Advanced Home Health Aides Frequently Asked Questions

Chapter 471 of the Laws of 2016 authorizes Advanced Home Health Aides to perform advanced tasks with appropriate training and upon assignment by registered nurses and under supervision by such nurses. The goal of the new law is to enable more people to live in home and community based settings and provide support to family caregivers and their loved ones.

The Department of Health (DOH) is making these Frequently Asked Questions available to provide interested parties with guidance on matters such as the types of tasks that can be performed by Advanced Home Health Aides, the required educational and training requirements for Advanced Home Health Aides, and the effective date of the law.

What are Advanced Home Health Aides?

Advanced Home Health Aides (AHHAs) are certified Home Health Aides who have been authorized to complete advanced tasks in accordance with regulations and after completion of training developed by the State Education Department (SED) in consultation with DOH.

What kinds of advanced tasks will Advanced Home Health Aides be authorized to perform?

The types of tasks that can be performed by Advanced Home Health Aides will be defined in regulations issued by SED. The law authorizing Advanced Home Health Aides specifies that Advanced Home Health Aides must be authorized to administer medication which are routine or prefilled or otherwise packaged in a manner that promotes relative ease of administration. This excludes medication administered by injection, sterile procedures, and central line maintenance, however, this exclusion does not apply to injections of insulin, other injections for diabetes care, injections of low molecular weight heparin, and pre-filled auto injections of naloxone and epinephrine.

Which entities will be authorized to utilize Advanced Home Health Aides when providing patient care?

An Advanced Home Health Aide must be supervised by a registered professional nurse employed by: (1) a home care services agency licensed or certified pursuant to Public Health Law (PHL) Article 36, meaning a certified home health agency (CHHA) or a licensed home care services agency (LHCSA); (2) a hospice program certified pursuant to PHL Article 40; or (3) an enhanced assisted living residence licensed pursuant to Social Services Law (SSL) Article 7 and certified pursuant to PHL Article 46-B.

Who will supervise Advanced Home Health Aides?

Advanced Home Health Aides will only be authorized to perform advanced tasks under the supervision of a registered professional nurse licensed in New York state and employed by one of the authorized entities listed above.

How will registered professional nurses supervise the Advanced Home Health Aides?

Supervising nurses will be required to:

  • Train and periodically assess the performance of advanced tasks by the Advanced Home Health Aides under his or her supervision;
  • Determine the advanced tasks to be performed by Advanced Home Health Aides based upon the complexity of the considered tasks, the skill and expertise of the AHHA under his or her supervision, and the health status of the individual receiving care;
  • Complete a comprehensive initial assessment of the individual's needs;
  • Complete regular and ongoing assessments of the individual's needs after the initial assessment;
  • Visit the individuals receiving care by Advanced Home Health Aides under their supervision no less than once every 2 weeks;
  • Be available by telephone to the Advanced Home Health Aides under their supervision 24 hours a day, 7 days a week;
  • Be available to visit an individual receiving services from Advanced Home Health Aides under their supervision as necessary to protect the individual's health and safety; and
  • Subject to SED regulations, provide supervision in a manner that takes into account individual care needs, case mix complexity and geographic considerations. The number of individuals served by the supervising registered nurse must be reasonable and prudent.

How will the supervising nurses assign tasks to the Advanced Home Health Aides?

In determining which types of advanced tasks will be performed by the Advanced Home Health Aides, the supervising nurses must:

  • Complete a nursing assessment to ascertain the patient's current health status and care needs;
  • Assign advanced tasks only where the AHHA has demonstrated competency in the authorized advanced tasks to the satisfaction of the supervising nurse after the nurse provides case-specific training to the AHHA and personally verifies that the AHHA can safely and competently perform the advanced tasks;
  • Ensure that the AHHA is willing to perform the advanced tasks;
  • Consider whether the AHHA is able to effectively and efficiently communicate with the individual receiving services and understands the individual's needs; and
  • Provide written, case-specific instructions to the AHHA for performing the advanced tasks and criteria for identifying, reporting and responding to problems or complications.

The supervising nurse has the authority to revoke any assigned task from any AHHA under his or her supervision for any reason. Any assigned advanced tasks must be performed in accordance with a health practitioner's ordered care for the individual receiving services. Advanced Home Health Aides are prohibited from performing any advanced tasks or activities outside the scope of practice of a licensed practical nurse or any advanced tasks that have not been specifically assigned by the supervising nurse. A supervising nurse retains the discretion to assign advanced tasks to Advanced Home Health Aides and will not be subject to coercion, retaliation, or the threat of retaliation by his or her employer.

Will the individual receiving services have the ability to request that an AHHA not perform advanced tasks when caring for that individual?

Yes. A supervising registered nurse is prohibited from assigning advanced tasks to an AHHA if the individual receiving services declines to be served by an AHHA.

What are the requirements for becoming an AHHA?

A certified home health aide may perform advanced tasks as an AHHA when he or she has:

  • At least one year of experience providing home health or personal care services, or a combination of the same;
  • Completed the requisite training and demonstrated competencies of an AHHA as determined by the Commissioner of Education in consultation with the Commissioner of Health;
  • Successfully completed competency examinations satisfactory to the Commissioner of Education in consultation with the Commissioner of Health; and
  • Meets other appropriate qualifications as determined by the Commissioner of Education in consultation with the Commissioner of Health.

It is important to note that only an individual who is listed in the home care services registry maintained by the Department of Health may perform advanced tasks and hold himself or herself out as an AHHA.

When will Advanced Home Health Aides be able to start performing advanced tasks?

The law becomes effective May 28, 2018, eighteen months after the bill became law. No advanced tasks may be performed before the effective date and until regulations have been adopted by SED in consultation with the DOH. In the interim, the SED is immediately authorized to promulgate the regulations necessary to implement the AHHA program.