New93 role standards, now public
MedTality
Role standards

Nursing

Home health nurse

What a registered nurse must be able to do alone in a patient's home: assess and find the danger, reconcile what is actually in the cupboard, teach so it holds after they leave, and direct the aides and the plan of care they are accountable for. Drawn from the 2025 updated Home Health Nursing Competencies and the Medicare Home Health Conditions of Participation.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
2
Version
1

Built from BMC Nursing, Centers for Medicare and Medicaid Services, Electronic Code of Federal Regulations. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent home health nurse does on day one, dimension by dimension.

Clinical skills

  • Performs a focused, systems-based assessment in the home that is prioritised to the patient's condition and environment, compares it against the patient's own baseline, and acts on what it finds before leaving.
  • Assesses, measures and treats a wound according to its cause and the order, recognises infection and deterioration, and addresses what is preventing healing in the home.

Workflow and tools

  • Documents each visit accurately and promptly so the record shows what was found, what was done, why skilled care was needed and what was communicated, and never records anything that did not happen.
  • Builds and revises an individualised plan of care with the patient and the ordering practitioner, with measurable goals, and changes it when the patient's condition or goals change.

Patient communication

  • Confirms that the patient or carer can explain and show the key parts of self-management in their own home, and teaches differently when something comes back wrong.
  • Explains the condition and the plan in plain language matched to the patient's literacy, language and sensory needs, without assuming understanding.

Compliance and safety

  • Reconciles what the patient actually takes at home against every current order and prescriber, identifies discrepancies and drug problems, and resolves the significant ones with the prescriber rather than by assumption.
  • Recognises acute deterioration in the home, where nobody else will see the patient until the next visit, and escalates to emergency services or the practitioner at once.

Role knowledge

  • Assigns to home health aides and licensed practical nurses only what their training and regulations allow, gives clear written instructions, supervises on schedule, and keeps the judgement and the accountability.
  • Coordinates the patient's care across the practitioner, therapies, aides, pharmacy and community services so that nothing is missed and the patient knows who to call.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Finds signs of acute danger on a home visit - chest pain, stroke signs, severe breathlessness or low oxygen saturation, signs of sepsis, a systolic pressure under ninety with symptoms - and leaves the home, or plans to recheck at the next visit, without calling emergency services or the practitioner first.

    In the home there is nobody down the corridor. Once the nurse leaves, nobody may see the patient until they collapse, and the delay is the harm.

  • Leaves a discrepancy in a high-risk medication - an anticoagulant, insulin, opioid, antiepileptic or a doubled diuretic - unresolved without contacting the prescriber, or tells the patient to start, stop or change a dose on the nurse's own authority.

    A patient taking two anticoagulants, or an old and a new insulin dose, will bleed, fall or become hypoglycaemic at home before anyone else looks, and changing a dose without an order is outside the nurse's scope.

  • Documents a visit, visit time, assessment finding or care that did not happen, backdates an entry, or scores assessment items to reach a payment or eligibility result rather than what was observed.

    Every clinician after them acts on a false record, and a false home health claim to Medicare is fraud under federal law.

  • Directs a home health aide to assess a patient, administer or adjust medication beyond assisting with ordinarily self-administered medicines, or perform a skilled nursing task such as a sterile dressing or injection.

    The aide is not trained or permitted to do it, so the patient receives care nobody competent is performing, and the finding the nurse needed never reaches them.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not start, stop or change a medication or treatment, or provide care beyond the plan of care, on their own authority.Contacts the physician or allowed practitioner, takes and reads back a verbal order where permitted, documents it and sends it for signature, and updates the plan of care.
  • Does not hand the start-of-care, resumption or recertification comprehensive assessment to a licensed practical nurse or aide.Performs it as the registered nurse, as Medicare requires for skilled nursing patients, and delegates only the visits and tasks within the other person's scope.
  • Does not remain in a home where their own safety is threatened, or enter one that is unsafe, to finish a visit.Leaves, calls emergency services if anyone is in danger, reports to the agency and arranges for the patient's care to continue safely.
  • Does not tell a patient they are or are not homebound, or change the frequency of visits, to fit what the payer will cover.Documents what they observe accurately and raises any mismatch between the patient's needs and the plan with the practitioner and the agency.
  • Outside the United States, aide supervision intervals, verbal order rules and payer requirements differ; this standard's regulatory detail is US Medicare.Applies the same principles - practitioner orders, supervision, honest records - under the local regulator's rules.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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