Overview Of Home Health, Home Services, And Home Nursing .
Overview of Home Health, HomeServices, and Home NursingServices
Overview of Home Health, Home Services, and Home Nursing ServicesPageOverview . 2Nursing and Therapy Services . 4Home Health Aide and Home Services Worker Services . 6Observation and Reporting . 6Companionship Services . 7Housekeeping Services. 7Skin Care . 7Ambulation . 7Bathing . 8Dressing . 8Exercise. 8Feeding . 9Hair Care . 9Mouth Care . 9Nail Care . 9Positioning . 10Shaving . 10Toileting. 10Transfers . 11Medication Reminding . 12Respiratory Care . 13DISCLAIMER: The information contained in this document is provided for informationalpurposes only, and should not be construed as legal advice on any subject matter. Theprovision of this document does not constitute legal advice or opinions of any kind. An entitylicensed under the Home Health, Home Services, and Home Nursing Agency Licensing Act (210ILCS 55/) should not act or refrain from acting on the basis of any content included in thisdocument without seeking its own legal or other professional advice. The content of thisdocument is general information and may not reflect current legal developments, addressspecific situations, or contain an exhaustive list of all relevant regulations. Reliance on thisdocument shall not serve as a defense to any enforcement action taken by the IllinoisDepartment of Public Health or any other state or federal agency. Reliance on this documentshall not indemnify an entity licensed under the Home Health, Home Services, and HomeNursing Agency Licensing Act (210 ILCS 55/) against any liability or wrongdoing.
OverviewHome Health AgencyHome Nursing AgencyHome Services AgencyStatutoryDefinitionA public agency or private organization thatprovides skilled nursing service and at leastone other home health service. 210 ILCS55/2.04An agency that provides services directly, oracts as a placement agency, to deliverskilled nursing and home health aideservices to people in their personalresidences. 210 ILCS55/2.11An agency that provides services directly, oracts as a placement agency, for the purposeof placing individuals in a client’s personalresidence to provide home services. 210ILCS 55/2.08Service Areas Part-time or intermittent nursing service Services that would require an individuallicensed under the Nursing and AdvancedPractice Nursing Act to work on a shiftschedule, one-time, full-time or part-timeand/or intermittent basis Non-medical services Physical therapy Occupational therapy Speech therapy Medical social services Home health aide services Home health aide services under thesupervision of a registered nurse Full list located in “Nursing and TherapyServices” and “Home Health Aide andHome Services Worker Services” Full list located in “Nursing and TherapyServices” and “Home Health Aide andHome Services Worker Services” Assistance with activities of daily living(ADL) Housekeeping Medication reminding Cooking Shopping Assistance with transportation Maintenance of household records Personal laundry Companionship Excludes skilled services and ADLassistance that requires the skills of ahome health aide under the supervisionof a registered nurse Full list located in “Home Health Aide andHome Services Worker Services”AgencyPersonnel Registered Professional Nurses andLicensed Practical Nurses Registered Professional Nurses Home Services Workers Physical Therapists and Assistants Licensed Practical Nurses Advanced Practice Nurses Certified Nursing Assistant s (CNAs)(scope of practice restricted to home2
Home Health Agency Occupational Therapists and AssistantsHome Nursing Agency Home Health Aides (CNAs)Home Services Agencyservices worker scope) Speech-Language Pathologists Social Workers and Assistants Home Health Aides (CNAs)Laws andRegulations Nurse Practice Act: 225 ILCS 65/68 Ill. Adm. Code 1300 Nurse Practice Act: 225 ILCS 65/68 Ill. Adm. Code 1300 Home Health, Home Services, and HomeNursing Agency Act: 210 ILCS 5577 Ill. Adm. Code Part 245 Home Health, Home Services, and HomeNursing Agency Act: 210 ILCS 5577 Ill. Adm. Code Part 245 Home Health, Home Services, and HomeNursing Agency Act: 210 ILCS 5577 Ill. Adm. Code Part 245 Illinois Occupational Therapy Practice Act225 ILCS 75 Illinois Physical Therapy Act 225 ILCS 90 Illinois Speech-language Pathology andAudiology Practice Act 225 ILCS 110 Clinical Social Worker and Social WorkPractice Act 225 ILCS 203
Nursing and Therapy ServicesHome Health AgencySkilled NursingServicesHome Nursing Agency Patient observation and assessment Patient observation and assessment Medication administration/medicine boxset up Medication administration/medicine boxset up Infusion Infusion Complex dressing changes including thosethat require application of medications Complex dressing changes includingthose that require application ofmedications Patient education regarding medications,diet, disease process, and related self-care Caregiver education Tube feedings Catheter and ostomy care Venipuncture Psychiatric evaluation, therapy, andteaching Oversight of aide services Other skilled nursing activitiesHome Services AgencyNot in Scope Patient education regarding medications,diet, disease process, and related selfcare Caregiver education Tube feedings Catheter and ostomy care Venipuncture Psychiatric evaluation, therapy, andteaching Oversight of aide services Other skilled nursing activitiesTherapy Services Assessment and care plan development Therapeutic exercises, exercise plandevelopment, and patient/caregiverteachingNot in ScopeNot in Scope Gait training Range of motion Ultrasound, shortwave, and microwave4
Home Health AgencyHome Nursing AgencyHome Services AgencyNot in ScopeNot in Scopediathermy treatments Hot-packs, infra-red treatments, paraffinbaths, and whirlpool baths Treatment of swallowing, breathing, andvoice disorders Family and caregiver training in cueing Restorative speech-language pathology foraphasia and memory Teaching compensatory techniques toimprove independence in ADLs Therapeutic tasks to restore sensoryintegrative function Teaching task-oriented therapeuticactivities to restore physical function Therapeutic activity programs for patientswith psychiatric illness Designing, fabricating, and fitting orthoticand self-help devicesSocial WorkServices Assessment of social and emotionalfactors related to illness Access to community resources Patient and family/caregiver counseling Discharge planning5
Home Health Aide and Home Services Worker ServicesDefinition of Certified Nurse Assistant (CNA) Certified Nursing Assistant or CNA – an individual who does not hold a professional license from the Department ofFinancial and Professional Regulation, volunteers to provide licensed services without pay; was grandfathered in, has successfully completed the Basic NursingAssistant Training Program (BNATP) and competency examination, or has met the equivalency requirements of 77 Ill. Adm. Code 300.663 (Skilled Nursing andIntermediate Care Facilities Code).Definition of Home Health Aide – an individual who meets training requirements by completion of a training program approved under the Long-Term CareAssistants and Aides Training Programs Code (see 77 Ill. Adm. Code 395).An individual may also establish equivalency by any one of the following:1) Documentation of current registration from another state.2) Documentation of successful completion of a nursing arts course, which included at least 40 hours of supervised clinical experience in an accreditednurse training program as evidenced by diploma, certificate, or other written verification from the school, and successful completion of the writtenportion of the IDPH-established nursing assistant competency test.3) Documentation of successful completion of a United States military training program that includes the content of the Basic Nursing Assistant TrainingProgram (see 77 Ill. Adm. Code 395), as evidenced by a diploma, certification DD-214, or other written verification, and successful completion of thewritten portion of the IDPH-established nursing assistant competency evaluation.4) Documentation of completion of a nursing program in a foreign country and successful completion of the written portion of the IDPH-establishedcompetency test. Documentation includes: a copy of the license, diploma, registration, or other proof of completion of the program; a copy of the socialsecurity card; and Visa or proof of citizenship. Requests to establish equivalency shall be submitted to IDPH with accompanying documentation.PersonnelHome Health AgencyHome Nursing AgencyHome Services AgencyHome Health Aide (CNA)Home Health Aide (CNA)Home Services Worker and CNAObservation and Reporting changes in the patient's/client'scondition and needs to the registeredReportingnurse or the appropriate therapist May perform vital signs (temperature,blood pressure, pulse, respirations, pulse Reporting changes in the patient's/client'scondition and needs to the registerednurse; includes inputs and outputs,weight, bowel movement, and appetite Observation of client functioning andreporting to designated authority May not perform vital signs May perform vital signs (temperature,blood pressure, pulse, respirations, pulse6
PersonnelHome Health AgencyHome Nursing AgencyHome Services AgencyHome Health Aide (CNA)Home Health Aide (CNA)Home Services Worker and Not applicableNot applicableMinimal housekeeping services related topatient medical needsHousekeeping services related to patientmedical needs Companionship Assistance with shopping andappointments outside the home Assistance with household chores Cooking and meal preparation Cleaning LaundrySkin Care Skin care using only non-medicated ornon-prescription products Skin care using only non-medicated ornon-prescription products Preventive skin care Preventive skin care Skin care only when skin is intact, usingonly non-medicated or non-prescriptionproducts Preventive general care of unbroken skinExclusions: No care of broken skin No wound care or dressing changes No application of lotion/solutionsrequiring a physician prescriptionAmbulation Assist with ambulation Assist with ambulation Assist with ambulation Assist with ambulation of patient using Assist with ambulation of patient usingadaptive equipment for ambulation(walker, cane, wheelchair) Assist with ambulation using adaptiveequipment for ambulation (walker, cane,and wheelchair) after the patient hasbeen trained by a registerednurse/physical therapist/occupationaltherapist and released to work on his/herown with the equipmentExclusions:adaptive equipment for ambulation(walker, cane, wheelchair)7
PersonnelHome Health AgencyHome Nursing AgencyHome Services AgencyHome Health Aide (CNA)Home Health Aide (CNA)Home Services Worker and CNA No ambulation of patient with a devicepatient is in training to useBathing Bathing assistance including provision ofbed baths Bathing assistance including provision ofbed baths Includes bathing of patients whose skin is Includes bathing of patients whose skin isnot intactnot intact Assist client with bathing Bed bath if worker is trained andcompetency evaluated, and client candirect the bathExclusions: No bathing services if client has skilledskin care needs or wound dressings thatwill require attention before, during, orafter bathDressingExercise Assist client with dressing includingclothing and support stockings that can bepurchased without a physicianprescription Assist client with dressing includingclothing and support stockings that can bepurchased without a physicianprescription Assist client with dressing includingclothing and support stockings that can bepurchased without a physicianprescriptionExclusions: Can apply physician prescribed supportstockings if trained and competencytested Can apply physician prescribed supportstockings if trained and competencytested Assist with exercise, including passiveassistance limited to normal bodilymovement Assist with exercise, including passiveassistance limited to normal bodilymovement Assist with exercise, including passiveassistance limited to encouraging normalbodily movement Encourage a prescribed exercise program Encourage a prescribed exercise program Perform simple procedures as anextension of therapeutic services Perform simple procedures as anextension of therapeutic services Encourage a prescribed exercise programExclusions: No elastic bandages applied No sequential compression device thatrequires a physician MD prescription Passive range of motion8
PersonnelFeedingHair CareMouth CareNail CareHome Health AgencyHome Nursing AgencyHome Services AgencyHome Health Aide (CNA)Home Health Aide (CNA)Home Services Worker and CNA Assist with normal feeding when patientcan independently swallow and can bepositioned upright Assist with normal feeding when patientcan independently swallow and can bepositioned upright Assist with feeding when patient canindependently swallow and can bepositioned uprightExclusions: Can assist patients with special feedingneeds if trained and competencyevaluated, and services are providedunder the general supervision of a nurseExclusions: Can assist patients with special feedingneeds if trained and competencyevaluated, and services are providedunder the general supervision of a nurseExclusions: No syringe feeding, tube feeding, orintravenous nutrition No syringe feeding, tube feeding, orintravenous nutrition No feeding of a patient at high risk ofchoking No feeding of a patient at high risk ofchoking Assist with the maintenance andappearance of hair (non-medicatedshampooing, drying, combing, styling hair) Assist with the maintenance andappearance of hair (non-medicatedshampooing, drying, combing, styling hair) Can apply medicated shampoo and/orshampoo requiring a physicianprescription Can apply medicated shampoo and/orshampoo requiring a physicianprescription Assist in and perform mouth care, denturecare, and basic oral hygiene, includingsuctioning for mouth care Assist in and perform mouth care, denturecare, and basic oral hygiene, includingsuctioning for mouth care Can provide mouth care for anunconscious patient Can provide mouth care for anunconscious patient No suctioning related to respiratory care No suctioning related to respiratory care No suctioning related to respiratory care Assist with nail care including soaking ofnails, pushing back cuticles with utensils, Assist with nail care including soaking ofnails, pushing back cuticles with utensils, Assist with nail care including soaking ofnails, pushing back cuticles without No syringe feeding, tube feeding, orintravenous nutrition No feeding of a patient at high risk ofchoking Assist with the maintenance andappearance of hair (non-medicatedshampooing, drying, combing, styling hair)Exclusions: No shampooing with shampoo requiring aphysician prescription Assist in and perform mouth care, denturecare, and basic oral hygiene, includingsuctioning for mouth careExclusions: No mouth care for unconscious patient9
PersonnelHome Health AgencyHome Nursing AgencyHome Services AgencyHome Health Aide (CNA)Home Health Aide (CNA)Home Services Worker and CNAfiling of nails, and nail trimmingPositioningfiling of nails, and nail trimming Excludes nail trimming of patients withconditions that might involve peripheralcirculatory problems or loss of sensation(e.g. diabetic) Excludes nail trimming of patients withconditions that might involve peripheralcirculatory problems or loss of sensation(e.g. diabetic) Assist client/patient with positioningwhen the client is able to identify to theworker, verbally, non-verbally, or throughother means, when the position needs tobe changed and when skilled skin care isnot required in conjunction with thepositioning Assist client/patient with positioningwhen the client is able to identify to theworker, verbally Assist client/patient withpositioning when the client is able toidentify to the worker, verbally, nonverbally, or through other means, whenthe position needs to be changed andwhen skilled skin care is not required Inconjunction with the positioning, nonverbally, or through other means, whenthe position needs to be changed andwhen skilled skin care is not required inconjunction with the positioning Positioning may include simple alignmentin a bed, wheelchair, or other furniture Positioning can be provided without thepatient requesting the change, but basedon the written assignment/plan of careutensils, and filing of nailsExclusions: No nail trimming No nail care of patients with conditionsthat might involve peripheral circulatoryproblems or loss of sensation (e.g.diabetic) Positioning may include simple alignmentin a bed, wheelchair, or other furniture Positioning may include simple alignmentin a bed, wheelchair, or other furniture Positioning can be provided without thepatient requesting the change, but basedon the written assignment/plan of careShaving Assist client with shaving only with anelectric or safety razorToileting Assist client to/from the bathroom Assist client with shaving only with anelectric or safety razor Assist client with shaving only with anelectric or safety razor Assist client to/from the bathroom Assist client to/from the bathroom10
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Overview Home Health Agency Home Nursing Agency Home Services Agency Statutory Definition A public agency or private organization that provides skilled nursing service and at least one other home health service. 210 ILCS 55/2.04 An agency that provides services directly, or acts as a placement agency, to deliver skilled nursing and home health aide
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