Chapter 19: HHA Care Plans
Chapter Overview
What You'll Learn:
- What an HHA Care Plan is (a document — not a visit)
- How the plan is created when HHA is ordered
- How the plan is updated later
- What happens on Recertification
- Why Complete Visit can be blocked without an active plan
- Where to find the plan under Documents
Text-only.
19.1 What It Is
An HHA Care Plan is a document for this Care Order episode. It lists the aide tasks (and optional vital-sign parameters) the Home Health Aide should follow on HHA visits.
| It is | It is not |
|---|---|
| An episode document under Documents | A visit you schedule in Schedule Center or My Schedules |
| Created/updated when HHA is ordered on assessments | An OASIS / CMS form by itself |
| The checklist HHA visits use | Something you “start” like Start Visit |
You create and change it from assessment screens (and related edit/approve flows below) — not by creating a visit type called HHA Care Plan.
19.2 When Do You Need One?
Whenever HHA services are ordered on the episode (HHA frequency / aide services on the care plan / summary of care).
Until the plan is active for this Care Order:
- Check for Errors / completing the assessment can be blocked
- Starting or completing an HHA Visit can be blocked
This applies on SOC, ROC, Recertification, Discharge, and Non-OASIS SOC when HHA is ordered.
19.3 How the Plan Is Created (first time on an episode)
Typical path on SOC (and other assessments when HHA is ordered):
- Open the assessment (for example OASIS SOC).
- In the toolbar, click Create HHA Care Plan.
- You may also see an Aide Care Plan section on SOC / Non-OASIS SOC. On ROC, that nav item may be hidden — use the toolbar button.
- In the modal, add aide tasks (the UI requires at least 5 tasks). Vital-sign parameters can be optional.
- Click Save & Activate Care Plan.
- The button changes to ✓ HHA Care Plan Created.
That creates the document as active for this Care Order. You can then open it anytime from:
- Patient → Documents → View HHA Care Plan
- Care Order → Documents → View HHA Care Plan
- PDF title: HHA Care Plan
19.4 How the Plan Is Updated
After an active plan exists, staff can change tasks and settings. Saving creates a new active version of the document for the same Care Order (the previous version is kept as history / archived).
Common places to update:
| Where | What you click |
|---|---|
| Assessment / care plan editor in edit mode | Save Care Plan |
| HHA Supervisory Visit | Edit HHA Care Plan → save |
| Care Order flow when a plan is waiting for RN / Clinical Manager approval | Approve HHA Care Plan → Approve & Activate |
You do not schedule a new visit just to “make a new HHA Care Plan.” You edit the existing document (or activate it on a new episode — see Recert below).
19.5 Recertification — new episode needs its own active plan
Each Care Order episode has its own HHA Care Plan document. When care continues into a new recert episode, do not assume the old episode’s plan is enough.
Common path: Review & Activate on the new episode
- Open the Recertification assessment.
- If HHA is ordered and this episode does not yet have an active plan, the button may say Review & Activate HHA Care Plan.
- Review the content brought forward from the prior episode.
- Click Save & Activate Care Plan on this episode.
Until you do that, finalize can stay blocked with a message like: review the prior plan and Save & Activate on this episode.
If the plan shows as Draft (pending approval)
Sometimes a plan appears on the new episode as Draft after QA (waiting for Clinical Manager / RN). Then use Approve HHA Care Plan → Approve & Activate so it becomes active.
19.6 Buttons You May See (quick legend)
| Button / title | Meaning |
|---|---|
| Create HHA Care Plan | No active plan yet — build and activate one |
| ✓ HHA Care Plan Created | Active plan exists for this episode |
| Review & Activate HHA Care Plan | Prior content available; activate on this episode |
| Edit HHA Care Plan | Change an existing active plan |
| Approve HHA Care Plan / Approve & Activate | Activate a draft waiting for approval |
| Save & Activate Care Plan | Save and make the plan active |
| Save Care Plan | Save edits to an existing plan |
19.7 Common Mistakes
- Looking for an “HHA Care Plan visit” in Schedule Center — it does not exist; create the document from the assessment.
- Finishing SOC/ROC/Recert with HHA ordered but never clicking Save & Activate.
- On Recert, assuming the old episode’s plan still covers the new Care Order — activate (or approve) on the new episode.
- Trying to complete an HHA Visit before an active plan exists.
19.8 Quick Checklist
- HHA ordered → Create HHA Care Plan → Save & Activate
- Recert: Review & Activate (or Approve draft) on the new episode
- Updates done via Edit / Supervisory — not by scheduling a “care plan visit”
- Plan visible under Documents
- HHA Visit can use the checklist
Next: Chapter 20: Visit Forms