Title: 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.
VOLUME E (Title 10)