SCOPE OF PRACTICE
Providers of non-medical home care services assist individuals with their Activities of Daily Living (ADL’s); a physician’s order is not needed to have non-medical home care services. ADL’s are routine activities that most people take for granted and that people tend do every day without needing assistance. There are six basic ADL’s: eating, bathing, dressing, toileting, transferring (walking) and continence. When an individual is unable to perform these activities, they need help in order to cope, either from Caregivers, mechanical devices or both.
Some of the specific services within the scope of non-medical home care providers include:
- Ambulation, walking, using a walker, repositioning in a bed, or using a wheel chair
- Transferring to and from bed to commode, from bed to chair or wheelchair, or a vehicle
- Personal hygiene care
- Continence of bowel and/or bladder issues and products
- Using the commode
- Bathing in bathtub, showering, or bed bath
- Shampooing, rinsing, and drying of the hair
- Shaving, both electric and manual
- Oral hygiene, including brushing teeth and denture care
- Dressing and undressing
- Meal and snack preparation according to the client’s dietary requirements, serving, and cleanup
- Laundry, including washing, drying, folding and putting the clothes away
- Light housekeeping, such as making the bed and changing bedding; cleaning the bathrooms, client’s bedroom, kitchen, etc.
- Provide a sense of security to their client and their client’s families or loved ones.
- Transportation for grocery shopping, doctors’ appointments, and other errands
While there are no requirements for non-medical home care businesses to employ a nurse or other licensed professionals, AZNHA acknowledges that some non-medical home care businesses do employ registered nurses, licensed practical nurses, and other licensed health care professionals for purposes of performing non-skilled services such as: evaluations of care, client assessments, intakes, case openings, training and supervision of staff, medication compliance, client wellness visits, and other non-medical services. We believe these activities, when performed by a licensed nurse or health care professional, are within the scope of services for non-medical home care service providers in Arizona.
AZNHA considers medication compliance to be:
- Right Patient
- Right Drug
- Right Dosage
- Right Time
- Right Route
- Medication Handling
One of the roles of medication compliance includes safe and appropriate handling, storage, access and disposal of medications within the consumer’s home.
All of the above descriptions of non-medical home care services are often referred to as the “traditional non-medical home care services business model.” Providers of these services who are members of AZNHA are classified as “Business Members.”
AZNHA acknowledges that, in Arizona, there is a mixed business model for non-medical home care service providers. This model incorporates the “traditional non-medical home care services business model” and, in addition, legally offers and provides skilled nursing and other medical services to their clientele. Businesses that employ this mixed model approach are also classified as AZNHA’s Business Members. Providers of traditional non-medical home care services are not regulated or overseen by the state. However, the delivery of skilled nursing and other skilled medical services is regulated in Arizona and the entity responsible for their oversight and regulation is the Arizona Department of Health and/or the Arizona State Board of Nursing.
AZNHA requires Business Members who, in addition to offering traditional non-medical home care services, offer skilled nursing and any other skilled medical services to adhere to the scope of practices as set forth by AZNHA and detailed below:
- AZNHA’s Business Members who have a licensed nurse(s) or other licensed medical professional(s) on staff and who providing skilled nursing and or any skilled medical services are required to be the employer of that nurse or licensed professional.
- AZNHA defines these Business Members and their scope of practice as follows:
- Businesses that offer and provide non-medical home care services in combination with skilled nursing and/or any skilled medical service(s) provided by a licensed nurse(s) and or other medical professional(s).
- Nurses employed by AZNHA’s Business Members offering skilled services are required to practice within the legal boundaries of nursing within the scope of practice authorized and detailed by A.R.S. Title 32, Chapter 15 and Arizona Administrative Code Chapter 19.
- Skilled services that fall within the scope of practice for these Business Members would be defined as those activities that can be performed by a licensed nurse or other licensed medical professional under the direction and supervision of a licensed physician. These activities would normally be of the types that are delegated to non-skilled family members who have received instruction by a skilled professional to perform such activities.
- Any activities delegated by a Business Member’s nurse or other medical professional to a non-skilled person must meet the statutory requirements of, and be in compliance with, the Arizona Administrative Code Title 4. Professions and Occupations, Chapter 19. Board of Nursing, Article 4. Regulation, R4-19-402. Standards Related to Registered Nurse Scope of Practice and the Arizona Administrative Code Title 4. Professions and Occupations, Chapter 19. Board of Nursing, Article 4. Regulation, R4-19-401. Standards Related to Licensed Practical Nurse Scope of Practice.