(a) A home health aide may be used by an agency providing licensed home health services if the aide meets one of the following requirements:      
        (1) a minimum of one year of full-time experience in direct client care in an institutional setting (hospital or nursing facility);       
        (2) one year of full-time experience within the last five years in direct client care in an agency setting;       
        (3) satisfactorily completed a training and competency evaluation program that complies with the requirements of this section;       
        (4) satisfactorily completed a competency evaluation program that complies with the requirements of this section;       
        (5) submitted to the agency documentation from the director of programs or the dean of a school of nursing that states that the individual is a nursing student who has demonstrated competency in providing basic nursing skills in accordance with the school's curriculum; or       
        (6) listed on the HHSC nurse aide registry (NAR) with no finding against the aide relating to client abuse or neglect or misappropriation of client property.       
      (b) A home health aide must have provided home health services within the previous 24 months to qualify under subsection (a)(3) or (4) of this section.     
      (c) Assignment, delegation, and supervision of services provided by home health aides must be performed in accordance with rules in this chapter governing the agency's license category.     
      (d) The training portion of a training and competency evaluation program for home health aides must be conducted by or under the general supervision of an RN who possesses a minimum of two years of nursing experience, at least one year of which must be in the provision of home health care. The training program may contain other aspects of learning, but must contain the following:      
        (1) a minimum of 75 hours as follows:                  (A) an appropriate number of hours of classroom instruction; and                   (B) a minimum of 16 hours of clinical experience, which will include in-home training and must be conducted in a home, hospital, nursing home, or laboratory;         
        (2) completion of at least 16 hours of classroom training before a home health aide begins clinical experience working directly with clients under the supervision of qualified instructors;       
        (3) if LVN instructors are used for the training portion of the program, the following qualifications and supervisory requirements apply:                  (A) an LVN may provide the home health aide classroom training under the supervision of an RN who has two years of nursing experience, at least one year of which must be in the provision of home health care;                   (B) LVNs, as well as RNs, may supervise home health aide candidates in the course of the clinical experience; and                   (C) an RN must maintain overall responsibility for the training and supervision of all home health aide training students; and         
        (4) an assessment that the student knows how to read and write English and carry out directions.       
      (e) The classroom instruction and clinical experience content of the training portion of a training and competency evaluation program must include, but is not limited to:      
        (1) communication skills;       
        (2) observation, reporting, and documentation of a client's status and the care or service furnished;       
        (3) reading and recording temperature, pulse, and respiration;       
        (4) basic infection control procedures and instruction on universal precautions;       
        (5) basic elements of body functioning and changes in body function that must be reported to an aide's supervisor;       
        (6) maintenance of a clean, safe, and healthy environment;       
        (7) recognizing emergencies and knowledge of emergency procedures;       
        (8) the physical, emotional, and developmental needs of and ways to work with the populations served by the agency including the need for respect for the client and his or her privacy and property;       
        (9) appropriate and safe techniques in personal hygiene and grooming that include:                  (A) bed bath;                   (B) sponge, tub, or shower bath;                   (C) shampoo, sink, tub, or bed;                   (D) nail and skin care;                   (E) oral hygiene; and                   (F) toileting and elimination;         
        (10) safe transfer techniques and ambulation;       
        (11) normal range of motion and positioning;       
        (12) adequate nutrition and fluid intake;       
        (13) any other task the agency may choose to have the home health aide perform in accordance with §558.298 of this chapter (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel and Tasks Not Requiring Delegation); and       
        (14) the rights of the elderly.       
      (f) This section addresses the requirements for the competency evaluation program or the competency evaluation portion of a training and competency evaluation program.      
        (1) The competency evaluation must be performed by an RN.       
        (2) The competency evaluation must address each of the subjects listed in subsection (e)(2) - (13) of this section.       
        (3) Each of the areas described in subsection (e)(3) and (9) - (11) of this section must be evaluated by observation of the home health aide's performance of the task with a client or person.       
        (4) Each of the areas described in subsection (e)(2), (4) - (8), (12), and (13) of this section may be evaluated through written examination, oral examination, or by observation of a home health aide with a client.       
        (5) A home health aide is not considered to have successfully completed a competency evaluation if the aide has an unsatisfactory rating in more than one of the areas described in subsection (e)(2) - (13) of this section.       
        (6) If an aide receives an unsatisfactory rating, the aide must not perform that task without direct supervision by an RN or LVN, until the aide receives training in the task for which he or she was evaluated as unsatisfactory and successfully completes a subsequent competency evaluation with a satisfactory rating on the task.       
        (7) If an individual fails to complete the competency evaluation satisfactorily, the individual must be advised of the areas in which he or she is inadequate.       
      (g) If a person, who is not an agency licensed under this section, desires to implement a home health aide training and competency evaluation program or a competency evaluation program, the person must meet the requirements of this section in the same manner as set forth for an agency.     
     Source Note:        The provisions of this §558.701 adopted to be effective February 1, 2002, 26 TexReg 9159; amended to be effective June 29, 2003, 28 TexReg 4931; amended to be effective April 1, 2004, 29 TexReg 2383; transferred effective May 1, 2019, as published in the April 12, 2019 issue of the Texas Register, 44 TexReg 1893; amended to be effective April 25, 2021, 46 TexReg 2427