of the Code © 2006 National Private Duty Association Approved
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,
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
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
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
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
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
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.