Kan. Admin. Regs. § 28-51-117

Current through Register Vol. 43, No. 46, November 14, 2024

Section 28-51-117 - Supportive care services

(a) Admission criteria. Each person that applies to provide supportive care services shall have a written policy that addresses admission criteria consistent with the definition of "supportive care services" in K.S.A. 65-5101, and amendments thereto, and the requirements of this regulation.

(b) Scope of practice and training. Each licensee providing supportive care services shall have written policies and procedures describing the appropriate scope of practice for a supportive care worker consistent with the following:

(1) The definition of "supportive care services" in K.S.A. 65-5101, and amendments thereto;

(2) the requirements of this regulation; and

(3) the training required for each supportive care worker to provide the necessary supportive care services to a client.

(c) Competency. Each licensee shall ensure that each supportive care worker demonstrates competency before providing supportive care services to a client without the manager being present and shall reevaluate each supportive care worker on an annual basis in the following subject areas:

(1) Communication skills with special focus on communicating with clients with a hearing deficit, dementia, or other special needs;

(2) observation, reporting, and documentation of client status and the supportive care service provided;

(3) basic infection control procedures;

(4) basic elements of body functioning and changes in body function that shall be reported to the supportive care worker's supervisor;

(5) maintenance of a clean, safe, and healthy environment;

(6) recognizing emergencies and knowledge of the home health agency's emergency procedures;

(7) respecting the client and the client's privacy and property;

(8) knowledge of the clients' bill of rights specified in K.A.R. 28-51-111;

(9) appropriate and safe techniques in personal hygiene and grooming; and

(10) appropriate use of any equipment needed for the provision of supportive care services.

(d) Ongoing training. Ongoing training shall be provided to each manager and supportive care worker annually or more often as needed to adequately provide the supportive care services needed by the clients served by the home health agency. Ongoing training shall include training on the supportive care services provided and the equipment used by the home health agency. The subject matter and date of the ongoing training provided shall be documented in each manager's and supportive care worker's file.

(e) Supervision of supportive care workers. Each licensee providing supportive care services shall supervise each supportive care worker as follows:

(1) Employ a manager who is available to a supportive care worker for questions at all times; and

(2) provide on-site supervision of each supportive care worker, at least every three months, including an assessment of client satisfaction of the supportive care services provided and the supportive care worker's adherence to the plan of care.

(f) Written assignments.

(1) Written assignments and instructions for supportive care workers shall be prepared by a manager based on the plan of care.

(2) Written assignments and instructions for supportive care workers shall include the following:

(A) The procedures to be used for meeting the client's needs;

(B) specification of when the supportive care worker is required to report to the supportive care worker's supervisor; and

(C) a requirement for the supportive care worker to document the supportive care services provided during each visit.

(3) Each manager shall review the written assignments and instructions every three months or more frequently as changes in the client's status and needs occur.

(g) Assigned duties. Each licensee shall include the following requirements in written policies and procedures for use by a supportive care worker:

(1) Assisting with medication.

(A) Any supportive care worker may assist a client with medication only if the medications have been preselected by the client, a family member, a nurse, or a pharmacist and are stored in containers other than the prescription bottles, including medication reminder containers. Each medication reminder container shall be clearly marked with day and time of dosage. Assistance shall be limited to the following:

(i) Inquiries whether medications were taken;

(ii) verbal prompting to take medications;

(iii) handing the appropriately marked medication reminder container to the client; and

(iv) opening the appropriately marked medication reminder container for the client if the client is physically unable to open the container.

(B) Paragraph (g)(1)(A) shall apply to all prescription and nonprescription medications. Each supportive care worker shall report immediately to the manager whenever medications are taken too often, not taken often enough, or not taken at the correct time as marked in the medication reminder container. Supportive care workers and other employees of a home health agency providing supportive care services shall not participate in medication administration.

(2) Skin care. Each supportive care worker performing skin care assistance shall provide skin care assistance only if the client's skin is unbroken and the client does not have active chronic skin problems. A supportive care worker shall not apply medication. Supportive care workers and other employees of a home health agency providing supportive care services shall not provide wound care, including dressing changes and application of medications.

(3) Ambulation. Any supportive care worker may assist a client with ambulation who can balance and bear weight if a qualified health professional determines that the client is independent with an assistive device.

(4) Bathing. Any supportive care worker may assist a client with bathing. If a client has wounds requiring changes to bandages before, during, or after bathing, the client shall be in the care of a home health agency licensed to provide home health services.

(5) Dressing. Any supportive care worker may assist a client with dressing, including assistance with ordinary clothing and application of over-the-counter support stockings that can be purchased without a physician's prescription. A supportive care worker shall not assist with the application of an elastic bandage wrap or anti-embolic or pressure stockings that can be purchased only with a prescription.

(6) Exercise. Any supportive care worker may assist a client with exercise. The assistance shall not include assistance with exercise prescribed by a qualified health professional, including a physical therapist or occupational therapist, and shall be limited to assistance with normal bodily movement as tolerated by the client. Any supportive care worker may provide encouragement to the client to comply with a prescribed exercise program.

(7) Feeding. Any supportive care worker may assist a client with feeding if the client can independently chew and swallow without difficulty and maintain an upright position. Assistance by a supportive care worker shall not include syringe feedings, tube feedings, and intravenous nutrition. If a client is at a high risk for choking or aspiration, the client shall be in the care of a home health agency licensed to provide home health services.

(8) Hair care. Any supportive care worker may assist a client with the maintenance and appearance of the client's hair. Hair care may include shampooing with a shampoo that does not require a physician's prescription and drying, combing, and styling hair.

(9) Mouth care. Any supportive care worker may assist with and perform mouth care for a client, including denture care and basic oral hygiene. Mouth care for clients who are unconscious, have difficulty swallowing, or are at risk for choking and aspiration or have had recent surgical procedures to the mouth shall be performed by a home health agency licensed to provide home health services.

(10) Nail care. Any supportive care worker may assist a client with nail care, including soaking nails, pushing back cuticles without utensils, and filing nails. Nail trimming for clients shall be performed only by a supportive care worker of a home health agency that indicated in the home health agency's initial application or renewal application that it intends to provide home health services.

(11) Positioning. Any supportive care worker may assist a client with positioning if the client is able to indicate to the supportive care worker verbally, nonverbally, or through others, whenever the client's position needs to be changed. Positioning shall not be performed if skin care is required in conjunction with the positioning. Positioning may include simple alignment in a bed, wheelchair, or other furniture.

(12) Shaving. Any supportive care worker may assist a client with shaving only with an electric or a safety razor.

(13) Toileting. Any supportive care worker may perform the following:

(A) Assisting a client to and from the bathroom;

(B) providing assistance with bedpans, urinals, and commodes;

(C) assisting with personal hygiene or changing clothing and pads of any kind used for the care of incontinence;

(D) emptying urinary collection devices, including catheter bags. The insertion and removal of catheters and care of external catheters shall be considered a skilled care service and shall not be performed by a supportive care worker; and

(E) emptying ostomy bags. A supportive care worker shall not insert suppositories or administer an enema.

(14) Transfers. Any supportive care worker may assist a client with transfers as provided by written assignments if the client has sufficient balance and strength to stand and pivot and assist with the transfer. Any supportive care worker may assist a family member with transferring the client. A supportive care worker shall not perform assistance with a transfer if the client is unable to assist with the transfer.

Adaptive and safety equipment may be used in a transfer if the client and the supportive care worker are fully trained in the use of the equipment and the client, client's family member, or guardian can direct the transfer step-by-step. Adaptive and safety equipment may include wheelchairs, tub seats, and grab bars. A gait belt may be used in a transfer as a safety device for the supportive care worker if the supportive care worker has been properly trained in the use of a gait belt.

Any supportive care worker with training and demonstrated competency may assist a client in a transfer involving a lift device.

(15) Respiratory care. Respiratory care shall be considered a skilled care service and shall not be performed by a supportive care worker.

(16) Masks and oxygen flow. Any supportive care worker may temporarily remove and replace a cannula or mask from a client's face for the purposes of shaving or washing the client's face. Any supportive care worker may set a client's oxygen flow according to written instructions when changing tanks, if the supportive care worker has been specifically trained and has demonstrated competency for setting a client's oxygen flow.

Kan. Admin. Regs. § 28-51-117

Authorized by K.S.A. 65-5109; implementing K.S.A. 65-5101; adopted by Kansas Register Volume 41, No. 18; effective 5/20/2022.