Certified Home Health, RN, CommunityHealth Educator

Are home health aides allowed to administer medication in your State, and if so, under what conditions?

PA - No. Aides in other provider settings are allowed to administer medications if they case a course through our Dept. of Public Welfare.

NH - In NH the answer is yes and no. All home health aides in NH must be licensed nursing assistants (formerly called CNAs). There are two levels of licensure— LNAs and Medication LNAs. The latter must take an additional 50 hr course to be able to pass meds. MNAs are not currently used in home health, but are not restricted from being used in home care.

ID - Idaho has an Assistance with Medications course which is taught by an RN or pharmacist. They have to be approved through the university and have a curriculum orientation. This instructor then gets classes approved, requests specific cards, and facilitates and 8 hour course to all Unlicensed Assistive Personnel. There is a standard test proctored at the end of the course and a one time card issued. These cards are required for all RALF, shelter home, DD, ICFMR, hospice, home health, etc. utilizing UAPs (CNAs or non CNAs) assisting with meds.

NE - In Nebraska, home health aides are allowed to give meds if they have taken the Medication Aide course, and have been checked off skill-wise with the individual agency. The guidelines for the Medication Aide is such that each individual agency must decide how they will use them, and then do the skills check off and of course, have supporting documentation of the check off.

UT - In Utah they are allowed to assist taking meds but not to administer or setup the meds. A nurse has to set up the meds first.

VA - No in Virginia

MA - In Mass, the Nurse Practice Act prohibits any delegation of med administration to home health aides.

IN – Yes under these conditions: Medication assistance:

(a) through providing reminders or cues to take medication, the opening of preset medication containers, and providing assistance in the handling or ingesting of non-controlled substance medications, including eye drops, herbs, supplements, and over-the-counter medications; and

(b) to an individual who is unable to accomplish the task due to an impairment and who is:

(i) competent and has directed the services; or

(ii) incompetent and has the services directed by a competent individual who may consent to healthcare for the impaired individual.

NY - Yes to self directing patients only *This activity can only be provided for a patient who is self-directing; i.e. has the capability to make choices

about the activities of daily living, understands the impact of these choices and assumes responsibility for the results of the choices. They are allowed to open containers, bring medication to the patient, etc., but not remove it unless the patient is self directed.

WV – NO

NM - the answer is no at this time

NJ - In NJ the practice of Certified Home Health Aides administering medications is strictly prohibited per regulation. However, I can share that at our recent annual meeting the Executive Director of the NJ Division of Disability Services (Bill Ditto) and the Co-Director of the Rutgers Center for Health Policy (Susan Reinhard) announced the coming of the Nurse Delegation Pilot Project.

KY - In Kentucky home health aides can only remind patients to take self

administered medications. They are not to administer meds.

WA - Washington State has several exceptions, as usual. In the in-home services licensing law home health aides may assist with medications where the dose is determined by an RN/LRN or family member. The assistance is limited to handing the container, opening it if necessary and assisting the client to take the meds. Direct administrating is not allowed.

The Board of Pharmacy as promulgated rules related to medication assistance in community settings. I have attached those rules here.

We also have nurse delegation in which an RN may delegate a nursing task, including administration of medications, to a home care or home health aide who is registered or certified in the State. There are very specific rules related to nurse delegation in the Nurse Practice Act 18.79 RCW. The administration of insulin is not allowed to be delegated.

MT - In Montana, HH aides cannot administer meds; they can “assist” only. We do have a statute allowing licensed medication aides, but it applies to assisted living facilities only.

NC - The Home Care licensure rules in NC state that aides can: “assist client with self-administration of medications which are ordered by a physician or other person authorized by state law to prescribe”. So, the aides cannot administer the meds, they can assist the client to take their own meds.

CT – No. Only "certified unlicensed personnel" in a licensed Residential Care Home are permitted to administer meds (besides nurses). They have to go through training to become certified. They are looking at potentially allowing this kind of model in assisted living as well. This is an area of controversy as you can imagine.

FL – NO

MN - Class A Home Care & Hospice

A registered nurse may delegate the task of medication administration only to a HHA after documentation of competency of task and orientation to client. Exclusions are written to prohibit delegation of IV and any IM/Subq/Intradermal injections

OH - In Ohio, home health aides are not permitted to administer medications. Home health aides may only assist an individual in the self-administration of medication.

AR - The HHA are not allowed to administer medicine in Arkansas...they can only remind the patient.

TN - Tennessee does not allow home health aides to administer, only assist.

TX - In Texas, RNs may delegate administration of medications (including insulin) to an unlicensed assistive personnel in an independent living environment when the client's condition (for which the medication is given) is stable. This delegation is specific to the UAP and to the client. Click here for the Board of Nurse Examiners rules specific to delegation (ch 224 & 225). Nurses cannot be forced to delegate anything. They are empowered to use their assessment, training, and judgment to determine when it is appropriate.

Certified home health medication aides can administer medications in acute patient conditions or environments.

Unlicensed persons (not limited to home health aides) can assist with administration of medications without any RN supervision or delegation.

Below are the definitions for administration of medication and assistance with administration of medications that are in our Home and Community Support Services Agency licensure rules:

Administration of medication — The direct application of any medication by injection, inhalation, ingestion, or any other means to the body of a client. The preparation of medication is part of the administration of medication and is the act or process of making ready a medication for administration, including the calculation of a client's medication dosage; altering the form of the medication by crushing, dissolving, or any other method; reconstitution of an injectable medication; drawing an injectable medication into a syringe; preparing an intravenous admixture; or any other act required to render the medication ready for administration.

Assistance with self-administration of medication — Any needed ancillary aid provided to a client in the client's self-administered medication or treatment regimen, such as reminding a client to take a medication at the prescribed time, opening and closing a medication container, pouring a predetermined quantity of liquid to be ingested, returning a medication to the proper storage area, and assisting in reordering medications from a pharmacy. Such ancillary aid includes administration of any medication when the client has the cognitive ability to direct the administration of their medication and would self-administer if not for a functional limitation.

IL - Aides in Illinois are not permitted to administer medication.

NJ - the home health aides are under the NJ Board of Nursing. There is a current clause that does not allow the home health aide to administer any medications. The aide may only ‘assist’. However, the Board has granted a waiver that does allow Home Health Aides who have taken a NJ Department of Health Certified Medication Aide course and passed the competency exam, to administer a specific list of meds (including pre-drawn insulin) under RN supervision in Assisted Living settings.

IA - In Iowa HCA’s are not allowed to administer medications. They can, however, remind the client to take medications, and can apply some topical creams and do simple dressing changes.

VT - home health aides are not permitted to administer medications. Home health aides may only assist an individual in the self-administration of medication.

GA - home health aides are not permitted to administer medications. Home health aides may only assist an individual in the self-administration of medication.

ND - North Dakota is very similar to that in Kentucky. Reminders regarding medications are common. We can do specific delegation if the RN determines the patient condition is stable and the CNA has the knowledge, skills, and abilities to administer the medication, after training and completing skills checks specific to that individual and to a specific medication. It is a complex and time consuming process, so is used infrequently. ND does have Certified Medication Aides that complete an extensive education and training program and can pass medications with RN oversight, but these are used in LTC facilities rather than in the home setting.

LA - Nurse aides in Medicare certified home health agencies, are not allowed to administer medications in Louisiana, under any circumstances. However personal care attendants, who take care of only one disabled or medically fragile patient, for months and years at a time, are able to administer medication and do other simple procedures for that one patient. They require about 40 plus hours of training, some of which is basic general stuff and some of which is patient specific.

MO - In Missouri HH aides may not administer medications, but may assist.

CA - In California, Certified Home Health Aides may assist patients with medications which are ordinarily self administered but shall not administer medications of any kind.

HI – In Hawaii nurse delegation is only authorized in settings where a registered nurse may not always be present. The rules are specific to which tasks can be delegated. Rather than list each one, the primary policy is that the registered nurse is the responsible entity for insuring that the UAP is competent to complete the task that is delegated. It is not a carte blanche delegation.

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