Section .0500 ‑ Scope Of Services

Link to law: 10a - health and human services/chapter 13 - nc medical care commission/subchapter k/10a ncac 13k .0501.html
Published: 2015

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now



The governing body shall ensure through policies and

implemented procedures that the following services encompassing the essential

elements of hospice care be provided, either directly by hospice personnel, or

by contractual arrangement:

(1)           Hospice nursing services, available 24 hours a day,

by or under the supervision of a registered nurse; provided in accordance with

the North Carolina Nurse Practice Act (G.S. 90, Article 9A) and the hospice

care plan; and sufficient to ensure that nursing needs of each patient are met.

(a)           Registered nurse duties include the

following as a minimum:

(i)            regularly assess the nursing needs of the

hospice patient;

(ii)           develop and implement the patient's hospice

nursing care plan;

(iii)          provide hospice nursing services,

treatment, and diagnostic and preventive procedures;

(iv)          initiate nursing procedures appropriate for

the patient's hospice care and safety;

(v)           observe signs and symptoms and report to the

physician any unexpected changes in the patient's physical or emotional


(vi)          teach, supervise, and counsel the hospice

patient and family members about providing care for the patient at home; and

(vii)         supervise and train other nursing service


(b)           Licensed practical nurse duties are

delegated by and performed under the supervision of a registered nurse. 

Consistent with the hospice care plan, duties may include:

(i)            participating in assessment of the

patient's condition;

(ii)           implementing nursing activities, including

the administration of prescribed medical treatments and medications;

(iii)          assisting in teaching the hospice patient

and family members about providing care to the patient at home; and

(iv)          delegating tasks to nurse aides and

supervising their performance of tasks within the limitations established in 21

NCAC 36 .0225(d)(2) adopted by reference.

(c)           The agency must retain current nursing on‑call

schedules and previous schedules for one year and make them available, on

request, to the Department.

(2)           Social work services which shall include, but not

be limited to conducting an assessment of the psychosocial needs of the patient

and family with the establishment of goals in the care plan to meet those

needs; on‑going counseling related to issues of death and dying to the

patient and family as needed; and assisting the patient and family in the

utilization of appropriate community resources.

(3)           Spiritual counseling shall be offered to each

hospice patient/family.  The hospice shall assure that:

(a)           no spiritual value or belief system is

imposed on patients and families;

(b)           a spiritual assessment is completed on each

patient during the admission process; and

(c)           a liaison and consultation is maintained

with the patient family clergy or spiritual caregiver and other community based

clergy or spiritual caregivers.

(4)           Patient family volunteer services for a broad range

of activities under the direction of the coordinator of patient family


(5)           Inpatient care services, for symptom management or

respite care in a licensed hospital, nursing facility or licensed hospice

inpatient facility, unless the hospice operates its own inpatient facility. 

The hospice shall assure that:

(a)           a written agreement, is signed by both

providers, which assures that the inpatient facility will provide care and

services to hospice patients when necessary;

(b)           the inpatient provider has policies

consistent with the needs of hospice patients and their families and will, if

necessary, modify policies such as visiting hour restrictions and routine

tests, to meet those needs;

(c)           the hospice monthly updated plan of care is

furnished to the inpatient provider to ensure that the regimen established is

followed as closely as feasible during the inpatient stay;

(d)           all inpatient treatment and services are

documented in the inpatient medical record and copy of the discharge summary

retained as part of the hospice record; and

(e)           effective transition from one type care to

another be maintained with continuity of care being the primary goal.

(6)           If the hospice provides or arranges for nurse aide

services, those services shall be provided in accordance with physician's

orders and interdisciplinary team care plan.

(a)           Nurse aides shall only be assigned duties

for which competence has been demonstrated and recorded in appropriate

personnel records.

(b)           Nurse aide duties may include, but are not

limited to:

(i)            providing or assisting with personal care,

i.e. bathing, mouth care, hair and skin care;

(ii)           checking vital signs and observing the

patient's condition;

(iii)          assisting with ambulation and limited,

routine exercises.

(c)           All nurse aide services shall be performed

in accordance with a written assignment prepared by and under the supervision

of the registered nurse.  Supervision shall include a visit to the home by the

nurse at least every two weeks, with or without the aide's presence, to assess

the care and services provided.  Documentation of supervisory visits shall be

maintained in the medical record and include an assessment of the aide's

performance in carrying out assigned duties and of the aide's relationship with

the patient and family.

(7)           Additional services shall be offered either

directly by the hospice or by arrangement when ordered by the physician.  These

include physical therapy, occupational therapy, nutritional assessment and

dietary counseling and other services as needed and ordered by the physician in

accordance with the hospice plan of care.

(8)           Bereavement counseling shall be offered to family

members and others identified in the bereavement plan of care for a period of

12 months after the patient patient's death.  The hospice shall assure that:

(a)           an assessment of survivor risk factors is

completed during the patient's admission to hospice and during the patient's


(b)           the bereavement care plan is established

within six weeks after the patient's death;

(c)           the bereavement care plan shall contain

information about who shall receive bereavement services and what services will

be offered;

(d)           the bereavement care plan is reviewed

quarterly at a minimum or more often as needed; and

(e)           discharge from bereavement services before

the 12 months expire is justified and documented.


History Note:        Authority G.S. 131E‑202;

Eff. November 1, 1984;

Amended Eff. February 1, 1996; June 1, 1991; November 1,