(a) Hospice aide services must be provided by a hospice aide who meets the training and competency evaluation requirements, or the competency evaluation requirements specified in §558.843 of this division (relating to Hospice Aide Qualifications).
(b) A client's hospice aide services must be:
  (1) ordered by the designated interdisciplinary team (IDT);
  (2) included in the client's plan of care;
  (3) performed by a hospice aide in accordance with State law and applicable rules, including 22 TAC Chapter 224 (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments), and 22 TAC Chapter 225 (relating to RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments For Clients with Stable and Predictable Conditions); and
  (4) consistent with a hospice aide's documented training and competency skills.
(c) An RN who is a member of a client's designated IDT must assign a hospice aide to a specific client. An RN who is responsible for the supervision of a hospice aide, as specified in subsection (d) of this section, must prepare written client-care instructions for the hospice aide. The duties of a hospice aide include:
  (1) providing hands-on personal care;
  (2) performing simple procedures as an extension of therapy or nursing services;
  (3) assisting with ambulation or exercises;
  (4) assisting with self-administered medication;
  (5) reporting changes in a client's medical, nursing, rehabilitative, and social needs to an RN as the changes relate to the client's plan of care and the hospice's quality assessment and improvement activities; and
  (6) completing client record documentation in compliance with the hospice's policies and procedures.
(d) An RN must make an on-site visit to a client's home to supervise the hospice aide services at least every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice IDT meet the client's needs. The hospice aide does not have to be present during this visit.
  (1) If the RN notes an area of concern in the care provided by the aide, the RN must make an on-site visit to the location where the client is receiving care to observe and assess the hospice aide while the aide performs care.
  (2) If, during the on-site visit to observe the hospice aide, the RN confirms an area of concern in the aide's skills, the hospice must ensure that the aide completes a competency evaluation in accordance with §558.843 of this division.
(e) An RN must make an annual on-site visit to the location where a hospice client is receiving care to observe and assess each hospice aide while the aide performs care. During this on-site visit, the RN must assess the aide's ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria including:
  (1) following the client's plan of care for completion of tasks assigned to the hospice aide by an RN;
  (2) creating successful interpersonal relationships with the client and the client's family;
  (3) demonstrating competency with assigned tasks;
  (4) complying with infection control policies and procedures; and
  (5) reporting changes in the client's condition.

Source Note: The provisions of this §558.842 adopted to be effective October 1, 2013, 38 TexReg 6628; 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