Scope Audit — Own Your Care

How to use this tool

1Run this for each active client every 30 days. Things drift. Catching it early is easier than having a hard conversation after six months.

2Check anything that is currently happening — not hypothetically. What are you actually being asked to do?

3If you flag items in Section 1 (medical tasks) or multiple items in Section 2–4, address them directly or in writing before the next shift.

flags checked

Check the items that are currently happening with this client. The score updates as you go.

Client

Section 1 — Medical Tasks Outside Your Scope

Any yes here requires immediate action — these are not gray areas.

Being asked to administer or measure medications (not just remind)

Passing, crushing, drawing up, or measuring a dose = medication administration. Not within CNA/HHA scope.

Performing wound care, dressing changes, or packing

Applying a bandage to a fresh scratch is different from changing a wound dressing. If in doubt, it's nursing.

Catheter care (insertion, irrigation, emptying a suprapubic or Foley)

Emptying a urostomy bag may be within scope in some states — catheter care generally is not. Know your state rules.

G-tube or NG-tube feeding, flushing, or management

Skilled nursing task in every state. If this is expected of you, it is out of scope.

Injections of any kind (insulin, blood thinners, etc.)

No exceptions. This is a nursing or physician task regardless of whether the family says "it's easy."

Interpreting vitals and making care decisions based on readings

Taking vitals may be within scope. Being expected to interpret and respond to abnormal readings is not.

Section 2 — Agreement Drift

Being asked to do tasks not listed in the service agreement

If it's not in Section 2 of your agreement, it wasn't agreed to. It needs to be added — or it stops.

Schedule has changed but no amendment has been signed

Verbal schedule changes happen. They still need to be documented.

Regularly working more hours than the agreement specifies

If you're always staying longer, that's a scope and billing issue — not just a scheduling one.

Being asked to care for someone other than the named client

The agreement names one client. Assisting a second household member — even briefly — is outside the agreement.

Payment is consistently late or payment method has changed informally

Payment terms are in the agreement. Consistent lateness without a conversation is a contract issue.

Section 3 — Home Safety

The home environment has become physically unsafe (clutter, hazards, unsanitary conditions)

You have the right to work in a safe environment. Document it and raise it.

Client's behavior has become physically threatening or dangerous

Escalating aggression is a safety issue. Document each incident and bring it to the family in writing.

Client's care needs have increased beyond what you are trained for

Providing care you're not trained for puts you and the client at risk. Raise it before it becomes a crisis.

You have witnessed or suspect neglect or abuse from another household member

You may be a mandated reporter depending on your state. Know your obligation and document what you observed.

Section 4 — Client Relationship Health

Multiple people in the family are giving conflicting directions and it hasn't been resolved

You can only take direction from one person. If this isn't resolved, you're working in an impossible position.

The family's expectations have shifted significantly since you started

What was agreed to at the meet-and-greet vs. what's expected now are different things. That gap needs a conversation.

You're dreading this shift in a way that's affecting your other clients

That's information. Not every client relationship has to continue. You get to make that call.

You have not had a family check-in call in more than 30 days

Silence is not stability. Regular check-ins catch problems before they escalate.