Ga. Comp. R. & Regs. R. 111-8-100-.04 - Use of Proxy Caregivers and Informed Consent

(1) Proxy Caregiving Permitted. Licensed facilities, may allow proxy caregivers to perform health maintenance activities for individuals with disabilities who are being served by or through the licensed facility, as authorized in these rules, provided that the individual with a disability or legally authorized representative has executed a written informed consent.

(2) Written Informed Consent. No licensed facility will permit a proxy caregiver to provide health maintenance activities by or through the licensed facility unless the individual with a disability, or the legally authorized representative has executed an informed consent. The written informed consent must contain the following information:

(a) a definition of health maintenance activities as set forth in the law;

(b) the actual health maintenance activities to be performed;

(c) an explanation that such health maintenance activities are to be provided pursuant to the written orders of an attending physician, advance practice registered nurse or physician's assistant working under protocol or job description as further detailed in the written plan of care;

(d) the name(s) of the proxy caregiver(s) who are being authorized to provide health maintenance activities;

(e) a disclosure that Georgia law now allows licensed healthcare professionals to train unlicensed proxy caregivers to provide the specific health maintenance activities listed on the written plan of care;

(f) an acknowledgement that proxy caregivers are not licensed healthcare professionals and do not have the same education and training as licensed healthcare professionals. Therefore, there may be additional health risks associated with receiving this care from proxy caregivers who may not recognize an important change in the individual's medical condition requiring assessment and/or treatment;

(g) an acknowledgment that the individual with a disability, or the legally authorized representative consents and is willing to take such risks;

(h) that the informed consent is conditioned upon the proxy caregiver(s) being determined by an appropriately qualified licensed healthcare professional to have the knowledge and skills necessary to perform safely the specific health maintenance activities listed on the consent;

(i) a statement that the informed consent for any proxy caregiver designated to deliver health maintenance activities may be withdrawn orally or in writing by the individual with a disability or the legally authorized representative by informing the proxy caregiver and any licensed facility through which the proxy caregiver may be operating; and

(j) an authorization for such health maintenance activities to be provided which is signed and dated by the individual with a disability or the legally authorized representative.

(3) Proxy Caregivers Functioning Independently in Licensed Residential Facilities. Where the licensed residential facility permits the individual with a disability or the legally authorized representative to hire a proxy caregiver directly to perform tasks that are appropriately classified as health maintenance activities, the licensed residential facility must do the following:

(a) Develop and enforce written policies and procedures which do not conflict with the requirements of the law and these rules, and which outline the following:

1. The scope of the health maintenance activities that proxy caregivers are permitted to perform;

2. The notification procedures that will be utilized when either the proxy caregiver observes a change in the condition of the individual with a disability which may require evaluation/treatment by a licensed healthcare professional, or there is a change in the care being provided through the licensed residential facility that might impact the performance of health maintenance activities; and

3. The safety and security precautions that will be employed in the licensed residential facility to protect clients being served from harm by proxy caregivers who are independent and not under the control of the facility.

(b) Maintain a copy of the written informed consent which meets the requirements of rule 111-8-100-.04(2) and appears to be properly executed by the individual with a disability or the legally authorized representative

(c) Maintain a copy of the written plan of care for the individual with a dis ability which has been developed by a licensed healthcare professional pursuant to written orders of an attending physician, or an advanced practice registered nurse or physician assistant working under a nurse protocol agreement or job description respectively.

(d) Determine that the written plan of care provided specifies the health maintenance activities to be performed, the frequency of training and evaluation for the proxy caregiver and the kinds of changes in the written plan of care that would necessitate additional training for the proxy caregiver.

(e) Maintain current documentation signed by a licensed healthcare professional which reflects that the proxy caregiver has been determined to have the knowledge and skills necessary to perform safely the required health maintenance activities for the individual client.

(f) Verify that there is a back-up proxy caregiver service plan which has been put in place for the individual with a disability which addresses at a minimum the following:

1. The notification procedures and contact information that will be utilized when the proxy caregiver and/or licensed facility staff observe a change in the condition of the individual with a disability which may require evaluation/treatment by a licensed healthcare professional;

2. The alternative resources to be used to provide needed health maintenance activities in the event that the proxy caregiver is not available for any reason; and

3. The notification procedures and contact information that will be utilized if staff members of the licensed facility become aware of a potentially unsafe situation involving the client and the proxy caregiver.

(g) Ensure that the proxy caregiver is familiar with emergency evacuation procedures.

(4) Licensed Facilities Delivering Services Through Proxy Caregivers. Where the licensed facility employs, contracts or refers proxy caregivers to deliver health maintenance activities to individuals with disabilities receiving services through the licensed facility, the licensed facility must do the following:

(a) Develop and enforce written policies and procedures, which do not conflict with the requirements of the law and these rules and which outline the following:

1. The scope of the health maintenance activities that proxy caregivers are permitted to perform;

2. The notification procedures that will be utilized when the proxy caregiver observes a change in the condition of the individual with a disability which may require evaluation/treatment by a licensed healthcare professional; and

3. The safety and security precautions that will be employed by the licensed facility to protect clients being served by the licensed facility from harm by proxy caregivers.

(b) Disclose to individuals with disabilities who are potential clients of the licensed facility or the legally authorized representative the following:

1. The manner in which proxy caregivers are used to deliver health maintenance activities and the general professional qualifications of the staff providing supervision to the proxy caregivers;

2. Whether there are additional charges for such proxy caregivers and the amount that would be charged;

3. The manner in which the licensed facility ensures that clients are permitted to designate and change proxy caregivers;

4. The qualifications of the licensed healthcare professionals who develop written plans of care for the clients and provide training; and

5. The frequency of competency-based skills determinations and the extent of trainings provided to proxy caregivers.

(c) Ensure that the individual with a disability or the legally authorized representative has executed a written informed consent which meets the requirements of rule 111-8-100-.04(2).

(d) Ensure that a written plan of care is developed for the individual with a disability by a licensed healthcare professional in accordance with the written orders of an attending physician, an advanced practice registered nurse or physician's assistant working under a nurse protocol agreement or job description respectively, and that such plan of care specifies the frequency of training and evaluation requirements for the proxy caregiver and when additional training will be required for new duties added to the written plan of care for which the proxy caregiver has not been previously trained. The licensed facility must either use the written plan of care form made available by the Department or another form containing all the required elements.

(e) Ensure that the written plan of care is implemented by appropriately trained proxy caregivers who have been specifically designated by the individual with a disability or the legally authorized representative.

(f) Maintain documentation of the specific training that was provided on the health maintenance activities that the proxy caregiver performs. The documentation must include a competency-based skills checklist completed by the licensed healthcare professional. The checklist must reflect that the proxy caregiver has personally demonstrated to the satisfaction of the licensed healthcare professional the necessary knowledge and skills to perform safely the specific health maintenance activities. There must be a separate skills checklist for each health maintenance activity that the proxy caregiver provides. For the medication administration training, the facility must use the curriculum established by DCH and any associated checklist.

(g) Maintain supporting documentation reflecting that the employee or contractor serving as the proxy caregiver has the basic qualifications as represented, e.g. no findings of abuse, neglect or exploitation entered against the individual in the nurse aide registry, a satisfactory report of motor vehicle driving record where the proxy caregiver may be transporting clients and a satisfactory criminal records check where required by other rules applicable to the specific licensed facility.

(h) Maintain written evidence of satisfactory performances on initial and annual skills competency determinations utilizing skills competency checklists which have either been made available by the department or developed and completed by appropriately licensed healthcare professionals. The competency-based skills checklists must reflect a testing of the knowledge and observation of the skills associated with the completion of all of the discrete tasks necessary to do the specific health maintenance activity in accordance with accepted standards of care.

Notes

Ga. Comp. R. & Regs. R. 111-8-100-.04

O.C.G.A. §§ 31-7-2.2, 31-9-2, 43-26-12(a)(9).

Original Rule entitled "Use of Proxy Caregivers and Informed Consent" adopted. F. Jul. 18, 2011; eff. Aug. 7, 2011. Amended: F. Apr. 16, 2018; eff. May 6, 2018.