Can a nurse delegate tasks to home care caregivers in California?

In limited cases. California has no Board of Nursing rule for delegating nursing tasks to home care aides. Licensed home care organizations may only provide nonmedical help, which includes assisting with medicine the client takes on their own. Medicine that needs a licensed professional to give it, such as insulin injections, is outside a home care aide's role. The exception is IHSS, where a provider can give medications and injections as paramedical services ordered and directed by a licensed health professional.

What conditions apply?

• Licensed home care organizations provide only nonmedical services through registered home care aides
• Home care aides may assist with medication the client self-administers
• Aides may not assist with medication that would otherwise need administration or oversight by a licensed health care professional
• IHSS paramedical services (medications, injections, sterile procedures) must be ordered by a licensed health care professional, given under that professional's direction, and consented to by the recipient

Is there an exception for self-directed care?

The Nurse Practice Act exempts free nursing by family or friends. It also exempts people who do physical care or carry out a physician's medical orders without claiming to be a nurse. In the IHSS program, a provider can give medications, injections, and sterile procedures as paramedical services under a licensed professional's direction.

What is the difference between medication reminders and administration?

Reminding a client to take their medicine, or handing them a container they open themselves, is usually treated as assistance. Giving the medicine, such as placing pills in the mouth, giving an injection or crushing tablets, is administration and generally needs a license or nurse delegation. Check your state's rule and the client's care plan.

What should you confirm with the state?

The IHSS paramedical route covers individual providers in the IHSS program, not private-pay home care agency staff.