Searching for a caregiver is hard enough, but not knowing what they can do can be frustrating. One of the most common questions I hear is “What can a caregiver do in our home?”. Well, I think I can answer that question with the following:
All In-Home Care agencies in Illinois are licensed, and regulated, by the Illinois Department of Public Health (IDPH). Below, word for word, is how the IDPH defines an in home caregiver (In-Home Services Worker). It also spells out, in great detail, what a caregiver Can, and Cannot, do while providing care. This regulation is what ALL licensed Non-Medical, In Home Care agencies must follow.
Home Services or In-Home Services Worker (In Home Caregiver)
1) As defined in this Part and under the Act, Home Services or in-home services means assistance with activities of daily living , housekeeping, personal laundry, and companionship provided to an individual in his or her personal residence, which are intended to enable that individual to remain safely and comfortably in his or her own personal residence. Home Services or in home services does not include services that would be required to be performed by an individual licensed under the Nurse Practice Act. (Section 2.09 of the Act) Home services are focused on providing assistance that is not medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence, such as companionship, cleaning, laundry, shopping, meal preparation, dressing, and bathing.
2) Home services or in-home services workers shall provide services only in accordance with this Part.
3) Duties of home services or in-home services workers may include the following:
A) Observation of client functioning and reporting changes to his or her supervisor or employer or to a person designated by the client;
B) Assistance with household chores, including cooking and meal preparation, cleaning and laundry;
C) Assistance in completing activities such as shopping and appointments outside of the home;
E) Completion of appropriate records documenting service provision; and
F) Assistance with activities of daily living and personal care.
4) To delineate the types of services that can be provided by a home services worker, the following are examples of acceptable tasks and also limitations when a more medical model of assistance would be needed to meet the higher needs of the client.
A) Skin Care. A home services worker may perform general skin care assistance. Skin care may be performed by a home services worker only when skin is unbroken, and when any chronic skin problems are not active. The skin care provided by a home services worker 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 must be provided by an agency licensed as a home health or home nursing services agency. Skilled skin care includes wound care, dressing changes, application of prescription medications, skilled observation and reporting.
B) Ambulation. A home services worker may assist clients with ambulation. Clients in the process of being trained to use adaptive equipment for ambulation, such as walkers, canes or wheelchairs, require supervision by an agency licensed to provide home health or home nursing services during the period of training. Once the prescribing individual or the health care provider responsible for training the client is comfortable with releasing the client to work on his or her own with the adaptive equipment, a home services worker may assist with ambulation.
C) Bathing. A home services worker may assist clients with bathing. When a client has skilled skin care needs or skilled dressings that will need attention before, during, or after bathing, the client shall be in the care of an agency licensed as a home health agency or a home nursing agency to meet those specific needs. Home services workers may assist individuals who are unable to be bathed in a tub or shower only when the following requirements are met:
i) The home services worker shall have been trained in the particular methods required to perform a bed bath;
ii) The client or client's representative shall be able to participate in or direct the bathing process and provide ongoing feedback to the home services worker; and
iii) The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform a bed bath.
D) Dressing. A home services worker 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. A home services worker may not assist with applying an elastic 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 applying a sequential compression device that can be purchased only with a physician's prescription.
E) Exercise. A home services worker may assist a client with exercise. Passive assistance with exercise that can be performed by a home services worker is limited to encouraging normal bodily movement, as tolerated, on the part of the client, and to encouragement with a prescribed exercise program. A home services worker shall not perform Passive Range of Motion.
F) Feeding. A home services worker may provide assistance with feeding. Home services workers can assist clients with feeding when the client can independently swallow and be positioned upright. Assistance by a home services worker 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 shall be in the care of an agency licensed as a home health or home nursing agency to fulfill this function.
G) Hair Care. As a part of the broader set of services provided to clients who are receiving home services, home services workers 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.
H) Mouth Care. A home services worker may assist in and perform mouth care. This may include denture care and basic oral hygiene, including oral suctioning for mouth care. Mouth care for clients who are unconscious shall be performed by an agency licensed as a home health agency or home nursing agency.
I) Nail Care. A home services worker may assist with nail care. This assistance may include soaking of nails, pushing back cuticles without utensils, and filing nails. Assistance by a home services worker shall not include nail trimming. Clients with a medical condition that might involve peripheral circulatory problems or loss of sensation shall be under the care of an agency licensed as a home health agency or home nursing agency to meet this need.
J) Positioning. A home services worker 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.
K) Shaving. A home services worker may assist a client with shaving only with an electric or a safety razor.
L) Toileting. A home services worker 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.
i) A home services worker 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 a home services worker.
ii) A home services worker 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. A home services worker shall not perform digital stimulation, insert suppositories, or give an enema.
M) Transfers. A home services worker 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, wheelchairs, tub seats, and grab bars. Gait belts may be used as a safety device for the home services worker as long as the worker has been properly trained in their use. A home services worker shall not assist with transfers when the client is unable to assist with the transfer. Home services workers may assist clients in the use of a mechanical or electrical transfer device only when the following conditions are met:
i) The home services worker must have been trained in the use of the mechanical or electrical transfer device by the licensed agency;
ii) The client or client representative must be able to direct the transfer step by step; and
iii) The agency must have conducted a competency evaluation of the worker using the type of device that is available in the home.
N) Medication Reminding. A home services worker 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 home services worker shall immediately report to the supervisor, or, in the case of a placement worker, to the client or the client's advocate or designee, 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.
O) A home services worker 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, home services workers 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.
5) In addition to the exclusions prescribed in subsection (c)(4), home services workers shall not act in the following capacities:
A) Provide skilled personal care services as defined in Section 245.20;
B) Become or act as a power of attorney;
C) Be involved in any financial transactions of the client outside of contracted services. In these cases, the home services worker shall follow agency policies in regard to securing receipts for items purchased and ensuring both client and worker signatures documenting those expenditures;
D) Perform or provide medication setup for a client; and
E) Other actions specifically prohibited by agency policy or other State laws.
6) Supervision of a home services worker shall include the following (these provisions do not apply to placement agencies):
A) An individual who is in a supervisory capacity shall be designated and available to the worker for responses to questions at all times.
B) On-site supervision shall take place at a minimum of every 90 days or more often if the plan of service requires it. The supervisory visits may be made when the home services worker is present so that the supervisor may observe, or when the home services worker is absent so that the supervisor may assess relationships and determine whether the service plan is being met.
C) Supervision does not constitute time or an activity that can be billed as a service to the client/consumer.
As detailed as this description is, I hope it help you understand what a non-medical In Home Care agency can, and cannot do for you or a loved one.
Based in Oak Park and operating throughout Chicagoland, ARIS at home is a family-owned provider of compassionate, quality in-home care. ARIS stands for Accountability, Respect, Integrity and Service. Online, visit www.arisathome.com, email: firstname.lastname@example.org, or by Phone: 708-934-4676.