Unlicensed assistive personnel and lay caregivers in the home.

As a result of the changes in the health care delivery system, professional home health agency staff must provide clinical assessments, care planning, and patient outcome evaluation to higher acuity patients with limited resources. Because the number of home visits per patient is closely monitored by managed care companies, duplication of services may not be reimbursed, causing financial loss to home care agencies. Every aspect of care from admission to discharge must be coordinated to ensure that each patient receives the best care available within the limitation of the number of reimbursable or capitated visits. Professionals on an interdisciplinary team must know the legal scope of practice as well as the competencies of all members of the team. Decisions relating to delegation of patient care tasks to UAP and to lay caregivers are complex. Professional staff must consider the patient's condition, the caregiving environment, and the amount of social support available for the patient and family. The knowledge, skills, and abilities of the caregivers must then be matched to the needs of the patient. Because on-site supervision in the home setting is limited, nurses and therapists are required to know how to safely delegate patient care tasks and supervise others.