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(1) Provision of services. Skilled nursing services shall be provided by or under the supervision of a registered nurse.
(2) Duties of the registered nurse. The registered nurse shall:
(a) Make the initial evaluation visit to the patient.
(b) Regularly reevaluate the patient’s needs.
(c) Initiate the plan of care and necessary revisions.
(d) Provide those services requiring substantial specialized care.
(e) Initiate appropriate preventive and rehabilitative procedures.
(f) Prepare clinical and progress notes.
(g) Promptly inform either the physician, advanced practice nurse prescriber, or physician assistant, as well as other personnel participating in the patient’s care of changes in the patient’s condition and needs.
(h) Arrange for counseling the patient and family in meeting related needs.
(i) Participate in inservice programs for agency staff.
(j) Supervise and teach other personnel.
(3) Scope of duties. Nurses shall perform only those duties within the scope of their licensure.
(4) Practical nursing. Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse.
(5) Coordination of services. A registered nurse shall maintain overall responsibility for coordinating services provided to the patient by the agency.
(6) Contracted registered nurse services. A home health agency may purchase registered nurse services on an hourly or per visit basis, in accordance with the requirements in s. DHS 133.19. Persons providing registered nurse services under contract shall meet the requirements in s. DHS 133.06 (4) (a) to (d), be assigned to duties for which they are licensed and trained and be utilized only in non-supervisory nursing assignments.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; cr. (6), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (2) (c) and (g) Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. (2) (a) to (i) Register September 2017 No. 741 eff. 10-1-17; correction in (2) (b) made under s. 35.17, Stats., Register September 2017 No. 741.
DHS 133.15 Therapy services.
(1) Provision of services. Physical therapy, occupational therapy, speech therapy, and other therapy services provided directly by the home health agency or arranged for under s. DHS 133.19, shall be given in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (a), (c), (f), (h) and (i).
(2) Physical therapy. If offered, physical therapy shall be provided by a physical therapist or by a qualified therapy assistant under the supervision of a qualified physical therapist.
(3) Occupational therapy. If offered, occupational therapy shall be provided by an occupational therapist or by a qualified therapy assistant under the supervision of a qualified occupational therapist.
(4) Speech therapy. If offered, speech therapy shall be provided by a speech pathologist or audiologist.
(5) Other therapies. Therapies other than those under subs. (2), (3) and (4), shall be provided by persons qualified by training or by being licensed to perform the services.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (1) Register November 2007 No. 623, eff. 12-1-07.
DHS 133.16 Medical social services. If offered, medical social services shall be provided by a social worker in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (c), (f), (h) and (i).
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. Register November 2007 No. 623, eff. 12-1-07.
DHS 133.17 Home health aide services.
(1) Provision of services. When a home health agency provides or arranges for home health aide services, the services shall be given in accordance with the plan of care provided for under s. DHS 133.20, and shall be supervised by a registered nurse or, when appropriate, by a therapist.
(2) Duties. Home health aide services may include, but are not limited to:
(a) Assisting patients with care of mouth, skin and hair, and bathing;
(b) Assisting patients into and out of bed and assisting with ambulation;
(c) Assisting with prescribed exercises which patients and home health aides have been taught by appropriate health personnel;
(d) Preparing meals and assisting patients with eating;
(e) Household services essential to health care at home;
(f) Assisting patients to bathroom or in using bedpan;
(g) Assisting patients with self-administration of medications;
(h) Reporting changes in the patient’s condition and needs; and
(i) Completing appropriate records.
(3) Assignments. Home health aides shall be assigned to specific patients by a registered nurse. Written instructions for patient care shall be prepared and updated for the aides at least each 60 days by a registered nurse or appropriate therapist, consistent with the plan of care under s. DHS 133.20. These instructions shall be reviewed by the immediate supervisors with their aides.
(4) Training of aides.
(a) Curriculum. In addition to the orientation required by s. DHS 133.06 (4) (a), the agency shall ensure that all home health aides providing service have successfully completed a course of training covering at least the following subjects:
1. The role of the home health aide as a member of the health services team;
2. Instruction and supervised practice in in-home personal care of the sick, including personal hygiene and activities of daily living;
3. Principles of good nutrition and nutritional problems of the sick and elderly;
4. Preparation of meals, including special diets;
5. The needs and characteristics of the populations served, including the aged and disabled;
6. The emotional problems accompanying illness;
7. Principles and practices of maintaining a clean, healthy, and safe environment;
8. What, when and how to report to the supervisor; and
9. Record-keeping.
(b) Training. Training, if provided by the agency, shall be directed by a registered nurse. Physicians, nutritionists, physical therapists, medical social workers, and other health personnel shall provide relevant training when pertinent to the duties to be assigned.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (1) and (3) Register November 2007 No. 623, eff. 12-1-07.
DHS 133.18 Supervisory visits.
(1) If a patient receives skilled nursing care, a registered nurse shall make a supervisory visit to each patient’s residence at least every 2 weeks. The visit may be made when the home health aide is present or when the home health aide is absent. If the patient is not receiving skilled nursing care, but is receiving another skilled service, the supervisory visit may be provided by the appropriate therapist providing a skilled service.
(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, or physical, occupational or speech-language therapy, the registered nurse shall make a supervisory visit to the patient’s residence, when the home health aide is present or when the home health aide is absent, at least every 60 days to observe or assist, to assess relationships, and to determine whether goals are being met and whether home health services continue to be required.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: r. and recr. Register November 2007 No. 623, eff. 12-1-07.
DHS 133.19 Services under contract.
(1) Terms. A written contract shall be required for health care services purchased on an hourly or per visit basis or by arrangement with another provider. The contract shall contain:
(a) A statement that patients are accepted for care only by the primary home health agency;
(b) A list of services to be provided;
(c) Agreement to conform to all applicable agency policies including personnel qualifications;
(d) A statement about the contractor’s responsibility for participating in developing plans of treatment;
(e) A statement concerning the manner in which services will be controlled, coordinated and evaluated by the primary agency; and
(f) Procedures for submitting clinical and progress notes, scheduling visits, and undertaking periodic patient evaluation.
(2) Qualifications of contractors. All providers of services under contract shall meet the same qualifications required of practitioners of the same service under the terms of this chapter.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.
DHS 133.20 Plan of care.
(1) Requirement. A plan of care, including physician’s, advanced practice nurse prescriber’s, or physician assistant’s orders, shall be established for every patient accepted for care and shall be incorporated in the patient’s medical record. An initial plan shall be developed within 72 hours of acceptance. The total plan of care shall be developed in consultation with the patient, home health agency staff, contractual providers, and the patient’s physician, advanced practice nurse prescriber, or physician assistant and shall be signed and dated by the physician, advanced practice nurse prescriber, or physician assistant within 20 working days following the patient’s admission for care.
(2) Contents of plan. Each plan developed under sub. (1) shall include:
(a) Measurable time-specific goals, with benchmark dates for review; and
(b) The methods for delivering needed care, and an indication of which professional disciplines are responsible for delivering the care.
(3) Review of plan. The total plan of care shall be reviewed by the attending physician, advanced practice nurse prescriber, or physician assistant, and appropriate agency personnel as often as required by the patient’s condition, but no less often than every 60 days. The agency shall promptly notify the physician, the advanced practice nurse prescriber, or the physician assistant of any changes in the patient’s condition that suggest a need to modify the plan of care.
(4) Orders. Drugs and treatment shall be administered by the agency staff only as ordered by the attending physician, advanced practice nurse prescriber, or physician assistant. The nurse or therapist shall immediately record and sign and date oral orders and obtain the physician’s, the advanced practice nurse prescriber’s or physician assistant’s countersignature and date within 20 working days.
History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (4), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (1), (3) and (4) Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. (1), (3), (4) Register September 2017 No. 741 eff. 10-1-17.
DHS 133.21 Medical records.
(1) Requirement. A medical record shall be maintained on each patient and shall be completely and accurately documented, systematically organized and readily accessible to authorized personnel.
(2) Security. Medical record information shall be safeguarded against loss, destruction or unauthorized use. Written procedures shall be established to control use and removal of records and to identify conditions for release of information.
Note: For information regarding confidentiality of patient health care records, see s. 146.82, Stats.
(3) Retention. For the purposes of this chapter medical records shall be retained for a minimum of 5 years following discharge. Arrangements shall be made for the storage and safekeeping of records if the agency goes out of business.
(4) Transfer. If a patient is transferred to another health facility or agency, a copy of the record or summary of the record shall be provided to the receiving agency or facility.
(5) Content. The medical record shall document the patient’s condition, problems, progress and services rendered, and shall include:
(a) Patient identification information.
(b) Appropriate hospital information (discharge summary, diagnosis, current patient status, post-discharge plan of care).
(c) Patient evaluation and assessment.
(d) Plan of care.
(e) Physician’s, advanced practice nurse prescriber’s, or physician assistant’s orders.
(f) Medication list and documentation of patient instructions.
(g) Progress notes, as frequently as necessary to document patient status and services provided.
(h) Summaries of reviews of the plan of care.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.