Caregiver's Frequently Asked Questions
Washington State Law allows
caregivers to provide
medication assistance with
legend drugs and controlled substances to a
resident who meets certain criteria and resides in a
community-based care setting or an
in-home care setting
(WAC 246-888-020). However,
medication administration must be done only by a resident, family member, licensed medical professional
or by nurse delegation (WAC 246-840-910 to 970).
Under Washington State law, caregivers can not provide the services of a licensed health care provider (RN, LPN, ARNP or pharmacist) or function in the capacity of a nursing assistant (NAC or NAR). The caregiver must be familiar with the rules specifically regulating their residential setting and the tasks that they are legally authorized to provide. Chapter 246-888 WAC,
chapter 388-78A WAC & chapter 388-76 WAC
Back to Top
What is the difference between Adult Family Homes, Boarding Homes, In-home Settings, and In-home Services?
An Adult Family Homes is considered a
community based setting. It is a residential home licensed to care for two to six residents. They provide
room, board, laundry, and necessary supervision, assistance with activities of daily living, personal
care, and social services. Some provide nursing care or may specialize in serving people with mental health
problems, developmental disabilities, or dementia.
Chapter 388-76 WAC.
A Boarding Home is a community based facility licensed to care for seven or more
residents. Boarding homes provide board, help with activities of daily living, and assume general responsibility for the safety and well-being of the resident. Some boarding homes offer limited nursing
services and others may specialize in serving people with mental health problems, developmental disabilities,
or dementia. Chapter 388-78A WAC
An In-Home Settings is an individual's place of temporary or permanent residence that does not include acute care or skilled nursing and not a community-based care setting.
RCW 18.79.260(3)(e)(ii)
Back to Top
In-Home Services may occur in any of these settings
and may provide any of the following:
- Home Health Services are provided to ill, disabled, infirm, or vulnerable individuals. These
services include but are not limited to nursing services, home health aide services, physical therapy
services, occupational therapy services, speech therapy services, respiratory services, nutritional services,
and home medical supplies or equipment services.
- Hospice Services provide symptom and pain management to a terminally ill resident and emotional
spiritual, and bereavement support for the resident or family in a place of temporary or permanent residence.
Hospice Services may include the provision of home health and home care services for the terminally ill
resident.
- Home Care Services provide non-medical services and assistance to ill, disable, infirm, or
vulnerable individuals that enable them to remain in their residences. Home care services include, but are
not limited to: Personal care, such as assistance with dressing, feeding, and personal hygiene to facilitate
self-care; homemaker assistance with household tasks, such as housekeeping, shopping, meal planning and
preparation, and transportation, respite care assistance and support provided to the family; or non-medical
services.
- Hospice Care Centers provide a homelike, non-institutional facility where hospice services are
offered, and that meets the requirements for operation under RCW 70.127.280
Back to Top
Any registered nurse licensed in Washington State may delegate in
accordance with the Nurse Practice Act
(WAC 246-840-700 through 710). The Nurse Delegation Program allows only nursing assistants (NAC or NAR) who work in certain settings to perform certain tasks (such as administration of
prescription medications or blood glucose testing) normally performed only by licensed nurses. Licensed
Practical Nurses (LPNs) are not allowed to delegate. RCW 18.79.260 (3)(e); WAC 388-76-625;
WAC 246-840-910;
WAC 246-840-970.
In a community based setting, who can administer non-prescribed over-the-counter (OTC) medications such as herbal medicines or supplements?
The resident, if able, may independently
administer prescribed or
OTC medications when no assistance is required. However, if a resident is unable to independently
administer, and OTC medications are used to treat a condition,
nurse delegation may be necessary.
Back to Top
If a resident cannot safely
self-administer medication, then the medication must be
administered by a person legally authorized to do so (RN, LPN, ARNP or pharmacist) or by
nurse delegation. WAC 246-840-910 to 970.
A caregiver can only communicate appropriate information regarding
self-administration; remind/coach the
resident to take as prescribed; hand a pre-filled insulin syringe to a resident.
WAC 246-888-020.
A caregiver may help in the preparation of
legend drugs or controlled substances for
self-administration. The licensed practitioner must
determine and communicate orally or by written direction that crushing tablets, cutting tablets in half, opening
capsules, mixing powdered medications, or mixing tablets or capsules with foods or liquids is appropriate
(WAC 246-888-050). The
resident receiving assistance must be aware of the alteration if added to their food. Caregivers may not put medication into the resident's mouth.
Back to Top
How can a caregiver assist a resident with medications in a nebulizer?
A caregiver can transfer the medication into the nebulizer for the purpose of an individual dose. The caregiver can also turn on the machine, communicate appropriate information regarding self-administration; remind/coach the
resident to take as prescribed.
WAC 246-888-020; WAC 246-888-070.
Who can administer non-routine and narcotic medications?
Non-routine and narcotic medications must be administered by a
person legally authorized to do so (RN, LPN, ARNP or pharmacist) or by
nurse delegation WAC 246-840-910 to 970. Under self-directed care, the caregiver can provide these medications under the direction of the resident.
WAC 388-71-05640;
chapter 74.39 RCW
Back to Top
No, except when directed by the resident under
self-directed care.
Back to Top
