Response To Proposed Home Care Licensure Regulations

Line 8.3—“unacceptable health and safety risks”—determine by who—There are lots of situations where we believe the situation is unacceptable due to health and safety risks and clients don’t agree. Surveyors have to be careful not to hold providers to a standard that violates client rights.

Lines 11.20 to 11.33—will these “standards” be defined or referenced. Again lots of room for the surveyor to hold the provider to a “standard” that is not defined.

Line 12.27--survey all licensed home care providers on an interval that will promote the health and safety of clients—kind of what we have now and agencies go years without survey—My issue with this is providers should be able to expect surveys to assure compliance.

Lines 14.28-14.32: 14.28 Subd. 6. Basic home care license provider. Home care services that can be

14.29 provided with a basic home care license are assistive tasks provided by unlicensed personnel that include:

14.31 (1) assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing;

These services are provided in an agency that does not require nursing—yet these same tasks require supervision when provided in current class A and in Medicare agencies.

Lines 14.32 – 35: providing verbal or visual reminders to the client to take regularly scheduled 14.35 medication which includes bringing the client previously set-up medication, medication in 14.36 original containers, or liquid or food to accompany the medication

Who is directing the staff to assist client with previously set up medications—this is basic and no supervision. Most agencies will not allow their unlicensed staff to give meds set up by someone else because the agency is responsible –if aide gives wrong med—whose problem is it?

Subd. 10. Medications when client is away from home. A home care provider 41.5 providing medication management services must develop a policy and procedures for the41.6 issuance of medications to clients for planned and unplanned times they will be away from

41.7 home and need to have their medications with them which complies with the following:

41.8 (1) for planned time away, the medications should be obtained from the pharmacy or 41.9 set-up by the RN according to appropriate state and federal laws and nurse standards of 41.10 practice; and 41.11 (2) for unplanned times away from home for temporary periods when an adequate 41.12 medication supply cannot be obtained from the pharmacy or set-up by the RN in a timely

41.13 manner, the provider may allow an unlicensed personnel to set up the medications. 41.14 (b) The task of medication set up may be done by unlicensed personnel who has 41.15 been trained and determined competent according to subdivisions 6 and 7. Prior to

41.16 providing the medications to the client the unlicensed personnel must speak with the RN 41.17 to ensure that all appropriate precautions are taken. The unlicensed personnel may provide 41.18 the client or the client's representative up to a 72-hour supply of the client's medications. 41.19 (c) When preparing the medications, the medications must be taken from the 41.20 original containers prepared by the pharmacist and then placed in a suitable container. The 41.21 container must be labeled with the client's name; the medication name, strength, dose, and 41.22 route of administration; and the dates and times the medications are to be taken by the

41.23 client and any other information that the client should know regarding the medications. 41.24 For those medications which cannot be prepared in advance, the client must be given 41.25 the original container and complete directions and information for the administration 41.26 of that medication.

41.27 (d) The client or client's representative must also be provided in writing the home 41.28 care provider's name and contact information for the home care provider's RN.

41.29 The unlicensed personnel must document in the client's record the date the medications 41.30 were provided to the client; the name of medication; the medication's strength, dose, and 41.31 routes and administration times; the amounts of medications that were provided to the 41.32 client and to whom the medications were given. The RN must review set-up of medication 41.33 and documentation to ensure that the issuance of medications by the unlicensed personnel 41.34 was handled appropriately.

My concerns: This whole section makes NO sense for an agency that provides home care services outside of a facility. We are not there all the time. Clients come and go from their homes and if we are setting up their medications—they are in a medset box. We will set up extra if they are going to be gone for weeks but the reality of any of this makes no sense in home care. Assisted Living has clients living in their building and they manage all their meds. This is just one area where writing regulations like this –they will not be followed in the community. We are not there every day!! If assisted living is comprehensive home care—then we have to either have subsets for them or we have to be able to follow the same rules.

Subd. 19. Storage of drugs. A comprehensive home care provider providing

42.31 storage of medications outside of the client's private living space must store all prescription

42.32 drugs in securely locked and substantially constructed compartments according to the

42.33 manufacturer's directions and permit only authorized personnel to have access.

How is this feasible?? If the clients live in the community –outside of a HWS- how would we do this and why would we want to have drugs secured outside of the home?