What Nevada personal care attendants can and cannot do

The statute lets an agency provide "nonmedical services related to personal care to elderly persons or persons with disabilities to assist those persons with activities of daily living" (NRS 449B.465), such as toileting (elimination of wastes), dressing and undressing, bathing, grooming, preparing and eating meals, laundry, shopping, cleaning, transportation and other minor personal hygiene needs (NRS 449B.050).

For each client, the service plan is "a plan which includes a written description of the needs of a client for personal care services and which specifies the tasks that an attendant is authorized to provide for the client" (NAC 449.3967). Before services start, the agency must "ensure that the personal care services requested by the client are services which assist the client with the activities of daily living" (NAC 449.3981(3)(d)). Then the administrator ensures that only trained attendants serve the client (NAC 449.3973(2)(b)) and keeps each attendant "working within the attendant’s scope of service and conducts himself or herself in a professional manner" (NAC 449.3978(1)).

So, by our reading, a task is allowed for a given client only if it is a personal care service, it is written into that client’s plan, the attendant is trained for it, and it is not on the prohibited list.

"Without limitation". The list is not complete: by our reading, anything that needs a nurse’s judgment is out, even if not named. Item (i) draws the line at a certified nursing assistant’s scope: "Any task identified in chapter 632 of NRS and the regulations adopted by the State Board of Nursing as requiring skilled nursing care, except any services that are within the scope and practice of a certified nursing assistant."

A written list for the surveyor. HCQC’s checklist asks for a written policy listing the specific prohibited services; its workbook says the list does not need to be signed or kept in each employee’s file. (HCQC checklist, P0165; workbook, P0164) Your prohibited activities policy is separate: it covers conduct such as personal calls, gifts and loans (NAC 449.3974(2)).

Tell clients too. The disclosure statement says in plain words that "it is not within the scope of the license of the agency to manage the medical and health conditions of clients should the conditions become unstable or unpredictable" (NAC 449.3979(2)(a)).

HCQC’s 12.2024 workbook, still linked as the initial inspection workbook, prints the prohibited list from before R089-24, including medication, toenail trimming, specialized range of motion and medical case management. Its tag P0164 still reads, for example, "(i) Trimming or cutting toenails;" and "Providing medical case management, including, without limitation" (HCQC workbook (12.2024), P0164). Its health-related task rows also use the pre-2026 subsection numbers (HCQC workbook, P0340 to P0360).

The workbook is HCQC’s survey tool, not the rule, and it predates R089-24. By our reading the amended rule governs. What we suggest:

• Base your prohibited services list on NAC 449.3978 as amended, and say in the policy that it follows R089-24 section 62.
• Keep a printed copy of R089-24 sections 14, 61 and 62 with your policy manual for the prelicensure survey.
• If you offer a new task, ask HCQC at (702) 486-6515 how its surveyors are checking it until the workbook is updated (HCQC).

How HCQC uses the workbook at the prelicensure survey is on our Nevada guide.

An attendant may "trim or cut the fingernails or toenails of a client" (NAC 449.39775(6)(a), as amended), with two limits on toenails:

• A podiatrist only, if the provider says so. Not if the client’s physician or other provider has indicated the toenails must be trimmed only by a licensed podiatrist or "a nail technologist licensed pursuant to chapter 644A of NRS" (NAC 449.39775(6)(a)).
• Diabetes. "If the client has been diagnosed with diabetes, the attendant shall consult with the client’s physician or other provider of health care before trimming or cutting the toenails of the client." (NAC 449.39775(6)(a))

Not settled: whether one documented consultation covers later trims for a client with diabetes, or the provider must be consulted before every trim. By our reading, document the consultation and renew it when the client’s condition or the advice changes; ask HCQC if you rely on it.

Training. The rule names no special trainer for nail care. The Division said the rule sets no task-specific course for nail care or exercise because NAC 449.3977 already requires attendants to be trained in any service they provide. (Division memo, Jul 17, 2025)

An attendant may "assist a client with physical exercises, including, without limitation, exercises for strength training and exercises designed to help with balance, flexibility, endurance and range of motion". The limit: "An attendant shall not assist a client with any exercises in which the physician or other provider of health care of the client has determined that the client should not participate." (NAC 449.39775(6)(b), as amended)

This replaces the old ban on "Providing specialized services to increase the range of motion of a client" (R089-24 section 62). Massage stays prohibited (NAC 449.3978(2)(h)). By our reading, if a physical therapist has given the client a program, the attendant may help with it, but not design or change it: changing a program is a clinical judgment.

An attendant may "assist a client with scheduling and attending medical and nonmedical appointments" (NAC 449.39775(6)(c), as amended). Within federal and state privacy law, an attendant may give information about the client to the client’s provider, receive information from the provider, and share it with the client, the client’s representative or an attorney-in-fact under the client’s power of attorney. (NAC 449.39775(6)(d))

The old rule called this medical case management and banned it, including accompanying a client to the doctor to give or receive medical information (R089-24 section 62).

Privacy. The rule makes this subject to federal and state law on protected health information. By our reading, get the client’s written permission for whom the attendant may share information with, and keep it in the client record. Your confidentiality policy should cover what attendants say and write after an appointment.

Driving. Transportation is a listed personal care service (NRS 449B.050); an attendant who drives clients needs at least the state minimum auto liability insurance on file (NAC 449.3976(1)(h)).

The statute tells the Board to let an attendant, with the client’s consent, check vital signs, give insulin by auto-injector and run blood glucose tests (NRS 449B.130(1)). The rule adds weighing (NAC 449.39775(5)).

• Training first, yearly and on device change. Before doing these tasks, each year after, and whenever the device changes, the attendant is trained and shows understanding, follows the manufacturer’s instructions and meets CLIA rules where they apply. (NAC 449.39775(1)) Task training covers doing the task accurately under nationally recognized infection control guidelines, how to interpret the result, and what action to take, such as notifying a physician. ((8))
• Blood glucose. If a client with diabetes cannot test their own blood glucose and an attendant does it, the federal CLIA rules are treated as applying. HCQC’s checklist asks for a CLIA waiver if attendants do blood glucose testing. (NAC 449.39775(2); HCQC P0320) A device "is not used on more than one person" ((3)).
• Insulin. Only if a physician, PA or APRN has found the client’s condition stable and predictable and the insulin dose is a maintenance dose with no daily assessment such as a sliding scale. ((4)) The statute allows the employee to give it "or assist such a person with the self-administration of such insulin" (NRS 449B.130(1)(b)). Any other injection stays prohibited (NAC 449.3978(2)(d)).
• Weighing. An attendant may weigh a client only after training on accurate weighing and with the client’s consent. HCQC looks for a consent form (HCQC P0340).

Reporting what the attendant finds. Task training must cover how to interpret a reading and what to do next, for example notifying a physician. By our reading, the service plan should say what readings the attendant reports, to whom, and how fast, because the attendant may not assess the client (NAC 449.3978(2)(e)).

R089-24 section 14 says "an attendant may assist in the administration of medication, including, without limitation, an over-the-counter medication or dietary supplement, to a client if": there is a written agreement where NRS 453.375 and 454.213 require one, the attendant has completed the training, and the medication was prescribed or ordered by a practitioner and is given per that practitioner’s written instructions (R089-24 section 14(1); NRS 453.375).

• The prohibited list still applies. The section opens: "Except as otherwise provided in NAC 449.3978, an attendant may assist in the administration of medication" (R089-24 section 14(1)).
• Training. Before assisting with medication, an attendant completes at least 16 hours of medication management training from a Division-approved course and gets a certificate, then at least 8 hours a year. (R089-24 section 14(2)) An approved medication course is taught entirely in English: at least 16 hours (not less than 12 hours of classroom and 4 hours of practical training), or at least 8 hours of refresher training. (R043-22 section 13, as amended by R089-24 section 86)
• The course. R089-24 ties the attendant medication course to the approved courses for residential facilities for groups (LCB File No. R043-22). HCQC’s medication management page is still written for group homes. (HCQC, Medication Management) R089-24 rewrote the approved course content so it covers an agency’s own medication policies (ordering, refills, storage, destruction and delivery logs) as well as group homes’. (R089-24 section 86) Ask HCQC which listed courses it accepts for personal care attendants before you enroll anyone.
• Program and record. An agency whose attendants assist with medication develops a training program and keeps a record for each client: medication type, date and time given, refusals or missed doses, and current instructions from the practitioner. (R089-24 section 14(3))
• Optional. The Division told the State Board of Health that an agency may choose not to offer medication assistance if it does not want the training costs; the regulation does not require it. (Division memo, Jul 17, 2025) If you do not offer it, say so in your services policy and disclosure statement.

Not settled:

• Routes. The struck item named "the insertion of rectal suppositories, the application of a prescribed topical lotion for the skin and the administration of drops in the eyes". The rules do not say whether section 14 now lets trained attendants assist with each of these. Ask HCQC before you put them on a service plan.
• Errands. Whether collecting a client’s medication from the pharmacy, with the bag unopened, counts as assisting with medication for an agency that does not offer it. By our reading it is a shopping errand, not assistance.

The qualifying employee. Besides a physician, PA, licensed nurse or (for insulin and glucose) a pharmacist, an employee may train a task if trained by one of them, with at least a year of experience doing the task and shown competency. The amended text still says an employee "of the residential facility". (NAC 449.39775(7)(c), as amended) By our reading the words "residential facility" were carried over from the group home rules and mean your agency, but HCQC has not said so; ask before an employee trains others. HCQC’s surveyor checks that the trainer meets the requirements (P0350) and that the training topics do (P0360) (HCQC workbook).

Every attendant also completes your training program, with supervised on-the-job instruction, before working alone, and at least 8 hours of training a year (NAC 449.3977(1)(b); 449.3975(6)). The full training picture: Nevada caregiver training.

Skilled nursing at home is a different license. Under NRS 449.0015, an agency to provide nursing in the home provides "skilled nursing and assistance and training in health and housekeeping skills", and it is a medical facility under NRS chapter 449 (NRS 449.0015(1), 449.0151(4)). HCQC lists it as "An agency to provide nursing in the home (HHA)" (HCQC Background Check page). An agency to provide nursing in the home must, besides skilled nursing, provide at least one of speech or occupational therapy, nutrition or vocational guidance, physical therapy, pharmaceutical services, or other social or medical services. (NRS 449.248)

How the licenses compare, including intermediary service organizations and employment agencies: Nevada home health vs home care.

By our reading, a client needs a nursing agency (or their own clinicians) for anything on the prohibited list: inserting or irrigating a catheter (routine care of an indwelling catheter drainage system, such as emptying the bag, is an attendant training topic in NAC 449.3977(1)(c)(6)), wound dressings with prescription medication or aseptic technique, injections other than insulin pens, physical assessments, tube or other specialized feeding, or insulin on a sliding scale. A personal care agency may coordinate with that provider; the rules require it to coordinate its services with care from other organizations and people (NAC 449.3981(3)(e)).

Personal assistants. For a person with a disability, a provider of health care may authorize a personal assistant to perform specific simple medical or nursing tasks the person would normally do themselves, if the condition is stable and predictable; the provider notes the authorization in the medical record. (NRS 629.091; NRS 449B.465(1)) By our reading this is a separate route, client by client, and it does not widen the prohibited list for other clients.