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Advanced Home Health Aide Initiative Advanced Home Health Aides Update on Implementation Update on Implementation DRAFT - November XX, 2017 November 16, 2017 Rebecca Fuller Gray, Director Division

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DRAFT - November XX, 2017

Advanced Home Health Aides

Update on Implementation November 16, 2017 Rebecca Fuller Gray, Director Division of Home and Community Based Services

Advanced Home Health Aide Initiative

Update on Implementation

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DRAFT - November XX, 2017 2

Chapter 471 of the Laws of 2016

  • Chapter 471 of the Laws of 2016 authorizes Advanced Home Health Aides with

training to perform advanced tasks upon assignment by registered nurses and under supervision by such nurses

  • The goal of the law is to enable more people to live in home and community based

settings and provide support to family caregivers and their loved ones

  • The law takes effect May 28, 2018 and no advanced tasks may be performed prior

to that date and until the regulations are adopted, training programs are approved, and individuals complete the training and satisfy competency requirements pursuant to such regulations

  • The law will expire March 31, 2023 unless extended
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DRAFT - November XX, 2017 3

Regulations

  • The State Education Department (SED) and the Department of Health (DOH) are

currently developing regulations to implement the law

  • The SED regulations will specify the types of advanced tasks that could be

performed by Advanced Home Health Aides and will set forth qualifications, training and competency requirements

  • The DOH regulations will define Advanced Home Health Aides and provide for

their inclusion on the Home Care Registry when they have completed training programs

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DRAFT - November XX, 2017 4

Advanced Tasks

  • SED regulations will specify the types of advanced tasks that can be performed by

Advanced Home Health Aides, which may not be outside the scope of practice of a licensed practical nurse

  • Advanced tasks will include administering medications which are routine, prefilled,
  • r otherwise packaged in a way that promotes relative ease of administration
  • Advanced Home Health Aides will not be authorized to administer medication by

injection, except for injections of insulin, other injections for diabetes care, injections of low molecular weight heparin, and pre-filled auto injections of naloxone and epinephrine

  • Advanced Home Health Aides will not be able to perform tasks involving sterile

procedures or central line maintenance

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DRAFT - November XX, 2017 5

Advanced Home Health Aide Qualifications

To become an Advanced Home Health Aide, an individual must:

  • Be a certified home health aide listed on the DOH Home Care registry with at least
  • ne year of experience providing home health or personal care services, or a

combination of the same

  • Complete a training course approved by SED and demonstrate competencies as

specified in SED regulations

  • Successfully complete competency examinations as specified by SED
  • Meet other qualifications as set forth in SED regulations
  • Be listed in the DOH Home Care Registry
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DRAFT - November XX, 2017 6

Supervising Nurses

Advanced Home Health Aides may only perform advanced tasks assigned by and under the direct supervision of a licensed registered professional nurse employed by:

  • A home care services agency licensed or certified under Public Health Law (PHL)

Article 36

  • A hospice program certified pursuant to PHL Article 40
  • An enhanced assisted living residence licensed pursuant to Social Services Law

Article 7 and certified pursuant to PHL Article 46-B

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DRAFT - November XX, 2017 7

Assigning Advanced Tasks

  • Advanced tasks may not be assigned if the individual receiving services declines

to be served by an Advanced Home Health Aide

  • An Advanced Home Health Aide may only perform advanced tasks that are

specifically assigned by the supervising registered nurse

  • Any assigned advanced tasks must be performed in accordance with a health

practitioner's ordered care for the individual receiving services

  • A supervising nurse retains the discretion to assign advanced tasks and will not be

subject to coercion, retaliation, or the threat of retaliation by his or her employer

  • The supervising nurse may revoke any assigned task from any Advanced Home

Health Aide under his or her supervision for any reason

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DRAFT - November XX, 2017 8

Assigning Specific Advanced Tasks

In determining which types of advanced tasks to assign to an Advanced Home Health Aide, the supervising nurse must:

  • Assess the current health status and care needs of the individual being served
  • Be satisfied as to the aide’s competency to perform the particular advanced tasks
  • Ensure that the Advanced Home Health Aide is willing to perform the tasks
  • Consider whether the Advanced Home Health Aide can effectively and efficiently

communicate with the individual being served and understands his or her needs

  • Provide case-specific instructions for performing the advanced tasks and criteria

for identifying, reporting and responding to problems or complications

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DRAFT - November XX, 2017 9

Supervision of Advanced Tasks

Supervising nurses will be required to:

  • Train and periodically assess the performance of advanced tasks by the Advanced

Home Health Aides under his or her supervision

  • Complete ongoing assessments of the needs of the individuals being served
  • Visit the individuals being served no less than once every two weeks
  • Be available by telephone to the Advanced Home Health Aides under their

supervision 24 hours a day, seven days a week

  • Be available to visit an individual receiving services as necessary to protect the

individual's health and safety

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DRAFT - November XX, 2017 10

AHHA Support of Patient Quality Care

Advanced Home Health Aides may support patient’s quality of care by:

  • acting as an integral member of the patient’s care team updating the

Supervising Nurse on an ongoing basis about the patient’s care needs;

  • supporting improved medication compliance by the patient;
  • decreasing hospitalization or emergency room use through improved

medication compliance;

  • increasing length of visit time to be available to support and observe patient.
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DRAFT - November XX, 2017 11

Procedures and Practices for use of AHHAs

As implementation continues discussion will consider best practices for:

  • Establishing guidelines for determining what patients may benefit from use of an

AHHA

  • Establishing clear communication processes for RN supervisors and AHHAs to

assure information regarding the patient is being exchanged in a timely manner e.g. adverse reactions by the patient to medications

  • Establishing a system of reporting any medication errors that occur and providing

a plan of correction to prevent future errors

  • Tracking successful completion of required annual in-service training for all AHHA

staff

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DRAFT - November XX, 2017 12

Statutory Reporting on Implementation required by 10/1/22

  • Convene a Workgroup to discuss progress in implementation made by 1/1/22
  • SED must provide data to DOH regarding the number of AHHAs that became

licensed practical nurses by 4/1/22 (SED)

  • Number of certified AHHAs
  • Types of tasks the AHHAs have performed
  • The number of PCAs and HHAs who became certified AHHAs
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DRAFT - November XX, 2017 13

References

  • For more information, please see the DOH website at

https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides