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Scope of Services

TYPE AND SCOPE OF SERVICES
 
PERSONAL CARE SERVICES
HOMEMAKER SERVICES  
COMPANION SERVICES    
EXAMPLES OF ACCEPTABLE TASKS AND LIMITATIONS
 

PERSONAL CARE SERVICES 
Assistance with the normal ADLs as described below:
  • Assistance with bathing/dressing/grooming.
  • Assistance with toileting needs and routine care of an incontinent recipient.
  • Assistance with transferring and positioning non-ambulatory recipients from one stationary position to another, including adjusting/changing recipient’s position in a bed or chair
  • Assistance with ambulation, which is the process of moving between locations, including walking or helping the recipient to walk with support of a wheelchair, walker, cane or crutches, assisting a recipient out of bed, chair or wheelchair.
  • Assistance with eating, including cutting up food. Specialized feeding techniques may not be used.
  • Assistance with medications which are self-administered, including verbal reminders to the recipient to take medications, bringing medication to the recipient and loosening the cap to the medication container. Medication administration by In-Home Caregiver is not permitted.
   
HOMEMAKER SERVICES  
  • Meal preparation: menu planning, storing, preparing, serving of food, cutting up food, buttering bread and plating food.
  • Laundry services: washing, drying and folding the recipient’s personal laundry and linens (sheets, towels, etc.) excludes ironing.
  • Light housekeeping: changing the recipient’s bed linens, dusting, vacuuming the recipient’s living area, cleaning kitchen and bathroom areas;
  • Essential shopping to obtain: prescribed drugs, medical supplies, groceries, and other household items required specifically for the health and maintenance of the Recipient.
  • Assisting the recipient and family members or caregivers in learning homemaker routine and skills, so the recipient may carry on normal living when the homemaker is not present.
   
COMPANION SERVICES  
  • Provides non-medical care, supervision and socialization to a functionally impaired recipient in his or her home or place of residence, which may provide temporary relief for the primary caregiver.
  • Companions may assist the recipient with such tasks as meal preparation and clean up, light housekeeping, shopping and facilitate transportation/escort as needed. These services are provided as an adjunct to Companion Services and must be incidental to the care and supervision of the recipient.
  • The provision of Companion Services does not entail hands-on medical care.
   
EXAMPLES OF ACCEPTABLE TASKS AND LIMITATIONS
  • Skin Care.  In-Home Caregiver may perform general skin care assistance.  Skin care may be performed by In-Home Caregiver only when skin is unbroken, and when any chronic skin problems are not active.  The skin care provided by In-Home Caregiver must be preventative rather than therapeutic in nature, and may include the application of non-medicated lotions and solutions, or of lotions and solutions not requiring a physician's prescription.  Skilled skin care may not be provided by In-Home Caregiver.  Skilled skin care includes wound care, dressing changes, application of prescription medications, skilled observation and reporting.
  • Ambulation.  In-Home Caregiver may assist clients with ambulation.  However, In-Home Caregiver may not assist clients in the process of being trained to use adaptive equipment for ambulation, such as walkers, canes or wheelchairs.  Once the prescribing individual or the health care provider responsible for the training of the client is comfortable with releasing the client to work on his or her own with the adaptive equipment, In-Home Caregiver may assist with ambulation.
  • Bathing.  In-Home Caregiver may assist clients with bathing.  In-Home Caregiver may not assist a client who has skilled skin care needs or skilled dressings that will need attention before, during, or after bathing.
  • Dressing.  In-Home Caregiver may assist a client with dressing.  This may include assistance with ordinary clothing and application of support stockings of the type that can be purchased without a physician's prescription.  In-Home Caregiver may not assist with application of an Ace bandage that can be purchased only with a physician's prescription (the application of which involves wrapping a part of the client's body) or with application of a sequential compression device that can be purchased only with a physician's prescription.
  • Exercise.  In-Home Caregiver may assist a client with exercise.  Passive assistance with exercise that can be performed by In-Home Caregiver is limited to the encouragement of normal bodily movement, as tolerated, on the part of the client, and to encouragement with a prescribed exercise program.  Passive Range of Motion may not be performed by In-Home Caregiver.
  • Feeding.  In-Home Caregiver may provide assistance with feeding.  In-Home Caregivers can assist clients with feeding when the client can independently swallow and be positioned upright.  Assistance by In-Home Caregiver does not include syringe, tube feedings, and intravenous nutrition.  Whenever there is a high risk that the client may choke as a result of the feeding, the client may not be in the care of In-Home Caregiver.
  • Hair Care.  As a part of the broader set of services provided to clients who are receiving home services, In-Home Caregivers may assist clients with the maintenance and appearance of their hair.  Hair care within these limitations may include shampooing with non-medicated shampoo or shampoo that does not require a physician's prescription, drying, combing and styling hair.
  • Mouth Care.  In-Home Caregiver may assist in and perform mouth care.  This may include denture care and basic oral hygiene, including oral suctioning for mouth care.  In-Home Caregiver may not assist with mouth care for clients who are unconscious.
  • Nail Care.  In-Home Caregiver may assist with nail care.  This assistance may include soaking of nails, pushing back cuticles without utensils, and filing of nails.  Assistance by In-Home Caregiver may not include nail trimming.  In-Home Caregiver may not assist clients with a medical condition that might involve peripheral circulatory problems or loss of sensation.
  • Positioning.  In-Home Caregiver may assist a client with positioning when the client is able to identify to the personal care staff, either verbally, non-verbally or through others, when the position needs to be changed, only when skilled skin care, as previously described, is not required in conjunction with the positioning.  Positioning may include simple alignment in a bed, wheelchair, or other furniture.
  • Shaving.  In-Home Caregiver may assist a client with shaving only with an electric or a safety razor.
  • Toileting.  In-Home Caregiver may assist a client to and from the bathroom; provide assistance with bed pans, urinals, and commodes; provide pericare; or change clothing and pads of any kind used for the care of incontinence.
    • In-Home Caregiver may empty or change external urine collection devices, such as catheter bags or suprapubic catheter bags.  In all cases, the insertion and removal of catheters and care of external catheters is considered skilled care and shall not be performed by In-Home Caregiver.
    • In-Home Caregiver may empty ostomy bags and provide assistance with other client-directed ostomy care only when there is no need for skilled skin care or for observation or reporting to a nurse.  In-Home Caregiver shall not perform digital stimulation, insert suppositories, or give an enema.
  • Transfers.  In-Home Caregiver may assist with transfers only when the client has sufficient balance and strength to reliably stand and pivot and assist with the transfer to some extent.  Adaptive and safety equipment may be used in transfers, provided that the client is fully trained in the use of the equipment and can direct the transfer step by step.  Adaptive equipment may include, but is not limited to, wheel chairs, tub seats, and grab bars.  Gait belts may be used as a safety device for the In-Home Caregiver as long as the worker has been properly trained in their use.  In general, In-Home Caregiver may not assist with transfers when the client is unable to assist with the transfer.  In-Home Caregivers may assist clients in the use of a mechanical or electrical transfer device only when the following conditions are met:
    • The In-Home Caregiver must have been trained in the use of the mechanical or electrical transfer device by the licensed agency;
    • The client or client representative must be able to direct the transfer step by step; and
    • The agency must have conducted a competency evaluation of the worker using the type of device that is available in the home.
  • Medication Reminding.  In-Home Caregiver may assist a client with medication reminding only when medications have been pre-selected by the client, a family member, a nurse, or a pharmacist and are stored in containers other than the prescription bottles, such as medication minders.  Medication minder containers shall be clearly marked as to day and time of dosage.  Medication reminding includes:  inquiries as to whether medications were taken; verbal prompting to take medications; handing the appropriately marked medication minder container to the client; and opening the appropriately marked medication minder container for the client if the client is physically unable to open the container.  These limitations apply to all prescription and all over-the-counter medications.  The In-Home Caregiver shall immediately report to the supervisor any irregularities noted in the pre-selected medications, such as medications taken too often or not often enough, or not at the correct time as identified in the written instructions.
  • In-Home Caregiver shall not provide respiratory care.  Respiratory care is skilled and includes postural drainage; cupping; adjusting oxygen flow within established parameters; nasal, endotracheal and tracheal suctioning; and turning off or changing tanks.  However, In-Home Caregivers may temporarily remove and replace a cannula or mask from the client's face for the purposes of shaving or washing a client's face and may provide oral suctioning.
 
In addition to the exclusions prescribed in above, In-Home Caregivers shall not act in the following capacities:
  • Provide skilled personal care services as defined in 77 ill. Adm. code 245.20;
  • Become or act as a Power of Attorney;
  • Be involved in any financial transactions of the client outside of contracted services.  In such cases, the In-Home Caregiver shall follow agency policies in regard to securing receipts for items purchased and ensuring both client and worker signatures documenting those expenditures;
  • Perform or provide medication setup for a client; and

 

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