Zephyr Hospice

“It is required that all hospice aide services must be provided by an individual who has successfully completed one (1) of the four (4) training and competency evaluations programs described below, and the individual furnishes hospice aide services on behalf of a hospice only after successfully completing a competency evaluation program also described below, and the individual furnishes hospice aide services on behalf of a hospice only after successfully completing a competency evaluation program also described below, and the hospice maintains documentation that each hospice aide has met the requirements. Documentation of training includes a description of the training and competency evaluation program, the qualifications of the instructor, a statement that distinguishes skills taught in a laboratory using a real person (not a mannequin), indicators of which skills the aide was judged to be competent in, and how additional skills, if any, are taught and tested if the hospice’s admission policies and case-mix of hospice patients requires aides to perform more complex procedures. Option 1: Hospice Aide Training and Competency Evaluation: a qualified hospice aide has successfully completed: 1) A training program and competency evaluation that includes classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a registered nurse or licensed practical nurse who is under the supervision of a registered nurse: a) classroom and supervised practical training that total at least 75 hours b) a minimum of 16 hours of classroom training that precedes a minimum of 16 hours of supervised practical training as part of the 75 hours, and a training program that addresses each of the following subject areas communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff, observation, reporting, and documentation of patient status and the care or service provided, reading and recording temperature, pulse, and respiration, basic infection control procedures, basic elements of body function and changes in body function that must be reported to an aide’s supervisor, maintenance of a clean, healthy, and safe environment, recognizing emergencies and the knowledge of emergency procedures and their application, the physical, emotional, and developmental needs of—and ways to work with—the populations served by the hospice, including the need for respect for the patient, his or her privacy, and his or her property, appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed), nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques and ambulation, normal range of motion and positioning, adequate nutrition and fluid intake, and any other task that the hospice may choose to have an aide perform not addressed in item 2.i (a-f) above, the basic checklist; and the competency evaluation addresses each of the following subject areas from item 2, above; they are evaluated by observation of an aide’s performance with a patient or pseudo-patient, including: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff, reading and recording temperature, pulse, and respiration, appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist, bed bath, sponge, tub, and shower bath, hair shampoo (sink, tub, and bed), nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques and ambulation, normal range of motion and positioning. The remaining subject areas in item 2 above may be evaluated through written examination, oral examination, or after observation of a hospice aide with a patient or a pseudo-patient during a simulation, and the competency evaluation is performed by a registered nurse in consultation with other skilled professionals, as appropriate, a hospice aide is not considered competent in any task for which he or she is evaluated as “unsatisfactory.” A hospice aide may not perform that task without direct supervision by a registered nurse until after he or she has received training in the task for which he or she was evaluated as “unsatisfactory” and has successfully completed a subsequent evaluation. A hospice aide is not considered to have successfully completed a competency evaluation if the aide has an “unsatisfactory” rating in more than one (1) of the required areas, and the hospice maintains documentation that demonstrates the requirements of competency evaluation are met (items 3-5 above). Option 2. Hospice Aide Training and Competency Evaluation: a qualified hospice aide has successfully completed a competency evaluation program that evaluates the aide’s competency in the following subject areas by observation of the aide’s performance with a patient or pseudo-patient: communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff, reading and recording temperature, pulse, and respiration, appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath, hair shampoo (sink, tub, and bed), nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques and ambulation, normal range of motion and positioning, evaluates the aide’s competency in the following subject areas by written exam, oral examination, or after observation of a hospice aide with a patient or a pseudo-patient during a simulation: observation, reporting, and documentation of patient status and the care or service provided, basic infection control procedures, basic elements of body functioning and changes in body function that must be reported to an aide’s supervisor, maintenance of a clean, safe, and healthy environment, recognizing emergencies and the knowledge of emergency procedures and their application, the physical, emotional, and developmental needs of—and ways to work with—the populations served by the hospice, including the need for respect for the patient, his or her privacy, and his or her property, adequate nutrition and fluid intake, any remaining task(s) that the hospice chooses to have an aide perform; and the competency evaluation is performed by a registered nurse in consultation with other skilled professionals, as appropriate; and a hospice aide is not considered competent in any task for which he or she is evaluated as “unsatisfactory.”. A hospice aide may not perform that task without direct supervision by a registered nurse until after he/she has received training in the task for which he/she was evaluated as “unsatisfactory” and has successfully completed a subsequent evaluation. A hospice aide is not considered to have successfully completed a competency evaluation if the aide has an “unsatisfactory” rating in more than one (1) of the required areas, and the hospice maintains documentation that demonstrates the requirements of competency evaluation are met. Option 3: Hospice Aide Training and Competency Evaluation: a qualified hospice aide has completed a nurse aide training and competency evaluation program approved by the state as meeting the requirements of nurse aide training and competency evaluation per CMS CFR 483.151-154 (state approval of aide training and competency program per regulation, and is currently listed in good standing on the state nurse aide registry .Option 4 : Hospice Aide Training and Competency Evaluation: a qualified hospice aide has completed a state licensure program. This standard was not met as evidenced by interview and personnel record review. In 1 of 2 (50%) hospice aide personnel records reviewed, the agency did not ensure that the hospice aide successfully completed a competency evaluation program which included observation of a hospice aide’s performance with a patient or pseudo-patient satisfactorily prior to performing patient care. PERSONNEL RECORD 1: This hospice aide was hired on 07/19/2025. The personnel record review revealed that the hospice aide initial competency was performed on 07/23/2025. The following tasks were documented as “discussed”: sponge bath, tub bath, shower, shampoo in sink, shampoo in tub, and shampoo in bed. This discussion was signed and dated by the Registered Nurse on 07/23/2025. In an interview conducted with the Director of Nursing on 08/14/2025, it was stated that a home visit was conducted on 07/23/2025. The hospice aide was observed performing a bed bath only. The following tasks were not observed but discussed with the hospice aide: sponge bath, tub bath, shower, shampoo in sink, shampoo in tub, and shampoo in bed. The hospice aide was then permitted to perform all hospice aide tasks independently. The Administrator stated that the hospice aide competency would be completed before the hospice aide performed any of the tasks that had not been observed by the Registered Nurse.”