(a) A hospice must use a qualified hospice aide to provide hospice aide services. A qualified hospice aide is a person who has successfully completed:
  (1) a training program and competency evaluation program that complies with the requirements in subsections (c) and (d) of this section; or
  (2) a competency evaluation program that complies with the requirements in subsection (d) of this section.
(b) A person who has not provided home health or hospice aide services for compensation in an agency during the most recent continuous period of 24 consecutive months must successfully complete the programs described in subsection (a)(1) of this section or the program described in subsection (a)(2) of this section before providing hospice aide services.
(c) A hospice aide training program must address each of the subject areas listed in paragraph (1) of this subsection through classroom and supervised practical training totaling at least 75 hours. At least 16 hours must be devoted to supervised practical training. At least 16 hours of classroom training must be completed before the supervised practical training begins.
  (1) Subject areas that must be addressed in a hospice aide training program include:
    (A) communication skills, including the ability to read, write, and verbally report clinical information to clients, caregivers, and other hospice staff;
    (B) observation, reporting, and documentation of a client's status and the care or service provided;
    (C) reading and recording temperature, pulse, and respiration;
    (D) basic infection control procedures;
    (E) basic elements of body functioning and changes in body function that must be reported to an aide's supervisor;
    (F) maintenance of a clean, safe, and healthy environment;
    (G) recognizing emergencies and the knowledge of emergency procedures and their application;
    (H) the physical, emotional, and developmental needs of and ways to work with the populations served by the hospice, including the need for respect for a client and his or her privacy and property;
    (I) appropriate and safe techniques for performing personal hygiene and grooming tasks, including:
      (i) bed bath;
      (ii) sponge, tub, and shower bath;
      (iii) hair shampoo in sink, tub, and bed;
      (iv) nail and skin care;
      (v) oral hygiene; and
      (vi) toileting and elimination;
    (J) safe transfer techniques and ambulation;
    (K) normal range of motion and positioning;
    (L) adequate nutrition and fluid intake; and
    (M) other tasks that the hospice may choose to have an aide perform. The hospice must train hospice aides, as needed, for skills not listed in subparagraph (I) of this paragraph.
  (2) The classroom training of hospice aides and the supervision of hospice aides during supervised practical training 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 of which must be in the provision of home health or hospice care. Other persons, such as a physical therapist, occupational therapist, medical social worker, and speech-language pathologist may be used to provide instruction under the supervision of a qualified RN who maintains overall responsibility for the training.
  (3) An agency must maintain documentation that demonstrates that its hospice aide training program meets the requirements in this subsection. Documentation must include a description of how additional skills, beyond the basic skills listed in paragraph (1) of this subsection, are taught and tested if the agency requires a hospice aide to perform more complex tasks.
(d) A hospice aide competency evaluation program must address each of the subject areas listed in paragraphs (2) and (3) of this subsection.
  (1) An RN, in consultation with the other persons described in subsection (c)(2) of this section, must perform the competency evaluation.
  (2) The RN must observe and evaluate the hospice aide's performance of tasks with a client in the following areas:
    (A) communication skills, including the ability to read, write, and verbally report clinical information to clients, caregivers, and other hospice staff;
    (B) reading and recording temperature, pulse, and respiration;
    (C) appropriate and safe techniques for performing personal hygiene and grooming tasks, including:
      (i) bed bath;
      (ii) sponge, tub, and shower bath;
      (iii) hair shampoo in sink, tub, and bed;
      (iv) nail and skin care;
      (v) oral hygiene; and
      (vi) toileting and elimination;
    (D) safe transfer techniques and ambulation; and
    (E) normal range of motion and positioning.
  (3) The RN must evaluate a hospice aide's performance of each of the tasks listed in this paragraph by requiring the aide to submit to a written examination, an oral examination, or by observing the hospice aide's performance with a client. The tasks must include:
    (A) observing, reporting, and documenting client status and the care or service provided;
    (B) basic infection control procedures;
    (C) basic elements of body functioning and changes in body function that must be reported to an aide's supervisor;
    (D) maintaining a clean, safe, and healthy environment;
    (E) recognizing emergencies and knowing emergency procedures and their application;
    (F) the physical, emotional, and developmental needs of and ways to work with the populations served by the hospice, including the need for respect for a client and his or her privacy and property;
    (G) adequate nutrition and fluid intake; and
    (H) other tasks the hospice may choose to have the hospice aide perform. The hospice must evaluate the competency of a hospice aide, as needed, for skills not listed in paragraph (2)(C) of this subsection.
  (4) A hospice aide has not successfully completed a competency evaluation program if the aide has an unsatisfactory rating in more than one subject area listed in paragraphs (2) and (3) of this subsection.
  (5) If a hospice aide receives an unsatisfactory rating in any of the subject areas listed in paragraphs (2) and (3) of this subsection, the aide must not perform that task without direct supervision by an RN until after:
    (A) the aide receives training in the task for which the aide was evaluated as unsatisfactory; and
    (B) successfully completes a subsequent competency evaluation with a satisfactory rating on the task.
  (6) An agency must maintain documentation that its hospice aide competency evaluation program meets the requirements in this subsection. The agency's documentation of a hospice aide's competency evaluation must demonstrate the aide's competency to provide services to a client that exceed the basic skills taught and tested before the aide is assigned to care for a client who requires more complex services.
(e) A hospice aide must receive at least 12 hours of in-service training during each 12-month period. The agency may provide the 12 hours of in-service training during the 12-month calendar year, or within 12 months after a hospice aide's employment or contract anniversary date.
  (1) The in-service training must be supervised by an RN.
  (2) An agency may provide hospice aide in-service training supervised by an RN while the aide is providing care to a client. The RN must document the exact new skill or theory taught in the client's residence and the duration of the training. The in-service training provided in a client's residence must not be a repetition of a hospice aide's competency in a basic skill.
  (3) An agency must maintain documentation that demonstrates the agency meets the hospice aide in-service training requirements in this subsection.
(f) An agency that hires or contracts to use a hospice aide who completes a training program and competency evaluation program, or a competency evaluation program provided by another agency or a person who is not licensed as an agency must ensure that the programs or program completed comply with the requirements in subsection (c) and (d) of this section.
(g) A Medicare-certified hospice agency must also comply with 42 CFR §418.76(b) and 42 CFR §418.76(f).

Source Note: The provisions of this §558.843 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