SECTION .0500 ‑ SCOPE OF SERVICES
10A NCAC 13K .0501 SERVICE REQUIREMENTS
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
condition;
(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
personnel.
(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
volunteers.
(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
illness;
(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,
1989.