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

In limited cases. No Missouri Board of Nursing rule on delegating nursing tasks to home care aides was found. Missouri's in-home services standards for Medicaid providers bar aides from giving prescription or over-the-counter medications; nursing visits must be done by licensed nurses. Missouri's consumer-directed program lets a disabled adult hire and direct their own attendant for routine personal care tasks.

What conditions apply?

• Medicaid in-home service providers under DHSS rules may not administer over-the-counter or prescribed medications, and may not perform health-related activities that belong to RNs, LPNs or Medicare/Medicaid home health aides
• In-home aides may pick up medications as an errand
• Advanced personal care (help with ADLs involving devices and procedures related to altered body functions) is a separate service under 13 CSR 70-91.010
• Authorized nurse visits in the home are done by an LPN or graduate nurse under RN direction, not by aides

Is there an exception for self-directed care?

Missouri's consumer-directed personal care program (RSMo 208.900-208.927) lets a physically disabled consumer hire, train, supervise and direct their own personal care attendant for routine tasks; the statute's definitions do not mention medications.

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 medication ban found applies to Medicaid in-home services providers; private-pay agencies should confirm with the Missouri Department of Health and Senior Services and the Board of Nursing.