FAQS

A delegated task is patient-specific, meaning that each specific task needs to be delegated for each patient and each caregiver. Delegation occurs every 3 months, any time there is a change in patient condition, and ANY time a new medication is added (including a dosage change). Tasks that may be delegated include but are not limited to: administration of oral, topical, nebulizer, G‑tube, and rectal medications; insulin administration; tracheal suctioning; in-and-out urinary catheterization; tube feedings; oxygen administration, and certain dressing changes.

• Injections, other than insulin
• Sterile procedures
• Maintenance of IV lines that go into the heart
• Anything that requires nursing judgment/assessment

May be completed in four community settings:

• Homes
• Residential programs for the developmentally disabled
• Adult Family Homes
• Assisted Living Facilities

The caregiver must have a CNA, HCA, or NAR certification with proof of completed 75-hour basic training. Their license must be in good standing. They must have completed a 9-hour Nurse Delegation Core Course, plus an additional 3-hour Nurse Delegation Diabetes Course if giving insulin. Their skills must be verified and signed off by the nurse delegator

The caregiver must always use their six medication rights:

• Right patient
• Right time
• Right route
• Right dose
• Right Medication
• Right Documentation

The community must notify Journey Nursing Services IF or WHEN

• the patient has a change in condition, medication side effects or ineffectiveness
• the patient is admitted to the hospital
• the patient has a new medication or task that requires delegation
• there is a new caregiver that requires delegation
• a caregiver needs additional training or is unable to perform a task
• the patient moves or passes away.

Examples:

1. Any time there is a new medication added, or a medication dosage has been changed. For patients on hospice, this would include when a new medication is initiated, the caregiver may have been trained in advance.
2. Any time a new procedure is added.
3. Any time the patient or caregiver has concerns or questions about elements of care.

An RND must be a Registered Nurse willing and able to assume formal delegation responsibility for the client per DSHS standards. LPNs CANNOT delegate. CNAs CANNOT Delegate. Home Health and Hospice nurses cannot delegate if they are not taking the formal state required steps of a Registered Nurse Delegator.

Washington State requires consent for any images taken of a patient. Images are then uploaded into the patients record. Images are frequently used to monitor skin condition or wounds so that the nurse can compare healing progression. Images would also be taken if there was a concern about abuse or neglect.

Washington State requires a consent be completed for any telehealth services. Although our team completes visits in person and makes weekly visits to our assisted living communities, we like to have the consent on file in case there is a need. Examples may be a concern about a patient or medication change when the nurse is unable to be onsite such as facility shutdowns for COVID-19 outbreaks or the occasional snowstorm.

It is the policy of Journey Nursing Services that patient privacy is protected, as well as the integrity and confidentiality of patient protected information. Personal Health Information: is any information in a medical record that can be used to identify an individual, and that was created, used, or disclosed while providing a health care service, such as a diagnosis or treatment. Covered Entity: communication within the patient care team at Journey Nursing Services, disclosures made during and emergency/ life-threatening event, to protect a child or vulnerable population from suspected abuse, in response to a court order, during an audit of Journey Nursing Services, or when communicating with insurance providers. Patients may request records for themselves, or another entity may request patients’ records, summary of care, on behalf of the patient by faxing a records request to 425-276-8202.

Advanced Directive (also called a “Healthcare Power of Attorney”): Is a legal document that appoints a person or persons to make health care decisions if, and when the individual loses the capacity to make health care decisions. It provides guidance and instruction in making life saving and end-or-life decisions in various situations. POLST: The National POLST Form is a single form that will make it easier to Honor patient treatment wishes. POLST communicates your wishes as medical orders. A POLST form informs all health care providers during a medical emergency what you want:

• “Take me to the hospital” or “I want to stay here”
• “Yes, attempt CPR” or “No, don’t attempt CPR”
• “These are the medical treatments I want”
• “This is the care plan I want followed”

It is always Journey Nursing Services' goal to work as a teammate to our clients and their family. However, if you ever have a concern regarding care, we request that you speak with your assigned case manager to resolve any concerns. If this concern becomes elevated to a level of grievance, (a written concern submitted to management), Journey Nursing Services will initiate an investigation regarding the complaint. Journey Nursing Services will respond appropriately to all complaints within 14 business days of receiving the complaint and all grievances within 30 days of receiving a written grievance. If Journey Nursing Services determines that this complaint requires state reporting, a report will be initiated. Individuals who file grievances will not be the subject of any form of retaliation.

Journey Nursing Services is Owned and Operated by a board-certified nurse practitioner with clinical experience. We have developed an amazing team of nurses and caregivers that put patient care 1st. We listen to our patients so that we can develop a personalized care plan that positively impacts their lives. We advocate for our patients and develop complex care plans as needed. We believe that both the patient and their family are part of the in-home care team. As a nurse-owned and operated organization with a robust nursing team, we are able to provide complex care at any level, including caregiving, at a lower price point, with nurse delegation supplementing that care. Meaning that caregivers always have access to nursing insight and education while on our staff. For our more complex patients, we will build a plan that meets their needs, whether it is ventilator dependence, complex behavior navigation, or spinal cord injury. Our experienced professionals follow a collaborative approach, ensuring that both caregiving and nursing teams work in harmony to deliver holistic and personalized support tailored to each individual's needs. We believe that all patients, regardless of their income level, deserve excellent care. That's why we work with a variety of payment sources, including Medicaid and private pay options. This approach enables us to assist clients during transitions in their services, such as managing a Medicaid spend-down, while ensuring they can retain the same caregiver even after their income changes and they become eligible for Medicaid benefits. We want to be good stewards of your resources while also ensuring that you get the care that you need. By choosing Journey Nursing Services, you are selecting a partner in care that is committed to enhancing the quality of life for our patients and their families.

When choosing a home care provider, it’s essential to consider several key factors to ensure you find the best fit for your needs. Here are some important aspects to keep in mind:

1. Expertise and Experience: Look for a provider with a solid track record of caring for individuals with specific conditions, whether it's chronic illness, recovery from surgery, or age-related issues. Experienced caregivers can offer specialized support and guidance.
2. Personalized Care Plans: A good home care agency will work with you to create a tailored care plan that addresses your unique needs and preferences. Personalization is crucial for effective care.
3. Services Offered: Ensure the provider offers a full spectrum of services that you might need, such as personal care, medication management, companionship, and skilled nursing care. This versatility can be important as needs change over time.
4. Staff Qualifications: Check the qualifications and training of caregivers. Look for agencies that hire certified professionals and provide ongoing training to their staff.
5. Safety Measures: A reputable agency will prioritize safety, implementing the latest protocols and equipment to maintain a safe environment for patients. This includes everything from maintaining hygiene standards to using assistive devices.
6. Communication and Support: Good communication is vital. Choose a provider that keeps families informed about care plans, changes in condition, and encourages questions and feedback.
7. Client Testimonials and Reviews: Research the agency’s reputation through reviews and testimonials from other families. Positive feedback can provide insights into the level of care and service you can expect.
8. Cost and Insurance: Understand the pricing structure and what is covered by insurance. It’s important to choose a provider that is transparent about costs and can work with your insurance plan or offer payment options if needed.
9. Cultural Compatibility: Consider whether the caregivers respect and understand your cultural preferences. A good match can make the caregiving experience much more comfortable.

Choosing the right home care provider can have a significant impact on the quality of life for you or your loved one. Take your time to research and ask questions to ensure you find a provider that meets your needs with compassion and expertise.

The level of provider coordination typically depends on the services being provided. Basic home care does not typically need coordination with the primary care provider however if nurse delegation is implemented, we would be required to obtain orders for the medications that the nurse's training the caregivers to give. If we are providing home health services or private duty nursing, we would be in regular contact with your primary care provider to ensure that all of your health needs are met.

Medicare, which is federally funded, does not currently cover long-term caregiving services. However, it does provide coverage for short-term home health services, including intermittent nursing, physical therapy (PT), occupational therapy (OT), and bath aide visits. While some private insurance plans may offer coverage for caregiving services, only a few do. In Washington State, Medicaid can cover in-home caregiving services based on eligibility requirements regarding a client’s need and their financial means. If you believe you qualify for these services, you can apply for them.

• Role of a 1:1 Caregiver: to ensure the safe and proper care of a client, make sure they are clean and that their ADLs and IADLs in the care plan are met.
• Role of a Private Duty Nurse: to complete continuous nursing interventions (monitoring a trach/vent, suctioning) with continuous assessment, completing ADLs for the client and assist in some IADLs.
• Role of a Visiting Nurse: The role of a nurse visit does not typically include ADLs. The nurse comes in to assess a patient and ensure their medical/nursing needs are met. Examples: ongoing assessments of body systems to ensure that each body system is functioning appropriately, providing intermittent interventions such as wound care, IV therapy, medication management, administration of medications such as suppository or injections that may be difficult for the client or are outside the scope of practice for the caregiver.

• Feeding: setting up meals and feeding patients.
• Bathing: assisting clients to bath: using the method given in the care plan, standing, sitting, bed bath, etc.
• Toileting: toileting may involve transferring to the toilet, changing briefs, or emptying a Foley Catheter.
• Transferring/ Walking: Transferring clients based on the type of transfer determined as safe in their care plan – or voicing if a transfer is no longer safe.
• Repositioning: Repositioning a client to ensure that their skin stays in good health or encouraging movement.
• Medicating: Providing medications assistants or administration to a client to meet their medical needs.
• Companionship: accompanying the client on outings or shopping trips
• Personal Care needs: Shaving, hair care, make up, nail care (non-diabetic), dressing, grooming.

Instrumental Activities of Daily Living: (IADLs) include:

• Shopping for groceries: some insurances do require the client to be will the caregiver on errands.
• Picking up medications from the pharmacy
• Preparing meals
• Paying Bills
• Doing Laundry
• Light House Keeping: Client-specific light housekeeping. Cleaning as they go: washing dishes used to prepare food and feed client, washing laundry used to bath client, cleaning client spaces.
• Transportation
• Using the phone
• Using the computer

Yes, nurses or caregivers can transport clients under certain conditions. They may drive your vehicle, such as a wheelchair van, provided both parties are comfortable with the arrangement and the staff member has a valid driver's license and insurance on file. In some cases, it may also be permissible for a caregiver to transport a client in their private vehicle. However, a liability waiver must be signed by the client to allow transportation by Journey Nursing Services staff. It is required to list how a caregiver will transport the client within the plan of care.

Yes, your caregiver can accompany you in a transport van at any times.

‘Clean as you go,’ is listed in every client care plan. Specifics of cleaning will also be included in the care plan. Caregivers are encouraged to leave spaces better than they found them. However, the caregiver’s primary role is to provide care to the client. Caregivers are expected to do light housekeeping, but they do not serve in the role of a housekeeper. Our general rule: if it is a task that someone would be specifically hired for that it is probably outside to role of the caregiver assisting with ADLs. Examples may include a housekeeper, landscaper, window washer, plumber, or mechanic. On occasion, we may include additional tasks in the care plan or navigate this in an alternative way to distribute workload. For example, a spouse may cook dinner for both people and the caregiver may wash dishes for both. Instances such as these do not need to be listed in an individualized care plan. It is important to note that many these tasks are client-specific and some payer sources my reduce or discontinue benefits if caregiving is providing care outside of covered tasks. Some specific examples can be found below: Task that may be included in the care plan: These tasks are specific to the client

• Washing dishes
• Washing, drying, and folding laundry
• Making the bed
• Changing bedding
• Sweeping, moping, and vacuuming
• Putting belongings away.
• Ensuring bathroom clean after giving given a client a bath.
• Wiping down the tub or shower doors
• Dusting
• Organizing spaces
• Cleaning off countertops
• Ensuring the floor is clear of clutter
• Reorganizing closet and patient supplies.
• Preparing meals
• Emptying trash cans
• Tossing expired food from the fridge.
• Taking trash cans to the road for pick up.

Task that should not be completed in the care plan:

• Standing on a ladder and washing second story windows.
• Cleaning outdoor windows
• Shampooing carpets
• Scrubbing grout lines
• Scrubbing “mopping” on hands and knees
• Cleaning roofs
• Polishing brass/ stainless steel fixtures.
• Deep scrubbing ovens, microwave, fridge
• Cleaning ceiling fans
• Cleaning blinds
• Mowing the lawn
• Detailing cars
• Moving heavy furniture
• Meal prepping
• Working in the capacity of a housekeeper, managing household tasks for family.