2023 California Code › Welfare and Institutions Code - WIC › DIVISION 4.5 - SERVICES FOR THE DEVELOPMENTALLY DISABLED › CHAPTER 6 - Development and Support of Community Facilities and Programs › ARTICLE 4 - Services and Supports for Persons Living in the Community › Section 4686.

4686. (a) Notwithstanding any other provision of law or regulation to the contrary, an in-home respite worker who is not a licensed health care professional but who is trained by a licensed health care professional may perform incidental medical services for consumers of regional centers with stable conditions, after successful completion of training as provided in this section. Incidental medical services provided by trained in-home respite workers shall be limited to the following:
(1) Colostomy and ileostomy: changing bags and cleaning stoma.
(2) Urinary catheter: emptying and changing bags and care of catheter site.
(3) Gastrostomy: feeding, hydration, cleaning stoma, and adding medication per physician’s or nurse practitioner’s orders for the routine medication of patients with stable conditions.
(b) In order to be eligible to receive training for purposes of this section, an in-home respite worker shall submit to the trainer proof of successful completion of a first aid course and successful completion of a cardiopulmonary resuscitation course within the preceding year.
(c) The training in incidental medical services required under this section shall be provided by physicians or registered nurses. Training in gastrostomy services shall be provided by a physician or registered nurse, or through a gastroenterology or surgical center in an acute care hospital, as defined in subdivision (a) of Section 1250 of the Health and Safety Code, which meets California Children Services’ Program standards for centers for children with congenital gastrointestinal disorders, or comparable standards for adults, or by a physician or registered nurse who has been certified to provide training by the center.
(d) The in-home respite agency providing the training shall develop a training protocol which shall be submitted for approval to the State Department of Developmental Services. The department shall approve those protocols that specifically address both of the following:
(1) A description of the incidental medical services to be provided by trained in-home respite workers.
(2) A description of the protocols by which the training will be provided. Protocols shall include a demonstration of the following skills by the trainee:
(A) Care of the gastrostomy, colostomy, ileostomy, or urinary catheter site.
(B) Performance of gastrostomy tube feeding, changing bags and cleaning stoma of colostomy or ileostomy sites, and emptying and changing urinary catheter bags.
(C) Identification of, and appropriate response to, problems and complications associated with gastrostomy care and feeding, colostomy and ileostomy care, and care of urinary catheter sites.
(D) Continuing education requirements.
(e) Training by the gastroenterology or surgical center, or the certified physician or registered nurse, shall be done in accordance with the approved training protocol. Training of in-home respite workers shall be specific to the individual needs of the regional center consumer receiving the incidental medical service and shall be in accordance with orders from the consumer’s treating physician or surgeon.
(f) The treating physician or surgeon shall give assurances to the regional center that the patient’s condition is stable prior to the regional center’s purchasing incidental medical services for the consumer through an appropriately trained respite worker.
(g) Prior to the purchase of incidental medical services through a trained respite worker, the regional center shall do all of the following:
(1) Ensure that a nursing assessment of the consumer, performed by a registered nurse, is conducted to determine whether an in-home respite worker, licensed vocational nurse, or registered nurse may perform the services.
(2) Ensure that a nursing assessment of the home has been conducted to determine whether incidental medical services can appropriately be provided in that setting.
(h) The agency providing in-home respite services shall do all of the following:
(1) Ensure adequate training of the in-home respite worker.
(2) Ensure that telephone backup and emergency consultation by a registered nurse or physician is available.
(3) Develop a plan for care specific to the incidental medical services provided to be carried out by the respite worker.
(4) Ensure that the in-home respite worker and the incidental medical services provided by the respite worker are adequately supervised by a registered nurse.
(i) Notwithstanding any other provision of law or regulation to the contrary, the hourly rate for an in-home respite agency shall be increased to provide a fifty cent ($.50) per hour wage increase and an eight-cent ($.08) per hour benefit increase for the hours the in-home respite agency is providing incidental medical services.
(j) To expand the availability of trained in-home respite agency staff, a regional center may reimburse the in-home respite agency up to two hundred dollars ($200) semiannually, for the provision of training pursuant to subdivision (c).
(k) For purposes of this section, “in-home respite worker” means an individual employed by an agency which is vendored by a regional center to provide in-home respite services. These agencies include, but are not limited to, in-home respite services agencies, home health agencies, or other agencies providing these services.
(Amended by Stats. 2009, 4th Ex. Sess., Ch. 9, Sec. 18. Effective July 28, 2009.)