Essential Functions of the health care facility and the differences between acute, long-term, assisted living, home care, and hospice.

Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite of chronic care or longer-term care.

Long term care refers to a continuum of medical and social services designed to support the needs of people living with chronic health problems that affect their ability to perform everyday activities. Long term care services include traditional medical services, social services, and housing.

Assisted living is a system of housing and limited care that is designed for senior citizens who need some assistance with daily activities but do not require care in a nursing home.

Home care, (also referred to as domiciliary care, social care, or in-home care), is supportive care provided in the home.

Rehabilitation: The process of helping a person who has suffered an illness or injury restore lost skills and so regain maximum self-sufficiency. For example, rehabilitation work after a stroke may help the patient walk and speak clearly again.

Hospice Care: Care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure.

Home Care

Home care is becoming an increasingly viable and attractive alternative to facility-based long-term care (nursing homes and assisted living), and it is only expected to grow in popularity as baby boomers age. Home care covers a wide range of services for individuals who require ongoing healthcare and assistance with the activities of daily living. When family and friends cannot provide adequate support, home care allows people to receive the care they need to remain in their homes.

The individuals who receive home care may be elderly, disabled, terminally or chronically ill, or they may be recovering from surgery. While the majority of individuals receiving home care are over the age of 65, home care consumers may be any age, beginning with infants who may need ventilators or other care in order to live at home. Home care agencies deliver services through physicians, nurses, therapists, social workers, home health and personal care aides, and volunteers.

Home care may include health-related services such as injections, intravenous therapy, and wound care. It may include assistance with personal care, such as getting in and out of bed, walking or mobility, bathing, using the toilet, and dressing, and it may also include assistance with household tasks, such as laundry, meal preparation, general housekeeping, and shopping.

Home care services may be paid for by an individual or family member, by health insurance companies, managed care organizations, the Veteran’s Administration, community organizations, Social Services Block Grants, Medicare, Medicaid, and other sources.

Most states license home care agencies, but licensure requirements vary widely from state to state. Forty-four states, including Colorado, require a license for agencies that provide home health services (e.g., medication administration, injections, intravenous therapy, and wound care), and 30 states, including Colorado, additionally require a license for agencies that provide personal care services. In order to receive funds from Medicare and Medicaid, home care agencies must meet minimum federal standards.

Colorado licenses two types of home care agencies

Class A and Class B. Only Class A agencies may provide home health services.

Both Class A and Class B agencies provide assistance with personal care, medication reminders, companionship, and homemaking services.

        PCA/PCW is an individual who has completed personal care training and is competent to perform assigned functions of personal care to the client in their residence. The essential functions of PCW could include working with other members of the team, e.g. nurse, physician, dietician, physical therapist, speech therapist and social worker, client.

 QUALIFICATIONS:

 Must have completed a personal care training program and competency.

1. Have a sympathetic attitude toward the care of the sick and elderly.
2. Ability to carry out directions, read and write.
3. Maturity and ability to deal effectively with the demands of the job.

 RESPONSIBILITIES:  

1. Assist clients with personal hygiene, including shower, tub or bed baths, oral care, hair, and skincare.

2. Assist clients in the use of toilet facilities, including bedpans.

3. Assist clients in and out of bed, excluding the use of mechanical lifting equipment unless trained and documented as competent.

4. Assist clients with walking, including the use of walkers and wheelchairs, when applicable.

5. Assist clients with self-administration of medications.

6. Meal preparation and feeding, when required.

7. Assist with prescribed exercises when the client and the aide have been instructed by the appropriate health professional.

8. Record and report changes in the client’s physical condition, behavior or appearance to supervisor or Case Coordinator.

9. Documenting services delivered in accordance with facility policies and procedures.

10. Maintain good relationships with clients, families, and co-workers.

11. Report any suspicions of abuse, whether physical or financial, to proper authorities as indicated in P&P Home Services.

12. Perform job duties in a safe and sanitary manner.

Standards of conduct:

A code of conduct is a set of rules outlining the social norms and rules and responsibilities of, or proper practices for, an individual, party or organization. Related concepts include ethical, honor and moral codes, as well as halachic and religious laws.

Ethics in the workplace:

Workplace ethics and behavior are a crucial part of employment, as both are aspects that can assist a company in its efforts to be profitable. In fact, ethics and behavior are just as important to most companies as performance as high morale and teamwork are two ingredients for success. Every business in every industry has certain guidelines to which its employees must adhere, and frequently outline such aspects in the employee handbook.

Informed consent:

Informed consent is a permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.

 Quality Management Plan: Every licensed or certified facility shall establish a Quality management program appropriate to the size and type of facility that evaluates the quality of patient or resident care and safety, and complies with rules and regulations.

 Personnel Management Recruitment/hiring. Advertising, screening, reference check, background checks, orientation, continuing education, supervision, scheduling.

Professional work habits and time management skills:

Time management is the act or process of planning and exercising conscious control over the amount of time spent on specific activities, especially to increase effectiveness, efficiency or productivity.

PCW Daily Jobs and time management.

ROUTINE HOUSEWORK:

A Personal care worker may be responsible for providing a safe, clean living area for the care recipient. The extent of these home services will depend on the needs of the loved one. A clean environment keeps harmful bacteria under control and helps stop the spread of communicable diseases. It also makes one feel more relaxed and comfortable, and is, therefore, conducive to the good health of the care recipient. Food stored properly and spills wiped up promptly keep insects from becoming a problem. Cleanrooms provide an orderly way of living, enable us to find things easily, and help prevent accidents. It may be helpful to set up a daily work plan for the jobs that family members can follow. Always make a list of what you need to keep a living area clean, and use those products already in the home where possible. Before beginning your tasks, collect all supplies and equipment needs for a chore and carry them in a pail, tray, shopping bag, or laundry basket from one room to another. Carry a pad and pencil for noting items that need to be bought or replaced. Plan major jobs for different days of the week – i.e. don’t do laundry, vacuuming, and wash floors all on the same day.

Dusting:

Dusting helps prevent the spread of bacteria. It also helps those who are sensitive to dust. Dusting should be done daily or at least weekly. Lightly dampen a rag with water or a commercial spray to keep the dust from spreading. Move the cloth to gather the dust onto it.

Cleaning:

Floors Rugs and carpets should be vacuumed or swept regularly. Furniture may have to be moved to do a proper job. Smaller rugs can be shaken and washed. Do not wash wood floors. Instead, vacuum and clean with a vinegar/water solution or use a commercial product. Hard floors can be swept or vacuumed and mopped. Always mop tile or linoleum floors with a well wrung-out mop or rag so as not to loosen the tiles or make them slippery. Small rugs placed in entryways can catch a lot of dirt from the outside.

Washing Dishes:

Proper dishwashing kills bacteria. Always wash dishes as soon after a meal as possible. When using a dishwasher, first scrape and rinse the dishes. Load the dishwasher and run it when you have a full load to conserve water and electricity. If you don’t have a dishwasher, wash and rinse dishes by hand. Wash the cleanest dishes first and the dirtiest last (glasses and cups, silverware, plates, pots and pans.) Rinse dishes well and place in a drainboard or on the towel. Allow them to air dry if possible.

Cleaning the Kitchen:

A kitchen is cleaned more frequently than any other room in the home. You should clean up after each meal to kill as many bacteria as possible. Keeping a kitchen clean and tidy is easy if you remember to do each of these chores:

1. Refrigerate or otherwise store all food immediately after each meal.
2. Clean up any spills regularly, especially on a stove where they can become baked on.
3. Wipe out the refrigerator regularly, defrosting when necessary.
4. Wipe down any small appliances with soap and water. Remember to disconnect them first.
5. Wipe off the countertops, areas around the drawer handles, and door pulls. Keep surfaces uncluttered.
6. Wash, rinse, drain, and put away all dishes as soon as possible after each meal.
7. Scrub cutting boards between and after each use.
8. Mop the floors and take out any garbage.

Cleaning the Dining and Living rooms:

1. Clean up crumbs under and around the table.
2. Tidy up.
3. Throw out recycle newspapers.
4. Empty ashtrays and wastebaskets.
5. Dry-mop floor.
6. Dust furniture and window sills.

Cleaning the Bathroom:

Bathrooms usually have constant moisture in the air. Therefore, they need to be cleaned regularly to kill bacteria and odors. Water left on the floor can be slippery and dangerous. When you clean a bathroom, make a point of doing the following:

1. Wipe out the shower/tub after each use.
2. Clean sinks and other fixtures regularly.
3. Clean the toilet:

     a) Scrub the toilet bowl with soap or detergent, especially under the rim.

     b) Leave the suds in the bowl while you wash the outside.

     c) Do NOT mix toilet bowl cleaner with other cleansers.

     d) Use clean, hot water to rinse off the toilet.

4. Mop the floors or vacuum the carpet.

     a) Use care when scrubbing.

     b) Change cleaning water when moderately dirty.

     c) Rinse if needed to avoid streaking or filming.

     d) Store all cleaning products safely. They should be kept in their original containers, away from children, pets, and any heat sources. Cleaning tools and supplies should be stored safely as close as possible to where you will use them.

 Cleaning the Bedroom:

1. Put clothes away or into the wash.
2. Straighten room and empty trash.
3. Dry-mop or vacuum floor.
4. Air out beds and make them up

BEDMAKING:

     Your care recipient may spend part of or all of the days in bed. As a result, many individuals are fed, bathed, and use the bedpan in bed. Making a bed properly is, therefore, very important. A clean, neat bed will make the care recipient comfortable. Wrinkles are uncomfortable and restrict circulation, and can cause pressure sores (decubitus ulcers). Make the bed wherever your care recipient has decided to sleep, whether in bed or on the couch. Use whatever linens are in the house.

     There are three basic types of beds:

1. Closed bed – used when the bed will be empty for a while. It will stay clean, not exposing the linens.
2. Open bed – used when the care recipient is out of bed for a while but needs to get into it easily. The top sheet of the closed bed is fan-folded down.
3. Occupied bed – used when the bed is made with the care recipient in it and not able or permitted to get out of the bed.

Tips for bed-making:

1. Keep the bed dry and clean. Change linens when needed.
2. Keep the bed wrinkle-free.
3. Keep the bed free of food and crumbs.
4. Make the bed suit your care recipient.

Bed Linen

Folding Flat and Fitted Sheets

   › Show respect and consideration for client preferences. Solicit their input.

   › Fold sheets promptly while still hot from the dryer to minimize wrinkling.

   › Exercise careful folding. Smooth on a flat surface to minimize wrinkling.

   › Fold lengthwise by carefully matching ends.

   › Fold widthwise, smoothing wrinkles. Fold to achieve a compact, rectangular shape (4-6 folds total).

   › With fitted sheets, mimic the flat sheet method. Place one fitted corner into the opposite corner. Keep as flat as possible.

   › Repeat is as necessary to achieve an approximately rectangular shape to match the flat sheet.

   › Fold lengthwise into a rectangular shape (4-6 folds total).

Hints on Bed-Making

   › Respect client wishes. Note client limitations.

   › Ensure bottom fitted or flat sheet is snug, secure, and wrinkle-free.

   › Place the top sheet according to client preference:

Well-centered from side to side, adequate length at head of the bed, adequate length of the sheet at foot of the bed for proper tucking Hospital corners – then secure or leave loose as preferred.

   › Bottom sheet, then optional water-resistant pad (“Chucks”), and draw sheet for the client with bladder-control problems.(optional).

   › Pleat or fold in a center foot of top sheet (optional) to relieve pressure on feet.

 Linen Change Procedure:

   1. Plan ahead.
   2. Keep clean linen on a clean surface, separate from soiled linen.
   3. If linen is soiled with body fluids, WEAR GLOVES.
   4. Loosen linens on the bed. Remove them, folding the cleaner areas over the stained area
   5. Complete the linen change.
   6. Hold soiled linens away from clothing. Avoid shaking or fanning the linens.
   7. Place dirty linens in the designated area (hamper, dirty pillowcase, laundry basket, etc.), or launder immediately in the family’s washing machine.
   8. Remove and discard gloves if used.
   9. Wash hands.

Seasonal Bedding Changes:

   1. Offer assistance with winter/summer bedding changes. Launder blankets per label/client instruction prior to storage.
   2. Ensure placement of an electric blanket to avoid direct contact with the client’s skin.
   3. Place electric blanket controls in easy to reach location.
   4. The elderly are at increased risk for hypothermia. Be sure there are adequate, easily available, additional blankets.

WEEKLY JOBS

Kitchen

   1. Clean out the refrigerator. Wash inside and out before doing weekly marketing.

   2. Give the stove thorough washing inside and outside.

   3. Clean appliances such as the microwave.

   4. Scrub the floor with hot, sudsy water. Rinse with hot water or as client directs.

   5. Grocery shopping – as directed

Bathroom

   1. Scrub toilet bowl with a toilet brush and toilet bowl cleaner.

   2. Wash outside toilet surfaces with disinfectant.

   3. Wash the mirrors.

   4. Make sure there is enough soap in each soap dish.

   5. Launder the bath mat and bathroom rug.

   6. Scrub the shower stall.

   7. Wipe shower curtain with a weak mixture of bleach and water.

Bedrooms

   1. Open the closet doors to air out clothes.

   2. Put clean sheets and pillowcases on the beds.

   3. Change or wash the mattress covers or waterproof pads if they are soiled.

   4. Vacuum or use slightly damp mop to dust bare floors.

   5. Use cloth squeezed in hot, sudsy water to clean fingerprints off walls, woodwork, and light switches.

   6. Dust furniture, light fixtures, lamps, books, windowsills, phone, and small items.

Dining room

   1. Sweep or vacuum carpet or rug

   2. Vacuum or clean bare floors with a slightly damp mop

   3. Use cloth squeezed in hot, sudsy water to clean fingerprints off walls, woodwork, and light switches.

   4. Dust the furniture, light fixtures, any open shelves, ornamental china, glassware or sliver, as client directs.

MONTHLY JOBS

(Respect Client wishes and directions)

Kitchen

   1. Defrost freezer

   2. Clean and organize cupboards and drawers.

   3. This is a good time to discuss with the client any stored food.

   4. Wash cabinet doors with soapy water, or as recommended by the client

   5. Dust light fixtures, clean oven vent, and hood as needed.

Bathroom

Perform organizational tasks; straighten medicine chest or closet.

Bedroom

   1. Offer to clean or organize closets or drawers.

   2. Take clothes to dry cleaner if necessary.

   3. Vacuum under bed and furniture

   4. Wash baseboards & windowsills.

   5. Vacuum under furniture

   6. Dust light fixtures or wash with warm soapy water.

Be careful not to burn yourself!

   1. Use vacuum attachments or CLEAN broom or mop to remove cobwebs from ceiling and walls.

   2. Windex pictures if requested by the client.

   3. Dust the phone or wipe with warm water or disinfectant as needed.

   4. Dust plants, if desired by the client.

Monthly tasks take time away from your ordinary routine.

You will need to plan ahead with your client and take about ten minutes out of each visit to accomplish them.

Remember To Follow Standard Precautions – Wear Gloves

URINE STAIN REMOVAL

Dried stains on Carpet or Upholstered   furniture:

• Apply 1 teaspoon white vinegar mixed with 3 teaspoons warm water. Let dry.
• Mix teaspoon of liquid dishwashing soap in 1 cup water. Sponge on sparingly. Let dry.
• Rinse and then repeat step 1 and rinse again.

Wet stain on carpeting

Sprinkle baking soda on the stain.

Let dry, then vacuum.

Cleaning Floors

• Always sweep or vacuum first to remove base dirt and crumbs.
• Use disinfectant if possible. Use the proper amount.
• Change the water when dirty.
• Dispose of by flushing down the toilet. – Do not pour down the kitchen sink!
• Avoid getting floors too wet.
• Wipe dry with a clean cloth if requested.
• Avoid waxing clients’ floors to minimize slipping.

Dusting

• Use clean cloths and appropriate product.
• Remove all items on furniture and dust top.
• Dust sides, legs of furniture, and rungs of chairs.
  • Return all items to their original places.

Cleaning Appliances

• To clean the microwave interior, boil a cup of water in the microwave before you wipe it clean.
• Use Windex type products to clean and shine exteriors of microwaves, stoves, and refrigerators.
• If using an oven cleaner, read instructions thoroughly.
  • Place newspapers on the floor in front of the stove. WEAR GLOVES.
  • Carefully rinse the oven interior and remove all traces of cleaner.

Trash Cans

• Fill with hot, soapy water. Scrub with a long-handled brush.
• Rinse with ammonia or bleach added to the final rinse to eliminate odors.
• Air-dry in the sunshine if possible.

 LAUNDRY TECHNIQUES

Clean clothes are important for good health and for making us feel and look good. You should wash clothes regularly, keeping in mind the care recipient’s routine and wishes, if possible. Make any repairs necessary, such as sewing buttons or hems, or replacing a zipper. This can be done whenever it is needed, but especially before washing them. Bed linens should be changed once a week and whenever soiled. If they are soiled, they should be washed as soon as possible. Assist the care recipient to have laundry that is clean to contribute to your well-being.

Laundry Hints:

• Follow client instructions. Ask what the client prefers.
  • Read labels on items to be laundered.
  • Empty pockets. Close zippers and other fasteners.
  • Remove belts and non-washable ornamentation.
  • Read detergent instructions.

Other Factors to Consider:  Size and age of item, and type of fabric

General Sort/Laundry Instructions	Water Temp/Washer Cycle
Heavily soiled –colorfast cycle	Pre-treat, hot water, regular
Sturdy white -colorfast	Hot water, regular cycle
Non-colorfast – dark colors	Coldwater, regular cycle
Permanent press	Warm water regular cycle
Delicate Items and knits	Warm water, gentle cycle

Pre-treating/Stain Removal: Treat as soon as possible.  Some stains set when washed.

Laundry/Guidelines:

1. Presoak linens and clothing soiled with blood or bodily fluids in cold water. Wash separately.
2. To launder linens, wash in hot water with detergent.
3. Add one cup bleach to linens and white garments.
4. Handle laundry as little as possible to avoid contamination of their.
5. Rinse in cold water rinse
6. Rub gently
7. May respond to pre-treat products like Resolve, Spray ‘n Wash or cold water/detergent solution
8. Or, mix up a pre-wash spray with 1/3 Cup each: water, liquid detergent, and ammonia.
9. Store in a spray bottle with a label noting the contents.

Blood, urine, and chocolate stains:

Other stains:

Caution:

General Washing Guidelines:

• Follow washer’s specific instructions. Do not overload.
• Read detergent instructions for the proper amount.
• To minimize urine odor, use liquid Lysol and fabric softener or carefully use 1/4 to 1/2 cup chlorine bleach in wash water if appropriate for the item.
• Wash shower curtains with 3 or 4 white towels on the warm cycle with detergent and 1/2 cup bleach and add 1 cup vinegar to the rinse cycle. Avoid the Spin cycle. Hang to dry.
• If using fabric softener, pour softener into the dispenser or dilute with water before adding to rinse water.

Do not mix ammonia with bleach. The combination gives off a deadly gas.

 Washing Clothes

1. Using the clothing labels, sort the clothes by:

a)    Color: separate dark from light

b)    Fabric: separate delicate from heavy-duty

c)    Soil: separate very dirty clothes

d)    Dry Clean: separate from washables

1. While sorting, check clothes for spots and stains, then pretreat.
2. Fill the machine with water and detergent (and bleach and fabric softener, when used). Add clothes, making sure not to overload.
3. Move clothing to the dryer. When dry, remove immediately from the dryer to minimize wrinkling.

Drying:

• Separate items.
• Read labels on items.
• Do not overload.

a)    High Setting – Sturdy, shrink-resistant cotton

b)    Medium Setting – Permanent press and linens

c)    Low or Fluff Setting – Delicates

• Keep colorfast clothes separate from non-colorfast to avoid “bleed”.
• Hang air-dry items prone to shrinkage, like wool & some cotton.
• Ensure towels and other sturdy items have adequate drying time.
• Hot items can misleadingly feel dry. Check them carefully.
• Check with the client for preference on items such as polyester slacks or blouses.
• Some prefer brief dryer time on permanent press/medium then put the item on a hanger to air dry.
• Remember to use fabric softener on sheets, if requested.
• Fold items when they are hot to minimize wrinkling.

Ironing:

• Check label/iron instructions for proper temperature setting.
• If in doubt, use the lowest setting or test on an area that won’t show.
• Best results are achieved on slightly damp items.
• For shirts and blouses – iron inside/out collars, cuffs, and facings first, front, back of the shoulder, the lengthwise body of the shirt, sleeves – then finish off collars, cuffs again.
• Iron pile fabrics (velvet, corduroy), dark fabrics, silks, rayon, linens, and wools on the backside to avoid “shine” and retain qualities.
• Do any ironing necessary and return clothes to drawers and closets.

COORDINATION WITH EXTERNAL HOME CARE AGENCIES

With the consent of the patient, the Agency coordinates patient services and shares patient information with outside health care agencies that are providing care and services to the Agency’s patient. Should the patient not agree to such coordination, the refusal will be documented in the patient’s record.

These are agencies frequently coordinating with home care agencies

• Meals on Wheels
• Agency resource lists
• Social worker, social services
• Transportation: American Red Cross, RTD
• Diagnosis specific associations (MS, Cancer )
• Respite care, daycare
• Special libraries
• Churches

MANAGING A BUDGET

As a family caregiver, you must be able to manage money in several different ways. This includes assisting the care recipient with paying bills, balancing a checkbook, and preparing & managing a household budget. You must be able to add and subtract. As the family caregiver, you may need to help the care recipient with writing out bill payments accurately recording deposits and expenses (checks are written) in a check register, and balancing the checkbook. Make sure the care recipient is aware of his/her financial situation when you assist with the balancing. You might have to assist the care recipient in setting up a household budget to follow, within available income. Keep in mind monthly expenses such as rent, utilities (electricity, water, gas), and telephone. There are other expenses to consider: food, clothing, cleaning supplies, personal supplies, insurance, car care and gas, health care, and house maintenance. A budget is a guideline for a person to follow every month and doesn’t really change from month to month. If the care recipient asks you to handle money, for buying groceries, etc., keep the receipts to show them. Return the proper amount of change to the care recipient.

Recognize warning signs of excessive stress at work

        When you feel overwhelmed at work, you lose confidence and may become irritable or withdrawn. This can make you less productive and less effective in your job, and make the work seem less rewarding. If you ignore the warning signs of work stress, they can lead to bigger problems. Beyond interfering with job performance and satisfaction, chronic or intense stress can also lead to physical and emotional health problems.

Signs and symptoms of excessive job and workplace stress:

• Feeling anxious, irritable, or depressed
• Apathy, loss of interest in work
• Problems sleeping
• Fatigue
• Trouble concentrating
• Muscle tension or headaches
• Stomach problems
• Social withdrawal
• Loss of sex drive
• Using alcohol or drugs to cope

Taking Steps to Manage Stress

• Track your stressors. Keep a journal for a week or two to identify which situations create the most stress and how you respond to them. Record your thoughts, feelings, and information about the environment, including the people and circumstances involved, the physical setting and how you reacted. Did you raise your voice? Get a snack from the vending machine? Go for a walk? Taking notes can help you find patterns among your stressors and your reactions to them.
• Develop healthy responses. Instead of attempting to fight stress with fast food or alcohol, do your best to make healthy choices when you feel the tension rise. Exercise is a great stress-buster. Yoga can be an excellent choice, but any form of physical activity is beneficial. Also, make time for hobbies and favorite activities. Whether it’s reading a novel, going to concerts or playing games with your family, make sure to set aside time for the things that bring you pleasure. Getting enough good-quality sleep is also important for effective stress management. Build healthy sleep habits by limiting your caffeine intake late in the day and minimizing stimulating activities, such as computer and television use, at night.
• Establish boundaries. In today’s digital world, it’s easy to feel pressure to be available 24 hours a day. Establish some work-life boundaries for yourself. That might mean making a rule not to check email from home in the evening, or not answering the phone during dinner. Although people have different preferences when it comes to how much they blend their work and home life, creating some clear boundaries between these realms can reduce the potential for work-life conflict and the stress that goes with it.
• Take time to recharge. To avoid the negative effects of chronic stress and burnout, we need time to replenish and return to our pre-stress level of functioning. This recovery process requires “switching off” from work by having periods of time when you are neither engaging in work-related activities nor thinking about work. That’s why it’s critical that you disconnect from time to time, in a way that fits your needs and preferences. Don’t let your vacation days go to waste. When possible, take time off to relax and unwind, so you come back to work feeling reinvigorated and ready to perform at your best. When you’re not able to take time off, get a quick boost by turning off your smartphone and focusing your attention on non-work activities for a while.
• Learn how to relax. Techniques such as meditation, deep breathing exercises and mindfulness (a state in which you actively observe present experiences and thoughts without judging them) can help melt away stress. Start by taking a few minutes each day to focus on a simple activity like breathing, walking or enjoying a meal. The skill of being able to focus purposefully on a single activity without distraction will get stronger with practice and you’ll find that you can apply it to many different aspects of your life.
• Talk to your supervisor. Healthy employees are typically more productive, so your boss has an incentive to create a work environment that promotes employee well-being. Start by having an open conversation with your supervisor. The purpose of this isn’t to lay out a list of complaints, but rather to come up with an effective plan for managing the stressors you’ve identified, so you can perform at your best on the job. While some parts of the plan may be designed to help you improve your skills in areas such as time management, other elements might include identifying employer-sponsored wellness resources you can tap into, clarifying what’s expected of you, getting necessary resources or support from colleagues, enriching your job to include more challenging or meaningful tasks, or making changes to your physical workspace to make it more comfortable and reduce strain.
• Get some support. Accepting help from trusted friends and family members can improve your ability to manage stress. Your employer may also have stress management resources available through an employee assistance program (EAP), including online information, available counseling, and referral to mental health professionals, if needed. If you continue to feel overwhelmed by work stress, you may want to talk to a psychologist, who can help you better manage stress and change unhealthy behavior.

Characteristics of professional behavior (examples such as):

Caring:

1. Competent
2. Conscientious (including personal hygiene)
3. Courteous
4. Dependable/Timely
5. Honest
6. Team player.

Summary: Ensure each client’s basic needs are met. Provide a safe, caring, and comfortable environment. Learn appropriate communication skills to build positive relationships and to overcome physical and emotional barriers. Keep a positive attitude, and ask for help in difficult situations or when you feel overwhelmed.

The Client’s Bill of Rights in the home care settings.

Principles and rationale of Client’s Rights (Right to…)

1. Free choice
2. Freedom from abuse and restraints: freedom from any physical or chemical restraint, unless agreed to by client, ordered by the doctor, and necessary to protect a client.
3. Methods to maintain privacy (i.e. not talking about client in public areas such as the dining room, elevators….

Maintaining privacy while performing client care).

1. Confidentiality of personal and clinical records (Health Insurance Portability and Accountability Act – HIPAA standards);
2. Accommodation of needs;
   • Physical (independency in care, or self-care).
   • Psychosocial.

1. Organize and participate in family & resident groups;
2. Participate in social, religious and community activities;
3. Examine survey results and correction plans;
4. Manage personal funds;
5. Information about eligibility for Medicare/Medicaid benefits;
6. File complaints about abuse, neglect or misappropriation of property;
7. Information about advocacy groups;
8. Immediate & unlimited access to family or relatives;
9. Use personal possessions;
10. Notification of change in condition.

It is important to recognize and accept others beliefs and lifestyles, even if they clash with your own. Every person has the right to quality of life, regardless of age, gender, physical or mental ability, race, culture, religion, beliefs, or lifestyle.

Vocabulary words/terms related to ethical/legal behavior and client rights.

Personal Care Worker have a legal obligation to uphold clients’ rights and protect them from physical and mental harm. Each client entitled to quality of life that enhances the person’s dignity and self-esteem. Quality care respects individual beliefs and focuses on individuality, strengths, needs, and preferences.

1. Privacy:

• Personal.
• Visits
• Telephone conversation.
• Information about care.

What is Privacy and Confidentiality?

• Basic rights of every person
• Privacy is the right of an individual to keep personal information from being disclosed
• Confidentiality is how we as health care providers/employees treat private information once we and others receive it

Why are privacy and confidentiality important? No matter where one works in healthcare- the hospital, labs, radiology centers, nursing homes, doctors’ offices, business units IT, or in the patient’s home- it is important to understand what privacy and confidentiality mean.

Patients, residents, clients have the right to control who will see their protected, identifiable health information. Communications with or about patients involving patient health information will be private and limited to those who need the information for treatment, payment, and healthcare operations. Such communications may involve verbal discussions, written communications, or electronic communications. Only those people with an authorized need to know will have access to the protected information.

Hospitals and healthcare organizations have always upheld strict privacy and confidentiality policies. Unless you are new to healthcare, this idea will be familiar to you. However, the U.S. government strengthened the laws protecting privacy and confidentiality in response to situations in which private medical information has ended up in the wrong hands.

There have been cases in which employers have fired good employees after learning of illness that could lead to lost work time and increased insurance costs, people’s medical information has ended up in the newspaper, and medical information has been used to damage other’s reputations.

With the enactment of HIPAA the Health Insurance Portability and Accountability Act of 1996, patients have the right to keep their medical information kept private and secure. It no longer is an ethical issue- it is the law.

So what is HIPAA?

HIPAA is a broad law that deals with quite a variety of issues. Part of the focus of the law is to make it easier to move from one health insurance carrier to another. Because of this they must have their medical information and other information moved as well.

HIPAA provided for healthcare organizations to standardize the way they communicate with one another to make it easier to share information. This is especially important to transmit information electronically.

With the ease of records transfer it is also easy to sort out patients who have expensive illnesses or potentially use that information to hurt their chances at getting jobs or insurance.

As a result HIPAA focuses on patient privacy and confidentiality. Under this law it is illegal to release health information to inappropriate parties or to fail to adequately protect health information from release.

What information do we keep confidential? Confidential information includes patient identity, address, age, Social Security number, and any other personal information that patients are asked to provide.

Confidential information also includes the reason a person is sick or in the hospital, the treatments, medications that he or she may receive, and other observations about his or her condition or past health conditions.

Penalties associated with violation of HIPAA.

Civil penalties are fines up to $100 for each violation of the law per person, up to a limit of $25,000. For example, if 100 patient records were released illegally, a healthcare institution could be fined $10,000.

Criminal penalties for wrongful disclosure can also result in jail time. The criminal penalties increase as the severity of the offense increases. Intentionally selling patient information is significantly more serious than accidental disclosure. These fines can be as high as $250,000 or a prison sentence of 10 years.

How do we protect our patient’s/client’s privacy? We are committed to protecting their privacy and confidentiality in the following ways:

• Patient/client care or discussion about patient/client care is kept private by closing doors or conducting them in an area where the discussion will not be overheard.
• Patient medical records are not left where others can see them or gain access to them.
• Computerized patient records are closed when the caregiver is away from the computer.
• Written patient information is kept covered from the public.
• Diagnostic tests results are kept private.
• Paper records no longer needed are shredded or placed in closed receptacles for disposal. They are not left in the garbage.
• Information is not disclosed to visitors about a patient/client.
• Physical abuse.
• Sexual abuse.
• Verbal abuse.
• Emotional abuse. (Threats, humiliation).
• Involuntary seclusion.
• Financial abuse.

2. Abuse:

How do you recognize signs of abuse and neglect?

Unfortunately, we occasionally read about or hear news reports of abuse and neglect occurring in personal homes. Clients, client’s family member may abuse one another, staff may abuse clients or clients may abuse staff. By law, signs of abuse and neglect are to be reported. Therefore, you must become knowledgeable about this topic. Abuse can be physical or emotional. Some examples of abuse are:

• Pushing, hitting or shaking.
• Pulling hair or ear.
• Tying a client to a bed or chair.
• Locking a client in a room.
• A staff person engaging in any sexual contact with a resident.
• Giving too much medicine on purpose.
• Yelling at or threatening with words.
• Harassing a person.
• Using ethnic slurs.
• Sexual harassment.
• Rape.
• Attempted rape.
• Sexual assault.
• Threatening to make a person leave the home.

Another form of abuse is “financial abuse.” This involves taking property or money from a client or encouraging a client to hand over his/her assets. Clients have the right to protection of their money and property.

Neglect is the failure to provide necessary care that results in harm to the client.

Examples of neglect include:

• Leaving a group of aggressive clients unsupervised;
• A direct care staff person falling asleep while on duty;
• Delaying the normal scheduling of routine medical or dental visits for health maintenance;
• Isolating a client in their room;
• Leaving a client unattended by staff for long periods of time;
• Failing to seek medical help when a client shows symptoms of injury or illness, or if a client complains of pain;
• Delaying assistance with activities of daily living, such as failure to help a client with toileting and causing the client to soil himself/herself.

What should you do if you see abuse or neglect?

You should ask your supervisor what the home’s procedures are to report suspected abuse or neglect. It is not your responsibility to investigate or confirm the suspected abuse or neglect—only to report what you see. When reporting to your supervisor, it is important to be “objective.” State only what you see or hear, not your interpretation of what you see or what you assume is happening, which is “subjective” information. In other words, just state the facts.

Methods to report abuse, mistreatment or neglect:

1. Chain of command.
2. Agency policy.
3. Community agencies.

Occurrence Reporting:

Home care agencies are required to report certain events or “occurrences” to the The Health Facilities and Emergency Medical Services Division (Division) by the next business day. Home care agencies report occurrences through an internet portal and may submit them any day of the week or time of day. The Division prepares a summary of all reported occurrences and makes them available to the public. Any identifying information about specific individuals in occurrence reports is redacted from the reports released to the public.

The Division receives and investigates complaints from any member of the public, including home care clients and their family members, home care workers, other government agencies, and adult protective services. Family members are the most common source of complaints.

ABUSE AND NEGLECT IN THE HOME

 Abuse and neglect in the home is a serious issue. It can consist of physical, sexual, or psychological abuse, or just obvious neglect of a person. The person abused or neglected can be anyone, from an infant to a senior citizen. Very often, when someone suspects abuse or neglect, the incident does not get reported because it is thought to be a family or personal affair that is none of anyone’s business.

Staff should be taught to recognize signs of abuse and neglect and should be schooled in what steps should be taken for intervention and documentation of the abuse or neglect that was observed.

Definitions

Physicalabuse is the use of physical force that results in pain, injury, or impairment.

Sexual abuse is nonconsensual sexual contact of any kind.

Emotional or psychological abuse is inflicting anguish, pain, or distress from verbal or nonverbal acts.

Neglect is refusing or failing to fulfill one’s obligation or duty toward a person in one’s care.

Abandonment is desertion by someone who has the responsibility for providing care.

Financial or material exploitation is illegal or improper use of someone’s funds, property, or assets.

Signs of abuse or neglect:

• Bite marks, bruises, burns, or welts on the face or body
• Fractures or dislocations
• Unbelievable or inconsistent explanations for injuries
• Behavioral extremes, i.e. withdrawal, aggression, regression, depression
• Inappropriate or excessive fears
• Antisocial behavior, i.e. substance abuse, truancy, running away
• Unexplained crying or “zoning out”
• Exaggerated, startled response to touch
• Avoiding eye contact
• Eating disorders, speech disorders
• Poor hygiene, bedsores, severe diaper rash
• Untreated injury or illness
• Financial discrepancies

 Procedure:

1. If there is a potential for violence, staff should leave the home immediately.
2. When any of the above signs are observed during a client visit, it is important that the circumstances be reported immediately to the supervisor and the Director of Client Services.
3. It is necessary to notify the State’s Division of Adult or Child Protective Services if abuse is suspected.  Call the Department of Social Services in the county of the client’s residence.
4. Reporting abuse or neglect may save a victim’s life and is required by State Law.
5. It is urgent that agency staff document clearly and accurately any signs noted and actions taken.

3. Client’s right to voice disputes and grievances.

Every client has the right to file complaints. A complaint is defined as expressing dissatisfaction or concern about something. A concern can include one or more issues, which, if not addressed, can escalate into a complaint. Clients make complaints about the care they’re receiving to fix issues which are affecting their lives. A complaint can be made by anyone – the client, or the client’s family members, friends, representatives and advocates, as well as aged care staff, carers, health and medical professionals and volunteers.

Staff in health organizations need to maintain a balance between being neutral/objective and being personal. Tips for complaint handling:

1. Be confident in your ability to help.
2. Remain flexible – don’t be too rigid in your approach;
3. Communicate clearly – check if you’re being understood;
4. Know your limits – be willing to get help from someone else or pass the problem on to someone with more knowledge, time or authority;
5. Try to remain calm and think clearly;
6. Strike a balance between logic and emotion.

4. How to resolve complaints about treatment and care.

1. Assessment.
2. Information gathering (What happened?)
3. Resolution outcome. (Report back to consumer, staff, management).Refer to external organizations if necessary.
4. Implementation. (Quality improvement: system, staff training, etc.)

5. Personal Choice/ Independency.

• The patient/ client has the right to personal choice regarding private association, receive and refuse care , communication with other people. The patient/client may send and receive unopened mail unless medically contraindicated. The patient/client has access to stationery, postage and writing implements at their expense. The patient/client has the right to personal choice regarding participation in activities of social, religious, and community nature unless medically contraindicated. The patient/client may use clothing and possessions as space, unless to do so would infringe upon the rights of other patients/clients. The patient/client is not required to perform services for the facility/home that are not included for therapeutic purposes in his/her plan of care. The client has the right to choose a personal care worker.
• Professionals must actively promote independence to help patients/clients take control and to ensure they play a crucial part in the decisions made about their care.

Guidelines to support client’s independence, and assist client to participate in activities.

Personal Care Worker can help a client with everyday activities while supporting his/her independence and helping the client keep a sense of self-respect.

Why is helping clients with everyday activities so important?

Think about all of the little things you need to do each day. Just to start your day you must get out of bed, take care of your personal hygiene (bathe or shower, shampoo hair, brush teeth, etc.), pick out clothes, get dressed and get something to eat. As the day goes on there are many more activities that are so basic that most of us take them for granted. In completing most of these activities many little steps are involved. For example, getting out of bed requires that you are able to roll to the side of the bed, swing your legs over the edge of the bed, place your feet on the floor and stand.

Now think about what would happen if you couldn’t do these things any longer or had great difficulty in doing them. Like most people, you would find that life was getting more difficult and you might feel frustrated, helpless or vulnerable. For many people, a loss in the ability to do the simple daily things can make them feel badly about themselves and angry with the world around them. If the clients you serve have these kinds of feelings about everyday activities, you can be sure that the quality of their lives will not be as high as it could be. This is important because a major part of what you do as a personal home care agency staff person is aimed at helping people maintain or improve the quality of their lives.

Which activities are important?

Generally, the kinds of activities that are important to the people in a personal home care are organized into two groups:

• ADLs – This stands for Activities of Daily Living. These are the most basic activities necessary for daily life. They include the following:

1. Eating & drinking;
2. Ambulating – the ability to move about, such as walking with or without devices like canes, crutches, walkers, etc;
3. Transferring – the ability to get in and out of bed, a chair or on and off a toilet;
4. Taking medications;
5. Personal hygiene – bathing or showering, shampooing hair, brushing teeth;
6. Bladder & bowel management;
7. Positioning and changing positions in a chair or bed;
8. Dressing;
9. Securing health care;

• IADLs – This stands for Instrumental Activities of Daily Living. These activities are more complex and include:

1. Using the telephone.
2. Shopping.
3. Doing laundry.
4. Obtaining and keeping clean clothing appropriate for the season.
5. Making and keeping appointments.
6. Writing letters or other correspondence.
7. Taking part in social and leisure activities.
8. Using a prosthetic device – a substitute for a missing body part such as a hand or leg.
9. Managing finances.
10. Driving or arranging transportation.

As you can see, many activities are part of everyday life. For some of the people you serve, your help with ADLs and IADLs will have a great impact on their ability to participate in and enjoy life. For others, you will be the only way they are able to complete much of what they need to keep safe and healthy from day to day.

What causes changes in ADLs and IADLs?

Many things can cause a change in a resident’s ability to perform these basic activities. You will learn more about this in later modules. For right now, it is important to know four basic things about changes in ADLs and IADLs: 

1. Some clients have been unable to perform some activities for quite some time—maybe years. These clients have had a longer time to adjust to their loss. Many also know a great deal about how they like to be helped and have strong preferences. For example, Mr. Smith may like to brush his teeth before combing his hair, or he may like to get dressed by putting on clothes in a particular order, or eat, awake or go to bed at a certain time. Wherever possible, it is important to honor these preferences.
2. Other clients have experienced a recent loss of ability. This means that they have had less time to adjust to their losses and may still be learning about how they can best receive help. In some cases, the client is also trying to adjust to the fact that they may never recover the ability they’ve lost. Some clients have a high ability to adjust to their loss. Others find it more difficult and may display sadness, anger or frustration. In these cases, it is important to know that the angry things a client may say is probably not directed at you, but is really anger at the loss. To overcome and adjust to loss inability, it is often helpful that clients have a strong sense that they can still have some control in their everyday lives. For this reason, it is important to involve clients in choosing how activities will be completed. It is important to encourage them to do as much as they can do on their own.
3. It is likely that a number of clients with whom you work will have experienced loss in the ways their brains function and are unable to remember, solve problems or even be fully aware of what is taking place around them. For some of these individuals, each time you interact with them is like the first. So your patience and understanding are critical elements of being a caring worker. You must accept and honor that their experiences are real for them. You can also provide hints and suggestions for these clients. For example, Mr. Jackson forgets to bring a jacket when going outside in cold weather. You can give him a cue by saying, “Mr. Jones, the weatherman says it is cold outside today. I’m going to get my jacket. Would you like me to get yours?”
4. Finally, some clients will be experiencing a temporary loss in their mental or physical abilities from which they will eventually recover. This loss may be due to mental illness, an injury or the process of recovering from something like surgery. These clients will not have the same sense of having to make permanent adjustments in how they do things. So, it is not unusual for them to be impatient with the recovery process. Once again, patience and understanding on your part are important tools to use when you interact with these clients. Additionally, they may need encouragement to do as much as possible as part of their recovery. You should always check their support plan to see how you can best assist.

Four general helping rules:

1. The support plan is the starting place for knowing what kind of help is needed by each client. The support plan is the tool that provides the basic information for how you will care for a client. Each support plan should give a clear picture of the client’s needs and preferences. Always make sure you read and understand the support plan for each client you serve.
2. When you are unsure about preferences or if help is needed, ask. Sometimes you will observe a client struggling with a task, or even after having read the support plan, you may not be sure of the client’s needs or preferences. While your immediate impulse might be to simply start helping, it is better to ask first. If you have a client who cannot understand or respond to your questions, try to find out from family members or others who know about the client’s preferences and remember to record this information in the support plan so it is available to all staff. (In some personal home care services, the appropriate procedure is to ask your supervisor to record information in the support plan.)
3. Try to use a “person-centered” approach. A “person-centered” approach involves respecting and honoring the uniqueness of each person and respecting that person’s right to be involved in all decisions that impact his/her life. These include the little decisions about how ADLs and IADLs are accomplished with your help.
4. If you believe the client is in immediate danger of injury, move to help right away. For example, if a client has fallen asleep and is about to fall out of a chair, move to help reposition him/her immediately.
5. Many of the tasks with which you will help clients have been studied and analyzed to find safe, respectful and effective ways for you to assist the client.