an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative as provided for in subdivision (b) of section 793.1 of this Part may file the election statement;  

(1) The election statement shall remain in effect as long as the individual remains in the care of a hospice unless the individual revokes the election in accordance with paragraph 3 of this subdivision or is discharged from the hospice in accordance with subdivision (e) of this section. He/she may at any time file an election if again eligible for hospice care. 

(2) The signed election statement must:  

(i) identify the hospice that will provide care; 

(ii) include the individual's or representative's acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care; and 

(iii) include the effective date of the election, which may be the first day of hospice care or a later date, but no earlier than the date of the election statement. 

(3) An individual or representative may revoke the election of hospice care at any time by filing a signed and dated revocation statement with the hospice. This statement must include the effective date for the revocation. 

(4) An individual may elect to receive hospice care during one or more of the following election periods, which are available in the order listed and may be selected separately at different times: 

(i) an initial 90-day period; 

(ii) a subsequent 90-day period;  

(iii) an unlimited number of subsequent 60-day periods. 

(e) a patient is discharged only if: 

(1) the patient moves out of the hospice's service area or transfers to another hospice; 

(2) the hospice determines that the patient no longer meets the eligibility criteria set forth in subdivision (c) of this section; or 

(3) the hospice determines, under a policy set by the hospice for the purpose of addressing discharge for cause that the patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired.  

(i) The hospice must do the following before it seeks to discharge a patient for cause: 

(a) advise the patient that a discharge for cause is being considered; 

(b) make a serious effort to resolve the problem(s) presented by the patient's behavior or situation; 

(c) ascertain that the patient's proposed discharge is not due to the patient's use of necessary hospice services; and 

(d) document the problem(s) and efforts made to resolve the problem(s) and enter this documentation into the clinical record. 

(ii) prior to discharging a patient, a written discharge order must be obtained from the hospice medical director. If a patient has an attending physician involved in his or her care, this physician should be consulted before discharge and his or her review and decision included in the discharge note. 

(iii) prior to discharging a patient or transferring the patient from one hospice to another, continuing care and services shall be arranged and a discharge summary completed as specified in section 794.4 of this Title. 

Effective Date: 
Wednesday, August 31, 2016
Doc Status: 
Complete

Section 793.3 - Initial and Comprehensive Assessment

793.3 Initial and Comprehensive Assessment. (a) The hospice registered nurse, as a member of the interdisciplinary group identified in section 793.4 of this Part, must complete an initial assessment within 48 hours after the election of hospice care in accordance with section 793.2 of this Part unless the physician, patient, or representative requests that the initial assessment be completed in less than 48 hours. Initial assessment means an evaluation of the patient’s physical, psychosocial and emotional status related to the terminal illness and related conditions to determine the patient’s immediate care and support needs. 

(b) The hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), shall conduct and document in writing a patient-specific comprehensive assessment no later than 5 calendar days after the election of hospice care. Comprehensive assessment means a thorough evaluation of the patient's physical, psychosocial, emotional and spiritual status related to the terminal illness and related conditions including the caregiver's and family's willingness and capability to care for the patient. 

(c) The comprehensive assessment must take into consideration the following factors: 

(1) the nature and condition causing admission (including the presence or lack of objective data and subjective complaints); 

(2) complications and risk factors that affect care planning; 

(3) functional status, including the patient’s ability to understand and participate in his or her own care; 

(4) imminence of death; 

(5) severity of symptoms; 

(6) a review of all of the patient’s prescription and over-the counter drugs, herbal remedies and other alternative treatments that could affect drug therapy. This includes, but is not limited to, identification of the following: 

(i) effectiveness of drug therapy; 

(ii) drug side effects; 

(iii) actual or potential drug interactions; 

(iv) duplicate drug therapy; and  

(v) drug therapy currently associated with laboratory monitoring; 

(7) an initial bereavement assessment of the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment must be incorporated into the plan of care and considered in the bereavement plan of care; and 

(8) the need for referrals and further evaluation by appropriate health professionals. 

(d) The comprehensive assessment must include data elements that allow for measurement of outcomes. The data elements must: 

(1) take into consideration aspects of care related to hospice and palliation; 

(2) be measured and documented in the same way for all patients; 

(3) be an integral part of the comprehensive assessment and documented in a systematic and retrievable way for each patient; 

(4) be used in individual patient care planning and in the coordination of services; and  

(5) be used in the aggregate for the hospice’s quality assessment and performance improvement program. 

(e) The hospice interdisciplinary group must update the comprehensive assessment in collaboration with the individual’s attending physician, if any, as frequently as the condition of the patient requires, but no less frequently than every 15 days. The update must consider changes that have taken place since the initial assessment and include information on the patient’s progress toward desired outcomes, as well as a reassessment of the patient’s response to care. 

Effective Date: 
Wednesday, August 31, 2016
Doc Status: 
Complete

Section 793.4 - Patient Plan of Care, Interdisciplinary Group and Coordination of Care

793.4 Patient Plan of Care, Interdisciplinary Group and Coordination of Care. The governing authority must: 

(a) designate an interdisciplinary group or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. The members of the interdisciplinary group are responsible for providing the care and services offered by the hospice, and the group must collectively supervise the care and services.  

(1) The interdisciplinary group must include, but is not limited to:  

(i) a doctor of medicine or osteopathy (who is an employee or under contract with the hospice); 

(ii) a registered nurse; 

(iii) a social worker; and 

(iv) a pastoral or other counselor. 

(2) The governing authority must designate a registered nurse who is a member of the interdisciplinary group to coordinate care and ensure continuous assessment of each patient’s and family’s needs and implementation of the interdisciplinary plan of care;  

(b) if the hospice has more than one interdisciplinary group, specifically designate an interdisciplinary group to establish policies governing the day-to-day provision of hospice care and services;  

(c) ensure that all hospice care and services furnished to patients and their families follow an individualized written plan of care established by the interdisciplinary group in collaboration with the patient's attending physician, if any, and, if they so desire, the patient or representative and the primary caregiver. The plan of care shall indicate for each patient/family how palliative and supportive care is to be achieved including: 

(1) goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments; 

(2) all services necessary for the palliation and management of the terminal illness and related conditions and the individual(s) who will provide those services, including: 

(i) interventions to manage pain and symptoms; 

(ii) a detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs; 

(iii) measurable outcomes anticipated from implementing and coordinating the plan of care; 

(iv) drugs, biologicals, treatments, medical supplies, appliances and durable medical equipment that must be provided by the hospice while the patient is under hospice care; 

(v) identification of the registered nurse responsible for coordinating care; and 

(vi) documentation in the clinical record of the patient’s or representative’s level of understanding, involvement, and agreement with the plan of care, in accordance with the hospice’s own policies; 

(d) ensure that the hospice interdisciplinary group confers with an individual educated and trained in drug management to ensure that drugs and biologicals meet each patient’s needs;  

(e) ensure that each patient and the primary caregiver(s) receives education and training regarding their responsibilities for the care and services identified in the plan of care followed by an assessment of their ability to provide care including their ability to self-administer drugs and biologicals; 

(f) ensure discussion and written instructions are provided to the patient/family regarding the management and disposal of controlled drugs in the home when controlled drugs are initially ordered and documentation of such in the clinical record;  

(g) ensure that the hospice interdisciplinary group reviews, revises and documents the individualized plan as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. A revised plan of care must include information from the patient’s updated comprehensive assessment, must note the patient’s progress toward the outcomes and goals specified in the plan of care, and must be documented in the clinical record; and 

(h) develop and maintain a system of communication and integration, in accordance with the hospice’s own policies and procedures, to: 

(1) ensure that the interdisciplinary group maintains responsibility for directing, coordinating, and supervising the care and services provided by all hospice and non-hospice healthcare providers; 

(2) ensure that care and services provided are based on all assessments of the patient and family needs; 

(3) provide for and ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement; and 

(4) provide for an ongoing sharing of information with other non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. 

Effective Date: 
Wednesday, August 31, 2016
Doc Status: 
Complete

Section 793.5 - Quality Assessment and Performance Improvement

793.5 Quality Assessment and Performance Improvement  

The governing authority must ensure that the hospice:  

(a) develops, implements, and maintains an ongoing, effective, hospice-wide data-driven program for quality assessment and performance improvement, which shall be evaluated annually. The program must:  

(1) reflect the complexity of the hospice organization and services;  

(2) involve all hospice services, including those services furnished under contract or arrangement, and all locations;  

(3) include the use of quality indicator data in the design of the program, which focuses on improved palliative and end of life outcomes;  

(4) take actions to demonstrate improvement in hospice performance;  

(5) address priorities for improved quality of care and patient safety; and  

(6) be capable of showing measurable improvement in indicators related to improved palliative outcomes and hospice services.  

(b) maintains documentary evidence of the program, and be capable of demonstrating its operation;  

(c) designates one or more individual(s) responsible for operating the program;  

(d) designates a committee which includes licensed professionals, representative of the services provided by the hospice, and administrative personnel to participate in and make recommendations to the governing authority regarding the quality program and perform other quality management activities including:  

(1) review of quality assessment and performance improvement efforts, at least annually, and in collaboration with the hospice interdisciplinary group recommend revisions to the governing authority, as necessary, of policies and procedures;  

(2) review of patient care records for appropriateness of admission, adequacy of assessment of patient/family needs and quality and quantity of services provided;  

(3) review of complaints and other investigations; and 

(4) review of the effectiveness of the hospice’s infection control program, including appropriate identification of infection and communicable disease transmission and control problems and plans for appropriate corrective action, improvement and subsequent prevention.  

(e) measures, analyzes, and tracks quality indicators, including adverse patient events and/or potentially avoidable events and other aspects of performance, in the frequency and detail approved by the governing authority. The data shall include patient care data and other relevant data reflective of the hospice operation, the quality of all services provided and all activities that may impact patient care and must enable the hospice to:  

(1) assess processes of care, hospice services, and operations;  

(2) monitor the effectiveness and safety of services and quality of care; and  

(3) identify opportunities and priorities for improvement.  

(f) develops, implements and evaluates performance improvement projects conducted annually, sufficient in number and scope to reflect the hospice’s population, internal organizational needs, and scope, complexity and past performance of services and operation, using quality indicator data collected. These projects must:  

(1) focus on high risk, high volume, or problem-prone areas;  

(2) consider incidence, prevalence, and severity of problems in those areas;  

(3) take actions aimed at performance improvement in palliative outcomes, patient safety, and quality of care;  

(4) measure the success of such actions and track performance to ensure that improvements are sustained; 

(5) track and analyze the cause of any adverse patient event;  

(6) implement preventive actions and mechanisms that include feedback and learning throughout the hospice; and 

(7) be documented by the hospice including the reasons for conducting the project and the measurable progress achieved. 

Effective Date: 
Wednesday, August 31, 2016
Doc Status: 
Complete

Section 793.6 - Infection Control

793.6 Infection Control. The hospice must: 

(a) implement and enforce an agency wide program for the surveillance, identification, prevention, control and investigation of infectious and communicable diseases, which could result in staff, volunteers, visitors, or patients and family members becoming exposed to such communicable diseases or infections. Such a program shall include: 

(1) policies and procedures for maintaining and documenting an effective infection control program in all settings where patients reside, including but not limited to protocols for addressing patient care issues and prevention of infection related to airborne pathogens, infusion therapy, urinary tract care, respiratory tract care, wound care and multi-drug resistant organisms;  

(2) following accepted standards of practice to prevent transmission of infections and communicable disease;  

(3) monitoring staff for compliance with hospice policies and procedures related to infection control;  

(4) protocols for educating staff, contracted personnel, patients, families and other caregivers in infectious disease transmission, standard precautions and the prevention and control of infection; and 

(5) a specific program for protecting patients, staff and families from bi-directional spread of HIV and other blood borne pathogens, as specified in subdivision (b) of this section. 

(b) assure that a program be implemented and enforced for the prevention of circumstances which could result in staff, including housekeeping, direct care staff and volunteers, or patients and family members becoming exposed to significant risk body substances which could put them at significant risk of HIV infection, as defined in section 63.1 of this Title, or other blood borne pathogen infection, during the provision of services. Such a program shall include: 

(1) use of scientifically accepted protective barriers during job-related activities which involve, or may involve, exposure to significant risk body substances. Such preventative action shall be taken by the staff with each patient and shall constitute an essential element for the prevention of bi-directional spread of HIV or other blood borne pathogens.  

(2) use of scientifically accepted preventive practices during job-related activities which involve the use of contaminated instruments or equipment which may cause puncture injuries; 

(3) training at the time of employment and yearly staff development programs on the use of protective equipment, preventive practices, and circumstances which represent a significant risk for all employees whose job-related tasks involve, or may involve, exposure to significant risk body substances; 

(4) provision of personal protective equipment for staff which is appropriate to the tasks being performed; and 

(5) a system for monitoring preventive programs to assure compliance and safety. 

(c) implement and enforce a policy/procedure for the management of individuals who are exposed to significant risk body substances under circumstances which constitute significant risk of transmitting or contracting HIV or other blood borne pathogen infection. The policy/procedure shall include: 

(1) a system for reporting to a designated individual in the hospice any exposure thought to represent a circumstance which constitutes significant risk of transmitting or contracting HIV or other blood-borne pathogen infection; 

(2) evaluation of the circumstances of a reported exposure and services providing follow-up of the exposed individual which includes: 

(i) medical and epidemiological assessment of the individual who is the source of the exposure, where that individual is known and available; 

(ii) if indicated epidemiologically, HIV or other blood-borne pathogen counseling and voluntary testing of the source individual. Disclosure of the HIV status of the source individual can be made, consistent with Article 27-F of Public Health Law and Part 63 of this Title, with the express written consent of the protected individual, or a person authorized pursuant to law to consent to health care for the protected individual if such person lacks capacity to consent, or pursuant to court order, if the HIV status is not known to the exposed individual;  

(iii) appropriate medical follow-up of the exposed individual; and 

(iv) assurances for protection of confidentiality for those involved in reported exposures. 

Effective Date: 
Wednesday, August 31, 2016
Doc Status: 
Complete

Section 793.7 - Staff and services

793.7 Staff and services. (a) At a minimum, hospice staff shall be composed of: 

(1) a hospice administrator who is appointed by the governing authority and is an employee of the hospice who works a minimum of half-time for the hospice. The administrator is responsible for the day-to-day management of the hospice. 

(2) a hospice medical director who is:  

(i) a doctor of medicine or osteopathy who is licensed and registered to practice in New York State or maintains a current license and who is an employee or is under contract with the hospice. When the medical director is not available, a physician designated by the hospice shall assume the same responsibilities and obligations as the medical director; and  

(ii) responsible for supervision of all physician employees and physicians under contract; 

(3) a hospice nurse coordinator; 

(4) a hospice social worker; 

(5) a pastoral care coordinator; and 

(6) a coordinator of volunteer services, whose responsibilities shall include:  

(i) ensuring implementation of policies and procedures related to volunteer services; 

(ii) providing and documenting volunteer orientation and training;  

(iii) ensuring that volunteers are used in defined administrative or direct patient care roles under the supervision of a designated hospice employee; 

(iv) ongoing efforts to recruit and retain volunteers; and  

(v) demonstrating and documenting cost savings achieved through the use of volunteers including: 

(a) identification of each position that is occupied by a volunteer and his or her work time; and 

(b) estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions. Volunteers must provide services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract staff.  

(b) As the needs of the patient dictate, the hospice shall provide the following services: 

(1) core services, which include nursing, physician, medical social services, dietary, bereavement and spiritual or pastoral care counseling; and  

(2) non-core services which include physical therapy, occupational therapy, speech and language pathology, audiology, respiratory therapy, psychological, drugs and biologicals, laboratory, medical supplies, equipment and appliances, home health aide, personal care, housekeeper, homemaker, and inpatient services. 

(c) With the exception of physician services, core services must routinely be provided directly by hospice employees. A hospice may use contracted staff only if necessary to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances such as unanticipated periods of high patient loads, staffing shortages due to illness or other short-term temporary situations that interrupt patient care such as natural disasters and temporary travel of a patient outside the hospice’s service area. 

(d) Non-core services as specified in subdivision (b) of this section may be provided directly by the hospice or under contractual arrangements made by the hospice as specified in section 794.2 of this Title.  

(e) Physician, nursing, medical social services counseling and volunteer services shall be provided by the same health care practitioners to the same patient and family, whenever possible. 

(f) Nursing services, physician services and drugs and biologicals must be routinely available on a 24-hour basis, 7 days a week. Other services must be available on a 24-hour basis when reasonable and necessary to meet the needs of the patient and family.  

(g) The hospice medical director, physician employees, and contracted physician(s) of the hospice, in conjunction with the patient’s attending physician, must assume responsibility for the palliation and management of the terminal illness and conditions related to the terminal illness. If the attending physician is unavailable, the medical director, contracted physician, and/or hospice physician employee is responsible for meeting the medical needs of the patient. 

(h) Nursing care and services must be provided by or under the supervision of a registered nurse in accordance with patient assessments and plans of care:  

(1) Nursing services in the home shall be provided by or under the direction of hospice personnel who meet the requirements of community health nurse as defined in section 700.2 of this Title.  

(2) Highly specialized nursing services that are provided so infrequently that the provision of such services by direct hospice employees would be impracticable and prohibitively expensive, may be provided under contract. 

(3) Registered nurses certified as nurse practitioners may treat and write orders for hospice patients to the extent permitted by New York State Education Law. 

(i) Medical social services must be provided by a qualified social worker, under the direction of a physician. Medical social services must be based on the patient’s psychosocial assessment and the patient’s and family’s needs and acceptance of services. 

(j) Counseling services must be available to the patient and family to assist the patient and family in minimizing the stress and problems that arise from the terminal illness, related conditions, and the dying process. Counseling services must include, but are not limited to: 

(1) an organized program of bereavement counseling furnished under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services shall be available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient;  

(2) dietary counseling performed by a qualified individual, which include dietitians as well as nurses and other individuals who are able to address and assure that the dietary needs of the patient are met; and  

(3) spiritual counseling which is provided in accordance with the patient’s and family’s acceptance of this service, and in a manner consistent with patient and family beliefs and desires. All reasonable efforts should be made to facilitate visits by local clergy, pastoral counselors, or other individuals who can support the patient’s spiritual needs to the best of their ability. 

(k) All aide services must be provided by individuals who:  

(1) have successfully completed a home health aide training and competency evaluation program as required by paragraph (9) of subdivision (b) of section 700.2 or this Part or an advanced home health aide training program as required by paragraph (54) of subdivision (b) of section 700.2 of this Part; and  

(2) are currently listed in good standing on the Home Care Registry in the State. 

(l) Aide services must be ordered by a member of the interdisciplinary team, included in the plan of care and consistent with training and tasks permitted to be performed by home health aides, including but not limited to personal care and simple procedures as an extension of nursing or therapies or, in the case of advanced home health aide services, ordered by a physician, assigned by the supervising registered professional nurse, included in the plan of care and consistent with training and advanced tasks permitted to be performed by advanced home health aides.  

(m) A registered nurse who is a member of the interdisciplinary group must make patient assignments, prepare written patient care instructions and provide supervision of aides.  

(n) A registered nurse must make an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. 

(1) The aide should be present during the registered nurse’s on-site visit periodically, but no less frequently than every ninety days, or more frequently if an area of concern is noted by the supervising nurse. 

(2) If an area of concern is verified by the nurse during the on-site visit, then the hospice must conduct, and the aide must successfully complete a competency evaluation.  

(3) The supervising nurse must assess an aide’s ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include, but are not limited to:  

(i) following the patient’s plan of care for completion of tasks assigned to the aide by the registered nurse;  

(ii) creating successful interpersonal relationships with the patient and family;  

(iii) demonstrating competency with assigned tasks;  

(iv) complying with infection control policies and procedures;  

(v) reporting changes in the patient’s condition; and 

(vi) completing appropriate records and documentation of care provided. 

(o) The hospice must ensure that staff are adequately supervised. The department shall consider the following factors as evidence of adequate supervision: 

(1) supervision of nursing personnel is conducted by a supervising nurse; 

(2) personnel regularly provide services at the frequencies specified in the patient's plan of care, and in accordance with the policies and procedures of their respective services; 

(3) personnel are assigned to the care of patients in accordance with their licensure, as appropriate, and their training, orientation and demonstrated skills; 

(4) clinical records are kept complete, and changes in patient condition, adverse reactions, and problems with informal supports or home environment are charted promptly and reported to supervisory personnel; 

(5) plans of care are revised as determined by patient condition, and changes are reported to the authorized practitioner and other personnel providing care to the patient; 

(6) in-home visits are made by supervisory personnel to direct, demonstrate and evaluate the delivery of patient care and to provide clinical consultation; 

(7) professional guidance on agency policies and procedures is provided; 

(8) supervision of a home health aide is conducted by a registered professional nurse;  

(9) in-home supervision, by professional personnel, of home health aides takes place:

(i) to demonstrate to and instruct the aide in the treatments or services to be provided, with successful re-demonstration by the aide during the initial service visit, or where there is a change in personnel providing care, if the aide does not have documented training and experience in performing the tasks prescribed in the plan of care;

(ii) to evaluate changes in patient condition reported by the aide and initiate any revision in the plan of care which may be needed; and

(iii) to instruct the aide as to the observations and written reports to be made to the supervising nurse; and

(10) direct supervision of an advanced home health aide is conducted by a registered professional nurse who:

(i) provides training, guidance, direction and oversight, and evaluation related to the performance of advanced tasks by the advanced home health aide;

(ii) assigns advanced tasks to be performed by the advanced home health aide after completing a nursing assessment to determine the patient’s current health status and care needs;

(iii) provides case specific training to the advanced home health aide to verify and ensure the advanced home health aide can safely and competently perform the advanced tasks for the patient;

(iv) provides written, patient specific instructions for performing advanced tasks, including the criteria for identifying, reporting, and responding to problems, errors or complications;

(v) conducts a comprehensive medication review including evaluation of the patient’s current medication use, and prescribed drug regimen and identifies and resolves any discrepancies prior to assigning the advanced home health aide to administer medications;

(vi) determines direct supervision of the advanced home health aide based on the complexity of advanced tasks, the skill and experience of the advanced home health aide assigned to perform the advanced tasks, and the health status of the patient for whom the advanced tasks are being performed;

(vii) while on duty is continuously available to communicate with the advanced home health aide by phone or other means;

(viii) conducts home visits or arranges for another qualified registered professional nurse whenever necessary to protect the health and safety of the patient;

(ix)  performs an initial and ongoing assessments of the patient’s needs; and

(x) conducts a home visit at least every two weeks and more frequently as determined by the registered professional nurse, to observe, evaluate, and oversee services provided by the advanced home health aide;

(11) a process is in place to document the limitation or revocation of the assignment of advanced tasks by an advanced home health aide when deemed appropriate by a supervising registered professional nurse and to ensure that such information is available to other registered professional nurses that may supervise such aide; and

(12) any failure by a supervising registered professional nurse to comply with the requirements of paragraph ten of this subdivision shall be reported to the department.

(p) Homemaker services shall be provided to assist in patient care. A qualified homemaker is an individual who has successfully completed hospice orientation and training in the tasks to be performed.  

(1) Homemaker services must be assigned, coordinated and supervised by a member of the interdisciplinary group.  

(2) Homemakers must report all concerns about the patient or family to the member of the interdisciplinary group and complete appropriate documentation of care provided. 

Effective Date: 
Wednesday, December 12, 2018
Doc Status: 
Complete