CMS SOM App. M, Tag L615

An individual may furnish hospice aide services on behalf of a hospice only after

that individual has successfully completed a competency evaluation program as

described in this section.

§418.76(c)(1)

The competency evaluation must address each of the subjects listed in

paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i),

(iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s

performance of the task with a patient or pseudo-patient. The remaining subject

areas may be evaluated through written examination, oral examination, or after

observation of a hospice aide with a patient or a pseudo-patient during a simulation.

Interpretive Guideline for §418.76(c)(1)

The hospice may not allow an aide to provide services to patients independently until the

aide has successfully completed competency testing, either at the hospice or at another

training facility, and the hospice has verified successful completion through

documentation provided by the applicant or the training facility.

The relevant subject areas specified under §418.76(b)(3) are listed below.

The listed skills below must be evaluated by observing the aide’s performance while

carrying out the task with a patient or pseudo-patient in a practicum laboratory or other

setting as per §418.76(b)(1). A pseudo-patient is a person who is trained to participate in

a role-play situation or is a computer-based mannequin device. A pseudo-patient must be

capable of responding to and interacting with the hospice aide trainee and must be similar

in characteristics to the primary patient population served by the hospice in key areas

such as age, frailty, functional status, and cognitive status.

When pseudo-patients are used to test hospice aide competency, the simulated

environment must mimic the reality of the homecare environment, including

environmental distractions and constraints that evoke or replicate substantial aspects of

the real world in a fully interactive fashion, in order to assess proficiency in performing

skills.

The following are the relevant subject areas at §418.76(b)(3):

(i) Communication skills, including the ability to read, write, and verbally report

clinical information to patients, representatives, and caregivers, as well as to other

hospice staff;

. . .

(iii) Reading and recording temperature, pulse, and respiration;

. . .

(ix) Appropriate and safe techniques in performing personal hygiene and grooming

tasks that include—

(A) Bed bath;

(B) Sponge, tub, and shower bath;

(C) Hair shampooing in sink, tub, and bed;

(D) Nail and skin care;

(E) Oral hygiene;

(F) Toileting and elimination;

(x) Safe transfer techniques and ambulation;

(xi) Normal range of motion and positioning.

. . .

In accordance with §418.76(c)(3), a registered nurse, in consultation with other skilled

professionals (as appropriate), must observe the hospice aide candidate perform each of

the tasks above to confirm the competence of the candidate.