Illinois home care policies and procedures: what Part 245 requires

Governing body

A governing body with legal authority and responsibility for the agency.

"The agency shall have a governing body or a clearly defined body with legal authority and responsibility for the conduct of the agency."

Bylaws reviewed yearly

Bylaws or the equivalent stating the agency's objectives, available to every governing body member and reviewed every year.

"Have bylaws or the equivalent, which shall be reviewed annually and be revised as needed."

Policies adopted by the governing body

The governing body adopts the agency's operating and administrative policies and revises them as needed.

"Adopt and revise, as needed, policies and procedures for the operation and administration of the agency;"

Governing body meetings and minutes

The governing body meets to review the agency's operation and keeps minutes of every meeting.

"Meet to review the operation of the agency; and"

Written administrative policies

Written administrative policies and procedures that ensure clients receive safe and adequate care.

"The agency shall have written administrative policies and procedures to ensure that the patient or client is provided safe and adequate care."

Liability insurance

Liability coverage of at least $1 million per occurrence and $3 million aggregate, with evidence available.

"The agency shall show evidence of liability insurance in accordance with Section 245.90(a)."

Agency manager

Designate an agency manager with overall responsibility for day-to-day operation and supervision of services.

"A home services agency shall designate a person to supervise the provision of services or to oversee the placement of workers through the licensed home services agency."

Agency manager responsibilities

The manager ensures legal compliance, keeps the rules on hand, completes required reports and records, liaises with the governing body and community, manages business affairs, keeps personnel and administrative records and all policies, hires to job descriptions and provides orientation and in-service education.

"Ensure that the agency is in compliance with all applicable federal, State and local laws;"

Staff and contractors know the rules

Keep the IDPH rules in the agency and familiarize every employee and contractor with the Act and rules, with copies available.

"Familiarize all employees as well as providers through contractual purchase of services with the Act and the rules of the Department and make copies available for their use;"

Organization chart

A current organization chart showing lines of authority down to the client level.

"Maintain a current organizational chart to show lines of authority down to the patient or client level;"

Written alternate manager

Designate in writing the qualified staff member who acts when the manager is absent; the alternate is named in the license application.

"Designate in writing the qualified staff member to act in the absence of the administrator;"

Staffed office

An office with a working phone staffed during business hours, adequately equipped, keeping client records confidential and meeting local fire safety rules.

"Provide and maintain an office with a working telephone that is staffed during the agency's business hours."

Operating hours and after-hours access

A written policy stating operating hours and how clients get care from the agency or another provider outside those hours.

"Adopt and enforce a written policy identifying the agency's operating hours and including, at a minimum, provisions that ensure clients and patients are provided information regarding the procedures for accessing care from the agency or another health care provider outside of the agency's operating hours."

Change notices within 10 days

Tell IDPH within 10 days of a change to name, manager, physical or mailing address, operating hours, phone, fax or email, including at branches.

"A licensee shall notify the Department within 10 days after any change to the following information (this requirement also applies to change at branch locations):"

Service area changes approved first

Get IDPH approval before expanding or reducing the geographic service area.

"Expansion or reduction of agency's geographic service area."

Change of ownership

Written notice to IDPH at least 30 days before a change of ownership or sale; the new owner applies at least 30 days before the sale; return the old license by certified mail.

"A licensee shall notify the Department in writing at least 30 days in advance of any intention to:"

Closing the agency or a branch

Written notice 30 days before closing with reasons and the records custodian; transfer active clients' records to receiving agencies and tell IDPH which; surrender the license when services stop.

"The licensee shall include in the written notice the reasons for closing, the location of patient or client records, and the name and address for the custodian of the client and patient records."

Annual renewal

File the renewal 60 to 90 days before expiry with client load data, and be able to show client activity before the second renewal.

"If a licensee does not submit its renewal application and fee within 60 days prior to the expiration date, the licensee may be fined in accordance with Section 245.140."

Policies filed with the application

Copies of the complaint, employee health and safety, infection control, background check and mandated reporting, supervisory visit, client records and training policies go to IDPH with the initial application.

"Health care worker background check compliance as required per Section 245.72 and mandated reporting compliance as required per Section 245.250;"

Contract, acceptance criteria and service plan form

The initial application also includes the client service contract, the criteria for accepting clients and a sample service plan form.

"For home services and home nursing agencies, copies of client service contracts as required per Section 245.220."

Inspections and access

Help IDPH visit clients at home during inspections and make all books, records, policies and procedures available.

"Agencies shall facilitate any necessary visits by the Department's staff to patients or clients in their homes during the Department's investigations or inspections."

Plans of correction

File a plan of correction within 10 days of a notice of violation, stating how and by when each violation will be corrected; a modified plan within 10 days of any rejection.

"State with particularity the method by which the agency intends to correct each violation specified in the notice of violation."

Branch office operationif the agency has an approved branch office

Branches within 100 miles, same services, lines of authority traceable to the parent, parent manager supervising during all branch hours, parent-held personnel records, training and contracts, and branches included in quality reviews.

"Lines of authority and administrative control shall be clearly delineated in both organizational structure and in practice and shall be traceable to the parent office."

Monthly branch supervisory visitsif the agency has an approved branch office

At least monthly on-site visits to each branch, documented with the date, content, attendees and recommendations.

"All supervisory visits must be documented and include the date of the visit, the content of the consultation, the individuals in attendance, and any recommendations made to the staff at the branch location."

Drop-site limitsif the agency has an approved drop site

A drop site has no designated staff, takes no referrals or orders, does no payroll or billing, stores no files and is not advertised.

"Assigning orders, accepting client and patient referrals, conducting payroll or billing activities, or storing files (client or personnel)."

Contracted services agreementsif the agency provides any services through a contract with a third party

A written agreement for third-party services covering services, adherence to agency policies and background checks, agency control, notes, charges, liability, insurance and taxes, term, signatures and termination.

"If the agency provides services under contractual arrangements with a third party, it shall have a written agreement that includes, but is not limited to, the following:"

Qualified contract personnelif the agency uses contracted workers or services

Contracted services are provided by qualified, properly licensed or certified personnel under the agency's supervision.

"Home services and home nursing agencies that use some contractual services shall ensure that these services are provided by qualified personnel"

Student training agreementsif the agency takes students from an educational institution

A written agreement with each educational institution covering client care responsibility, education, expectations, supervision, ratios, confidentiality, insurance and joint evaluation.

"When an agency elects to participate with an educational institution to provide clinical experience for students as part of their health-related professional training, a written agreement between the agency and each educational institution shall specify the responsibilities of the agency and the educational institution."

List of services and scope of work

Keep a list of services offered and the scope of work for each, and give it to clients before contracting, with the signed contract and whenever it changes.

"Each agency shall maintain a listing of the types of services offered by the agency, and the scope of the work to be provided under each area, which the agency shall distribute to clients before contracting with the client, with the signed contract, and when changes occur."

Written client agreement

A written agreement with every client covering compliance with the Act and background checks, who pays employment taxes and workers' compensation, who supervises and hires and fires workers, charges and payment, term and termination, and contact details for concerns.

"When services are provided to clients by a home services agency, there shall be a written contractual agreement between the client and the agency that includes, but is not limited to:"

Client contract contents

Contracts in at least 12-point type include consent, agency contacts, the manager to contact, license status, compliance with the Act, duration, rate and services, how to modify or end it, the complaint process, billing and the emergency notification policy; copies to the client and the client file.

"The contracts shall be printed in no less than 12-point type, and shall include at least the following elements in the body or through supporting documents or attachments:"

Who is the employer notice

A notice naming the party responsible for employing, insuring, paying, taxing, supervising, assigning, hiring and firing the worker, and supplying equipment.

"A notice as developed and provided by the agency, indicating the responsible party for the following:"

Emergency notification policy

A policy on notifying a relative or other person in an emergency, stated in the client contract.

"A statement regarding the agency's policy on notification of a relative or other individual in case of an emergency;"

Acceptance and discharge policies

Written policies on accepting and discharging clients, followed in practice.

"Home services agencies shall develop and follow policies on acceptance and discharge of clients, which shall include, but not be limited to, the following:"

Who can be accepted

Accept clients for household or personal support or companionship; never provide medical services that need a home health or home nursing license.

"Persons shall be accepted for service on the basis of their desire or need for assistance with household or personal support or companionship services."

Documented acceptance information

Base acceptance on documented information, gathered with the client and family or representative, about functional limitations and circumstances such as medications, treatments, activity, diet and mental status.

"The acceptance of the client for non-medical services shall be based on the following documented information, in consultation with the client and the client's appropriate family members or representative:"

No discrimination

No one is refused service based on race, color, religion, national origin, ancestry, age, sex, marital status, order of protection status, disability, military status, sexual orientation, pregnancy or unfavorable military discharge.

"No person shall be refused services based on actual or perceived race, color, religion, national origin, ancestry, age, sex, marital status, order of protection status, disability, military status, sexual orientation, pregnancy, or unfavorable discharge from military service"

Clients needing full repositioningif the agency accepts clients who need complete repositioning

Accept a client who needs complete repositioning and cannot signal it only if the worker is trained and checked for competency and the client's representative can help or give feedback.

"The agency may accept a client who requires complete repositioning and where the client is unable to assist"

Seven working days' termination notice

At least seven working days' notice with a reason before the agency ends services, recorded in the client record; when a worker's safety is at risk, notice may be shorter but the risk is documented.

"Documentation of the risk to the provider shall be maintained in the client record."

Service plan contents

A plan for each client, made with the client or representative (and family at their request), covering ADL and support tasks, medication reminder times, treatments, activity, diet, functional limitations and safety procedures, mental health status, visit frequency, equipment and limitations.

"The plan shall address and include, but not be limited to:"

Plan stays within scope

The service plan never includes tasks outside the home services worker's permitted scope.

"The service plan shall not include services outside the scope of work for a home services worker as provided in Section 245.40(c)(4)(A) through (P)."

Yearly plan review

Review and revise the plan as needed and at least once a year.

"The service plan shall be reviewed and revised as necessary, but not less than once annually."

Complaint resolution

Written complaint resolution policies for clients and their advocates, described in the client contract.

"The agency shall develop and implement written policies for complaint resolution between the agency and its patients or clients and patient or client advocates in regard to services being provided to the patient or client."

Workers stay within home services

Workers provide only the home services Part 245 allows: observation and reporting, chores, errands, companionship, records of each visit and ADL and personal care help.

"Home services or in-home services workers shall provide services only in accordance with this Part."

Prohibited worker roles

Workers never give skilled personal care, act as a power of attorney, handle client money outside contracted services, set up medications or do anything else agency policy or law forbids.

"In addition to the exclusions prescribed in subsection (c)(4), home services workers shall not act in the following capacities:"

Receipts for client purchases

An agency policy on getting receipts for items bought for clients, signed by the client and the worker.

"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"

Skin care and first aid

Preventive skin care on unbroken skin with non-prescription products; simple first-aid bandages only after lay first aid training and a competency check. Wound care is skilled.

"The home services worker shall have completed training in first aid for a lay person; and"

Ambulation and adaptive equipmentif workers help clients who use adaptive equipment to walk

Help with walkers, canes and wheelchairs only once training on the equipment is finished by a licensed provider and the worker is trained and checked for competency.

"The home services worker shall have completed training in the methods required to assist clients with adaptive equipment for ambulation; and"

Bathingif workers help clients bathe

Bathing help only after training in the client-specific bath and a competency check, with bathing training and competency repeated every year. Clients with skilled skin or dressing needs go to a home health or home nursing agency.

"The agency shall conduct annual training and competency evaluation for skills to perform all types of bathing effectively and safely."

Prescription compression devicesif workers apply prescription compression devices

Applying prescription elastic bandages or compression devices needs a health care professional's order, worker training and a competency check.

"The client's prescribing health care professional has issued an order allowing the home service worker to apply the compression device as a part of daily activities of living;"

Feeding and thickenersif workers help clients eat

Feeding help only when the client swallows independently and sits upright; high choking risk goes to a home health or home nursing agency. Pre-measured thickeners need training and a competency check.

"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."

Prescription shampooif workers apply prescription shampoo

Prescription shampoo only with an order, training, a competency check and annual retraining; open skin lesions are documented and reported.

"The agency shall conduct annual training and competency evaluation for skills to apply and observe clients during shampooing."

Nail care

No nail trimming. For clients with circulatory problems or loss of sensation, filing only with an order, training and a competency check.

"Assistance by a home services worker shall not include nail trimming."

Positioningif workers help clients change position

Positioning help after training in cues and repositioning procedures and a competency check, following the service plan.

"The agency shall have conducted a competency evaluation of the home services worker's ability to employ the methods required to perform repositioning effectively and safely as needed."

Transfers and liftsif workers help clients transfer

Transfers, including with gait belts or mechanical lifts, only when the client has the balance and strength to stand and pivot and can help, directly or by giving feedback, after training on the client's equipment and a competency check.

"The home services worker shall have completed training in transfer techniques and any client-specific adaptive equipment, safety equipment, and mechanical or electrical transfer devices; and"

Toileting, catheters, ostomies and shaving limits

Workers may empty catheter and ostomy bags but never insert or remove catheters, give enemas or suppositories or do digital stimulation; shaving only with an electric or safety razor.

"In all cases, the insertion and removal of catheters and care of external catheters is considered skilled personal care and shall not be performed by a home services worker."

Medication remindingif workers remind clients to take medications

Reminding only from pre-filled, day-and-time-marked containers filled by someone else; report irregularities to the supervisor immediately.

"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"

Oxygen system changesif workers serve clients on continuous oxygen

Switching oxygen from stationary to portable only after training and a competency check, with a trained staff member able to train and evaluate workers. Other respiratory care is skilled.

"A home services agency seeking to have a home services worker assist a client with changing of oxygen delivery systems shall maintain an individual on staff that has been trained and is able to conduct training and administer competency evaluation"

Vital sign remindersif workers help with blood pressure, pulse oximeter or similar devices

Workers may remind clients to take readings and help record them, but the agency never interprets the data or acts clinically on it.

"The home service agency shall not provide the client and/or family any service to interpret the data or to take clinical action of the monitoring results."

Supervisor available at all times

A designated supervisor available to workers for questions at all times.

"An individual who is in a supervisory capacity shall be designated and available to the worker for responses to questions at all times."

Supervisory visits every 90 days

On-site supervision at least every 90 days, or more often if the plan requires, with the worker present or absent.

"On-site supervision shall take place at a minimum of every 90 days or more often if the plan of service requires it."

Observation visits

Observe a worker giving care by the next supervisory visit when there is a concern, and observe every worker on site at least once a year, checking safe care, the plan, competency, infection control, reporting, rights and communication.

"The supervisor shall make an annual on-site visit to the location where a client is receiving care in order to observe and assess each home services worker while he or she is performing care."

Supervision is not billed

Supervision time is never billed to the client.

"Supervision does not constitute time or an activity that can be billed as a service to the client or consumer."

Observation, reporting and visit records

Workers observe and report changes in the client to their supervisor and complete records of the services given at each visit.

"Observation of client functioning and reporting changes to their supervisor or employer or to a person designated by the client;"

Personnel policies

Personnel policies available to all staff covering wages, benefits, hours and leave; orientation and continuing education; Civil Rights Act compliance; and confidential personnel records.

"Personnel policies applicable and available to all full- and part-time employees shall include, but not be limited to, the following:"

Initial health evaluation

An initial health evaluation for each new employee with client contact, as the governing body specifies.

"Requirements for an initial health evaluation of each new employee or the placed home services worker or placed nurse who has contact with clients or patients, as specified by the governing body;"

Job descriptions

Job descriptions for every position, and staff hired to them; copies go with the initial application.

"Job descriptions for all positions used by the agency;"

Annual performance evaluation

An annual performance evaluation for every employee.

"Annual performance evaluation for all employees;"

Employee health and communicable disease

Employees report symptoms and exposure to communicable disease; the policy says when they are removed from client contact and when they may return.

"Employee health policies that require employees to report health symptoms and exposure to any communicable or infectious disease"

Worker safety in clients' homes

Procedures to identify dangers to staff working in homes and to protect them.

"Agency procedures for identifying potential dangers to the health and safety of agency personnel providing services in the home and procedures for protecting agency personnel from identified dangers."

Professional license checksif any position needs a state professional license

Before hiring anyone into a position needing a state professional license, verify it is active with IDFPR and keep the verification in the file.

"A copy of the verification of the individual's license shall be placed in the individual's personnel file."

Personnel records

Name and address, Social Security number, date of birth, next of kin, evidence of qualifications, dates of employment and separation and the reason.

"Personnel records for all employees or placement agency registry files for placement workers shall include the name and address of the employee or placement worker, Social Security number, date of birth, name and address of next of kin"

Worker eligibility documents

Each worker's file shows no disqualifying background check without a waiver, a copy of their Social Security card, and a visa or proof of citizenship.

"Does not have a disqualifying background check under the requirements of the Health Care Worker Background Check Act without a waiver;"

Ten hours of initial training

At least 10 hours for each worker: five before the first assignment and five in the first 30 days; prior training at another licensed agency in the past year may be accepted.

"Each home services agency shall provide or arrange for a minimum of ten hours of training for each home services worker."

Competency evaluations

No assignment until the worker passes a competency evaluation on the first five hours (including workers with prior training and CNAs); test again after the second five.

"The worker shall be similarly tested following the remaining five hours of training."

Initial training topics

Fourteen subjects: job limits, communication, observing and reporting, personal care tasks, adaptive equipment, hygiene and infection control, a safe home, safety precautions, emergencies and first aid, confidentiality, dementia, challenging behavior, abuse and neglect, and other assigned tasks.

"Training for the home services worker shall address each of the following subjects below, in addition to the training requirements included in Section 245.40(c)(4)(A) through (P):"

Ten hours of annual training

At least 10 hours a year, by calendar year or anniversary, covering client dignity and rights, disaster procedures, hygiene and infection control, abuse and neglect, and the listed personal care skills.

"All home services workers shall complete a minimum of ten hours of training during each year of employment to maintain placement availability"

Qualified supervisors and trainers

Supervisors or trainers with the required experience give initial training and ongoing supervision on the task list and are available for continuing education.

"The agency shall have home services supervisors or trainers that provide initial training and supervision on an ongoing basis to home service workers"

Training records and certificates

Document the date, time per topic, instructors and qualifications, content and the worker's signature or time-stamped e-certificate; give workers their certificate on request.

"All training shall be documented with the date of the training; the length of time spent on each training topic; instructors and their qualifications; short description of content; and staff member's signature or electronic certificate with a date and time stamp indicating completion."

Orientation and in-service education

Orient new staff and run regularly scheduled in-service education with chances for continuing education.

"Provide orientation of new staff, regularly scheduled in-service education programs and opportunities for continuing education for the staff;"

Background check compliance

Comply with the Health Care Worker Background Check Act and Part 955.

"An agency shall comply with the Health Care Worker Background Check Act [225 ILCS 46] and the Health Care Worker Background Check Code (77 Ill. Adm. Code 955)."

Policy defining direct care positions

A policy defining which unlicensed employees provide direct care, based on job duties, time alone with clients and physical contact.

"For purposes of the Act and this Part, the health care employer shall establish a policy defining which unlicensed employees provide direct care."

Registry check and six searches before hire

Check the Health Care Worker Registry before hiring, run the six web searches, and start a fingerprint check if the person has none or is inactive.

"If the individual has not had a background check or is not active on the Health Care Worker Registry, then the health care employer shall initiate a fingerprint-based criminal history records check."

Fingerprint check timelines

Start a check after a conditional offer; submit data within 2 working days; fingerprints within 10 working days or suspend; terminate if none within 30 days; send fees within 10 working days.

"If the student, applicant, or employee has not had his or her fingerprints collected electronically by a vendor within 30 days after being hired or beginning a training program, the employee shall be terminated"

Supervision while results are pending

Conditional employment up to three months with supervision enough to prevent abuse, neglect or theft.

"During this time, the employee shall have adequate supervision, which is the type and frequency of supervision required to prevent abuse, neglect, or theft regarding patients, clients, or residents."

Who cannot be employed

No direct care work for anyone with a disqualifying conviction without a waiver, or with a registry or APS finding; no work from a disqualifying notice until a waiver is granted.

"A health care employer shall not hire, employ, or retain, whether paid or on a volunteer basis, any individual in a position with duties involving direct care of clients, patients, or residents if the individual has a verified and substantiated finding of abuse, neglect, or financial exploitation"

Notice to applicants

Tell applicants and employees about the fingerprint check, their right to see and challenge the report and seek a waiver, and the consequences of disqualifying convictions.

"The student, applicant, or employee shall be notified of each of the following whenever a fingerprint-based criminal history records check is requested pursuant to the Act and this Part:"

Policy on employing waiver holders

A policy on employing people who have been granted waivers.

"The health care employer shall develop policies concerning employment of individuals who have been granted waivers."

Annual registry employment verification

Verify every employee and contracted worker in the registry at least yearly and enter hire and separation dates within 30 days.

"The health care employer or its designee shall indicate employment and termination dates (separation dates) within 30 days after hiring or terminating an employee."

Background check files

Keep criminal records requests 5 years and the forms and notices for the length of employment, plus screen prints of the registry result and the six searches.

"The health care employer shall retain a screen print of the background check initiation page"

Checks for contracted workersif the agency uses contracted or subcontracted workers

Unlicensed contracted or subcontracted workers also undergo the fingerprint-based check.

"Any unlicensed contracted or subcontracted worker shall undergo a fingerprint-based criminal history records check through the processes established in the Act and this Part."

Registry portal access

Register for the IDPH web portal so the agency can start checks and verify staff; the manager must be able to show access at survey.

"health care employers shall gain access to the secure login by having an employee register for access to the Department's secure web portal"

Reporting to Adult Protective Services

On reasonable suspicion of abuse, neglect or financial exploitation of a client 60 or over or an eligible adult, notify the designated elder abuse provider agency and keep documentation 12 months.

"The agency shall document this report and maintain documentation on the premises for 12 months after the date of the report."

Reporting child abuseif the agency serves anyone under 18

For an alleged victim under 18, call the DCFS Child Abuse Hotline and keep documentation 12 months.

"In the case of an alleged victim under the age of 18, the agency shall notify the Department of Children and Family Services through the Child Abuse Hotline."

Removing an accused employee

Immediately remove an accused employee from client contact and investigate.

"the agency shall immediately remove the alleged perpetrator from direct contact with clients and investigate the allegation"

Investigation report to IDPH

A written investigation report within 14 days with the six listed contents, sent to IDPH within 24 hours of completion and kept 12 months.

"In cases of allegations of abuse or neglect by an employee, the agency shall conduct an investigation and develop a written report of the findings of the investigation within 14 days after the initial report."

Staff and volunteers report

Employees and volunteers report abuse, neglect or exploitation to agency management and to the elder abuse provider agency or Department on Aging; mandated reporters still make their own reports.

"Agency employees and volunteers shall report abuse, neglect or financial exploitation of a client to the agency management and to the appropriate elder abuse provider agency or the Department on Aging."

Immediate police notification

Call local law enforcement immediately for physical injury or sexual abuse by staff, a crime in the home by someone other than the client, or a death not from disease or natural causes.

"Physical abuse involving physical injury inflicted on a patient or client by a staff member;"

Law enforcement notification policy

A policy on keeping clients safe when police are called, calling police for abuse by others, calling police, fire, ambulance and rescue, and preserving a possible crime scene.

"The agency shall develop and implement a policy concerning local law enforcement notification, including:"

Infection control policies

Policies and procedures for investigating, controlling and preventing infections.

"Each agency shall develop and implement policies and procedures for investigating, controlling and preventing infections."

CDC guidelines

Follow the CDC guidelines Part 245 incorporates (immunization best practice, hand hygiene, infection control in health care personnel) as appropriate.

"Each agency shall adhere, at a minimum and as appropriate, to the guidelines of the CDC, United States Public Health Service, Department of Health and Human Services, as incorporated in Section 245.25(c)."

Quality improvement program

A quality improvement program with written policies that evaluates the whole program at least yearly, including a client record review; results go to those running the agency, are acted on and kept as administrative records.

"The quality improvement program shall include written policies and shall evaluate the agency's total program at least once a year."

Quarterly record review

Review a sample of active and closed client records at least quarterly, including whether visit frequency matched the plan and workers followed the service plan.

"Whether the service plan was followed by the home services worker or nursing staff."

Client record contents

Client and representative contact details, an emergency contact, the agreed plan of services, the client agreement and the worker's documentation of services at each visit.

"A client record shall be maintained for each client receiving in-home services."

Documentation of each visit

Workers document every service provided at every visit.

"Documentation by the home services worker of each of the services provided at each visit."

Records policy and two-year retention

Written records procedures and maintenance policies; keep records at least two years after the last service, on paper or electronically.

"Each agency shall have a written policy on records procedures and shall retain records for a minimum of two years beyond the last date of service provided."

Record confidentiality and release

A written policy on protecting record confidentiality covering use, removal and release of records; the office protects paper and electronic records.

"Each agency shall have a written policy for protecting the confidentiality of patient records that explains the use of records, removal of records, and release of information."

Dementia services rulesif the agency serves clients with Alzheimer's disease or a related dementia

An agency offering any Alzheimer's or dementia services follows the Alzheimer's Disease and Related Dementias Services Act and Part 973.

"A home health, home nursing and home services agency that provides any and all Alzheimer's disease or related dementias services shall comply with the Alzheimer's Disease and Related Dementias Services Act and this Part."

Alzheimer's services supervisorif the agency serves clients with Alzheimer's disease or a related dementia

Designate an Alzheimer's services supervisor with a recognized dementia certification or two years' dementia experience, who completes 8 hours of dementia training a year.

"The entity shall designate an Alzheimer's services supervisor to oversee the entity's Alzheimer's disease and related dementias services."

Dementia care plansif the agency serves clients with Alzheimer's disease or a related dementia

A care plan for every client with a dementia diagnosis, following nationally recognized dementia care standards.

"The entity shall have a care plan for all clients or residents with an Alzheimer's disease or related dementias diagnosis."

Dementia services disclosureif the agency serves clients with Alzheimer's disease or a related dementia

At enrollment, give materials on the philosophy of services, services offered and behavior management and drug therapies, with a disclaimer that the services are not certified under the Special Care Disclosure Act; never advertise non-compliant dementia services.

"Materials defining the philosophy of the services, specific services offered, and behavior management tactics and drug therapies employed shall be provided to a resident or the resident's representative upon admission or enrollment to an entity"

Dementia trainingif the agency serves clients with Alzheimer's disease or a related dementia

Six hours of initial dementia training in the first 60 days for staff with direct access to clients with dementia, on the seven listed topics; 3 hours of advanced training each year; documented like other training.

"An Alzheimer's disease and related dementias services curriculum shall include, at a minimum, the following topics:"

Emergencies and disaster procedures

Part 245 has no stand-alone agency emergency plan rule for home services, but workers must be trained to implement each client's emergency preparedness plan and on disaster procedures every year, so the manual includes an emergency and disaster procedure.

"Recognizing emergencies and initiating emergency procedures, including basic first aid and implementation of a client's emergency preparedness plan;"