The 444 38 33 hotline is now available for Home Healthcare Service applications.

As of August 16, 2017, patient applications received via the 4443833 Home Healthcare Services hotline are being handled by the National Home Healthcare Services Call Center, and assignments and service orders are being assigned through the ESYS system.

REGULATIONS ON THE PROVISION OF HOME CARE SERVICES

CHAPTER ONE

Purpose, Scope, Basis and Definitions

Purpose
Article 1 — The purpose of this Regulation is to regulate the procedures and principles to be followed by the establishment, operation, and supervision of healthcare facilities providing home care services, as well as by the institutions, organizations, private legal entities, and individuals operating these facilities, in order to protect the health of individuals and society.

Scope

Article 2 — This Regulation covers healthcare facilities established for the purpose of providing home care services, whether as independent workplaces or within medical centers, specialized centers, polyclinics, and private hospitals, as well as their owners and operators and home care service activities.

Basis

Article 3 — This Regulation has been prepared based on the Law No. 1219 dated 11/4/1928 concerning the Manner of Practice of Medicine and Related Professions, Article 9(c) of the Basic Law on Health Services No. 3359 dated 5/7/1987, and Article 43 of the Decree Law No. 181 dated 13/12/1983 concerning the Organization and Duties of the Ministry of Health.

Definitions

Article 4 — In this Regulation:

a) Ministry: The Ministry of Health,

b) (Amended: Official Gazette: 6/11/2007-26692) General Directorate: The General Directorate of Treatment Services,

c) Directorate: The Provincial Health Directorate,

d) Home Care Service: The provision of health, care, and follow-up services to patients in their own environment, in accordance with physicians' recommendations, by a healthcare team, including rehabilitation, physiotherapy, and psychological treatment, to meet their medical needs,

e) Healthcare Institution: A center or unit operating to provide home care services,

f) Center: An independent home care center owned by private legal entities or individuals, established and operating solely to provide home care services,

g) Unit: A home care unit within private healthcare institutions such as hospitals, medical centers, specialized clinics, and polyclinics, established to provide home care services,

h) Treatment Plan: The treatment plan prepared by the physician responsible for the patient's medical treatment,

Care Plan: A written plan prepared by non-physician healthcare personnel working in a home care center/unit and approved by the home care physician, detailing the content and frequency of care to be provided to the patient.

SECTION TWO

Types and Establishment of Healthcare Institutions

Types of Healthcare Institutions

Article 5 — Healthcare institutions may be established as centers or units, depending on their field of activity, the scope of services provided, infrastructure characteristics, and the qualifications of the personnel providing the services.

Centers

Article 6 — Centers are independent institutions established under the responsibility of a physician and with the necessary minimum standard equipment and personnel support, solely for the purpose of providing home care services.

Units

Article 7 — Units are organizations that provide home care services as a unit within private healthcare institutions licensed according to the relevant legislation, such as hospitals, medical centers, specialized clinics, or polyclinics, with the necessary minimum standard equipment and personnel support.

Establishment of Healthcare Institutions

Article 8 — Centers may be established and operated independently by private legal entities and individuals.

Units, however, may be established within centers, polyclinics, and private hospitals licensed in accordance with the Regulation on Private Healthcare Institutions Providing Outpatient Diagnosis and Treatment, published in the Official Gazette dated 9/3/2000 and numbered 23988.

Public institutions and organizations and public hospitals whose legislation includes provisions regarding the provision of healthcare services to the public may provide home care services within the scope of this Regulation.


Required Documents for Application

Article 9 — Those who will open a healthcare facility must apply to the Directorate, either in person or through their responsible manager, with a petition (a sample of which is included in Annex 1) stating the name of the healthcare facility, the owner(s), the address where it will operate, the name and title of the responsible manager (if it will be opened as a center), the name and title of the unit head (if it will be opened as a unit), the areas it will serve, and requesting the initiation of procedures related to the opening of the healthcare facility.

The following information and documents must be included in the application file along with the petition:

c) If operating as a unit, a copy of the certificate of conformity/license of the health institution it is affiliated with, approved by the Directorate;

d) A list of all personnel who will work in the health institution, along with copies of their diplomas approved by the Directorate, (Amended wording: RG-17/10/2008-27027) Turkish Republic Identity Number and two passport-sized photographs of each;

e) A petition from all health personnel who will work in the health institution stating whether or not they are employed in any public institution, and for those who declare that they are employed, a document stating that the compensation stipulated in Law No. 2368 on Compensation and Working Principles of Health Personnel will begin to be deducted from their salaries from the date of notification of the personnel work certificate to be issued for the said health personnel.

f) A detailed list showing the minimum equipment and devices to be kept by personnel providing care services in the healthcare facility and at home,

g) A commitment signed by the responsible manager and the owners of the healthcare facility stating that the necessary materials and medical devices for the care and treatment of the individuals receiving services will be provided by the healthcare facility (Annex-2),

h) A commitment signed by the responsible manager and the owners of the healthcare facility stating that the individual receiving home care services will be transferred to a secondary healthcare facility without giving any reason when necessary (Annex-3).


Opening Permit

Article 10 — Applications for opening a healthcare facility, made pursuant to Article 9, will be reviewed by the Directorate within fifteen working days of the application date. If there are any deficiencies in the application file, the applicants will be notified. If there are no deficiencies in the application file, the Directorate will form a team consisting of at least one physician and two healthcare personnel to examine and inspect whether the establishment and operations of the healthcare facility comply with this Regulation. This team will conduct an on-site inspection of the healthcare facility.

Following this inspection, those deemed suitable will be issued a "certificate of conformity" (Appendix 4) and a "certificate of responsible manager" (Appendix 5) by the Directorate. Additionally, two copies of the "personnel work certificate" (Appendix 6) will be issued to each employee. One copy of these documents and the application file will be kept at the Directorate, and the other copies will be given to the responsible manager of the healthcare facility against signature.

For healthcare institutions operating as units, a "unit manager" certificate is issued instead of a "responsible manager" certificate.

If those who open and operate an existing healthcare institution within the scope of this Regulation wish to open a second institution as a branch, a new application must be made as specified in Article 9.

If only the address of operation changes, provided that the other conditions of the healthcare institution are maintained, an application must be made with a petition stating the situation and the documents required in clauses (a) and (g) of Article 9 for centers, and clauses (a), (c), and (g) for units.

CHAPTER THREE

Personnel Standards

Responsible Manager

Article 11 — Each center shall have a physician as its responsible manager. In the absence of the responsible manager and during the center's operating hours, a physician to whom authority has been delegated shall be present. The responsible manager may only hold the position of responsible manager in one center. The responsible manager is personally responsible for administrative matters and jointly responsible with other physicians for medical procedures. The owners of the healthcare facility are also personally responsible for the administrative duties of the responsible manager, the operation of the center, and the provision of the necessary infrastructure for the healthcare services provided.

The duties of the responsible manager are as follows:

a) To carry out all permit procedures related to the opening and operation,

b) To ensure the maintenance and upholding of the defined infrastructure and service quality standards in the operation,

c) To return the work permit documents of healthcare personnel whose employment has been terminated or who have left the center to the Directorate within one week at the latest,

d) To approve the relevant documents on behalf of the center.

e) To conduct necessary operational audits to ensure that the defined regulations are implemented by the relevant parties,

f) To provide the necessary information and documents to the authorities during the audit and to assist in the audit,

g) To ensure that the personnel undergo necessary tests and examinations, primarily HIV and hepatitis markers, at least once a year periodically,

h) To perform other duties specified in health legislation and defined by the authorities.

The responsible manager is the primary point of contact for the Directorate and the Ministry in all matters related to the establishment, operation, and audit of the center.

Changes in the responsible manager must be reported to the Directorate no later than the day the new responsible manager takes office.

The unit manager is responsible to the responsible manager of the health institution in which the home care unit is located for the performance of the duties mentioned above.

The responsible manager of the health institution in which the home care unit is located may also perform the duties of the unit manager.

Physician

Article 12 — A healthcare facility must have at least two physicians in addition to the responsible manager or unit head. At least one of these physicians must work full-time.

The physician is responsible for:

a) Conducting a comprehensive medical evaluation of the patient,

b) Preparing a treatment plan in accordance with the necessary information and recommendations from the physician who diagnosed and planned the patient's treatment, by contacting the physician who diagnosed and planned the patient's treatment, by visiting patients at regular intervals, gathering information about the patients' condition and care, continuously evaluating their needs and care outcomes, and, when necessary, adapting the treatment plan by consulting with the physician who diagnosed and planned the patient's treatment regarding new needs and problems,

d) Preparing reports on changes in the care plan according to the patient's condition by contacting the healthcare personnel providing home care services to the patient, and informing the other physicians who diagnosed and planned the patient's treatment when necessary.

e) Ensuring that patient care plans, patient files, and other records are kept accurately, completely, and on time,

f) Providing information and training to caregiving personnel, offering consultancy, making decisions to improve services, and organizing meetings to discuss problems,

g) Ensuring that all practices and procedures are carried out in accordance with ethical rules and patient rights,

h) Informing home care team members, patients, and their relatives about the provision of medications, medical supplies, and devices to be used during treatment, their storage under appropriate conditions, prevention of misuse, collection and disposal of medical waste, protection against infectious diseases, reporting of mandatory notifiable diseases, and reporting of forensic cases.

i) They are responsible for the medical procedures they perform on individuals receiving home care services, for recording these procedures in patient files, and for reporting any irregularities they observe in the functioning of the healthcare facility, primarily those related to their own area of work, to the responsible manager/unit head.

Patients receiving continuous home care services, day or night, are visited by a physician at least once a week to monitor the quality of services provided, and this visit is recorded.

Nurse or Health Officer

Article 13 — At least four nurses or health officers shall be employed on a permanent basis at the healthcare facility. If required, one of these four personnel may be a midwife.

The responsibilities of nurses and health officers are as follows:

a) To obtain the physician's written and signed treatment order, record it on nursing forms, implement it, and record the results of the implementation;

b) To provide support to the physician and other team members in performing necessary special procedures for the patient;

c) To perform tasks in the patient care plan, assess and record vital signs, and report changes to the physician;

d) To administer and record oral, parenteral, and topical medications to the patient according to the treatment plan, and to monitor and record the effects and side effects of the administered medications.

e) To request the necessary tools, equipment, and materials for the services, and to provide opinions on their adequate and functional maintenance;

f) To clean and disinfect the tools and equipment after use and prepare them for sterilization when necessary;

g) To provide the patient and their family with information regarding the illness, treatment, and care, within limits determined in consultation with the physician;

h) To educate the patient and their family, according to their needs, on topics such as self-care or assisted care techniques specific to the illness, and on general health issues;

i) To carry out all procedures and practices in accordance with ethical rules and patient rights.
Other Personnel

Article 14 — Non-physician healthcare personnel such as psychologists, physiotherapists, dieticians, and social workers may be employed by the home care service center or unit in relation to the area of service to be provided. However, their duties and responsibilities are limited by their own professional regulations. In addition, care support personnel may be employed to assist them.

CHAPTER FOUR

Physical Infrastructure Standards and Equipment

Interior and Physical Infrastructure Condition of the Building

Article 15 — Centers shall be established in reinforced concrete buildings or, if wooden, in a separate building. All sections must be located within the same building and adjacent to each other. The building must have fire safety measures in accordance with the relevant legislation.

Sections

Article 16 — Healthcare facilities must have at least the following sections:

Article 16 — Healthcare facilities must have at least the following sections:

a) Application and customer service section: A space of at least 20 square meters, furnished appropriately for the service, containing: the original certificate of conformity of the healthcare facility, the original certificate of responsible manager, a sign indicating the names of the service areas, and a list of telephone numbers of the Directorate and professional chambers where complaints regarding the healthcare facility can be made.

b) Call center: A space where employees can comfortably provide service by accepting patient requests, equipped with a telephone, fax machine, printer, internet connection, and computer for communication.

c) Examination and emergency room: A separate room or partitioned space of at least 8 square meters containing minimum medical supplies and equipment.

d) Material room: A space where medical instruments, equipment, and materials can be stored properly and where the necessary equipment is located.

e) Changing room: A room reserved for staff, where they can easily change clothes and where they can store personal belongings in lockers.

f) Waste collection area: An area isolated from areas used by individuals and containing a closed container or bin for waste.

g) Archive area: A closed compartment or room isolated from areas used by individuals.

In institutions providing home care services as a unit, sections other than the call center may be used as common areas.

Medical Devices, Materials and Drugs

Article 17 — The minimum medical devices, equipment, and drugs required to be kept in healthcare facilities, as well as the materials and drugs that must be carried by personnel providing home care services, shall be regulated by a Circular to be issued by the Ministry.

Signage

Article 18 — All rooms and units of the healthcare facility shall have a sign measuring 5 cm x 20 cm on their doors indicating the purpose of the room or unit.

Only the name and title of the healthcare facility as stated in the certificate of conformity shall be written on the external signage of the healthcare facility. In the naming conventions on signs and printed materials, the word "Private" shall be followed by the name of the healthcare facility, and then the title "Home Care Center" given by the Directorate in accordance with the provisions of this Regulation.

Another sign may indicate the names and titles of the service areas and personnel working in the healthcare facility, as well as the facility's opening hours. Service areas may only be listed on the signage in the form specified in the certificate of conformity, provided that they are included in the certificate.

CHAPTER FIVE

Working Procedures and Principles

Service Delivery

Article 19 — Continuity is essential in home care services. This continuity should be such that, according to the patient's request and the needs of the service, uninterrupted service can be provided 24 hours a day, including night and day, weekends and holidays, when necessary. Home care services may be provided at specific times if needed.

Individuals wishing to receive home care services can apply to a healthcare facility in person or by telephone. A call center representative will interview the requesting individual and provide the necessary information. Following this initial interview, a consultation will be conducted by a physician or nurse. The individual's condition and the services to be provided will be determined. The physician and nurse will then visit the individual at home to assess their care needs and home conditions. The physician will contact other physicians who may have diagnosed and planned the individual's treatment, obtain a treatment plan, and finally, a home care plan and treatment plan will be created.If other physicians who can diagnose and plan the patient's treatment are not available or cannot be contacted, the patient is examined by a physician at the healthcare facility according to their health condition, and a diagnosis and treatment plan is prepared. A care plan is also prepared by the nurse and submitted to the physician for approval. Necessary changes are made, and the care plan is finalized. If necessary, consultations are arranged with specialist physicians in relevant fields.

According to the home care plan, the working hours and procedures of non-physician healthcare personnel are determined and their duties are assigned.

The healthcare institution may enter into care contracts with an appropriate number of individuals, taking into account the number of people it can treat or care for at home and its current staffing situation.
Laboratory and Radiological Imaging Services

Article 20 — Healthcare institutions may, if they wish, provide medical analysis laboratory services by contracting with private medical analysis laboratories licensed by the Ministry in accordance with the provisions of the Law No. 992 of March 19, 1927, on Public Bacteriology and Chemistry Laboratories Where Clinical Investigations and Analyses are Performed and Standard Practices are Followed; and radiological imaging services by contracting with radiology laboratories licensed by the Ministry in accordance with the provisions of the Law No. 3153 of April 19, 1937, on Radiology, Radium and Electrical Treatment and Other Physiotherapy Institutions.
Units may obtain services from licensed medical testing and/or radiology laboratories operating within the healthcare facility they are affiliated with, if any.

Emergency Services

Article 21 — Healthcare facilities are obligated to transport individuals receiving home care services to the most suitable healthcare facility by ambulance in case of emergencies. Home care centers may have their own ambulance or contract with an ambulance company for use in all types of emergencies.

Medical Device Services

Article 22 — Centers or units providing home care services are responsible for the calibration, cleaning, and inspection of devices such as oxygen, oxygen concentrators, pulse oximeters, all types of respiratory equipment, orthopedic materials, air mattresses, hospital beds, and wheelchairs that may be needed during the provision of these services. If these services are obtained from registered distributors or manufacturers, they are obligated to document the contracts they have with these companies.

Clothing

Article 23 — Healthcare personnel providing home care services must wear a gown or uniform appropriate to their profession and services during home visits, and must wear a name tag with their name, surname, title or profession, a photograph, and the signature of the responsible manager.

CHAPTER SIX

Registration and Notification System

Records

Article 24 — Every person receiving services from a healthcare facility will have a file.

This file will contain the requests and diagnoses of the physician(s) who diagnosed and planned the patient's treatment, the follow-up notes and opinions of the healthcare team providing home care, laboratory and imaging test results, and other medical information. This file will be used to continuously record the patient's treatment, medical status, and progress.

The patient may request to view the information in their file at any time. Information regarding the patient's rights and responsibilities will be provided to the patient in a separate file.

Patient files kept with the patient during home treatment and care will be transferred to the healthcare facility's archives upon completion of the service.

Documents to be Provided to Patients

Article 25 — Healthcare institutions are obliged to provide the following documents free of charge upon request by patients:

a) A list showing the type and quantity of dressing materials used for the patient, the cost of which is borne by the patient,

b) X-ray films and their accompanying reports (originals of those related to forensic cases will not be provided),

c) A summary of the patient's clinical and laboratory findings, diagnosis and course of the disease, examinations performed, treatment, and its outcome, signed by the physician.
CHAPTER SEVEN

Admission of Patients to Home Care and Discharge from Home Care

Admission of Patients to Home Care

Article 26 — Home care services may be provided to patients who meet the following conditions:

a) The procedure is performed after obtaining the informed consent of the patient or, if the patient's medical condition does not allow for such consent, their legal representatives, through an informed consent form at the healthcare facility.

b) Patients accepted for home care services are informed about their rights and obligations and the content of the service, ensuring that their rights as defined by legislation are protected. The patient, or their legal representative if they lack the capacity to make such a decision, has the right to receive all information regarding the risks of the service to be provided, if any, and to refuse the service after evaluation.

c) Patients wishing to receive home care services must be under the care of their own physician. Patients without a physician who is monitoring them will be evaluated by physicians providing home care services at the healthcare facility, and by consultant physicians if necessary, and a physician will be assigned.

d) Home care services can be requested by the patient and/or their family. In this case, the patient's condition will be evaluated by the physician who diagnosed and planned their treatment, or by the home care physician, in terms of suitability for home care and responsibility for treatment. Physician approval will be obtained for any changes to the plan or for new, advanced service options.

e) The physical environment and equipment in the patient's home must be suitable for providing safe and effective care.

f) The patient's race, color, gender, place of birth, ethnicity, age, mental or physical disability, and communication disorders cannot be considered negative factors for admission.

g) If the patient does not accept the treatment plan recommended by the healthcare provider, the risks that may arise from the implementation of this treatment plan will be explained in a statement specifying the reason for not accepting the service.
Termination of Home Care Services Provided to a Patient

Article 27 — Home care services shall be terminated or the patient transferred to inpatient treatment facilities in the following cases:

a) The patient receiving home care services has recovered with the applied treatment and the need for further treatment has ceased;

b) The goals determined in the patient-specific care plans have been achieved;

c) The medication, care, and treatment to be applied to the patient receiving home care services can be administered without the need for healthcare personnel after a certain stage;

d) The medically necessary equipment or trained healthcare personnel for home care services cannot be fully provided;

e) An indication for hospitalization arises for the patient receiving home care services;

f) The patient or their representatives wish to terminate the service.

Situations Where Home Care Services Cannot Be Provided

Article 28 — Patients cannot be accepted for home care services in the following situations:

a) If the requested treatment, even if administered with the assistance of healthcare personnel, has a medical contraindication by the healthcare institution's physician to be performed in a home environment,

b) If the healthcare institution cannot provide the medically necessary equipment or trained healthcare personnel for the home treatment of the patient and their condition,

c) If the patient has been ordered by the courts to be placed under medical observation and/or treatment in a hospital due to mental illness or substance abuse.

If the patient or their family fails to comply with the treatment/care plan and working conditions, fails to fulfill their responsibilities, or engages in inappropriate or criminal behavior towards the personnel providing home care services, the healthcare institution may unilaterally suspend the service and terminate the service contract.

 CHAPTER EIGHT

Miscellaneous and Final Provisions

Inspection

Article 29 — Inspections of health institutions are carried out by at least two healthcare personnel, consisting of a physician and a nurse, appointed by the Directorate. Regular inspections, excluding extraordinary inspections conducted upon complaint, investigation, or request from the Ministry's central organization or the Directorate, are carried out at least every six months. The Inspection Form in Annex 7 is used during inspections. Findings and results related to the inspection are recorded in the Directorate's inspection and audit logbook.

Home care services provided to patients by non-physician healthcare personnel assigned by the healthcare institution are supervised by a team formed under the leadership of a healthcare professional appointed by the Directorate; this team includes a representative from the medical chamber and a representative from associations representing non-physician healthcare personnel. Except for extraordinary inspections conducted at the request of the Ministry's central organization or the Directorate, and in response to complaints or investigations, on-site inspections of services provided to at least two patients by each healthcare institution are conducted at least every three months. A report is prepared based on the inspection results and submitted to the Directorate. The Directorate evaluates the report and takes the necessary actions against the healthcare institution in accordance with the legislation.

In cases of temporary closures indicated on the inspection form, patients served by the healthcare facility are informed. If requested by the patients, services will continue temporarily under the supervision of a private healthcare facility proposed by the closed facility and approved by the Directorate. The healthcare facility cannot charge the patient any additional fees for this service, and all expenses will be covered by the temporarily closed healthcare facility.

Promotion and Information

Article 30 — Healthcare institutions may not engage in behaviors that mislead, cause panic, misdirect, or create unfair competition among similar institutions and their employees.

However, they may prepare educational materials, primarily intended for use by individuals requesting home care services from the healthcare institution, that are health-promoting and protective in nature, and contain information about health problems related to their field of activity, prevention of these problems, or the alleviation or reduction of negative effects caused by health problems through personal measures.

Healthcare institutions and their employees are required to obtain permission from the Directorate for all promotional and informational activities, provided they comply with the above-mentioned provisions.

Prohibitions

Article 31 — Healthcare institutions and their personnel are obliged to comply with the following:

a) Healthcare institutions cannot operate without obtaining a certificate of conformity.

b) Personnel for whom the Directorate has not issued a personnel work permit cannot be employed in a healthcare institution under any circumstances.

c) Physicians and other healthcare personnel working in a healthcare institution cannot work or be employed in another private healthcare institution.

d) If the healthcare institution is a company, other activities outside of general healthcare services, which fall within the scope of the company's activities, cannot be carried out in the healthcare institution.

e) Minimum personnel assigned to a unit cannot be temporarily assigned to another department within the healthcare facility to which the unit belongs.

f) To prevent public misperception and unfair competition, healthcare facilities cannot use names used by official healthcare facilities as commercial names or display them on their signs.

g) Healthcare facilities cannot enter into contracts with, or undertake the care and treatment of, a number of patients beyond their capacity to meet medical and ethical requirements.

h) Patient-related results cannot be disclosed to third parties in any way, except for requests related to inspections and court proceedings, and to the patient's relatives or those who have given their consent.

Additional Regulations

Article 32 — The minimum equipment, medical supplies and supplies, all types of record books, forms required in patient files, notifications of health institutions, and other procedures and principles related to operation not specified in this Regulation shall be regulated by a Circular to be issued by the Ministry within two months at the latest from the date of publication of this Regulation.

Sanctions

Article 33 — Those who do not comply with the procedures and principles determined in this Regulation and those who act contrary to the prohibitions shall be subject to the sanctions stipulated in this Regulation; they are subject to general provisions regarding their criminal and legal responsibilities.

Temporary Article 1 — Healthcare institutions that commenced operations before the entry into force of this Regulation shall be brought into compliance with the provisions of this Regulation within a maximum of three months from the date of its entry into force. The activities of healthcare institutions found to be non-compliant as a result of inspections shall be suspended by the Directorate until the deficiencies or irregularities are rectified.

Entry into Force

Article 34 — This Regulation shall enter into force on the date of its publication.

Enforcement

Article 35 — The Minister of Health shall enforce the provisions of this Regulation.