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

Yes. Maryland lets nurses delegate routine tasks to unlicensed caregivers, but medication administration can only be delegated to a Board-certified medication technician or certified medicine aide. In independent living settings, a medication technician can give oral, tube, inhaled, topical and suppository medicines and subcutaneous injections such as insulin when the nurse has calculated the dose. The RN must visit on site at least every 45 days. A capable adult may hire their own caregiver to help with self-administered medicines without these rules.

What conditions apply?

• Any nurse may delegate routine nursing tasks to an unlicensed person, CNA or medication technician after assessing the client, training or verifying competency, and supervising; tasks cannot require nursing judgment
• Medication administration may be delegated only to Board-certified medication technicians (20-hour Board-approved course) or certified medicine aides, in settings including independent living settings
• For case-managed delegation the RN documents that the client's needs are chronic, stable, routine and predictable, the environment is suitable, and the client cannot do their own care
• The RN makes an on-site supervisory visit at least every 45 days (every 2 weeks if the client does not meet those criteria)
• Delegable routes: inhalers, nebulizers and oxygen; gastrostomy or rectal tube and subcutaneous injections if the nurse calculated the dose; oral (nurse calculates liquid doses and cuts tablets); topical; suppositories; eye, ear and nose drops
• Medication technicians may not calculate doses and must be able to monitor effects, report changes and withhold a dose

Is there an exception for self-directed care?

The delegation rules do not restrict gratuitous care by family or friends, or a cognitively capable adult employing an unlicensed caregiver at home to assist with routine treatments and self-administration of medication.

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 rules list 'independent living settings' rather than naming private homes; confirm with the Maryland Board of Nursing how this applies to your agency.