Home Health & Hospice

Aide Supervision and One Nursing Visit

Homecare Insider, April 12, 2010

The ins and outs of home health aide supervision can create confusion.  Consider this question.

Can you tell me who is responsible for home health aide assignment and supervision when the physician has ordered only one skilled nursing visit along with physical and occupational therapy and aide services?

Let’s start with the pertinent language from the Conditions of Participation.
§484.36(c):  “Written patient care instructions for the home health aide must be prepared by the registered nurse or other appropriate professional who is responsible for the supervision of the home health aide under paragraph (d) of this section.”
§484.36(d):  “If the patient receives skilled nursing care, the registered nurse must perform the supervisory visits required by paragraph (d)(2) of this section.  If the patient is not receiving skilled nursing care, but is receiving another skilled service (that is, physical therapy, occupational therapy, or speech-language pathology services), supervision may be provided by the appropriate therapist.”

If the physician has ordered one nursing visit, the registered nurse should prepare the assignment for the aide.  After the one nursing visit is completed, the patient is no longer receiving skilled nursing, so the appropriate therapist can assume the supervisory responsibilities.

Don’t forget about the in-service requirement for home health aides.  They must receive 12 hours in a 12-month period.  Home Health Aide On-the-go, Volume 9, covers some important topics related to an agency’s best practices, such as a safe home environment, the heart failure, and stasis ulcers.  To discover how this series can improve the quality of patient care, click on — http://www.beaconhealth.org/item--Home-Health-Aide-On-the-Go-In-service-Volume-9--qoHHAIS9.html.