2016 Guide to Home Care Services

 

A GUIDE TO HOME CARE SERVICES IN MINNESOTA

February 2016

Information contained in this guide was taken substantially from the Minnesota Department of Health’s  “A Guide to Home  Care Services”, formerly available on its  website.

Revised with permission by Minnesota HomeCare Association {MHCA}.

Introduction

Minnesota Statute 144A. 4796, subd.1 states:

“All staff providing and supervising direct home care services must complete an orientation to home care licensing requirements and regulations before providing home care services. The orientation may be incorporated into the training required under subdivision 6. The orientation need only be completed once for each staff person and is not transferable to another home care provider.”

This guide was prepared by the Minnesota HomeCare Association as a means to satisfy part of this requirement. It is intended as an overview and not a replacement of the licensure statutes. For specific requirements, providers should refer to the Minnesota Home Care Licensure Statute 144A.43 – 144A.483, Chapter 144D Housing with Services Establishment, Chapter 144G Assisted Living Services, Chapter 245D Home and Community-Based Services Standards, the Vulnerable Adults Act Minnesota Statute 626.557 and 626.5572, and the

Maltreatment  of  Minors Act,  Minnesota Statute 626.556.

The statutes may be accessed at https://www.revisor.mn.gov/pubs.

Regulation of Home Care Providers: State Licensure

Under Minnesota Statutes 144A.43-144A.483, the Minnesota Legislature authorized the Minnesota Department of Health (herein after referred to as “Department”) to license most providers of home care, including private businesses, nonprofit organizations, and governmental agencies. The license is for the business, not for the employees who work for the home care provider.

The purpose of the license is to ensure that those who provide services are qualified to do so in a manner that affords some protection of the health, safety and well-being of the consumers of those services. A license is permission from the state to carry on the business of home care services. It does not provide payment for services and does not guarantee success in business.

Licensure also provides a quality mechanism for monitoring and remedying problems through routine inspections and investigations of complaints by the  Department.

If a survey or complaint investigation reveals a violation, the Department will issue a correction order, which is a notice of the violation and an order to correct the problem within a certain timeframe. If not corrected, the Department will issue a fine according to the schedule of fines as outlined in the statutes. In very serious situations, the Department may suspend, revoke or refuse to renew the license.

State licensing regulations are similar to Medicare Home Health Agency regulations, and include additional requirements. Only those home care providers that receive Medicare or Medicaid reimbursement must comply with Medicare regulations. All providers, including individuals (except for those individuals who are exempted by law), are required to meet state licensing laws and be licensed by the State.

CLASSES OF LICENSES

Basic Home Care License: Home care services that can be provided with a basic home care license are assistive tasks  provided by licensed or unlicensed personnel. These tasks include:

1. Assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing.
2. Providing standby assistance
3. Providing verbal or visual reminders to the client to take regularly scheduled medication, which includes bringing the client previously set-up medication, medication in original containers, or liquid or food to accompany the
   4. Providing verbal or visual reminders to the client to perform regularly scheduled treatments and
   5. Preparing modified diets ordered by a licensed health care provider
4. Assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services, if the provider is also providing at least one of the activities listed

Comprehensive Home Care License: Home care services that may be provided with a comprehensive  home care license include any of the basic home care services  listed above

Minnesota Department of Health (MDH} “A Guide to Home Care Services” and one or more of the following:

1. Services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietician or nutritionist, or social worker.
   1. Tasks delegated to unlicensed personnel by a registered nurse or assigned by a licensed health professional  within the  person’s scope  of
      3. Medication management
      4. Hands-on assistance with transfers and
   2. Assisting clients with eating when the clients have complicated eating problems as identified in the client record or through an assessment such as difficulty swallowing, recurrent lung aspirations, or requiring the use of a tube or parenteral or intravenous instruments to be
      6. Providing other complex or specialty  health care

Some Home Care Providers and/or the Housing with Services establishments they serve may choose to call themselves or their services “assisted living” and must meet the  requirements  for the  use of the term  assisted  living as defined  in Minnesota Statute 144G.

SERVICES AVAILABLE THROUGH STATE REGULATED HOME CARE PROVIDERS

State regulations cover a large variety of home care and home management services provided to clients whose illness, disability or physical condition creates a need for the services at their residences. The licensee may not accept a client unless the licensee has sufficient staff, in numbers and qualifications, to adequately provide the services agreed to in the service plan.

If the licensee terminates a service plan with a client, and the client continues to need home care services, the home care provider will provide the client and the client’s representative, if any, with a written  notice of termination  which  includes the following information:

1. The effective date of termination;
2. The reason for termination;
   1. A list of known licensed home care providers in the client’s immediate geographic area;
3. A statement that the home care provider will participate in a coordinated transfer of care of the client to another home care provider, health care provider or caregiver, as required by section 44, subdivision 1,clause (17) of the Home Care Bill of Rights;
4. The name and contact information of a person employed by the home care provider with whom the client may discuss the notice of termination; and
   1. If applicable, a statement that the notice of termination of home care services does not constitute notice of termination of the housing with services contract with a housing with services establishment.

Personnel employed by a licensee or providing services under a contract must be licensed, registered, or certified as required by the state and/or must meet the trainingand evaluation requirements of the statutes. Each applicant for a license and persons who provide direct care, supervise direct care, or manage services for a licensee must be oriented to home care requirements prior to providing home care services to clients. Home health aide tasks and services provided by unlicensed personnel must be supervised by a registered nurse or therapist, according to a schedule that is determined by the provider and client, and minimally established in the statute.

SERVICE PLAN

A licensee shall enter into a service plan with the client or the client’s responsible person. Any modifications to the service plan must be communicated to the client or the client’s responsible person.

The service plan must include the following items:

1. A description of the services to be provided, the fees for services, and the frequency of each service, according to the client’s current review or assessment and client preferences;
2. The identification of the staff or categories of staff who will provide the services;
3. The schedule and methods of monitoring reviews or assessments of the client;
   1. The frequency of sessions of supervision of staff and type of personnel who will supervise staff; and
   2. A contingency plan that includes the following sub items:
4. action to be taken by the licensee, client, or responsible persons, if scheduled services cannot be provided;
   1. information and a method for a client or client’s representative to contact the home care provider;
   2. names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in condition, including identification of and information as to who has the authority to sign for the client in an emergency; and
5. circumstances in which emergency medical services are not to be summoned, consistent with chapters 1458 and 145C, and declarations made by the client  under those

A comprehensive home care provider that provides medication management services must prepare and include in the service plan a written statement of the medication management services that will be provided to the client.

The home care provider must implement and provide all services required by the current service plan.

HOME CARE BILL OF RIGHTS

All home  care  providers, including those  exempt  from  licensure,  must  comply  with  all parts of Minnesota Statutes, section 144A.44, the Home Care Bill of Rights. A written notice of the Home Care Bill of Rights must be provided to the client or the client’s representative before the initiation of services to that client. The provider shall make all reasonable efforts to provide the notice of rights to the client or client’s representative in a language the client or client’s representative can understand. Written documentation  of receipt  of the  bill of rights  must  be maintained  by the  licensee.

The home care provider may not request nor require a client to surrender any of the rights as a condition of receiving services.

STATEMENT OF HOME CARE SERVICES PERTAINING TO CLIENTS WITH DEMENTIA, ALZHEIMER’S DISEASE OR RELATED DISORDERS

The home care provider that provides services to clients with dementia, Alzheimer’s disease or related disorders shall provide a description of the training program, including categories of employees trained, the frequency of the training and the basic topics covered to anyone who requests it. The description may be in written or electronic form.

DISASTER PLANNING AND EMERGENCY PREPAREDNESS

All home care providers must have a written plan of action to facilitate the management of the client’s care and services in response to a natural disaster, such as floods, storms or other emergencies that may disrupt the home care provider’s ability to provide care and services.

CLIENT PROTECTION

The home care statute was developed to achieve the goal that home care services are provided in a manner that protects the health, safety, and well-being of home care clients. Providers must comply with the requirements of the statute.

CRIMINAL DISQUALIFICATION*

Before the commissioner issues a temporary license or renews a license, an owner or managerial official is required to complete a background study under Minnesota Statute section 144.057. No person may be involved in the management, operation, or control of a provider, if the person has been disqualified under chapter 245C. An individual disqualified under these provisions can request reconsideration, and if the disqualification is set aside or rescinded by the commissioner, the individual is eligible to be involved in the management, operation or control of the  provider.

Owners of a home care provider subject to the background check requirement are those individuals whose ownership interest provides sufficient authority or control to affect or change decisions related to the operation of the home care provider. For the purposes of this section, managerial officials subject to the background check requirement are those individuals who provide direct “contact” as defined in section 245C.02, subdivision 11or those individuals who have the responsibility for the ongoing management or direction of the policies, services, or employees of the home care provider. All employees, contractors, and volunteers of a home care provider are subject to the background study required by section

• If appropriate, these individuals may be disqualified under the provisions of chapter 245C.

*Some language in this section was paraphrased from Minnesota law. Licensees should refer to the Statutes for the complete language.

REQUEST BY CLIENT FOR DISCONTINUATION OF LIFE SUSTAINING TREATMENT

Minnesota Statute 144A. 4791,Subdivision 13 defines the action that must be taken by a licensee if a client, family member, or other caregiver requests that life sustaining treatment be discontinued. The licensee shall act promptly upon the client’s request within the requirements of this rule.

CONFIDENTIALITY OF CLIENT INFORMATION

The licensee shall not disclose any personal, financial, medical, or other information about a client except:

1. As may be required by
2. To staff or contractors only that information necessary to provide services to the client.
3. To persons authorized by the client to receive the information.
4. Representatives of the commissioner authorized to survey or investigate home care providers.

HANDLING OF CLIENTS’ FINANCES AND PROPERTY

A licensee may not act as power-of-attorney nor accept appointment as guardian or conservator  of clients unless there  is a clear organizational  separation  between the home care service and the program that accepts guardianship or conservatorship appointments or unless the  licensee  is a  Minnesota county or other  unit of  government.

A licensee may assist clients with household budgeting, including paying bills and purchasing household goods but may not otherwise manage a client’s property. Receipts or documentation of all transactions and purchases paid with the clients’ funds must be recorded and maintained.

A licensee may not borrow or in any way convert a client’s property to the licensee’s possession except by payment at the fair market value of the property.

Gifts of a minimal value may be accepted by a licensee or its staff as well as donations and bequests that are exempt from income tax.

COMPLAINT PROCEDURE

The home care provider must have a written policy and system for receiving, investigating, reporting and attempting to resolve complaints from its clients or clients’ representatives. The required complaint system must provide for written notice to each client or client’s representative that includes:

1. The client’s right to complain to the licensee about services

1. The name or title of the person or persons with the home care provider to contact with
2. The method of submitting a  complaint  to the licensee.
3. A statement that the provider is prohibited against retaliation.

A home care provider must not take any action that negatively affects a client in retaliation for a complaint made or a concern expressed by the client or the client’s representative.

REPORTING OF MALTREATMENT OF VULNERABLE ADULTSAND MINORS

Minnesota law requires certain professionals and staff of licensed organizations to report maltreatment (abuse, neglect, exploitation, unexplained injuries) of vulnerable adults and children to governmental authorities. Reporting is mandatory, and a person who fails to report is subject to criminal prosecution and civil liability.

WHO MUST REPORT

All home care licensees and their employees must report suspected maltreatment. A report is required if there is reason to believe that abuse or neglect to a client has occurred. Staff of providers need not report directly to the authorities, but should follow their employers’ procedures for reporting to a supervisor. If staff is unable or uncomfortable reporting to the licensee, they may report directly to the authorities. All home care providers are required by law to have a procedure for reporting.

WHAT TO REPORT

Please refer to Minnesota Statute 626.556 (defines abuse of children) and Minnesota Statute 626.5572 (defines abuse of vulnerable adults).

WHEN AND  WHERE  TO REPORT

A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained, shall immediately (defined “as soon as possible, but no longer than 24 hours from the time initial knowledge that the incident occurred has been received”) orally report the information to the MN Adult Abuse Reporting Center (MAARC), the unit designated under Minnesota laws by the commissioner of human services for receiving reports of suspected maltreatment.

Staff should report any abuse or neglect to the person identified by the employer’s procedures. The provider, upon learning of abuse or neglect, must investigate and report to MAARC.

Suspected maltreatment of a vulnerable adult may be reported 24/7/365 to MAARC using its online reporting form or by calling 844-880-1574.  (Serious criminal activity should be reported to law enforcement immediately, and then to MAARC.)

This MAARC web page, in the Adult Protective Services section of the DHS website, provides tips, training information  and other reporting resources.

After a report is made, the agency may investigate. The law prohibits retaliation against anyone who makes a report in good faith.

Online reporting  form:  https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6303-ENG  

FOR FURTHER INFORMATION: Please contact DHS.AdultProtection@state.mn.us, by phone 651-431-2609 or 800-882-6262. TDD/TTY users please call (800)  627-3529 and ask for the phone number  listed above.

EMERGENCY PROCEDURES/HOW TO USE 911

Home health care personnel and clients should thoroughly know the provider’s policy on emergencies. Many agencies require that the home health staff has been trained in first aid, adult CPR (cardiopulmonary resuscitation) and infant and child CPR; and clearing the airway of an infant, child and an adult.

Examples of significant adverse changes in the client’s condition that may necessitate emergency contact and notifying 911include circumstances when the client:

1. Has trouble breathing or has stopped
2. Has no pulse
3. Is bleeding severely
4. Is having chest-neck-jaw-arm pain
5. Is in a state of deteriorating unconsciousness or is unconscious
6. If a fracture is suspected
7. If the person has been badly burned
8. Is unable to move one or more limbs
9. Is having a seizure
10. Is suffering from
    1. Hypothermia – below normal body
    2. Hyperthermia – well above normal body
11. Has been poisoned
12. Is having a diabetic emergency
13. Has suffered a stroke
14. If there is any doubt as to seriousness of the situation

Please note, pursuant to Minnesota Statute 144A.4791,Subd.9, a home care client’s service plan includes: “circumstances in which emergency medical services are not to be summoned, consistent with chapters 1458 and 145(,and declarations made by the client under those chapters.”

TO USE 911 

1. Call 911
2. Then state:
   1. “This is an emergency.” If you do not know how to give CPR, tell the dispatcher at once.
   2. The phone number you are calling from
   3. The address where the emergency is  occurring
   4. A description of the problem and how it happened, if known, otherwise just tell the facts and what has been observed
   5. Your name

Do your best to stay calm, follow the direction of the 911dispatcher, hang up last and reassure the client and family.