Module 07

Scope of
Practice

What You Can Do, What You Cannot, and Why It Matters

NobleCare Home Health — Caregiver Orientation 01

What You'll Learn

Learning Objectives

  1. Define scope of practice for NobleCare non-skilled caregivers
  2. List five specific tasks that are outside your scope and explain why
  3. Describe the correct response when a patient or family requests a task outside your scope
  4. Explain the supervisory visit process and what to expect during one
  5. Identify the elements of your assignment sheet and how to use it
Module 7 — Scope of Practice 02

The Core Rule

"When in doubt,
don't do it. Ask first."

Your authorized tasks are documented on your Patient Assignment Sheet. You may only perform tasks that are explicitly listed.

Module 7 — Scope of Practice 03

Authorized Tasks

What You Can Do

These are the categories of non-skilled tasks you may be assigned. Specifics vary by patient.

  • Personal care — bathing, grooming, oral hygiene, dressing, toileting, incontinence care
  • Transfers & ambulation — per care plan (note weight-bearing status)
  • Meal preparation — per patient preferences and dietary restrictions
  • Light housekeeping — areas used by the patient, laundry
  • Companion activities — conversation, reading, games, appointments
  • Vital signs observation — if authorized (noting, NOT interpreting)
  • Medication reminders — verbal reminder only, patient self-administers
If a task is not on your assignment sheet, do not perform it without supervisor approval.
Module 7 — Scope of Practice 04

Critical Distinction

Medication Reminders vs. Administration

This is the single most common scope violation in home care. Know the line.

You MAY Do This
  • Say: "Mrs. Jones, it's time for your medication"
  • Bring the patient their medication container
  • Remind them of the time their medication is due
  • Observe that the patient takes their medication
You May NEVER Do This
  • Open the medication bottle and hand them a pill
  • Crush, split, or prepare medications
  • Draw up insulin or any injectable
  • Decide which medication the patient should take

The patient must self-administer. You remind. They take. That is the line.

Module 7 — Scope of Practice 05

Absolute Prohibitions

What You Are NEVER Authorized to Do

Regardless of who asks — patient, family, even another caregiver.

Administering medications
Requires nursing license
IV access or infusion equipment
Requires nursing license
Wound care beyond observation
Requires nursing license
Catheter insertion or adjustment
Requires nursing license
Any injections
Requires nursing license
Interpreting vitals or lab results
Requires clinical training
Diagnosing or medical advice
Requires licensure
Handling finances or gifts >$25
Abuse risk and policy violation
Module 7 — Scope of Practice 06

The Stakes

Why Scope Violations Are Dangerous

Scope violations are not about paperwork. They are about real harm.

Patient Harm
A wrong medication dose can hospitalize or kill a patient. Improper wound care causes infection. This is life and death.
Legal Consequences
You can face personal criminal charges for performing medical acts without a license under Ohio law.
No Insurance Coverage
You are not covered by malpractice insurance for tasks outside your authorized scope. You are personally liable.
Agency Consequences
NobleCare can lose its ODH license, face lawsuits, and be shut down. One violation can end everything.
Module 7 — Scope of Practice 07

Communication

When They Ask You to Go Outside Scope

It will happen. A patient or family member will ask you to do something you're not authorized to do. Here's the protocol:

  1. Do not do it. No matter how simple it seems. No exceptions.
  2. Do not apologize excessively or make the patient feel bad for asking.
  3. Say calmly: "That's not something I'm authorized to do, but I want to make sure you get the support you need. Let me call the office and we can get the right person to help."
  4. Call your supervisor and document the request in your visit note.
Professional. Calm. Redirect. Document. That is the formula.
Module 7 — Scope of Practice 08

What to Say

The Words That Protect Everyone

When Asked to Give Medication

"I can remind you that it's time for your medication, but you'll need to take it yourself. If you need help with medication, I'll call the office to discuss options."

When Asked to Do Wound Care

"I'm not trained or authorized to do wound care — I could accidentally make it worse. Let me call the office right now to get a nurse out to help you."

When Asked for Medical Advice

"I'm not qualified to answer that, but it sounds important. I'd recommend calling your doctor, and I'll let my supervisor know about your concern."

Module 7 — Scope of Practice 09

Your Guide

Your Assignment Sheet

Every shift, you should have a current assignment sheet. This is your authorized task list.

If your assignment sheet is outdated, unclear, or doesn't match what the family is requesting — call the office BEFORE starting care.
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Common Situation

When Reality Doesn't Match the Sheet

Patient needs change. Family expectations shift. What do you do when the assignment sheet doesn't match what's happening?

Correct Response
  • Call the office before doing unassigned tasks
  • Respect the patient's same-day preferences (e.g., sponge bath vs. full bath)
  • Document what was requested vs. what was done
  • Notify supervisor so the care plan can be updated
Wrong Response
  • Just do whatever the family asks
  • Ignore the assignment sheet entirely
  • Insist on your assigned tasks despite patient refusal
  • Add tasks without authorization and not tell anyone
Module 7 — Scope of Practice 11

Support Mechanism

Supervisory Visits

Your supervisor will conduct periodic in-home visits. These are not evaluations to fear — they are a required support mechanism.

What Happens During a Visit

  • Supervisor observes your care delivery
  • Reviews your documentation
  • Provides feedback and guidance
  • Checks that care plan matches reality
  • Addresses any concerns you have

Frequency

  • Minimum: one visit every 60 days
  • New employees: more frequent visits
  • Performance concerns: additional visits as needed
  • Visits may be announced or unannounced
Module 7 — Scope of Practice 12

Financial Boundaries

Gifts, Money & Boundaries

This is a scope issue that comes from a place of kindness — but the rules are absolute.

Regardless of the amount, the patient's intent, or your length of service.

Module 7 — Scope of Practice 13

Balancing Act

Patient Rights vs. Care Plan

Patients have the right to refuse care. But you still need to follow protocol when they do.

  1. Respect the patient's decision — they have the right to refuse any task
  2. Offer alternatives when appropriate (sponge bath instead of full bath)
  3. Document what was refused and what was provided instead
  4. Notify your supervisor so the care plan can be updated
  5. Never force care on a patient — this is abuse, regardless of intent
Patient preferences supersede the assignment sheet for same-day care decisions. Document and notify.
Module 7 — Scope of Practice 14

Industry Fact

Scope violations are the
#1 cause of caregiver discipline

Most scope violations happen because someone was trying to help. Good intentions do not prevent bad outcomes.

Knowing your limits is professional.
Saying "I can't do that" is protecting the patient.
Calling the office is the right answer.

Module 7 — Scope of Practice 15

Always Available

When in Doubt — Call

You will never be disciplined for calling the office to ask a question. You may be disciplined for not calling.

NobleCare Office

(740) 262-9845

hello@noblecareohio.com
Ask before you act

After Hours / On-Call

(740) 262-9845

Urgent callback within 30 min
Scope questions are always urgent

Module 7 — Scope of Practice 16

What Would You Do?

Scenario

Situation

Priya has worked with the Wilson family for 6 months. Mrs. Wilson's daughter calls: "Mom's regular nurse is out sick. Can you just draw up her insulin? You've seen it done a thousand times."

Module 7 — Scope of Practice 17
Correct Answer: C

Decline Professionally, Then Get Help

What Priya Should Say

"I understand how stressful this is, and I really want to help. But giving insulin is something I'm not trained or licensed to do — if something went wrong, it could seriously hurt your mom. Let me call the office right now. We can try to arrange skilled nursing coverage."

Why Priya Must Refuse

Module 7 — Scope of Practice 18

What Would You Do?

Scenario

Situation

A patient's grandson asks you to help administer his grandmother's blood pressure medication because he forgot to give it to her before leaving. "It's just one pill."

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Correct Answer: B

Verbal Reminder — Patient Self-Administers

Why the Others Are Wrong

  • A — Administering medication (even "just one pill") is outside your scope. Period.
  • C — Waiting is not the best option when you can provide a verbal reminder
  • D — Skipping a dose without exploring the reminder option is not in the patient's best interest

The Right Approach

  1. Provide a verbal medication reminder
  2. The patient takes the medication herself
  3. Document the reminder in your visit note
  4. If the patient cannot self-administer, call the office
Module 7 — Scope of Practice 20

Review

Knowledge Check

1. A family member asks you to give a medication. What do you do?

Provide a verbal reminder only. The patient must self-administer. You may never handle, prepare, or give medications.

2. A patient asks you to check their wound by removing the dressing. What do you do?

Observe visible changes around the dressing, document, and notify your supervisor. Never remove dressings.

3. A long-term patient wants to include you in her will. What do you do?

Politely decline and report the conversation to your supervisor. No exceptions.

4. Your assignment sheet says "full bath" but the patient wants a sponge bath today. What do you do?

Respect the patient's preference, provide the sponge bath, document it, and notify your supervisor.

5. How often do non-skilled caregivers receive supervisory visits?

At minimum every 60 days. More frequently for new employees.

Module 7 — Scope of Practice 21
Module 07 Complete

Scope of Practice

Key Takeaways

Next → Module 8: Infection Control

NobleCare Home Health — Sahur Aser, RN BSN 22