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

In limited cases. Louisiana's Board of Nursing generally bars delegating medication administration to unlicensed staff. A separate state program lets trained direct service workers at licensed home and community-based services agencies give oral, topical, suppository, inhaled and gastrostomy-tube medications and tube feedings to stable clients. An RN must assess the client, train the worker and certify competency, and the worker needs 16 hours of medication training. Injections such as insulin are not on the allowed list.

What conditions apply?

• Only direct service workers (DSWs) in home and community-based settings, employed by an LDH-licensed or certified agency or a state self-directed program; the DSW must have no finding on the DSW Registry
• The client must receive home and community-based services, have a current plan of care, and either be able to self-direct services or live where a family member or other provider monitors daily
• An RN authorizes and monitors the tasks, assesses the client at least yearly, gives person-specific training, and certifies the DSW's competency in writing
• The DSW completes 16 hours of RN-approved medication administration training plus documentation and skills training, with an annual competency evaluation
• Allowed: oral and topical medications, ointments, suppositories, pre-measured oral inhalers, and routine hydration, nutrition or medication through an established gastrostomy tube, for a stable client following exact directions
• Outside this program, Board rules prohibit delegating medication administration to unlicensed assistive personnel (except outpatient clinics), and RNs may not delegate IV medications in home health

Is there an exception for self-directed care?

DSWs employed through an authorized LDH self-directed program can perform the same medication and noncomplex tasks, and a client who can self-direct services qualifies without daily family monitoring.

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.