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Training, competency, and RN oversight rules for aides
The rules governing hospice aide training, competency evaluation, and supervisory visits — including an RN on-site evaluation at least every 14 days — under 42 CFR 418.76.
Hospice aide supervision requirements are the rules governing the training, competency, and registered-nurse oversight of hospice aides under 42 CFR 418.76. A registered nurse must make an onsite supervisory visit to each patient no less frequently than every 14 days [1].
A hospice aide must complete a training program and competency evaluation; classroom and supervised practical training must total at least 75 hours, with a minimum of 16 hours of classroom training preceding a minimum of 16 hours of supervised practical training (42 CFR 418.76(a)–(c), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76). Each aide must receive at least 12 hours of in-service training during every 12-month period. A registered nurse who is a member of the IDG assigns the aide to the patient and prepares written patient care instructions, and the aide provides only the services in those instructions. A registered nurse must make an onsite visit to the patient's home no less frequently than every 14 days to assess the quality of aide services; the aide need not be present for that visit. In addition, the supervising RN must make at least one annual onsite visit to observe each aide while the aide is providing care, so that every aide is directly observed delivering care at least once a year (42 CFR 418.76(h), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76).
The 14-day RN supervisory visit is a high-frequency, bright-line requirement, and at scale it is easy to let a visit slip past the interval when caseloads spike or an RN is out — each lapse is a citable deficiency and can call the associated aide services into question. The annual direct-observation of every aide is the requirement most often overlooked, because it is easy to conflate the every-14-day patient visit (where the aide need not be present) with the once-a-year visit that specifically requires watching the aide work. The two supervision types — the every-14-day patient visit and the annual direct-observation visit — carry separate scheduling obligations. Because aide services are among the most-used hospice touchpoints, supervision gaps are both a survey risk and a quality signal that surfaces in family experience scores.
An RN must make an onsite visit no less frequently than every 14 days to assess the quality of the aide's services, and the aide does not need to be present (42 CFR 418.76(h), https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-C/subject-group-ECFR74797288a614803/section-418.76).
At least 75 hours total, with a minimum of 16 classroom hours preceding at least 16 hours of supervised practical training, plus 12 hours of in-service training every 12 months.
Yes; separate from the 14-day visit, the supervising RN must observe each aide delivering care during at least one onsite visit per year.
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