Nurse Registry vs. Home Health Agency – Update

The following is an update from Florida’s Agency for Health Care Administration’s (AHCA) home care unit May of 2015, the following link has the full presentation NurseRegistryMay_2015.pptx. Many Florida Nurse Registries continue to not be very forthcoming in disclosures to clients related to the scope of services and the nature of their business. The Nurse Registry does not have to disclose that they are a Referral Service to the client until they contracting for the referral. Text in BLUE is directly from the regulations governing Nurse Registries.

Change

G 153 Advise Patient of Independent Contractor quotes 400.506(6)(e), Florida Statutes (F.S.) that requires action by the nurse registry when referring caregivers.

“Upon referral of a registered nurse, licensed practical nurse, certified nursing assistant, companion or homemaker, or home health aide for contract in a private residence or facility, the nurse registry shall advise the patient, the patient ‘ s family, or any other person acting on behalf of the patient, at the time of the contract for services, that the caregiver referred by the nurse registry is an independent contractor and that it is not the obligation of a nurse registry to monitor, supervise, manage, or train a caregiver referred for contract under this chapter.”

Change

• Eliminates the requirement for a full-time administrator — since the administrator requirements are now at 400.506(18), F.S.
• At the time a referral is made, administrator is responsible for making sure that the nurse registry advises the patient and family or other person acting on behalf of the patient that:

–(1) the caregiver is an independent contractor [400.506(6)(e), F.S.]

–(2) that RNs are available to make visits for an additional cost when a home health aide or certified nursing assistant (CNA) is referred. [400.506(6)(c), F.S.]  

• Removes the requirement for the administrator to assure the orientation of new independent contractors.       (G 160)

Change

If there is a violation of state laws or a deficiency in the caregiver’s credentials that the nurse registry becomes aware of, the nurse registry will:

–advise the patient to terminate the referred individual, providing the reason for termination; 

–cease to refer the person to other patients or facilities; and,

–if there are practice violations for nurses or CNAs, notify the Department of Health, Board of Nursing by submitting a complaint G 154   400.506(19), F.S.

Change

If CNA or Home Health Aide assists a patient with self-administered medication, that is routine, regularly scheduled medications [legend & over-the-counter oral dosage forms, topical dosage forms, and topical ophthalmic, otic, & nasal dosage forms, including solutions, suspensions, sprays, and inhalers], there is: 

 — a documented request by & the written informed consent of the patient or the patient’s surrogate, guardian, or attorney in fact.

 — a review of the medications for which assistance is to be provided shall be done by an RN or LPN to ensure the CNA & Aide are able to assist per their training & with the medication prescription – and the medication is not required to be administered by a nurse. 

            If the patient will not consent to a visit by the nurse to review the medications, a written list with the dosage, frequency and route of administration shall be provided by the patient or the patient’s health care surrogate, family member, or person designated by the patient to the home health aide or CNA to have reviewed by the nurse. G 278   400.488, F.S.   59A-18.0081(14)(d), FAC

Change

59A-18.0081 Home Health Aides and CNAs. 

The nurse registry is not obligated to monitor, manage or supervise a certified nursing assistant or home health aide pursuant to Section 400.506(19), F.S.

The nurse registry is not obligated to review patient or client records per Section 400.506(20), F.S., but the nurse registry is not prohibited from reviewing records and may do so.  

Change

59A-18.009 Homemakers and Companions

Training of homemakers and companions was removed from state rule.

Unusual incidents or changes in the client’s behavior are now reported to the “person(s) designated by the client” – not the nurse registry administration.

Removed the requirement that homemakers and companions “understand the needs” of the clients and be “able to recognize those conditions that need to be reported to the nurse registry office.”

These changes have been prompted by the IRS and the U.S. Department of Labor to reduce the improper classification of employees as “independent contractors”. Many Nurse Registries continue to represent themselves as home health care companies leading consumers to believe they are Home Health Agencies instead of a Referral Service.   Many consumers falsely believe they are hiring a senior care nanny or an angel who is part of a real agency that has RNs which manage the care for their loved one. They are only hiring a contractor that they must train, manage and fire if necessary. Plus they pay a on-going management fee to the nurse registry which one can now see provides very little value once the referral is made for a contractor. They do not provide Professional Liability or Workers Compensation insurance for the caregivers. Taxes, social security, and unemployment responsibilities transfer to the client or their family.

The nurses at Partners in Healthcare are available to speak with you about your in-home senior care needs. They including how to stay healthy at home with RN managed affordable care. Our private duty home care agency that provides pediatric to elder home care services in the Orlando area; call us at 407-788-9393.