Library: Policy

340:100-5-26.3. Health-related services

Issued 5-11-06

(a) Scope and applicability. The rules in this Section apply to persons with mental retardation who:

(1) receive Home and Community-Based Waiver Services or state-funded Developmental Disabilities Services Division (DDSD) services; and
(2) have a need for health-related service or supportive assistance that the Personal Support Team (Team) has identified according to OAC 340:100-3-33.1 and 340:100-5-50 through 340:100-5-58.

(b) Supportive assistance. Supportive assistance services are those services rendered to a person with developmental disabilities that are sufficient to enable the service recipient to meet an adequate level of daily living. Supportive assistance services include:

(1) training;
(2) supervision;
(3) assistance in housekeeping;
(4) assistance in the preparation of meals; and
(5) assistance in activities of daily living (ADLs) as necessary for the health and comfort of the service recipient. ADLs include those personal care and normal routine activities in a person's life that provide for the health and comfort of the service recipient.

(c) Health-related services.Health-related services are those services provided by community service providers or community service workers, direct support staff, to persons with developmental disabilities that include, but are not limited to:

(1) mobility and transferring including, but not limited to:
- (A) prosthetics application;
- (B) splint application; and
- (C) positioning and comfort;
(2) range of motion; and
(3) basic nursing care.
- (A) Basic nursing care includes:
  - (i) taking temperature, pulse, and respiration;
  - (ii) positioning;
  - (iii) incontinent care; and
  - (iv) identification of signs and symptoms of disease.
- (B) Other basic nursing care tasks that may be performed by direct support staff if the staff member has completed appropriate training provided or approved by the Oklahoma Department of Human Services (OKDHS), the service recipient's Team has agreed in writing to the performance of the task, and the service recipient's physician has given acknowledgement and a specific order related to the task are:
  - (i) nutrition, including but not limited to:
    - (I) instilling medications or nutrition through a gastrostomy tube or jejeunostomy tube;
    - (II) maintenance of the tube and the site; and
    - (III) fluid support, including documentation of intake and output;
  - (ii) blood and urine dip stick glucose monitoring;
  - (iii) hygiene including, but limited to:
    - (I) stoma care;
    - (II) ostomy bag care;
    - (III) wound care, non-sterile dressing changes; and
    - (IV) oral and dental care including suctioning;
  - (iv) elimination including, but not limited to:
    - (I) application of external catheter;
    - (II) administration of enema; and
    - (III) stool and urine collection; and
  - (v) health and safety needs including, but not limited to:
    - (I) pulse oxygen reading for data collection and reporting of signs and symptoms or concerns to a health professional;
    - (II) suctioning of the opening of a tracheostomy tube;
    - (III) administration of oral metered dose inhalers and nebulizers;
    - (IV) non-sterile catheterization;
    - (V) oxygen administration;
    - (VI) chest physiotherapy and positioning for postural drainage; and
    - (VII) vagal nerve stimulator activation.

(d) Provision of health related services and supportive assistance services. The service recipient's Team develops a Plan of Care that incorporates the service recipient's needs, based on the physical status review (PSR) as described in OAC 340:100-5-26, professional evaluations, and team recommendations.

(1) Each community service worker completes competency-based classroom training and any individual-specific training as specified in OAC 340:100-3-38.
(2) When a licensed professional trains specific tasks to a community service worker, the licensed professional monitors and supervises that community service worker in accordance with the professional's licensing requirements.
- (A) The licensed professional validates the community service worker's ability to safely and accurately perform the specific health-related service through documented hands-on return demonstration.
- (B) The licensed professional who is responsible for the service or task must:
  - (i) assess the service recipient's care needs prior to the competency-based training and delegation;
  - (ii) develop a service plan;
  - (iii) using prudent judgment, make the final decision as to which services are trained or delegated, within the specific scope of the licensed professional's judgment;
  - (iv) implement the plan; and
  - (v) evaluate the outcome of the services.
- (C) The degree of supervision required must be determined by the licensed professional after evaluation of appropriate factors involved, including but not limited to, the:
  - (i) stability of the condition of the service recipient;
  - (ii) training and capability of the community service worker;
  - (iii) nature of the task; and
  - (iv) proximity and availability of the licensed professional to the community service worker when performing the task.
(3) The community service worker's performance of health-related and supportive assistance services is monitored and supervised by the identified community worker's employing community services provider agency.

(e) Quality assurance. Quality assurance procedures in the provision of health-related services are detailed in this subsection.

(1) The DDSD registered nurse's (RN) health review provides monitoring to determine if the health and comfort needs of a service recipient are met in accordance with the service recipient's identified health concerns. The DDSD RN health review identifies problems and makes recommendations to the provider agency and the case manager for appropriate action, including the problem resolution process described in OAC 340:100-3-27, if necessary.
(2) DDSD Quality Assurance staff monitor services in accordance with OAC 340:100-3-27.