No. Providers must meet the certification or licensing requirements in state law related to the service the participant wishes to include in his/her plan. If the participant needs nursing services as part of his/her CDCS community support plan, the person providing it must be a nurse.
When tasks require professional clinical judgment or assessment, analysis of clinical data and/or sterile techniques (i.e. deep suctioning), a nurse is the only person who may be paid to perform these tasks.
Examples of nursing tasks include, but are not limited to, the following:
- Initiate and administer both routine and complex medications
- Assess, monitor and revise the nursing plan of care
- Perform sterile tracheostomy care
- Check nasogastric (through the nose) tube patency (i.e. check for obstruction) and confirmation of placement
- Perform intermittent suctioning when assessed to be needed
- Insert a urinary catheter
- Give injections (including insulin)
- Perform PEG/PEJ tube-feeding (when it requires assessment/confirmation of placement before administration of nutrition).
If a family member (or other worker) performs nursing tasks because of a lack of available nursing services, they must perform those tasks as an unpaid family member/worker. CDCS workers cannot be paid to provide nursing tasks. The person or managing party/legal representative cannot delegate or assign a CDCS worker to perform any of the nursing tasks described above.
CDCS workers may be paid to perform tasks that do not involve clinical judgement or assessment, if the person or their managing party/legal representative provides the training, guidance and direction. These tasks must be specifically described in the worker’s job description and included in the person’s CDCS community support plan.
When reviewing the person’s plan, the lead agency is responsible to consult with medical professionals and/or other members of their long-term care consultation team to ensure the person has a safe and effective plan.
The person or managing party/legal representative may delegate or assign a CDCS worker to perform a non-nursing task, but is responsible to assess the task in relation to the needs of the person (i.e. stability, absence of risk of complications, predictability of change in condition).
This means that tasks a CDCS worker has been assigned to perform may no longer be appropriate because of a change in the person’s current condition or stability. For example, it may no longer be safe for a CDCS worker to tube-feed the person because of the person’s current illness, recent discharge from the hospital, change in the their condition, new physician orders or medication changes, overall health status, etc.
Examples of tasks that CDCS workers might be paid to provide include, but are not limited to, the following:
- Medication assistance for prescribed or over-the-counter medication (at the direction of the person or the person’s representative). Tasks may include, but are not limited to:
- Reminders to take medication
- Bringing and/or giving medication to the person that has been set up/pre-packaged by the person, their representative, the pharmacy or the nurse (i.e. pill boxes, medication envelopes, bubble packs/blister pack)
- Assistance with opening medication bottles
- Bringing and/or giving PRN (when necessary) or over-the-counter medication to the person upon request of the person or their representative. (CDCS workers cannot determine the dose of a medication or that a PRN medication is needed)
- Taking and recording vital signs and weights
- Monitoring intake and output, following the direction of the plan of care developed by a health care provider (RN or physician, APRN, PA) or under the direction of the family member
- Non-clinical assistance with tube-feeding (i.e. following the prescribed feeding schedule, amount of formula, etc.)