N.Y. Comp. Codes R. & Regs. Tit. 8 § 64.9 - Advanced Home Health Aides
(a)
Definitions. As used in this section:
(1)
Health services entity means a home care services agency licensed or certified
pursuant to article thirty-six of the public health law, a hospice program
certified pursuant to article forty of the public health law or an enhanced
assisted living residence licensed pursuant to article seven of the social
services law and certified pursuant to article forty-six B of the public health
law.
(2) RN means a registered
professional nurse who is licensed and registered to practice nursing pursuant
to article one hundred thirty-nine of the education law and is employed by a
health services entity to provide nursing services, including the direct
supervision of advanced home health aides or AHHAs, for clients of the health
services entity.
(3) Home care
services worker registry means the New York State home care services worker
registry that is maintained by the department of health pursuant to subdivision
(9) of section thirty-six hundred thirteen of the public health law.
(4) Advanced home health aide or AHHA means a
certified home health aide who has met all requirements to perform advanced
tasks as set forth in subdivision (2) of section sixty-nine hundred eight of
the education law and this section and is currently listed in the home care
services worker registry, as defined in paragraph (3) of this subdivision, as
having satisfied all applicable requirements for performing advanced tasks as
an advanced home health aide.
(5)
Routine medications means medications that are:
(i) prefilled or otherwise packaged in a
manner that promotes relative ease of administration;
(ii) routinely administered to a client with
stable health; and,
(iii)
administered by the following routes only:
(a) oral;
(b) sublingual;
(c) buccal;
(d) ophthalmic;
(e) otic;
(f) nasal;
(g) rectal;
(h) vaginal;
(i) topical; or,
(j) inhaled through the nose or mouth. Stable
health means that a client's physiologic status is not in flux and changes in
health status that require emergency or immediate medical intervention are not
expected or foreseeable.
(6) Advanced tasks mean health care tasks
delineated in subdivision (2) of section sixty-nine hundred eight of the
education law and this section. Provided that if a health services entity has
established a systematic approach to address drug diversion, advanced tasks
shall include the following medication administration tasks:
(i) the administration of routine medications
as defined in paragraph (5) of this subdivision;
(ii) a subcutaneous or intramuscular
injection of low molecular weight heparin or medication prescribed to treat
diabetes; and,
(iii) the use of a
prefilled auto-injector of naloxone or epinephrine in an emergency. Advanced
tasks shall not include:
(i) converting or
calculating the dose of any medication or determining a client's need for
medications;
(ii) medication
administration through enteral feeding tubes, including, but not limited to,
gastrostomy or nasogastric tubes;
(iii) medication administration parenterally,
except for certain routine medications and injections as expressly provided for
in this paragraph;
(iv) tasks
involving the use of intravenous or subcutaneous infusion devices on a client;
(v) tasks involving the use of a
mechanical ventilator on a client;
(vi) tasks involving sterile or aseptic
technique, except for the administration of injections as expressly provided
for in this paragraph;
(vii) tasks
involving professional nursing judgment, observation, monitoring or assessment
of a client; and,
(viii) tasks that
are outside the scope of practice of a licensed practical nurse.
(7) Direct supervision
means the provision by an RN of training, guidance, direction and oversight
relating to the performance of advanced tasks by an AHHA, including periodic
assessment of the AHHA's performance of advanced tasks. Such direct supervision
shall be determined by the RN responsible for supervising such advanced tasks,
based upon the complexity of such advanced tasks, the skill and experience of
the AHHA assigned to perform the advances tasks, and the health status of the
client for whom the advanced tasks are being performed, provided th at, at a
minimum:
(i) the RN, while on duty, shall be
continuously available to speak with the AHHA by telephone and by other means
as appropriate and shall personally visit a client or arrange for another
qualified licensed health professional, such as another RN, to visit the client
whenever necessary to protect the health and safety of the client;
(ii) th e RN performs an initial and
thereafter regular and ongoing assessment of the client's needs;
(iii) the supervising RN or another
supervising RN shall visit the client no less than once every two weeks for the
purpose of supervising the services provided by the AHHA by, among other
things, personally observing, evaluating, and overseeing the provision of such
services.
(8) Client
means a patient, resident or other individual who receives nursing and possibly
other health services from a health services entity in accordance with articles
thirty-six, forty or forty-six-B of the public health law.
(9) Established systematic approach to
address drug diversion means that a health services entity has written policies
and procedures in place to prevent drug diversion and address suspected
incidents of drug diversion, which are periodically reviewed as part of the
entity's quality assurance program.
(10) Case mix complexity and geographic
considerations means the clinical complexity of the clients who are being
served and the geographic distance(s) RNs travel to supervise the AHHAs
providing services that should be considered when assigning AHHAs to care for
client s and for RN supervision.
(b) Assignment of Advanced Tasks. An RN,
while employed by a health services entity, may assign an AHHA to perform one
or more advanced tasks for a client of the health services entity in accordance
with subdivision eight of section sixty-nine hundred nine of the education law
and this section.
(1) Prior to assigning an
AHHA to perform an advanced task for a client, the RN shall:
(i) complete a nursing assessment to as
certain the client's current health status and care needs;
(ii) provide case specific training to the
AHHA and verify that the AHHA can safely and competently perform the advanced
task for the client; and
(ii)
provide to the AHHA written, client specific instructions for performing the
advanced task and criteria for identifying, reporting and responding to
problems, errors or complications. In addition to the foregoing, prior to
assigning an AHHA to administer medications to a client, the RN shall evaluate
the client's current medication use and prescribed drug regimen to identify and
resolve any discrepancies.
(2) The RN shall not assign an advanced task
to an AHHA unless:
(i) the client's health
status is stable;
(ii) the
advanced task to be assigned is consistent with a physician's, nurse
practitioner's or prescriber's ordered or prescribed care;
(iii) the client (or when the client lacks
capacity to consent, a person authorized by law to consent for the client) has
consented to the assignment of advanced tasks to the AHHA;
(iv) the health services entity has written
policies and procedures in effect covering the assignment and performance of
advanced tasks in accordance with applicable law;
(v) the AHHA has demonstrated to the
satisfaction of the supervising RN that he or she can competently perform the
advanced task to be assigned;
(vi)
the AHHA has agreed to perform the advanced task, including, but not limited
to, documenting the performance of the task; and,
(vii) the AHHA is able to communicate
effectively with the client and understands the client's needs.
(3) Multiple authorized RNs
employed by a health services entity may jointly agree to assign one or more
advanced tasks to an AH HA, provided that only one RN shall be required to
determine if the AHHA has demonstrated competency in each advanced task(s) to
be performed in accordance with subsection (b) of this section. An AHHA is not
authorized to modify an assignment or assign or reassign advanced task(s) to
any other individual.
(4) Only a
supervising RN shall be authorized to revoke or modify an assigned advanced
task(s) to be performed by an AHHA.
(5) The RN shall document the assignment
advanced task(s) to each AHHA and any modification or termination of an
assignment in the client's individualized service or care plan or health
record.
(c) Direct
Supervision of AHHAs. An RN, while employed by a health services entity, may
provide direct supervision of an AHHA who performs assigned advanced tasks for
a client of the health services entity. The RN who provides such direct
supervision shall, at a minimum:
(1) be aware
of the client's current health status, health care needs and the client's
individualized plan of care;
(2)
be authorized to assign, revoke or modify assigned advanced tasks to an AHHA in
accordance with this section; and,
(3) consider client care needs, case mix
complexity and geographic considerations to ensure that the number of clients
serviced by the RN is reasonable and prudent. An RN may provide direct
supervision to more than one AHHA at a time.
(d) Performance of Advanced Tasks.
(1) An AHHA, while employed by a health
services entity, may perform one or more advanced tasks for a client of the
health services entity under the direct supervision of an RN, provided that:
(1) an RN assigned the performance of the
advanced task(s) in writing to the AHHA in accordance with subsection (b) of
this section; and,
(2) the AHHA
shall comply with written instructions from an assigning or super vising RN
pertaining to the performance of the advanced task(s) assigned to him or
her.
(2) An AHHA shall
not perform an advanced task if the client refuses the care from the AHHA, or
when the client lacks capacity to consent, a person authorized by law to
consent for the client, refuses the care.
(3) If an AHHA determines that he or she is
unable to perform an advanced task, the AHHA shall promptly notify the
supervising RN.
(4) An AHHA shall
document the performance or nonperformance of each assigned advanced task in
the client's individualized service or care plan or health record.
(5) An AHHA shall not or hold him or herself
out or accept employment as a person licensed to practice nursing pursuant to
article thirty-nine of the education law.
(e) AHHA Training and Competency
Requirements.
To qualify for certification as an AHHA, an individual shall:
(1) be currently listed in the
home care worker registry as having satisfied all applicable requirements for
certification as a home health aide;
(2) have at least one year of experience
providing either home health or personal care services, or a combination of the
same, as a certified home health aide or while working for a home health
services entity;
(3) successfully
complete an approved advanced home health aide training pro gram;
(4) pass one or more department approved
competency examinations; and,
(5)
meet other requirements as determined by the department of health.
(f) Advanced Home Health Aide
Training Programs.
(1) No advanced home
health aide training program shall be offered unless approved by the department
pursuant to this paragraph or by the department of health. To be considered for
approval, the program sponsor shall be currently authorized by the department
or the department of health to offer a certified home health aide training
program. The department may approve a program sponsor to offer an advanced home
health aide training program for terms of up to three years, to be co-terminus
with the approval of the program sponsor's certified home health aide training
program. Program sponsors seeking initial approval or to renew approval to
offer an advanced home health aide training program shall submit a completed
application and information as required by the department, as well as any
applicable fee.
(2) Before being
offered admission into an advanced home health aide training program, the
program sponsor shall, at a minimum, verify that each candidate:
(i) has earned a high school diploma or a
high school equivalency diploma;
(ii) is currently listed in the home care
worker registry as having satisfied all applicable requirements for
certification as a home health aide; and,
(iii) has completed at least one year of
experience providing home health or personal care services, or a combination of
the same, as a certified home health aide or while working for a health
services entity.
(3)
The advanced home health aide training program curriculum shall include at
least eighty hours of didactic classroom and skills laboratory training and at
least forty-five hours of supervised practical training, which shall not be
offered until at least three hours of didactic classroom training have been
provided. The advanced home health aide training program curriculum shall
address at least the following topics:
(i)
the assignment of advanced tasks;
(ii) working with supervising RNs;
(iii) infection control, injections and
injection safety;
(iv)
documentation relating to advanced tasks;
(v) medication administration;
(vi) client communication; and,
(vii) preparation for taking a department
approved competency examination. Supervised practical training shall be
provided in a home care setting in which the student performs advanced tasks
for a client while under the personal supervision of a registered professional
nurse with a minimum of two years of nursing experience, at least on e year of
which must be in home health care.
(4) As a requirement for successful
completion an advanced home health aide training program, the program sponsor
shall ensure that each student has successfully completed a competency
evaluation, as deter- mined by a registered professional nurse, after he or she
has personally observed the student perform the tasks described in
subparagraphs (i) through (vi) of paragraph (3) of this subdivision. The other
topics may be evaluated through written examination, oral examination, or
observation of an AHHA performing tasks. The program sponsor shall notify the
home care services worker registry when a student has successfully completed
the program sponsor's advanced home health aide training program.
(5) The program sponsor shall, upon
notification by the department of health that a student has completed all
requirements for certification as an AHHA, including passing a competency test
required by the department, issue a certificate to the student.
(6) The program sponsor shall maintain, for
at least six years, records relating to the operation of the advanced home
health aide training program, including but not limited to, approved curricula
and curricular changes, faculty, and records that demonstrate that each student
has met all criteria for enrolling in the advanced home health aide training
program and whether the student has completed the program. The program sponsor
shall make such records available to the department upon
request.
Notes
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