Part of the Code © 2006 National Private Duty Association Approved 7-19-06.

Attendant Care – hands on assistance with activities of daily living including, but not limited to: ambulation, transfer, toileting, and grooming.
Homemaker Services – assistance with household tasks, shopping, meals.
Companion Care – provision of fellowship, care and protections for client including transportation, letter writing, escort services, reading and medication reminding.

In-home personal care worker or in-home services worker – means an individual with appropriate training and competency for the tasks assigned, who provides services up to, and including, personal care services to a consumer in the consumer’s residence.

Duties of an in-home personal care services worker may include the following:
Supervision of the home environment that ensures the safety and security of the client.
Assistance with household chores including cooking and meal preparation, cleaning, and laundry.
Assistance in completing activities such as shopping, appointments outside the home.
Companionship, including but not limited to social interaction, conversation, emotional reassurance, and encourage reading, writing and activities that stimulate the mind.
Completion of appropriate records regarding service provision.
Assistance with activities of daily living and personal care.

In order to delineate the types of services that can be provided by an in-home personal care service worker, the following are examples of limitations where a more medical model of assistance would be needed to meet higher needs of the client.
Skin Care. An in-home personal care services worker may perform general skin care assistance. Skin care may be performed by an in-home personal care service worker only when skin is unbroken, and when any chronic skin
problems are not active. The skin care provided by an in-home personal care services worker must be preventative rather than therapeutic in nature and, may include the application of non-medicated lotions and solutions, or of
lotions and solutions not requiring a physician’s prescription. Skilled skin care must be provided by an agency licensed as a home health services or home nursing services agency. Skilled skin care includes wound care, dressing
changes, application of prescription medications, skilled observation and reporting.
Ambulation. An in-home personal care services worker may generally assist clients with ambulation. Clients in the process of being trained to use adaptive equipment for ambulation, such as walkers, canes or wheelchairs,
require supervision by an agency licensed to provide home health or home nursing services during the period of their training. Once the prescribing individual or the health care provider responsible for the training of the client is comfortable with releasing the client to work on their own with the adaptive equipment, an in-home personal services worker may be assigned to assist with ambulation.
Bathing. An in-home personal care service worker may assist clients with bathing. When a client has skilled skin care needs or skilled dressings that will need attention before, during or after bathing, the client should be in the
care of an agency licensed as a home health agency or a home nursing agency to meet those specific needs.
Dressing. An in-home personal care services worker may assist a client with dressing. This may include assistance with ordinary clothing and application
of support stockings of the type that can be purchased without a physician’s prescription. An in-home personal care service worker may not assist with
application of an Ace bandage and anti-embolic or other pressure stockings that can be purchased only with a physician’s prescription.
Exercise. An in-home personal care services worker may assist a client with exercise. However, this does not include assistance with a plan of exercise prescribed by a licensed health care professional. Assistance with exercise
that can be performed by an in-home personal care service worker is limited to the encouragement of normal bodily movement, as tolerated, on the part of the client and, encouragement with a prescribed exercise program. Passive range of motion (ROM) may not be performed by an in-home personal care services worker.
Feeding. Assistance with feeding may generally be performed by an in-home personal service worker. In-home personal care services workers can assist clients with feeding when the client can independently swallow and be
positioned upright. Assistance by an in-home personal care services worker does not include syringe, tube feedings and intravenous nutrition. Whenever there is a high risk that the client may choke as a result of the feeding the
client should be in the care of an agency licensed as a home health or home nursing agency to fulfill this function.
Hair care. As a part of the broader set of services provided to clients who are receiving in-home personal services, in-home personal care service agencies may assist clients with the maintenance and appearance of their hair. Hair care within these limitations may include shampooing with non-medicated shampoo or shampoo that does not require a physician’s prescription, drying, combing and styling of hair.
Mouth care. An in-home personal care services worker may assist and perform mouth care. This may include denture care and basic oral hygiene, including oral suctioning for mouth care. Mouth care for clients who are unconscious should be performed by an agency licensed as home health
services or home nursing services.
Nail care. Assistance with nail care can be generally performed by an inhome personal care services worker. This assistance may include soaking of nails, pushing back cuticles without utensils, and filing of nails. Assistance
by an in-home personal care services worker may not include nail trimming. Clients with a medical condition that might involve peripheral circulatory problems or loss of sensation should be under the care of an agency licensed
as a home health agency or home nursing agency to meet this need.
Positioning. An in-home personal care services worker may assist a client with positioning when the client is able to identify to the in-home personal care staff, verbally, non-verbally or through others, when the positions needs to be changed AND only when skilled skin care, as previously described, is not required in conjunction with the positions. Positioning may include simple alignment in a bed, wheelchair, or other furniture.
Shaving. An in-home personal care service worker may assist a client with shaving only with an electric or a safety razor.
Toileting. An in-home personal care services worker may assist a client to and from the bathroom, provide assistance with bedpans, urinals, and commodes; pericare; or changing of clothing and pads of any kind used for
the care of incontinence.

An in-home personal care services worker may empty or change external urinary collection devices, such as catheter bags or suprapubic catheter bags. In all cases, the insertion and removal of catheters and care of external catheters is considered skilled care and may NOT be performed by an in-home personal care service worker.
An in-home personal care services worker may empty ostomy bags and provide assistance with other client-directed ostomy care only when there is no need for skilled skin care or for observation or reporting to a nurse. An in-home personal care services worker may not perform digital stimulation, insert suppositories or give an enema.

Transfers. An in-home personal care service worker may assist with transfers only when the client has sufficient balance and strength to reliably stand and pivot and assist with the transfer to some extent. Adaptive and safety
equipment may be used in transfers, provided that the client is fully trained in the use of the equipment and can direct the transfer step by step. Adaptive equipment may include, but is not limited to wheel chairs, tub seats and grab bars. Gait belts may be used in a transfer as a safety device for the in-home personal care service worker as long as the worker has been properly trained in its use.
In general, assistance with transfers may not be performed by an inhome personal care service worker when the client is unable to assist with the transfer. In-home services workers, with training and demonstrated competency, may assist a client in a transfer involving a
lift device.

Medication reminding. An in-home personal care services worker may assist a client with medication reminding only when medications have been preselected, by the client, a family member, a nurse, or a pharmacist, and are stored in containers other than the prescription bottles, such as medication minders. Medication minder containers must be clearly marked as to day and time of dosage, and reminding includes: inquiries as to whether medications were taken; verbal prompting to take medications; handing the appropriately marked medication minder container to the client; and, opening the
appropriately marked medication minder container for the client if the client is physically unable to open the container. These limitations apply to all prescription and all over-the-counter medications. Any irregularities noted in the pre-selected medications, such as medications taken too often or not often enough, or not at the correct time as marked in the medication minder container, shall be reported immediately by the in-home personal care service
worker to the supervisor.
Respiratory care is considered skilled care and may NOT be performed by an in-home personal care service worker. Respiratory care includes postural drainage, cupping, adjusting oxygen flow within established parameters, nasal, endotracheal, and tracheal suctioning, and turning off or changing tanks. However, in-home personal care service workers may temporarily remove and replace a cannula or mask from the client’s face for the purposes of shaving, washing a client’s face or providing oral suctioning.
In addition to the exclusions prescribed in the preceding section, in-home personal care service workers may not act in the following capacities:
1) Perform skilled personal care services as defined in this Part
2) Becoming or acting as a Power of Attorney
3) Be involved in any financial transactions of the client, including check writing or account management, outside of contracted services such as grocery shopping or running general errands. In such cases, the inhome services worker will follow agency policies in regard to securing
receipts for items purchased and ensuring both client and worker signatures documenting those expenditures.
4) Perform or provide medication set up for a client
5) Other actions specifically prohibited by agency policy

Part of the Code © 2006 National Private Duty Association Approved 7-19-06.