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

In limited cases. Delaware Board rules bar RNs from delegating medication administration to unlicensed aides. A state law exception lets a direct care worker from a personal assistance services agency give medication in a client's home. A responsible family caregiver must prepackage each dose, give written instructions, and sign an agreement with the agency, and the worker must complete state-approved training. Injections such as insulin are excluded. A competent adult can also self-direct an unlicensed helper for most health care tasks.

What conditions apply?

• Only RNs (not LPNs) may delegate
• The task must be frequent, follow set steps, have a predictable outcome, and need no ongoing assessment
• The RN weighs the client's stability and the aide's training, and periodically verifies the aide's skills
• The RN must be readily available in person or by phone
• An RN may not delegate medication administration (including prescription topicals), sterile invasive procedures, NG tube feeding, or newly established G- or J-tube feeding
• Personal assistance services agency exemption: a responsible caregiver (the client's primary caretaker) prepackages each medication by date and time and gives written instructions
• Personal assistance services agency exemption: the caregiver and the agency sign an agreement confirming the medication and process are safe
• Personal assistance services agency exemption: no injections, IV, rectal, vaginal, catheter, or feeding-tube routes, and no Schedule II or IV controlled substances
• Personal assistance services agency exemption: the worker completes a DHSS-approved medication training program and documents every dose
• Limited lay administration of medications (LLAM) is limited to listed group settings (assisted living, group homes, intellectual disability services, residential child care), not private homes

Is there an exception for self-directed care?

A competent adult living outside a facility may delegate health care acts to unlicensed people if the acts are ones they would do themselves but for functional limits. Original IV insertion, new G- or J-tube feedings, tube insertions, and sterile invasive procedures not normally taught to caregivers are excluded. Family, friends, and housekeepers may give incidental care in private homes.

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.