Oregon Oregon Health Authority, Public Health Division
The agency shall provide skilled nursing service by or under the supervision of a registered nurse in accordance with agency policies and the plan of treatment. Such services shall comply with applicable laws. For the purposes of this rule, “critical and fluctuating” means a situation where the patient’s clinical or behavioral state is of a serious nature, expected to rapidly change, and in need of continuous reassessment and evaluation.(1) Registered Nurse’s Duties: The registered nurse shall make the initial visit, regularly reevaluate the patient’s nursing needs, initiate appropriate preventive and rehabilitative nursing procedures, provide those services requiring substantial specialized nursing skills, prepare clinical and progress notes, coordinate services, inform the physician or allowed practitioner and other personnel (including paid caregivers) of changes in the patient’s condition and needs, counsel the patient, family or other caregivers (as applicable) in meeting nursing and related needs, participate in in-service programs, and supervise, teach, and assign care tasks to other nursing personnel. The registered nurse may delegate aspects of patient care to unlicensed individuals in accordance with OAR chapter 851, division 047.(a) Supervision of the licensed practical nurse shall include:(A) Initial evaluation of the patient to identify appropriate tasks to be performed by the licensed practical nurse. These tasks shall be documented in the patient’s clinical record; and(B) A supervisory visit every 60 days when the patient’s condition is stable and predictable, and at least every two weeks when the patient’s condition is critical and fluctuating. This visit shall be made either when the licensed practical nurse is present to observe and assist or when the licensed practical nurse is absent, to assess relationships and determine that goals are being met. Documentation of these activities shall be maintained in the patient’s clinical record.(b) Home Health Aide Supervision: The registered nurse is responsible for supervising for quality and appropriateness of care provided by the home health aide service. The registered nurse shall be readily available to the home health aide by telephone at all hours services are provided. Supervisory visits by the registered nurse or therapist shall be documented in the patient’s clinical record.(A) When skilled nursing services and home health aide services are being furnished to the patient, the registered nurse shall make a supervisory visit to the patient’s residence at least every two weeks, either when the home health aide is present to observe and assist, or when the home health aide is absent to assess relationships and determine if goals are being met.(B) If a patient is receiving only skilled therapy services and home health aide services, a skilled therapist may make the supervisory visits at least every two weeks, in lieu of a registered nurse. The therapist must convey information about the performance of the home health aide to the aide’s registered nurse supervisor.(C) When only home health aide services are being furnished to a patient, a registered nurse must make a supervisory visit to the patient’s residence at least once every 60 days. Each supervisory visit must occur when the aide is furnishing patient care.(2) Licensed Practical Nurse:(a) Duties: The licensed practical nurse shall provide services in accordance with agency policies, prepare clinical and progress notes, assist the physician or allowed practitioner or registered nurse in performing specialized procedures, prepare equipment and materials for treatments, observe aseptic techniques as required, and assist the patient in learning designated self-care techniques.(b) Supervision of Licensed Practical Nurse: A licensed practical nurse shall provide services only under the supervision of a registered nurse.(3) Home Health Aide: When an agency provides or arranges for home health aide service, an aide shall be assigned if the plan of treatment, as described in OAR 333-027-0090 (Plan of Treatment), specifies that the patient needs personal care. Home health aide services shall be provided under the supervision of the registered nurse and in accordance with the registered nurse’s assignment and agency policies.(a) The duties of a home health aide shall include:(A) Performance of simple procedures as assigned by the registered nurse;(B) Personal care;(C) Ambulation and exercise;(D) Household services essential to health care at home;(E) Assistance with medications that are ordinarily self-administered;(F) Reporting changes in the patient’s condition and needs; and(G) Completing appropriate records.(b) A home health aide must have the following qualifications:(A) Oregon Certified Nursing Assistant (CNA) certification and inclusion on the Oregon State Board of Nursing Nurse Aide Registry.(B) Prior to providing care to a patient, the home health aide must be evaluated by a registered nurse for competency in each of the following areas:(i) Communication skills;(ii) Observation of, reporting of, and documentation about the patient and care provided;(iii) Maintenance of a clean, safe and healthy environment;(iv) Basic infection control procedures;(v) Basic nutrition and fluid intake, including food preparation techniques as appropriate;(vi) Reading and recording temperature, pulse, and respiration;(vii) Basic elements of body functioning and changes in body function that must be reported to an aide’s supervisor;(viii) Recognizing emergencies and knowledge of emergency procedures;(ix) The physical, emotional, and developmental needs of, and ways to work with, the populations served by the agency, including the need for respect for the patient, the patient’s privacy, and the patient’s property;(x) Appropriate and safe techniques in personal hygiene and grooming that include:(I) Bed bath;(II) Sponge, tub, or shower bath;(III) Shampoo: sink, tub, or bed;(IV) Nail and skin care;(V) Oral hygiene; and(VI) Toileting and elimination.(xi) Safe transfer techniques and ambulation;(xii) Normal range of motion and positioning; and(xiii) Any other task the agency may choose to have the home health aide perform.(c) Home health aide competency evaluation:(A) An individual may furnish home health aide services on behalf of an agency only after that individual has successfully completed a competency evaluation program that meets the following requirements:(i) The competency evaluation program must address each of the subjects listed in subparagraphs (3)(b)(B)(i) through (xiii) of this rule;(ii) The subject areas listed at subparagraphs (3)(b)(B)(vi), (x), (xi), and (xii) of this rule must be evaluated through observation of the aide’s performance of the tasks with a patient; and(iii) All other subject areas listed in paragraph (3)(b)(B) of this rule may be evaluated through written examination, oral examination, or observation of the aide with a patient.(B) A home health aide is not considered competent in any task for which the aide’s performance is evaluated as unsatisfactory. The aide must not perform that task without direct supervision by a licensed nurse until the aide receives training in the tasks for which the aide’s performance was evaluated as unsatisfactory and passes a subsequent evaluation with a satisfactory rating.(C) A home health aide has not successfully passed a competency evaluation if the aide’s performance is unsatisfactory in more than one of the areas delineated in paragraph (3)(b)(B) of this rule.(D) The agency must maintain documentation that demonstrates that the home health aide has met competency evaluation requirements.(d) Home Health Aide Orientation: The agency shall complete orientation of the home health aide to the agency’s program and document the completion within two weeks of employment. This orientation must include information about:(A) Policies and objectives of the agency;(B) The duties of a home health aide;(C) The functions of other agency personnel and how they relate to each other in caring for the patient;(D) Other community agencies; and(E) Ethics and confidentiality.(e) Training on the Job: In addition to orientation, an agency shall provide the home health aide patient-specific, on-the-job instruction for carrying out procedures that are not transferable to another patient. Such training shall be in accordance with OAR chapter 851, division 061, and shall be documented in the patient’s clinical record.(f) Inservice Training: The agency shall arrange for and document at least 12 hours of in-service training annually. These training sessions shall pertain to the role and responsibilities of the home health aide.(g) Home Health Aide Assignment: The agency shall provide teaching and supervision of the home health aide in accordance with OAR chapter 851, division 061. All assignments for patient care shall be written, prepared by a registered nurse, and updated on a monthly basis, or more often if the patient’s condition requires. Special tasks of nursing care may be delegated by a registered nurse to a home health aide according to the provisions of OAR chapter 851, division 047.