The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Activities of daily living" or "ADLs" means bathing, dressing, toileting, transferring, bowel control, bladder control and eating/feeding. A person's degree of independence in performing these activities is part of determining the appropriate level of care and services. A need for assistance exists when the client is unable to complete an activity due to cognitive impairment, functional disability, physical health problems, or safety. The client's functional level is based on the client's need for assistance most or all of the time to perform personal care tasks in order to live independently.

"Administer" means the direct application of a controlled substance, whether by injection, inhalation, ingestion or any other means, to the body of a client by (i) a practitioner or by his authorized agent and under his direction or (ii) the client at the direction and in the presence of the practitioner as defined in § 54.1-3401 of the Code of Virginia.

"Administrator" means a person designated in writing by the governing body as having the necessary authority for the day-to-day management of the organization. The administrator must be an employee of the organization. The administrator, the director of nursing, or other clinical director may be the same individual if that individual is dually qualified.

"Available at all times during operating hours" means an individual is readily available on the premises or by telecommunications.

"Barrier crimes" means certain offenses, specified in § 32.1-162.9:1 of the Code of Virginia, that automatically bar an individual convicted of those offenses from employment with a home care organization.

"Blanket fidelity bond" means a bond that provides coverage that protects an organization's losses as a result of employee theft or fraud.

"Branch office" means a geographically separate office of the home care organization that performs all or part of the primary functions of the home care organization on a smaller scale.

"Chore services" means assistance with nonroutine, heavy home maintenance for persons unable to perform such tasks. Chore services include minor repair work on furniture and appliances; carrying coal, wood and water; chopping wood; removing snow; yard maintenance; and painting.

"Client record" or "patient record" means the centralized location for documenting information about the client or patient and the care and services provided to the client or patient by the organization. A client record or patient record is a continuous and accurate account of care or services, whether hard copy or electronic, provided to a client or patient, including information that has been dated and signed by the individuals who prescribed or delivered the care or service.

"Client's residence" means the place where the individual or client makes his home such as his own apartment or house, a relative's home or an assisted living facility, but does not include a hospital, nursing facility or other extended care facility.

"Commissioner" means the State Health Commissioner.

"Companion services" means assisting persons unable to care for themselves without assistance. Companion services include transportation, meal preparation, shopping, light housekeeping, companionship, and household management.

"Contract services" means services provided through agreement with another agency, organization, or individual on behalf of the organization. The agreement specifies the services or personnel to be provided on behalf of the organization and the fees to provide these services or personnel.

"Criminal record report" means the statement issued by the Central Criminal Record Exchange, Virginia Department of State Police.

"Department" means the Virginia Department of Health.

"Discharge or termination summary" means a final written summary filed in a closed client record of the service delivered, goals achieved and final disposition at the time of client's discharge or termination from service.

"Dispense" means to deliver a drug to an ultimate user by or pursuant to the lawful order of a practitioner, including the prescribing and administering, packaging, labeling or compounding necessary to prepare the substance for that delivery.

"Drop site" means a location that HCO staff use in the performance of daily tasks such as obtaining supplies, using fax and copy machines, charting notes on care or services provided, and storing client records. These locations may also be called charting stations, workstations, or convenience sites.

"Employee" means an individual who has the status of an employee as defined by the U.S. Internal Revenue Service.

"Functional limitations" means the level of a client's need for assistance based on an assessment conducted by the supervising registered nurse. There are three criteria to assessing functional status: (i) the client's impairment level and need for personal assistance, (ii) the client's lack of capacity, and (iii) how the client usually performed the activity over a period of time. If a person is mentally and physically free of impairment, there is not a safety risk to the individual, or the person chooses not to complete an activity due to personal preference or choice, then that person does not need assistance.

"Governing body" means the individual, group or governmental agency that has legal responsibility and authority over the operation of the home care organization.

"Home attendant" means a nonlicensed individual performing skilled, pharmaceutical and personal care services, under the supervision of the appropriate health professional, to a client in the client's residence. Home attendants are also known as certified nurse aides or CNAs, home care aides, home health aides, or personal care aides.

"Home care organization" or "HCO" means a public or private entity providing an organized program of home health, pharmaceutical or personal care services, according to § 32.1-162.1 of the Code of Virginia in the residence of a client or individual to maintain the client's health and safety in his home. A home care organization does not include any family members, relatives or friends providing caregiving services to persons who need assistance to remain independent and in their own homes.

"Home health agency" means a public or private agency or organization, or part of an agency or organization, that meets the requirements for participation in Medicare under 42 CFR 440.70 (d), by providing skilled nursing services and at least one other therapeutic service, for example, physical, speech, or occupational therapy; medical social services; or home health aide services, and also meets the capitalization requirements under 42 CFR 489.28.

"Homemaker services" means assistance to persons with the inability to perform one or more instrumental activities of daily living. Homemaker services may also include assistance with bathing areas the client cannot reach, fastening client's clothing, combing hair, brushing dentures, shaving with an electric razor, and providing stabilization to a client while walking. Homemaker services do not include feeding, bed baths, transferring, lifting, putting on braces or other supports, cutting nails or shaving with a blade.

"Infusion therapy" means the procedures or processes that involve the administration of injectable medications to clients via the intravenous, subcutaneous, epidural, or intrathecal routes. Infusion therapy does not include oral, enteral, or topical medications.

"Instrumental activities of daily living" means meal preparation, housekeeping/light housework, shopping for personal items, laundry, or using the telephone. A client's degree of independence in performing these activities is part of determining the appropriate level of care and services.

"Licensed practical nurse" means a person who holds a current license issued by the Virginia Board of Nursing or a current multistate licensure privilege to practice nursing in Virginia as a licensed practical nurse.

"Licensee" means a licensed home care provider.

"Medical plan of care" means a written plan of services, and items needed to treat a client's medical condition, that is prescribed, signed and periodically reviewed by the client's primary care physician.

"Nursing services" means client care services, including, but not limited to, the curative, restorative, or preventive aspects of nursing that are performed or supervised by a registered nurse according to a medical plan of care.

"OLC" means the Office of Licensure and Certification of the Virginia Department of Health.

"Operator" means any individual, partnership, association, trust, corporation, municipality, county, local government agency or any other legal or commercial entity that is responsible for the day-to-day administrative management and operation of the organization.

"Organization" means a home care organization.

"Person" means any individual, partnership, association, trust, corporation, municipality, county, local government agency or any other legal or commercial entity that operates a home care organization.

"Personal care services" means the provision of nonskilled services, including assistance in the activities of daily living, and may include instrumental activities of daily living, related to the needs of the client, who has or is at risk of an illness, injury or disabling condition. A need for assistance exists when the client is unable to complete an activity due to cognitive impairment, functional disability, physical health problems, or safety. The client's functional level is based on the client's need for assistance most or all of the time to perform the tasks of daily living in order to live independently.

"Primary care physician" means a physician licensed in Virginia, according to Chapter 29 (§ 54.1-2900 et seq.) of Title 54.1 of the Code of Virginia, or licensed in an adjacent state and identified by the client as having the primary responsibility in determining the delivery of the client's medical care. The responsibility of physicians contained in this chapter may be implemented by nurse practitioners or physician assistants as assigned by the supervising physician and within the parameters of professional licensing.

"Qualified" means meeting current legal requirements of licensure, registration or certification in Virginia or having appropriate training, including competency testing, and experience commensurate with assigned responsibilities.

"Quality improvement" means ongoing activities designed to objectively and systematically evaluate the quality of client care and services, pursue opportunities to improve client care and services, and resolve identified problems. Quality improvement is an approach to the ongoing study and improvement of the processes of providing health care services to meet the needs of clients and others.

"Registered nurse" means a person who holds a current license issued by the Virginia Board of Nursing or a current multistate licensure privilege to practice nursing in Virginia as a registered nurse.

"Service area" means a clearly delineated geographic area in which the organization arranges for the provision of home care services, personal care services, or pharmaceutical services to be available and readily accessible to persons.

"Skilled services" means the provision of the home health services listed in 12VAC5-381-300.

"Supervision" means the ongoing process of monitoring the skills, competencies and performance of the individual supervised and providing regular, documented, face-to-face guidance and instruction.

"Sworn disclosure statement" means a document disclosing an applicant's criminal convictions and pending criminal charges occurring in Virginia or any other state.

"Third-party crime insurance" means insurance coverage that protects an organization's losses as a result of employee theft or fraud.

A. For the purposes of this section:

1. "Client" means an individual who receives personal care services from an HCO.

2. "Patient" means an individual who receives skilled services from an HCO and may receive personal care services as a client from an HCO.

3. "Plan of care" means a written plan of personal care services to provide direction on the type of care to be provided that address the client’s or patient's care needs and that is developed, signed, and periodically reviewed by a registered nurse employed or contracted by an HCO.

A. An organization B. The HCO may provide personal care services in support of the client's or patient's health and safety in his home residence. The organization shall designate a registered nurse responsible for the supervision of personal care services. and shall employ or contract with:

1. A registered nurse responsible for performing assessments of clients, patients, or both, as prescribed by subsection H of this section; and

2. A registered nurse or licensed practical nurse responsible for the supervision of personal care services as prescribed by subsection J of this section.

B. The C. In providing personal care services, the HCO shall include:

1. Assistance with the activities of daily living ADLs . A need for assistance exists when if the client or patient is unable to complete an activity ADL due to cognitive impairment, functional disability, physical health problems, or safety. The client's or patient's functional level is based on the client's his need for assistance most or all of the time to perform the tasks of daily living ADLs in order to live independently;

2. Administration of normally self-administered drugs as allowed in § 54.1-3408 of the Virginia Drug Control Act (Chapter 34 (§ 54.1-3400 et seq.) of Title 54.1 of the Code of Virginia);

3. Taking and recording vital signs, if specified in the plan of service care;

4. Recording and reporting to the supervisor any changes regarding the client's or patient's condition, behavior, or appearance; and

5. Documenting in the client record or patient record:

a. The date on which personal care services were delivered;

b. By whom the personal care services were delivered; and

c. The specific type of personal care services provided in the client's record.

Personal D. The HCO's personal care services may also include the instrumental activities of daily living related to the needs of the client or the patient.

C. Such services shall be delivered E. The HCO shall deliver personal care services based on a written plan of services care developed :

by a 1. By the registered nurse , in with whom the HCO has employed or contracted pursuant to subdivision B 1 of this section;

2. In collaboration with the client or patient and client's his family.; and

3. Prior to the delivery of personal care services by a home care attendant.

F. The HCO shall ensure that the registered nurse with whom the HCO has employed or contracted pursuant to subdivision B 1 of this section includes in each plan of care shall include at least the following:

1. Assessment of the client's or patient's needs;

2. Functional limitations of the client or patient;

3. Activities permitted;

4. Special dietary needs;

5. Specific personal care services to be performed; and

6. Frequency of personal care services.;

7. Frequency of supervision; and

8. Whether supervision should be in-person on-site at the client's or patient's residence, including rationale for providing supervision remotely if supervision is not provided in-person on-site at the client’s or patient’s residence.

D. G. The HCO shall:

1. Retain The the plan of care shall be retained in the client's client record or patient record.;

2. Provide a copy Copies of the plan of care shall be provided to the client or patient receiving personal care services; and

3. Ensure and document in writing that the plan of care has been reviewed with by the assigned home care attendant with their supervisor prior to delivering services.

E. Supervision of services shall be provided as often as necessary as determined by the client's needs, the assessment of the registered nurse, and the organization's written policies not to exceed 90 days.

H. The registered nurse with whom the HCO has employed or contracted pursuant to subdivision B 1 of this section shall perform an in-person on-site client or patient assessment:

1. Prior to the initiation of personal care services by the HCO;

2. As often as necessary to reassess the client's or patient's needs, not to exceed 60 calendar days from the last assessment or reassessment, unless:

a. The client or patient experiences a significant change in condition;

b. The client or patient has been discharged and returns to the same HCO during the 60-day calendar period; or

c. The client or patient has transferred to a different HCO during the 60-day calendar period;

3. Within 48 hours of the client's or patient's return to the residence from a hospital stay of 24 hours or more for any reason other than diagnostic tests, or on the health care practitioner-ordered resumption date; and

4. At discharge from the HCO.

F. I. If the plan of care does not require in-person on-site supervision of the client's or patient's residence, the HCO may not provide remote interactive audio and video supervision of personal care services without the client's or patient's signed consent.

1. The HCO shall disclose orally and in writing to the client or patient that:

a. He may refuse to consent to remote interactive audio and video supervision of personal care services;

b. He may withdraw previously given consent to remote interactive audio and video supervision of personal care services at any time; and

c. The HCO may not terminate the client’s or patient’s care for refusing or withdrawing consent to remote interactive audio and video supervision of personal care services.

2. The HCO may not terminate the client’s or patient’s care for refusing or withdrawing consent to remote interactive audio and video supervision of personal care services.

3. The HCO and any employee or contractor of the HCO may not decrease the frequency of supervision in the plan of care if the client or patient refuses or withdraws consent to remote interactive audio and video supervision of personal care services.

4. The client’s or patient’s consent to remote interactive audio and video supervision of personal care services may not imply consent to recording or storing of the audio or video. The HCO shall obtain separate consent from the client or patient to record or store the audio or video. A recording of the audio or video may not be utilized for reasons other than the client’s or patient’s care, except as otherwise authorized by the client or patient or as otherwise required by law.

A J. The registered nurse or licensed practical nurse with whom the HCO has employed or contracted with pursuant to subdivision B 2 of this section shall:

1. Supervise home care attendants as often as necessary as determined by the assessment of the registered nurse and the HCO’s written policies, provided that:

a. Remote interactive audio supervision of personal care services occurs at least once every 15 calendar days;
b. Remote interactive audio and video supervision of personal care services occurs at least once every 30 calendar days;

c. In-person on-site supervision of personal care services occurs at least once every 60 calendar days, which may be in conjunction wit the periodic assessment of the client or patient pursuant to subsection H of this section; and

d. The time, date, duration, and type of supervision is documented in writing in the client record or patient record by the registered nurse or licensed practical nurse who performs the supervision; and

be 2. Be available during all hours that personal care services are being provided.

G. Home K. The HCO shall ensure that home attendants providing personal care services shall receive at least 12 hours annually of inservice training and education., which Inservice training may be in conjunction with in-person on-site supervision.