Official Direction from the Center for Medicare and Medicaid Services

Home Health & Hospice Aides plan of care cannot use PRN or per patient choice for any task whether personal care or non-personal care. It is out of the scope of practice for the aide to determine what tasks need to be done and when. The qualified professional must develop the plan of care; indicate what task to be done and the frequency of these tasks. If the patient and/or caregiver are cognitively able to make a choice, then the RN must indicate this on the plan of care plus that the patient is functionally able to perform the task. The qualified professional, based on the needs of the patient, also selects non-personal tasks that need to be specific for frequency. Again, if the patient/caregiver is cognitively and functionally able to make a choice, the professional must indicate this on the plan of care.

The Centers for Medicare and Medicaid Services (CMS) recently stated that the Home Health & Hospice Aide plan of care CANNOT use “PRN” or “per patient choice” for ANY task, whether they are personal care or non-personal care

  • Use of “PRN” or “per patient request” in a patient record must be cited as a deficiency during an on-site survey.
  • Multiple types of care, such as the choice between a shower or sponge bath, can only be used when it has been documented by the nurse that the patient/caregiver has the ability to functionally and cognitively make a choice between the types of care that have been ordered.
  • The Aide Plan of Care must be individualized and refrain from using blanket statements like “patient is cognitively and functionally able to make the choice” for all patients and tasks.
  • If patients are requesting a specific type of care as a result of changes in their condition, Aides must still contact their supervisor prior to administering care.

Examples:

UNACCEPTABLE ACCEPTABLE
1. Tub bath or shower per patient request.  1. Tub bath or shower 3 times a week. Patient is functionally and cognitively able to make the choice.
2. May use walker or cane for ambulation per patient request. 2. May use walker or cane for ambulation. Patient is functionally and cognitively able to make the choice.
3. Change bed linens PRN. 3. Change bed linens weekly and anytime they are soiled.

Please contact Home Health Quality with questions. 1-800-447-5464

Article submitted by: Terry Greene, Director of Home Health Quality

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