Purpose

To expand and clarify what Personal Care Assistants (PCAs) can provide under Minnesota’s care programs by adding certain medication injections and broader health-related procedures, while strengthening requirements for training, delegation, supervision, and documentation.

Main provisions

• Expanded scope of services
  • Personal Care Assistance services may cover four main areas: activities of daily living (ADLs), health-related procedures and tasks, observation and redirection of behaviors, and instrumental activities of daily living (IADLs).
• Activities of daily living (ADLs)
  • Covered ADLs include dressing, grooming, bathing, eating, transfers, mobility, positioning, and toileting-related care (including hygiene and skin care). Nail care remains included with a note: nail care is not provided for recipients who are diabetic or have poor circulation.
• Health-related procedures and tasks
  • Includes procedures such as range of motion and passive exercise, assistance with self-administered medications (reminders, bringing medications, and helping with opening meds, including nebulized meds), and interventions for seizure disorders.
  • Allows other health-related tasks within the defined scope.
• Complex health needs and delegation
  • PCAs may perform health-related procedures and tasks for recipients with complex health needs if the tasks meet the defined criteria, and the PCA is trained by a qualified professional and demonstrates competency.
  • Delegation and training must be documented in the recipient’s personal care plan and both the recipient’s and the PCA’s files.
  • PCAs may not determine medication doses or timing unless specific requirements are met.
• Medication injections
  • Medication injections may be performed by a PCA only after: (a) the task is delegated by a registered nurse (RN) or advanced practice registered nurse (APRN) who provides training, (b) the PCA receives individualized training about the recipient’s needs, and (c) the PCA is supervised by a qualified professional who is an RN, APRN, physician assistant, physician, or other licensed professional.
• Tracheostomy suctioning and ventilator-related care
  • For tracheostomy suctioning and ventilator support, requirements include delegation and training by an RN/APRN/qualified professional, use of clean (not sterile) technique, specialized training about procedures and equipment (including ventilator operation/maintenance), individualized training, and supervision by an RN or other qualified professional.
• Observation and redirection of behaviors
  • PCAs may observe and redirect recipients during behavioral episodes, with training tailored to the recipient’s needs and documented in the care plan.
• Documentation and care planning
  • All training, delegation, and health-related procedures must be documented in the recipient’s personal care plan and in the PCA’s and recipient’s files.

Significant changes to existing law

• Broadens the scope of what PCAs can provide by formally including health-related procedures and tasks and, specifically, medication injections, under strict delegation, training, and supervision requirements.
• Establishes explicit requirements for delegation by RN/APRN and ongoing supervision for high-risk tasks (e.g., injections, tracheostomy suctioning, ventilator-related care).
• Recognizes observation and redirection of behaviors as a billable PCA service with defined training parameters.
• Adds detailed criteria for competency, individualized training, and documentation to ensure safety and accountability.
• Maintains a carve-out that PCAs cannot set medication doses or times without meeting the specified delegations and training.

Relevant Terms - Personal Care Assistant (PCA) - Medication injection - Self-administered medication - Health-related procedures and tasks - Range of motion - Nebulizer - Seizure interventions - Tracheostomy suctioning - Ventilator support - Delegation - Training - Supervision - Registered Nurse (RN) - Advanced Practice Registered Nurse (APRN) - Care plan - Documentation - Activities of Daily Living (ADL) - Instrumental Activities of Daily Living (IADL) - Observation and redirection of behaviors - Nail care exception (diabetes or poor circulation)