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Nursing Support Services

2 Nursing Support Services available to people who self direct:

Nursing Consultation

  • Health Risk Screening Tool (HRST) rating or reviewing.
  • Develop health care protocols or routines.
  • Develop means to communicate with the healthcare providers.
  • Identify community health related resources.
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Nursing Case Management and Delegation

  • Comprehensive nursing assessment.
  • Self-administration assessment.
  • Other assessment (as needed).
  • HRST rating or reviewing.
  • Develops care plan.
  • Train, delegate and supervise staff to do the task as listed on the care plan.
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How do you know which service you need?

What is your HRST Level? If it is Level 3 or higher you will need to recruit, interview, and hire a nurse to provide one of the Nursing Support Services.

Do you take responsibility for managing your meds yourself?

Can you direct your staff to assist you in managing your healthcare, administering your meds or doing any of your treatments?

Do you rely on your family or unpaid caregivers to administer your meds and do any treatments?

Will you need help from your paid staff to manage your healthcare, administer your meds, and complete any treatments?

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Nursing Consultation

Doctor smiling
  • You have an HRST Level of 3 or higher.
  • You manage your own healthcare and administer your own meds/treatments…
  • OR
  • You can direct your paid staff to assist you, but you take the responsibility…
  • OR
  • You rely on unpaid caregivers to manage your healthcare, administer meds, complete treatments.


  • Registered Nurse who has completed the DDA approved RN training
  • A comprehensive nursing assessment
  • A self administration assessment
  • HRST rating or reviewing (together with you, your family, and your CCS)
  • Help to develop heath care protocols or routines
  • Help you develop a way to communicate with your doctors
  • Help to identify community healthcare resources
  • Up to four visits per year, no more often than quarterly
  • Maximum of 16 hours per year but can be less


  • Delegation to staff (no med tech training required)
  • Direct staff training
  • Direct nursing care
  • On call nurse availability
  • Care plan development
  • Health care case management
  • Visits more often than quarterly

Nursing Case Management and Delegation

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Required if your paid staff is going to administer meds or complete healthcare treatments. Includes over the counter meds and those given as needed.

Emergency medications can be given by anyone with training, not necessarily CMT.

Required if your family is paid staff and they are going to administer meds or complete treatments during their work hours.

HRST level – any, but more likely the higher HRST levels.

  • Registered nurse, currently licensed in the State of Maryland who has completed the DDA two-day RN Case Manager/Delegating Nurse training and is approved by the DDA.
  • A comprehensive nursing assessment.
  • A self administration assessment.
  • Other assessments if you need them, i.e., choking risk and fall risk.
  • HRST rating or reviewing (together with you, your family, and your CCS).
  • Develops your care plan (with you, your family, and staff).
  • Trains your staff to do the things listed in your care plan.
  • Delegates and supervises staff to do the things listed in your care plan.
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  • Visits from your nurse at least every 45 days. Maybe more often if you need it.
  • Your nurse is on call for you and your staff during all the hours the staff are working and to your team during business hours.
  • Help to identify community healthcare resources.
  • Help to develop a way to communicate to your doctors.
  • Help to understand your medications and your healthcare needs.
  • Help to manage your medications and healthcare to the degree you want the nurse to help.

Consultation vs. Delegation: What’s included?

Provided by Nurse Consultation Delegation
Comprehensive Nursing Assessment
Self Administration Assessment
Provide recommendations to access health services & supports
Clinical Review/Updated HRST
Development of Health Care Protocols RN Assistance
Development of Care plans
Nursing Visits quarterly max of 16 hrs/year
Nursing Visits minimally every 45 Days
Training to Direct Support Staff
Monitor DSP & Delegate Nursing Tasks
Oversight to CMT Trained staff to administer medications