The importance of a particular service to an individual patient does not necessarily make it a skilled service. For example, a primary need of a nonambulatory patient may be frequent changes of position in order to avoid development of decubitus ulcers. Since changing of position can ordinarily be accomplished by unlicensed personnel, it would not be a skilled service.

Supportive services which can be learned and performed by the average nonmedical person (and which cannot be considered skilled services under the principles outlined in HI 00601.140) include but are not limited to the following:

1. 1. 

   Administration of routine oral medications, eye drops, and ointments.

2. 2. 

   General maintenance care of colostomy or ileostomy.

3. 3. 

   Routine services in connection with indwelling bladder catheters. (This includes emptying and cleaning containers, clamping tubing, and refilling irrigation containers with solution.)

4. 4. 

   Changes of dressings in noninfected postoperative or chronic conditions.

5. 5. 

   Prophylactic and palliative skin care, including bathing and application of creams, or treatment of minor skin problems.

6. 6. 

   General methods of treating incontinence, including use of diapers and rubber sheets.

7. 7. 

   General maintenance care in connection with a plaster cast.

8. 8. 

   Routine care in connection with braces and similar devices.

9. 9. 

   Use of heat for palliative and comfort purposes.

10. 10. 

    Administration of medical gases after initial phases of teaching the patient to institute therapy.

11. 11. 

    General supervision of exercises which have been taught to the patient.

12. 12. 

    Assistance in dressing, eating, and going to the toilet. (See HI 00620.130 for further discussion of custodial care.)