CNA logoMatching Capabilities with Client Needs and Expectations

Every home care provider needs a written plan that specifies the organization’s scope of services and defines the population served. The plan should be developed in accordance with all state and federal regulations, as well as applicable state nursing codes and guidelines from professional organizations.

Consumer needs and regulatory requirements continuously evolve, so the plan should be reviewed and revised at least annually. In addition, as services change or expand, creating new exposures, it is advisable to consult periodically with one’s insurance company regarding the adequacy of existing coverage and liability limits.

The following strategies can help promote awareness of appropriate scope of services on the part of both clients and staff, thus clarifying expectations and lessening the potential for misunderstanding:

Enhance Client Communication
Request that new clients and/or family members read a description of home care policies and services, and acknowledge in writing their receipt and understanding. Notifying clients and/or families in writing about program features and limitations, and documenting their consent, will help get the relationship off to a good start.

Implement a “read-back” process or other procedure in which clients and/or family members convey their expectations regarding services to be provided and their understanding of what caregivers can and cannot do. This procedure gives providers an additional opportunity to clarify the scope of services.

Promote ongoing communication among clients, staff and supervisors, eliciting questions in order to resolve any client service issues that may arise before they develop into serious conflicts.

Increase Staff Awareness
Foster staff awareness of scope of services by incorporating the subject into employee orientation. In addition, discuss scope of services whenever it changes and reinforce the message at least annually.

Draft written job descriptions that clearly define each caregiver’s role and responsibilities within the provider’s defined scope of services. Conduct random site visits to observe how well caregivers adhere to job duties and provide immediate feedback. In addition, evaluate compliance with defined job duties when giving annual performance appraisals.

Utilize the SBAR Technique
Caregivers are sometimes asked by clients or family members to perform tasks that are not covered in the scope of services or are beyond their competency. It is essential that home care providers instruct caregivers on how to respond when this occurs.

The “SBAR” (Situation-Background-Assessment-Recommendation) communication tool, as described in the example below, is an effective means of managing such requests and communicating concerns to supervisors:

S – Situation: What is the client or family request?
“Ms. Smith has asked me to cut one of her pills in half because she is afraid she will choke if she takes it whole. I am not sure I should do this.”

B – Background: What were the prior circumstances?
“The client’s daughter puts the pills in the daily medication box. The client has never previously voiced any similar concerns to me. ”

A – Assessment: How have the client’s needs changed?
“The client isn’t eating well and needs a reminder to take her medications. At times, she gets short of breath just walking across the room. Ms. Smith’s condition has worsened, and she needs more help.”

R – Recommendation: What course of action is indicated?
“I request that you reassess this client and her current level of services, and advise me on how to respond to her request.”

(For more information about the SBAR format, see “SBAR Technique for Communication: A Situational Briefing Model,” from the Institute for Healthcare Improvement.)

By clarifying the scope of services and utilizing sound communication techniques, home care providers can promote quality care, increase client satisfaction and reduce liability exposures.

The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. Please note that Internet hyperlinks cited herein are active as of the date of publication, but may be subject to change or discontinuation. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. Use of the term “partnership” and/or “partner” should not be construed to represent a legally binding partnership. CNA is a registered trademark of CNA Financial Corporation. Copyright ©2012 CNA. All rights reserved.