LESSON OBJECTIVES
Upon completion of this program, the home health aide will be able to:

• List three methods of observing patients
• Identify the differences between objective and subjective reporting
• List four patient observations which must be recorded and reported, and
• Recognize the importance of knowing what to report.

LESSON OVERVIEW
One of the Conditions of Participation (COP), §484.36, addresses home health aide services. A frequently cited deficiency is in the Standard: Assignment and duties of the home health aide, §484.36(c). The State Operations Manual indicates that surveyors should always make at least one home visit to observe a home health aide providing direct service. In addition, the surveyor may question the aide informally and will certainly review records of patients receiving home health aide services.

The Standard: Coordination of patient services is another problematic area frequently cited during surveys. The standard in §484.14(g) mandates that all personnel providing services maintain liaison to ensure coordination of care and that the clinical record establishes that effective interchange and reporting of patient care does occur. A lack of documentation by home health aides frequently contributes to deficiency in this standard. The Interpretive Guidelines gives specific guidance to surveyors to look for documentation by home health aides in the clinical record describing significant information or changes in the patients’ conditions and to whom these changes were reported.

As agencies struggle to provide the highest quality, most cost-effective care for patients in the Prospective Payment System (PPS), the importance of observation and reporting by home health aides has taken on even greater importance. Patient problems need to be identified and acted upon as quickly as possible. It is likely that the home health aide spends more time with the patient than any other discipline and thus is more likely to note changes in the patient sooner. The subject of observing, recording, and reporting should be addressed frequently with them.

ALSO
Check out the complete series to add flexibility to your in-service training.