Private Duty Standards of Practice

The Michigan Home Care recommends to it’s membership the following Standards of Practice as a basis of development for each agency’s individualized standards of care.

Guidelines for Implementation

The Michigan Home Care recommends to its membership the following Guidelines for Implementation of Standards of Practice as a basis of development for each agency’s individualized guidelines.

Standard I

Home care services are provided in accordance with professionally recognized standards for each discipline.

Guidelines:

1. Professional and paraprofessional credentials are verified for authenticity and validity per agency policy. Criminal background checks are conducted for job applicants, who shall be deemed eligible for employment in accordance with agency policy.
2. Employee files are maintained and updated per agency and/or regulatory policies.

Definitions:

Health Care Professional (HCP):  An individual who has completed the necessary educational requirements and possesses a valid Michigan license and/or professional accreditation in his/her specific field.

Health Care Paraprofessional (HCPP):  An individual who is supervised by a health care professional. He/she has demonstrated a minimal level of clinical competency in the provision of basic client care. Training for a paraprofessional may be through classroom activity and/or on the job training under the direction of a HCP. A paraprofessional may undergo written and/or clinical evaluation to demonstrate proficiency.

Standard II

The initial assessment visit is completed by the appropriate professional person.

Guidelines:

1. The professional nurse (RN) completes the initial assessment on all skilled care cases. The licensed practical nurse (LPN) may complete the initial assessment visit on all Homemaker/Home Health Aide cases.
2. The initial assessment visit of the client may include but is not limited to the following:
   1. collection related to the status of the client’s physical, psychosocial and environmental conditions
   2. An explanation of parameters of services
   3. Completion of necessary administrative paperwork related to reimbursement and agency policies
   4. Development of a nursing/service plan of care
   5. Establishment of an emergency plan
   6. Determination and/or confirmation of the appropriate skill level required
   7. Obtaining physician’s orders as necessary
   8. Arranging therapy and support services as necessary
3. The assessment information is recorded in a timely and efficient manner according to agency policy.
4. The need for and frequency of reassessment/supervisory visits are determined in accordance with agency policies.
5. Employees are assigned in a timely manner in accordance with agency policy. Factors influencing the choice of personnel may include:
   1. Skill level required
   2. Availability of personnel
   3. Client/family requests
   4. Third party payor coverage
   5. Physician’s orders
6. A designated on call coordinator is available for scheduling and clinical concerns after regular office hours.

Standard III

Data collection is ongoing and systematic. The data is accessible, communicated, and recorded.

Professional Level Guidelines:

1. The data collection may include:
   1. Holistic assessment of the client’s physical, psychological, and social status
   2. Assessment of the client’s residence/environment
   3. Assessment of the client’s concerns and immediate needs
   4. The client’s medical history, physician orders, medical treatment plan, when appropriate
   5. Assessment of the client’s support systems, community resources
   6. Assessment of family dynamics
   7. Assessment of social and cultural factors affecting health
2. The professional records the data in a timely, standardized, systematic, and concise form. The home care agency maintains a record keeping system that provides for:
   1. Systematic and complete collection of data
   2. Frequent updating of records
   3. Accessibility to the records, as determined by agency policy
   4. Confidentiality of the records

Paraprofessional Level Guidelines:

1. The paraprofessional is responsible for making observations on each visit. This may include:
   1. Physical and mental status
   2. Environment and safety
   3. Support systems
   4. Family dynamics
   5. Social and cultural factors affecting health
2. The paraprofessional reports client changes and unusual conditions to the supervisor.
3. The paraprofessional documents according to agency policy.
4. The paraprofessional maintains confidentiality regarding client information.

Standard IV

Problem statements are derived from client needs.

Professional Level Guidelines:

1. All assessment data is interpreted and analyzed in collaboration with the client and family prior to formulating problem statements.
2. The client’s potential and limitations are considered when developing a problem statement.
3. Problem statements are derived from assessed health related needs.
4. Problem statements are written in an accepted format that is recognized by the health care provider’s discipline and agency policy.
5. Problem statements are revised when necessary after review of ongoing data collection.

Paraprofessional Level Guidelines:

1. Problem statements are developed and written on the paraprofessional’s plan of care.
2. The paraprofessional reports any changes in client status to the supervisor.

Standard V

Plans for service include goals and expected outcomes derived from the assessment data.

Professional Level Guidelines:

1. To achieve the goals and expected outcomes the professional will:
   1. Evaluate the referral for appropriateness and accept or reject the referral accordingly
   2. Provide appropriate professional intervention
   3. Provide available community resources
   4. Provide instructions for a safe environment
   5. Minimize further dependency and deterioration as possible
   6. Initiate or develop a support system as needed
   7. Encourage client/family participation in determination of goals
   8. Educate the client and family toward goals and expected outcomes.
2. Expected outcomes for services provided by the professional may include:
   1. An improved level of functioning
   2. Maximum rehabilitation potential
   3. Projected independent living potential without caregiver assistance
   4. Physical and mental comfort

Standard VI

Plans for service include interventions to achieve the identified goals and expected outcomes.

Professional Level Guidelines:

1. The professional will:
   1. Develop a written plan for service
   2. Review and revise plan as condition warrants
   3. Encourage client and family to participate in the development of and changes in the plan of care
   4. Include information regarding community resources in the plan of care when needed
   5. Identify emergency plans for clients

Paraprofessional Level Guidelines:

1. The paraprofessional follows the paraprofessional plan of care prepared by the professional.
2. The paraprofessional will report changes in the client’s physical condition and psychosocial behavior to the appropriate professional.
3. The paraprofessional strives to provide the client with personalized, reliable, and timely service.

Standard VII

Interventions assist the client to achieve or maintain maximum potential.

Professional Level Guidelines:

1. Interventions are developed based on expected client outcomes. They may provide one or more of the following:
   1. Comfort
   2. Restoration/rehabilitation
   3. Improvement
   4. Health promotion/maintenance
   5. Prevention of complications
   6. Learning
   7. Safety
2. Professional interventions are:
   1. Specific/individualized
   2. Consistent with the plan of care
   3. Consistent with the defined standards of practice
   4. In accordance with the client’s physiological, psychological, and social behavior
   5. Inclusive of teaching and education
3. Interventions and the client’s response to the interventions are recorded systematically and timely and are easily retrievable, according to agency policy.
4. The agency maintains a policy/procedure manual for professional interventions.
5. The agency maintains an internal review to ensure that interventions follow the established policies/procedures.
6. The agency maintains a written job description for all professional staff.
7. Agency services are coordinated with and communicated to other members of the health care team and community.

Paraprofessional Level Guidelines:

1. Paraprofessional interventions are developed by the professional. They are based on the professional assessment, plan of care, and expected outcomes and provide one or more of the following:
   1. Comfort
   2. Restoration/rehabilitation
   3. Improvement
   4. Health promotion/maintenance
   5. Prevention of complications
   6. Learning
   7. Safety
2. Paraprofessional Interventions are:
   1. General in nature but individualized to the client
   2. Incorporated in the paraprofessional plan of care
   3. Consistent with the client’s physiological condition including functional status and psychological social behavior
   4. Appropriate to the level of experience and/or training of the paraprofessional
   5. Recorded systematically and timely and are easily retrievable according to agency policy
3. Access to professional guidance/supervision is available during the hours of services.
4. The agency maintains a policy/procedure manual for paraprofessional intervention.
5. The agency maintains an internal review to ensure that interventions follow the established policies/procedures.
6. The agency maintains a written job description for all paraprofessional staff.
7. Agency services are coordinated with and communicated to other members of the health care team and community.
8. Care is provided in accordance with accepted standards of practice in the community.

Standard VIII

The client’s progress toward goal achievement is evaluated regularly by the client and home care provider.

Professional Level Guidelines:

1. Plans toward goal achievement are dependent on continuous and ongoing evaluation of mutually agreed upon outcomes.
2. Baseline and current data are reviewed and interpreted to measure progress toward goals.
3. Active participation of client, family, or significant other is encouraged to revise priorities, goals, and interventions.
4. The professional documents revisions and evaluations.
5. A quality assurance mechanism is in place to evaluate the client’s progress toward goal achievement.

Standard IV

Continuity of care is assured through a process of planning and referral to appropriate community resources.

Professional Level Guidelines:

1. The plan of nursing care includes the utilization of available and appropriate resources. They may include any or all of the following:
   1. Support Service
   2. Client education materials
   3. Community resources
   4. Medical equipment resources
2. The client/family/significant other are provided with information needed to make decisions and choices about:
   1. Promoting, maintaining and restoring health
   2. Seeking and utilizing appropriate health care personnel
   3. Maintaining and using health care resources
3. There is a current listing and description of community resources available.
4. The professional identifies and plans for services to meet health care needs.
5. During transition from one agency to another, the professional provides adequate information to assure coordination of services.
6. There is documentation in the client record of coordination among referral sources.

Standard X

An emergency plan is established for the client.

Professional Level Guidelines:

1. During initial assessment the appropriate professional will establish the emergency plan related to the care or service provided.
2. The emergency plan may include, but is not limited to the following:
   1. Phone numbers of police, fire, ambulance, physician, pharmacy, home care organization, primary contact person, medical equipment company
   2. Basic home safety precautions
   3. Changes in medical condition to report to physician and/or home care organization
3. The emergency plan is reviewed with the client, family, and care givers.

Paraprofessional Level Guidelines:

1. The paraprofessional is responsible for knowledge of the emergency plan and to follow the emergency plan if necessary.

Standard XI

Continuing educational growth of staff is encouraged.

Professional and Paraprofessional Level Guidelines:

1. The home care organization provides opportunities to all staff for participation in continuing education activities on an individual or group basis.
2. The home care organization selects appropriate professionals to conduct or provide for continuing education programs/activities.
3. The home care organization provides staff with access to educational resources.