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007.05.4-12. Standards for Skilled Care Services

AR ADC 007.05.4-12Arkansas Administrative CodeEffective: August 4, 2022

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 4. Rules for Home Health Agencies in Arkansas
Effective: August 4, 2022
Ark. Admin. Code 007.05.4-12
007.05.4-12. Standards for Skilled Care Services
Currentness
In addition to meeting the General Requirements, agencies providing skilled care shall meet the following:
A) Acceptance of Patients
1) 1. Agencies shall only accept patients for treatment on the basis of a reasonable expectation that the patient's needs can be met adequately by the agency in the patient's place of residence.
2) 2. If an agency receives a referral on a patient who requires home health services that are not available at the time of referral, the agency shall contact the referral source and/or the patient's physician or licensed practitioner to let them know the situation. The agency shall only admit the patient if no other agency licensed in the area has the service(s) available.
B) Care and Services
1) All services shall be rendered and supervised by skilled professionals. Skilled services such as nursing, physical therapy, occupational therapy, speech-language pathology, and medical social work shall provide services and supervision according to the scope of practice determined by their applicable licensing board.
2) Assessments:
(a) An initial assessment shall be completed within 48 hours of the referral/discharge. The initial assessment shall be completed by a registered nurse, if nursing services are provided, or other skilled professional, as appropriate.
(b) For patients receiving skilled services, the assessment shall be updated every 60 days or when a significant change in patient status occurs.
3) Plan of Care:
(a) At the time of the admission, the plan of care shall be developed in conjunction with the patient and/or family and the skilled health care professional.
(b) Discharge planning shall be the responsibility of the skilled health care professional rendering the service and documented in the record.
(c) The plan of care shall include potential services to be rendered; the frequency of visits and/or hours of service, assignment of health care providers and the estimated length of services.
(d) The plan of care shall be revised at least every 60 days.
(e) The plan of care shall be individualized according to each of the individual patient's needs.
(f) The plan of care and each verbal order obtained shall be signed by the physician, podiatrist or licensed practitioner within 30 days of the of the order.
4) Case conferences shall be held at least every two months on each patient. The clinical record or minutes of these case conferences shall reflect input by the disciplines providing care to the patient.
5) For patients receiving extended care nursing services, a current medication administration record shall be maintained and incorporated into the clinical record. Notation shall be made in the clinical notes of medications not given and reason. Any untoward action shall be reported to the supervisor and documented.
6) The clinical record shall include documentation of medication allergies or sensitivities and medication interactions. There must be a medication profile, including the dose, frequency and route of administration for each prescription medication the patient is receiving.
C) 24 Hour Availability
1) If an agency provides 24-hour availability, the agency shall have a registered nurse available after hours. When an agency provides extended care, the agency shall provide 24-hour coverage and availability. A licensed practical nurse may take initial call and perform services as ordered on the plan of care. Any services outside the plan of care must be approved by a registered nurse prior to the services being rendered.
2) If 24-hour availability is provided, the agency shall have a policy describing at least the following:
(a) How patients will contact the agency after hours; and
(b) How the agency will ensure the registered nurse on call has access to all current patient information.
3) If 24-hour availability is not offered by the agency, the agency shall be responsible for assuring each patient is aware of the steps to take in an emergency or unusual situation.
D) Controlled Drugs
1) Agencies shall have a written policy stating how controlled drugs will be monitored if agency staff transports the drugs from the pharmacy to the patient.
2) If controlled drugs are being administered by the agency, there shall be a policy regarding how the drugs will be administered and monitored.
E) Home Health Aide Services
1) A home health aide shall have completed a 75-hour aide training course that meets the requirements set forth in Section 10 of these rules.
2) The agency is responsible for assuring the home health aide has successfully completed competency testing. The competency evaluation must address each of the topics in TABLE 2. The following skills must be evaluated by the registered nurse by observing the aide's performance while carrying out the following tasks with a patient:
(a) communication skills including the ability to read, write, and verbally report clinical information;
(b) reading and recording temperature, pulse, and respiration;
(c) appropriate and safe techniques in performing personal hygiene and grooming tasks that include:
(i) bed bath;
(ii) sponge, tub, shower bath;
(iii) hair shampooing in sink, tub, and bed;
(iv) nail and skin care;
(v) oral hygiene;
(vi) toileting and elimination;
(d) safe transfer techniques and ambulation; and
(e) normal range of motion and positioning.
3) A registered nurse shall complete an aide assignment sheet to delegate services according to the State Board of Nursing, for each patient receiving home health aide services.
4) Each aide caring for the patient shall receive a copy of the assignment sheet.
5) Provide services as assigned.
6) A copy of the assignment sheet shall be left in the patient's home.
7) Each aide assignment sheet shall be individualized and specific according to the patient's needs.
8) The qualified health care professional shall conduct a visit to the patient's place of residence and update the aide assignment sheet:
(a) every 14 days for the home health aide;
(b) every 60 days for the personal care aide.
(c) Aides shall receive a minimum of 12 hours of in-service training per 12 months. The in-services provided shall address areas that directly relate to the patient care aspects of the aide's job.

Credits

Amended May 1, 2010; June 15, 2020; Aug. 4, 2022.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.4-12, AR ADC 007.05.4-12
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