2. 10 AREAS FOR ALL PCAs/HHAs
• Patient Bill of Rights & Responsibilities
• Patient Confidentiality
• Professionalism
• Infection Control & Hand washing / Personal Protective Equipment (PPE)
• Observing & Reporting
• Elder Abuse
• Patient Binder
• Medications
• What is Light Housekeeping?
• Doctor’s Appointments
3. PATIENT BILL OF RIGHTS & RESPONSIBILITIES
All Patients have RIGHTS that are protected by Federal and State Law
1. Right to receive competent, individualized care & service from Home Instead Senior Care
staff regardless of age, race, color, national origin, religion, sex, disease, disability.
2. Right to be treated with dignity, courtesy, consideration, respect and have your property
treated with respect.
3. Right to be informed of any changes in the Plan of Care, and to be included in the planning
of care before treatment begins.
4. Right to refuse care and treatment and to initiate an Advance Directive, “Living Will”,
durable power of attorney.
5. Right to express complaints about the care and services provided and to expect Home
Instead Senior Care to investigate such complaints within 15 days
6. Right to privacy, including confidential treatment of records
4. PATIENT BILL OF RIGHTS & RESPONSIBILITIES
MAKE YOUR PATIENT AN ACTIVE PART OF THE PLAN OF CARE.
IT’S THEIR RIGHT!
1. Greet them VERY enthusiastically
2. Talk to them throughout the day
3. Review the Plan of Care with them by involving them enthusiastically (“Mr Jones, we have
a fun day ahead of us, why not start out with a big breakfast and then we can wash up”).
This will not only involve the client but also see if he is in agreement. Mr Jones has the
right to be informed of his care and the right to refuse it. Talking to the client in this
fashion allows for both of these to be addressed
6. PATIENT CONFIDENTIALITY (HIPAA LAWS)
Basic Rule: do not talk to anyone about your
Patient unless that person is directly related to
caring for your Patient.
Did you know?
• Violations of Patient Confidentiality laws are
taken very serious
• Most people who are fired for violations of
Patient Confidentiality laws had no idea they
were doing anything wrong
• Home Instead Senior Care punishes violations
of Patient Confidentiality laws by immediate
termination
7. PATIENT CONFIDENTIALITY - EDUCATE
YOURSELF
Question: how do I protect myself, my Patient and my agency so I do not violate the
Patient Confidentiality laws?
Answer: Educate yourself. The following few slides will educate you so you identify the
typical situations where violations take place so you can avoid them at all costs. As
always, call the office when you have a question.
8. PATIENT CONFIDENTIALITY
Who can I talk to about my Patient’s condition?
1. Home Instead Senior Care Office Staff and colleagues that also work with your
Patient
2. The Patient’s Doctors and Healthcare Professionals
3. The Patient’s Immediate Family (unless the Patient does not want you to talk to them)
4. Anyone that the Patient authorizes you to talk to
9. PATIENT CONFIDENTIALITY
WHO CAN I NOT TALK TO REGARDING MY PATIENT’S CONDITION?
Unless the Patient authorizes you, you cannot talk to anyone else, including:
- The Patient’s Neighbors
- The doorman
- The Patient’s Friends who are not directly related to the Patient’s Care
- The Patient’s Distant Family
- The Patient’s Accountant
10. PATIENT CONFIDENTIALITY
Question often raised: How to I tell someone that I cannot share information with them
without being rude?
Answer: “Thanks for asking. Everything is just fine” is usually enough to tell someone that
you are being polite and cannot share any meaningful information I am so sorry, I
cannot share that information. You’ll have to ask the Patient’s family. I hope you don’t
mind”.
11. PATIENT CONFIDENTIALITY LAWS -
TYPICAL VIOLATION
Scenario: the doorman (who has known Mrs Jones for 35 years) asks you “So ______, how
is Mrs Jones doing?”
Answer: “Thanks for asking. Everything is just fine”
Answer if they insist: “I am so sorry, I cannot share that information. You’ll have to ask
Mrs Jones or her family. I really hope you don’t mind.”
12. PATIENT CONFIDENTIALITY LAWS -
TYPICAL VIOLATION
Scenario: you are at the Patient’s home and the telephone rings and the Patient’s friend
asks you “Hi, __________, how is Mrs Franklin is doing?”
Answer: “Who is this? Thanks for asking. Everything is just fine”
Answer if they insist: “I am so sorry, I cannot share that information. You’ll have to ask
Mrs Franklin herself or her family. Can I have them get back to you? I hope you don’t
mind.”
13. PROFESSIONALISM - AMBASSADORS
As Home Instead CAREgivers we are ambassadors of this international
organization, we are ambassadors of the company and are under constant
observation and scrutiny.
14. PROFESSIONALISM
How do we define professional behavior for a caregiver?
• Be compassionate and empathetic at all times
• Never lose your patience
• Never raise your voice
• Never argue with people
• Always be dressed and groomed appropriately
• Never use your cell phone for personal use or talk about personal issues
Who do you need to be professional with?
• Patient
• Patient’s family, friends and neighbors
• Patient’s hired help (housekeepers, private aides, doormen, etc)
• Fellow CAREGivers
• Home Instead Senior Care office staff
• Anyone you deal with while you are on the case
15. PROFESSIONALISM – DRESS CODE
• Bottom line: you need to look clean,
appropriate and boring!
• Unless you are told otherwise, we are all
required to have a nurses aide uniform (aka
“scrubs”)
• Your ID Badge must be worn at all times
• Always be clean (showered, deodorant, clean
teeth, clean and combed hair; clean and
short nails)
• No jewelry beyond a watch and necklace
under your shirt
• Light perfume and light makeup in very small
amounts are acceptable
• Shoes must be worn at all times in the
client's home. Sandals are not permitted.
16. PROFESSIONALISM – CONVERSATIONS
WITH THE PATIENT AND THEIR FAMILY
AREAS APPROPRIATE INAPPROPRIATE
Your Family Size of your family, where they
live, etc
Engage in critical discussion, talking
about death, hardships or any
dysfunctionality in family
Patient’s family Size of their family, where
they live, etc
Engage in critical discussion, talking
about death, hardships or
dysfunctionality
Religion That you are of a certain faith
and that you attend services
-Preaching your religion
-Discussing sensitive religious topics
-Criticizing any religious belief(s)
Personal
Relationships
Names, nature of relationship Disenchantments, disappointments;
incidents of betrayal, or abuse
Your Future
Aspirations
Nature of your future
aspirations (school, open a
business, become a singer)
Imminent issues regarding such
aspirations that could affect the care
we give clients
Health Importance of your health,
examples of healthy actions we
take
Health problems; details of
operations, etc
17. PROFESSIONALISM – PROFESSIONAL DISTANCE
• Do not give your Patient your cell phone #
• Do not give your Patient your home phone #
• Do not bring any family or friends to your
Patient’s home
• Do not meet up with any family or friends
during your shift
• Do not involve yourself in giving personal advice
• Do not involve yourself in asking for or
receiving personal advice
• Do not engage in conversations that is of a
gossipy nature
18. INFECTION CONTROL/ HANDWASHING – WHEN?
HOW OFTEN AND WHEN YOU ARE EXPECTED TO WASH
•Arriving to the client’s home (both when you arrive to your shift as well as when
you re-enter after going for a walk, shopping, errands, etc)
•After using the toilet
•Before and after meal preparation
•Before and after assisting with Personal Care (even if you are wearing gloves)
•After coughing or sneezing into your hand
•Any other time you feel your hands have been soiled
•Before leaving the client’s home at the end of your shift
21. PERSONAL PROTECTIVE EQUIPMENT (PPE)
What is Personal Protective Equipment (PPE)? Gloves, Goggles, Aprons, Masks, etc (meant to protect you
against disease)
Why do we need to use it? For your protection, your Patient’s protection and because it is mandated under
law
When do need to use it?
SITUATION PPE THAT
YOU MUST
USE
You are assisting someone with personal care –
toileting
Disposable
Gloves
You are assisting someone with personal care –
bathing
Disposable
Gloves
You are helping someone and there is blood (or a
wound) exposed
Disposable
Gloves
You are helping someone and there is feces (or other
bodily fluid) exposed
Disposable
Gloves
You are helping someone who has a disease that can
transmit a bloodborne disease (HIV, Hepatitis)
through splashing of blood or other bodily fluids.
You will never be placed on an assignment like this if
you do not want to.
Disposable
Gloves,
Goggles,
Masks and
Aprons
22. OBSERVING AND REPORTING
Question: what is Observing and Reporting?
Answer: it is one of the most critical aspects of our jobs as
Personal Care Aides, Home Health Aides and Certified Nursing
Assistants
24. OBSERVING AND REPORTING – TYPICAL
SITUATIONS AND HOW TO DEAL WITH THEM
SITUATION DO I REPORT TO
OFFICE?
WHEN? DO I REPORT TO
OTHER CAREGIVER?
Patient is bored one day No Never Yes
Patient has fever Yes Immediately Always
Patient is unhappy with the political situation No Never Never
Patient fell Yes Immediately Always
Patient is having trouble breathing, chest pain, bleeding, loss of
consciousness
Yes First call 911 then office Always
Patient is not eating as much as normal Yes At the end of the shift Always
Patient has Pain (headache, chest pain, stomach ache) Yes Immediately Always
Patient is dizzy or disoriented? Yes Immediately Always
Patient is becoming verbally or physically abusive or combative Yes Immediately Always
Patient is weak Yes Immediately Always
Patient is coughing/ wheezing/ wet cough Yes Immediately Always
Patient is refusing to take medications Yes Immediately Always
Patient is not having bowel movements or is constipated Yes At the end of the shift Always
Patient has skin irritation Yes Immediately Always
Patient is having trouble sleeping Yes Immediately Always
Patient has diarrhea Yes Immediately Always
Patient’s urine has odor or different color Yes Immediately Always
25. OBSERVING AND REPORTING - WHEN
Question: at least how many times per shift should you be observing and
reporting?
(1) Upon Arrival: you want to ask the Patient how they are doing. If there is a
family caregiver or a fellow Personal Care Aide, you want to ask how they are
doing?
(2) Throughout the entire shift
(3) Before Leaving: this entail asking the Patient how they are doing, checking
for fever, discomfort, pain, calling the agency nurse and of course, share this
information with any caregiver that is relieving you
26. OBSERVING AND REPORTING – WHAT DO I DO?
Question: I arrived at the Patient’s home and noticed a scratch on her arm/ or a
bruise on her face/ or she had fever and the previous caregiver told me that
the Patient has had this for many days and that this is normal and not to
worry or report it. Do I need to report it to the office?
Answer: Absolutely. Unless you want someone to think that this happened during
your watch, you need to report this immediately. This is not snitching. This
simply means that you are not assuming that we in the office knew that this
took place before your shift commenced
27. OBSERVING AND REPORTING – WHAT DO I DO?
Question: what do I do if the caregiver I am relieving does not communicate
effectively with me as to how the Patient is doing?
Answer: you need to call the office immediately. If you cannot rely on effective
communication from the previous caregiver, you are not able to effectively
care for your Patient. Therefore, you must call the office. It is your
responsibility to inform us. This is not snitching. This is doing your job. If
there is something that you should have known and you are not aware of
because the previous caregiver did not tell you, it falls on your responsibility
for not having reported to the office that the previous caregiver did not
communicate with you. Remember that you do not want any inference that
something happened to the Patient on your watch when in fact it happened on
the previous person’s watch
28. OBSERVING AND REPORTING – – WHAT DO I
DO?
WHAT DO I DO?
• My Patient Falls
• My Patient tells me they are fine
• I observe it is not an emergency
• I observe a small scrape and minor discomfort, no pain
• I observe for no blood, no scar, no marks
• It looks like they are fine
• As discussed in previous section, I need to inform the office
• As I am about to, my Patients asks me, begs me, orders you, to NOT tell
anyone
• They mention that under the Patient Bill of Rights and Privacy laws, they
can ask me to not tell anyone
• They even tell me that if you tell the office or their family that I will be
fired
WHAT DO I DO?
• Acknowledge their right to privacy
• Call the office after the shift or excuse yourself
• If it seems like an emergency, you must call the agency
• This is not easy for you
29. OBSERVING AND REPORTING – CALLING 911
BEFORE CALLING 911
• Call from the Patient’s home, not from your cell phone (they can identify the address)
• If possible, before calling 911, grab the Patient Binder that contains important Medical
History, Medications, Contacts
• If possible, before calling 911, call the office and let us know you are calling 911 so that we
can contact the Patient’s family while you are on the phone with 911
CALLING 911
• Explain to them that you are the Personal Care Aide
• Explain the situation
• Offer to give them any information from the Patient Binder (address, medical history,
medications, etc)
• They will likely ask you questions as to what happened
• Answer calmly and honestly
• Ask them if they recommend that you do anything before the paramedics arrive (CPR)
• If you did not have the opportunity to call the HISC office, ask the 911 dispatcher if you
or they can call us so that we can contact the family
• Relax, breath easy and allow the 911 dispatcher to guide you through the process
WHEN THE PARAMEDICS ARRIVE
• Present them with the Patient Binder and let them know you want to accompany the
Patient wherever they decide to take them
• Call the office again and keep us informed
• Get your belongings and the Patient’s personal belongings so they are comfortable in the
hospital (including their keys and a change of clothing for the Patient)
• Always accompany your Patient in the ambulance
30. ELDER ABUSE - FACTS
Did you know that:
• New York State has one of the highest rates of elder
abuse incidents.
• Most people who get fired or prosecuted for elder
abuse do not believe they were engaging in elder abuse
• Most people who are committing elder abuse don’t even
realize it
• Over 50% of Manhattan seniors have hidden cameras in
their homes
• Home Instead Senior Care reports any and all
situations of elder abuse immediately to the NYPD and
the Attorney General
31. ELDER ABUSE - FACTS
Did you know that:
• New York State has one of the highest rates of elder
abuse incidents.
• Most people who get fired or prosecuted for elder
abuse do not believe they were engaging in elder abuse
• Most people who are committing elder abuse don’t even
realize it
• Over 50% of Manhattan seniors have hidden cameras in
their homes
• Home Instead Senior Care reports any and all
situations of elder abuse immediately to the NYPD and
the Attorney General
32. ELDER ABUSE - EDUCATE YOURSELF
Question: how do we protect ourselves so I do not violate Elder Abuse laws?
Answer: Education. Learn the typical situations where violations take place and avoid them
at all costs. Call the office when you have a question.
33. TYPICAL VIOLATION – RAISING YOUR
VOICE TO A SENIOR
“I raised my voice because my Patient is hard of hearing”
or
“I wasn’t yelling at my Patient, I was trying to get them to
hear me”
CONCLUSION: AVOID RAISING YOUR VOICE
TO A SENIOR
34. TYPICAL VIOLATION – MRS SMITH
“I was using TOUGH LOVE”
THIS IS THE #1 EXCUSE THAT VIOLATORS OF ELDER ABUSE LAWS USE WHEN
QUESTIONED. DO NOT MAKE THIS MISTAKE. IF YOU DO ANYTHING THAT IS
VIEWED AS TOUGH LOVE
35. LESSON: DON’T DO ANYTHING THAT MAY
BE VIEWED AS ELDER ABUSE
50% OF MANHATTAN FAMILIES HAVE HIDDEN CAMERAS
DO NOT DO ANYTHING THAT YOU WOULD NOT WANT TO SHOW UP ON A HIDDEN CAMERA.
Facts
• It is 100% Legal
• Many people go to jail as a result of things that come up on these videos
• We support the use of this
• Do not do anything you would not want to be seen on camera!
36. Every Senior is Special
“Mrs Jones” “Jody”
“Jessica and
Frank”
The Patient Binder (or Client Binder)
will answer the vast majority of the
questions you will have!
37. PATIENT BINDER – 4 SECTIONS
CLIENT’S NAME
PRIVATE &
CONFIDENTIAL
400 East 56th Street
Professional Wing, Suite 2
New York, NY 10022
212-614-8057
FIRST SECTION
KEY INFORMATION
Address
Date of Birth
Diagnosis
Prognosis
Medical History
Insurance Info
Height
Weight
SECOND SECTION
CONTACT INFO
Family
Doctors
Specialists
Lawyer
Accountant
Emergency
Contacts
THIRD SECTION
PLAN OF CARE
What to do
From Time
You get in
Until you
Leave
FOURTH SECTION
MEDICATIONS
List of Meds
Where the
Meds can be
Found
How much
When
etc
38. PLAN OF CARE – 7 SECTIONS, 2-3
PAGES
Section I: Beginning of Shift
• Hand washing
• Clock In
• Observe and Report
• Review Plan of Care
Section II: Personal Care/ Assistance
• Bathing
• Toileting
• Visual and Hearing Limitations
• Oral Care
• Skin Care
• Dressing
• Ambulation/ Walking
• Transferring
39. PLAN OF CARE – 7 SECTIONS, 2-3
PAGES
Section III: Meals and Medications
• Dietary Restrictions
• Fluid restrictions
• Food Allergies
• Typical Breakfast
• Typical Lunch
• Typical Dinner
• There food is purchased
• Medications - where they can be found
• Medications - whether we need to remind or assist
Section IV: Light Housekeeping and Errands
Section V: Other Activities
• Other things to look out for
• Social activities
40. PLAN OF CARE – 7 SECTIONS, 2-3
PAGES
Section VI: Overnight Activities
• Lotion
• Repositioning
• Bed Rail
• CPAP Machine
• 2 way baby monitor
Section VII: End of Shift
• Review Plan of Care to see all was completed
• Observations & Reporting (ask, look)
• Hand washing
• Clock Out (If another caregiver is coming, wait until
they arrive)
• Call Plan of Care Review hotline
• Say Goodbye!
41. PLAN OF CARE – CERTAIN SECTIONS -
BATHING
Level of Independence: Some seniors are 100% independent, others
need only supervision, others need some assistance, some need full
assistance
Equipment: Some seniors use a shower chair, some use a transfer
bench, some use grip bars that are installed in the shower. Some
seniors have a tub shower, some have a walk in shower
Mistakes: if you are not aware of your Patient’s bathing needs, they
can remain dirty, fall down, result in bodily injury etc
How do I know which to do for my patient? Read the Plan of Care or
call the office. Do not assume.
42. PLAN OF CARE – CERTAIN SECTIONS -
TOILETING
Level of Independence: Some seniors are 100% independent, others
need only supervision, others need some assistance, some need full
assistance
Equipment: Some seniors use a commode, some seniors use diapers,
some seniors use pull ups, some seniors use a regular toilet, some
seniors use a toilet with a toilet seat
Mistakes: if you are not aware of your Patient’s toileting needs, they
can be soiled, get skin breakdown, bed sores, etc
How do I know which to do for my patient? Read the Plan of Care or
call the office. Do not assume.
43. PLAN OF CARE – CERTAIN SECTIONS -
VISUAL LIMITATIONS
Visual Limitations: Some seniors are blind, some are legally blind, some
seniors have macular degeneration/ glaucoma, others are near sighted,
others are far sighted, some have perfect visions
Equipment: Some seniors use reading glasses, some use contact lenses,
some use glasses all the time
Mistakes: if you are not aware of your Patient’s visual limitations, they
can run into things, fall and get very hurt
How do I know which to do for my patient? Read the Plan of Care or
call the office. Do not assume.
44. PLAN OF CARE – CERTAIN SECTIONS -
HEARING LIMITATIONS
Hearing Limitations: Some seniors are deaf, hearing impaired, some
have perfect hearing
Equipment: Some seniors use reading hearing aides, some do not
hearing aides
Mistakes: if you are not aware of your Patient’s hearing limitations,
they can lose out on hearing important things, they can lose expensive
hearing aides
How do I know which to do for my patient? Read the Plan of Care or
call the office. Do not assume.
45. PLAN OF CARE – CERTAIN SECTIONS -
ORAL CARE
Dentures: Some seniors use dentures (upper, lower or both)
Mistakes: if you are not aware that your patient has dentures, you may
forget to remove them, clean them and care for them
How do I know which to do for my patient? Read the Plan of Care or
call the office. Do not assume.
46. PLAN OF CARE – CERTAIN SECTIONS -
AMBULATION/ WALKING
Limitations: Some seniors can walk 100% independently, some need to use
devices, some need to be held onto by the arm
Equipment: Some seniors do not need any equipment, some use wheelchairs,
some use walkers, some use rolling walkers, some use canes
Mistakes: if you are not aware of your Patient’s ambulatory limitations and
what equipment they use, your Patient can fall and result in major bodily harm
How do I know which to do for my patient? Read the Plan of Care or call the
office. Do not make assumptions.
47. PLAN OF CARE – CERTAIN SECTIONS -
TRANSFERRING
Limitations: Some seniors can transfer 100% independently, some need to use
devices, some need basic assistance.
Equipment: Some seniors do not need any equipment, some use hoyer lifts, some
use gait belts, some transfer by the pivot transfer techniques you were tested
on
Mistakes: if you are not aware of your Patient’s transferring limitations and
equipment they use, your Patient can fall and result in major bodily harm
How do I know which to do for my patient? Read the Plan of Care or call the
office. Do not make assumptions.
48. PLAN OF CARE – CERTAIN SECTIONS -
MEAL PREPARATION
Limitations: Some seniors can eat anything, some have major dietary
restrictions, some need to be on liquid diets, some need to be fed
Equipment: Some seniors do not need any equipment, some need to have their
food blended, some need to have their liquids thickened, some need to be fed
manually because they can no longer feed themselves
Mistakes: if you are not aware of your Patient’s transferring limitations, your
Patient can choke, aspirate their food and result in pneumonia and death
How do I know which to do for my patient? Read the Plan of Care or call the
office. Do not make assumptions.
49. PLAN OF CARE – CERTAIN SECTIONS -
OVERNIGHT
Limitations: Some seniors can sleep through the night, some get up a few times and
need basic assistance, some need to be repositioned every 2 hours, some need to
have their bed rails up, some need to have a baby monitor turned on before sleep
Equipment: Some seniors need bed rails up, some need baby monitors, some need an
alternating pressure pad to be turned on
Mistakes: if you are not aware of your Patient’s overnight needs, your Patient can
develop horrible bed sores, fall out of their bed and result in bodily injury or death
How do I know which to do for my patient? Read the Plan of Care or call the
office. Do not make assumptions.
50. PLAN OF CARE – CERTAIN SECTIONS -
MEDICATIONS
Pill boxes vs Pill Organizers: Some seniors need no medication reminders, some
take their medications taken directly from pill bottles, others from pill organizers
Specific Instructions: Some seniors need their medications crushed, some need
them taken with water, some need them taken with food, some need them given
with apple sauce, some need to have no access to their medications, some can
Mistakes: if you are not aware of your Patient’s medication needs, your Patient may
not receive crucial medication or may take too much, which can result in sickness or
even death
How do I know which to do for my patient? Read the Plan of Care or call the
office. Do not make any assumptions!
51. PLAN OF CARE AND TIME
MANAGEMENT
Arrival:
• Hand washing
• Clock In
• Review Plan of Care
• Observe and Report
Duration of the Shift: determine how much time is available and see to it to
accomplish those items on the Plan of Care during that time
End of Shift:
• Review Plan of Care
• Observe and Report
• Clock Out
• Call the Plan of Care Review Hotline
• Hand washing
53. MEDICATIONS – 2 WAYS SENIORS TAKE
MEDICATIONS
Method #1: Directly from
the Pill Bottles
Method #2: From Pill
Organizers
54. MEDICATIONS AND THE LAW: YOU CANNOT
DISPENSE OR ADMINISTER MEDICATION
You cannot administer
medications
You cannot put pills in a
pill organizer
Only a Registered Nurse
can put pills in a pill
organizer
Only a Registered Nurse
can administer
medications
55. MEDICATIONS AND THE LAW: YOU CAN
REMIND OR ASSIST
You can assist a
Patient in
reading
Patient name,
medication,
route, dosage
If it matches,
you can give
and open the
pill bottle to
the Patient
You can assist a
Patient take a
Pill Organizer
and choose the
right time and
day
56. MEDICATIONS AND THE LAW: YOU CAN
REMIND OR ASSIST
We can deliver prescriptions
to the Pharmacy!
We can pick up filled
prescriptions when they are
ready from the Pharmacy!
57. MEDICATIONS AND THE PLAN OF CARE
Plan of Care will say if Patient
uses Pill Organizer or Pill
Bottles
Plan of Care will say if Patient
needs a reminder or if they
are self directing
Patient is Self Directing/ Needs no Reminders
Patient Needs reminders/ assistance
58. PILL ORGANIZERS
3 Types of Pill Organizers
• 4 times a day (Morning, Noon, Evening and Bed)
• 1 time a day
• 2 times a day (Daytime and Nighttime)
59. PILL ORGANIZER - EXAMPLE
• It is Thursday 7pm and the Patient is
ready to go to bed
• Go to Thursday
• Go to Time of Day that corresponds for
today
• See if the previous box was taken
• Remind or Assist Patient to take the
medication (depends on Plan of Care)
60. PILL ORGANIZERS – WEEK LABELS
Week A: the 1st
week of the 4 week cycle
Week B: the 2nd week of the 4 week cycle
Week C: the 3rd week of the 4 week cycle
Week D: the 4th week of the 4 week cycle
61. PILL ORGANIZERS – SUNDAY RULE
VERY SIMPLE – EVERY SUNDAY, USE A
NEW TRAY/ ORGANIZER
62. MEDICATIONS AND THE LAW: YOU CANNOT
DISPENSE OR ADMINISTER MEDICATION
You cannot administer “finger
sticks” to measure blood sugar
You cannot touch insulin, measure
insulin, you cannot inject insulin
(or anything)
Only an Licensed Practical Nurse (LPN) or Registered
Nurse (RN) can do this
63. What is Light Housekeeping? The following is
considered appropriate in home care
Cleaning
Sinks
Cleaning
Toilets
Dusting
Dishes Making
bed
Vacuuming Laundry
Throwing out garbage
64. When am I doing more than just
“Light Housekeeping”?
Question to ask: are you spending more than 20% of any given day
doing housekeeping?
Yes, more than 20% of my
days are spent doing
housekeeping. If you are
spending more than 20% of any
given day doing housekeeping, call
the office and we will see to it
that this is changed so that you
are not working outside the
scope of our services
No, more than 20% of my days
is NOT spent doing
housekeeping. If you are
spending less than 20% of any
given day doing housekeeping,
then what you are doing is within
the scope of our services
65. What Light Housekeeping IS NOT!
We are not here to clean drapes and
windows We are not here to clean apartments and
messes
66. DOCTOR’S APPOINTMENTS –
#1 - WHAT TO DO BEFORE
• Help Client Remember appointment and
confirm it.
• Call our office to see if we need to
discuss or present something to the
doctor
• Dress yourself nicely (hair, scrubs, ID)
• Dress the client nicely (bath, groom,
clothing)
67. DOCTOR’S APPOINTMENTS –
#2 - WHAT TO DO WHEN YOU ARE
THERE
• Prescriptions for new medications (we
need it by fax and to update our files)
• Refills
• Discussion between Agency Nurse and
Doctor
68. DOCTOR’S APPOINTMENTS –
#3 - WHAT TO DO AFTERWARDS
Please call office to discuss
- New Prescriptions
- Any recommendations
- Any follow up appointments
We need to communicate these things to
family members
We are going to review 10 crucial areas of Patient Care that are very important for all Personal Care Aides. Please pay careful attention since you will be tested in all of these areas right after this presentation. More importantly, on a daily basis, you will be required to perform these tasks to the best of your ability! Every year we will require you to review these areas. The areas are as follows:
AT THE END, SAY: Let me give you an everyday application of violations of the Patient Bill of Rights. Your Patient Mr Jones woke up and soiled himself and his bed. Your clear assumption is that Mr Jones wants and needs to be cleaned. You realize that Mr Jones has a doctor’s appointment soon and time is of the essence and so your instinct is to immediately start cleaning the bed, Mr Jones and to get them ready and out the door. Well, the Mr Jones' BORR requires that you make them aware of what you are doing, make them a part of it and give them the right to participate or refuse. Instead of rushing Mr Jones, I would first (as always) Greet Mr Jones with a big sile and say “Good morning Mr Jones, how are you today?”. I would then say “Mr Jones, are you aware that we have an appointment to get to in 1 hour?” Assuming they say Yes, I would follow by saying “Mr Jones, are you aware that before we go, we will need to eat breakfast, take your medications, shower and tidy up the room?” Assuming he says Yes, I would follow by saying “Do you mind if I start immediately?”. The likelihood of Mr Jones agreeing to all of the above is really high and the chances of Mr Jones appreciating your professional demeanor and unwaivering respect for his rights are even higher and to think, it only took you an extra minute or 2. Let’s say Mr Jones refuses to get up, to take his medication, to go to the doctor. How do we handle this? Well, first of all, you need to know that this is within his Patient Bill of Rights since he has the right to refuse care. However, there are consequences to these actions but you are not to take any action above and beyond reporting this to the office immediately. So let’s say Mr Jones tells you that he is under no circumstances going to get up, to take his medication, to go to the doctor etc. What do you do? First and foremost, treat your Patient with respect and say “I understand Mr Jones, no problem”. Give Mr Jones some space, do not confront him. Wait some time and try again. If it persists, call the office (but not in the presence of Mr Jones) and we will take care of the situation. You are never to involve yourself in confronting the Patient. If there is something that needs be communicated, that will come from us or Mr Jones doctors
Have you ever heard the term HIPAA? HIPAA stands for the Health Insurance Portability and Accountability Act (HIPAA). You are not required to know all those words but you do need to know what Patient Confidentiality is all about. Let’s review the history. What was happening was that health care professionals were talking about their patients with people who had nothing to do with the Patient’s care. The government felt that this was a complete violation of the Patient’s privacy. Let me ask you. If you were sick and your friend Jane came to your house to help you, would you want Jane to talk about you and your condition to your neighbor? To the doorman of the building you live in? to a nosy friend of yours? You probably wouldn’t accept that from your friend Jane. Imagine if that was someone you hired? Sounds unacceptable? Well, it happens every day and it is illegal under federal law and state law and many people are losing their certifications and their ability to work as a result. Let’s explore this further. [read the Q & A above]
Never assume that your Patient wants his or her friends or family to know about health related issues. Many people are private. Many people have pride and do not want their friends and family to know what is going on. Other people have legal reasons why they do not want to share this type of information with people. Do not assume. Their reasons are irrelevant. If you have to assume something, assume that your Patient does not want anyone to know anything [READ ABOVE]
One of the typical excuses that caregivers make when fired for violating these laws is “Oh, I assumed that the Patient would want these people to know”. Once again, I am telling you now to assume the exact opposite. Let’s review a few specific people to avoid sharing information with
I realize that you may feel rude and that you do not want to get in the middle of this. If they have a right to know, then the Patient will tell them or will tell you to share information with them
Violation of the law will result in immediate termination. You need to make a decision as to what is more important. However, if you feel like you offended someone by telling them that you cannot share information with them, call us at the office immediately and we will call them and explain to them the situation. This way they will feel that you acknowledged their feelings.
Let’s go over a few scenarios you may encounter.
If you say this in a polite way, you will not offend anyone
Let’s do 1 llast example and I think you will get the picture…….
Accordingly, we expect the highest standards of professionalism whenever you are working with a client of ours or if you are in a situation whereby you can be identified as one of our employees. It is so easy to forget this since you may be working day after day with difficult Patients, difficult family members, difficult co-workers. We understand this completely. We understand that it is often times difficult to maintain your composure. However, we do expect you to always endeavor your best to represent the company well
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Is there a dress code? Absolutely! Let’s review it
Conversing with your Patient is not only allowed but highly encouraged. Meaningful conversations go to the heart of companionship. This is the same in our personal relationships. However, please note that the relationship with your Patient is not a personal relationship. Many people say that we are like family to them. Although this is endearing and beautiful to hear, you must remember that we are not family. We are hired to create comfort, support and stability. As a result, there are many conversations that although may be appropriate with family and friends, they are NOT appropriate with your Patients. Please pay careful attention to just a few examples so you understand where to draw the line. END: appropriate conversations go to the heart of companionship, inappropriate conversations create anxiety and go to the heart of unprofessional conduct. The line can be crossed very easily. Make sure that you do not.
BEGINNING: Maintaining Professional Distance with your Patient is very important. It will not only preserve your relationship with your Patient, but it will enhance it. Here are a few things to remember: read verbatim END: Remember, these things are meant to preserve and enhance your relationship with your Patient, not place limitations on it.
[READ TITLE] Later on, in the Skills Testing portion, we will review how to wash your hands and sanitize your hands. In this section, we will review those basics and review how often and when you are expected to wash: [Read the entire slide]
[READ TITLE] Later on, in the Skills Testing portion, we will review how to wash your hands and sanitize your hands. In this section, we will review those basics and review how often and when you are expected to wash: [Read the entire slide]
[READ TITLE] Later on, in the Skills Testing portion, we will review how to wash your hands and sanitize your hands. In this section, we will review those basics and review how often and when you are expected to wash: [Read the entire slide]
Read the entire slide. END: It is our responsibility to make sure there are gloves in the Patient’s home. If there are ever any missing, please call us immediately and we will make sure to have a box delivered immediately.
Many seniors get pneumonia, infections, strokes, heart attacks and other illnesses.
Many seniors fall and hurt themselves lightly
These incidents take the lives of many seniors every year
Most of these incidents can be detected and treated before they becomes serious
As PCAs, we are in the best position to detect this and save the lives of our Patients
We are also required to observe and report at all times under NYS law
As we have discussed throughout, if your Patient is in respiratory distress or is bleeding significantly or is in significant emotional distress or has lost consciousness, you immediately call 911 and the office
Those situations, let's be honest, are pretty easy to spot and do not require a lot of thought since they are so obvious
The tricky situations are the other less obvious ones. That is what we will spend some time reviewing
When most people are not feeling well, they observe this change in their health and consider seeing a doctor. The doctor then runs standard tests to see what is wrong and then treats them. Have you ever worked with a senior that refused seeing their doctor? I have worked with many like this. Have you ever worked with a senior that did not mind seeing a doctor but was just not very quick in observing that their health was deteriorating? I have worked with plenty like this. Last but not least, have you ever worked with a senior who saw that their health was deteriorating but did not know where to go or who to tell? I have worked with plenty.
The bottom line is that seeing a doctor is very important when a senior is not feeling well. We as PCAs, HHAs and CNAs are not responsible for making the decision as to whether or not the senior needs to see the doctor. Instead, we as PCAs, HHAs and CNAs are responsible for observing and reporting certain changes in the senior’s health to Francyne, our nurse. Francyne will then communicate everything to the appropriate health care professional (because she, is trained to do so, not you). That is the essence of Observing and Reporting. The next slide will detail those specific situations which are the typical warning signs that you need to look out for and to report them immediately to the office.
Lets go over TYPICAL SITUATIONS AND HOW TO DEAL WITH THEM
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The following scenario will present you with a very common situation. In this section we will try and explain to you what you are supposed to do. We realize that it is easier said than done. However, the law is clear and so we need for you to educate yourself so you do the right thing. Just remember that the Patient and their family depend on us to do the right. If they were 100% independent , they wouldn’t have hired us to help them. Remember that. Here is the situation
A few things to know about calling 911
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IF YOUR PATIENT CANNOT HEAR WELL, ENUNCIATE LOUD WITH A PROFESSIONAL DEMEANOR AND TONE AND MAKE SURE THEY SEE THAT YOU ARE DOING SO
ANYTHING ELSE IS CONSIDERED SHOUTING AND YELLING, BOTH OF WHICH ARE CONSIDERED VIOLATIONS OF THE ELDER ABUSE LAWS. MANY PERSONAL CARE AIDES ARE PROSECUTED FOR ELDER ABUSE FOR THINGS THEY FEEL WERE PART OF THEIR JOB. DO NOT MAKE THAT MISTAKE
In this hypothetical, you are having a very bad day and your Patient Mrs Smith cannot get up without assistance and is very scared to fall and begins to tremor and pull at you and yell at you and scream at you and call you names and say personal things and do things that you may feel are annoying, offensive and abusive. Unfortunately, this is not uncommon for seniors to do. After all, the aging process has impaired their social graces. Just as you would not judge someone who was diabetic, you should not judge Mrs Smith who is acting in a way that many Patients in our industry act. This is not the same as someone on the street doing those things to you. This is a senior citizen, this is your Patient. Your inclination may be to get annoyed and impatient. Your inclination may also be to yell or use force to get them to do what you need for them to do in order for you to do your job. Some people call this “Tough Love”. NYS law calls this elder abuse. Do not make that mistake. Be Patient. Take a breather. Call the office. Any shouting back, yelling, grabbing or even a harsh look may be considered elder abuse. Do not make this mistake. If you feel that you cannot accept the possibility of a senior saying or doing things that may otherwise offend you, maybe elder care is not the right field for you. However, no job is worth being treated poorly and without dignity. Therefore, you need to report anything the senior does of that nature to the office. Often times, the problem can be corrected by the doctor prescribing medication, by the office clarifying misunderstandings or simply by putting you on another case. We at the office will assist in that. Please do not feel like we will view your observation as a complaint. We are here to help you just as much as we are here to help our clients
Read above
UNFORTUNATELY, EVERY YEAR MANY PERSONAL CARE AIDES, HOME HEALTH AIDES GET ARRESTED AND SERVE TIME FOR THINGS THEY CLAIM THEY DIDN’T KNOW WAS A CRIME. THOSE PEOPLE CAN NO LONGER WORK IN THIS BEAUTIFUL FIELD OF SENIOR HEALTH CARE. MAKE SURE THAT YOU ARE NOT ONE OF THOSE PEOPLE
Every senior is special. Pls take a look at [Name each of them]. Pretend you are assigned to work with these 4 people. Which one has Alzheimers? which one has Parkinson? which one is diabetic? which one wears diapers? which one is deaf? which one takes their own medication and needs no assistance? which one is disoriented and needs assistance with medication reminders? which one is a fall risk? which one has dentures? which one has sleep apnea and needs to use a CPAP machine at night? which one has a bed sore and needs to be repositioned? Which one has their medications hidden above the refrigerator because they like to throw it out? Which one needs bathroom reminders every hour? Which one needs assistance in bathing? Which one is on a restricted diet? Which one needs are their food to be pureed? Which one is a night time wanderer and needs to make sure his or her caregiver is following him or her all night so they don’t leave the apartment? Which one thinks the year is 1975 and that they live in California? which one suffers from great depression? which one is bipolar and will love you one day and hate you the next day? which one recently suffered a death in their family and is very sensitive about certain subjects? which one is Polish and speaks little English? Well, looks can be deceiving and we are not mind readers. That is why it is SO important to be properly oriented on the facts about each senior BEFORE going to work with them. Our job in the office is to give you that information and your job is to make sure you ask for it and understand it. All this needs to be done before you walk in.
You can be the best Personal Care Aide, HHA, C.N.A, LPN, RN, NP, MD in the world. However, you are not a mind reader. Since all of you have years of experience working with the elderly, you know that every senior and their needs are different . You also know that you need to be properly oriented and advised as to the person’s medical history, diagnosis, the person’s emergency contact information, the person’s functional limitations, where their medications are, what level of assistance they need in terms of eating? Personal care? Shopping/ Errands? It isn’t fair to you to not know. It is not fair to the Patient to have someone who doesn’t know. The good news is that Francyne, our nurse, prior to sending you to this assignment, has done a full nursing assessment, has created a POC, all of which was approved by the Patient’s doctor. Therefore, we need to be properly orient you to each Client to all this and we do this thru the Client Binder. Every Client has one. Every Client has the following sections filled out. Therefore, the first thing you do on a daily basis is to look for the Binder (not just the first day, but every day) and get to work. If you cannot find the Binder or there are pages or sections missing, please call the office and we will help you get one immediately.
You can be the
Medications! With few exceptions, all seniors take medications. It is part of aging. Medication Management in home health is one of the areas where mistakes can lead to Patient intoxication, Patient death as well as the agency and the aides involved getting themselves into trouble. NYS law is very clear and very reasonable in terms of what can and cannot be done by Personal Care Aides and Home Health Aides like yourself. At HISC we take the laws very seriously and our clients depend on us to make sure we follow them. I am going to review with you in a few simple steps how to help your Patient with their medications while maintaining safety. As always, pay careful attention to educate yourself so you understand what you should and should not be doing. As always, if you have any questions, please ask them of the HISC staff as we are here to
There are 2 methods our clients take their medication. Method #1 (see the left) is to take them directly from the actual medication bottles and Method #2 is from Pill Organizers (like the type you can see to the right hand side of the monitor) that are labeled Sunday thru Saturday on the top and across the bottom will tell you Morning, Noon, Evening and Bedtime. When people have very few medications to take here and there, Method #1 is more common. When people have to take lots of medications, at different times of the day and sometimes different times of the week, the second method that you see off to the right is much easier and is usually prepared once every week or 2 weeks.
Please note that Personal Care Aides like yourself can engage and are required to engage in medication reminders and assistance, but NOT administration. For example, as you see off to the left hand side of the screen you cannot pick and choose and hand a senior their medication. Similarly, you cannot put pills in a pill organizer, the only person from HISC that can do that is our registered nurse can do that. In almost 20 years doing home health, I have seen dozens and dozens of seniors who have asked our aides to organize the pill organizers with medications. I completely understand the fact that they don’t want to do it. But remember, organizing pill organizers (as you see on the right) is for a Registered Nurse, not a home health aide. If you ever find yourself in a situation whereby you are being asked to do so, please call the office immediately and we will arrange for our Registered Nurses to do so. Again, [repeat]
We engage in medication reminders, not administration. We can also help pick up the prescriptions. Below, we describe what we mean by medication reminders as opposed to medication administration.
Look at what we can do: read both options
Now that we know the rules under NYS law, let’s now focus on our Patients. Every Patient is different and has a different situation. Some Patients take medication from Pill Bottles, other from Pill Organizers. Some of them do not need any reminders at all, some need reminders, some need assistance in reading the medication bottles, others don’t, some need assistance opening the bottles, some don’t. How do we know what to do for each Patient? If medication management is an ocean, the Plan of Care is the map. It will tell you if Patient uses Pill Organizer or Pill Bottles. It will say if Patient needs a reminder or if they are self directing. You will be oriented to this for each Patient. However, as always, if you have any questions, do not assume but rather call the office and we will be happy to explain everything to you as many times as necessary.
There are 3 types. Remember that with pill organizers, a registered nurse or a family member of the Patient filled them. As mentioned, you can never fill these pill organizers as it is prohibited by law
First, wash your hands. Second, check the plan of care to see if in fact they need a reminder or assistance. If you are not sure, call the office`
We try to make it so that every client has 4 weeks of medications pre poured at all times. However, if you have 4 trays and you are not sure which week we are in, this could be a huge problem, resulting in great harm to your Patient. It is important to understand not only what day you are supposed to give medication from but also from which week. Each of the 4 trays will always be labeled as either Week A, Week B, Week C or Week D. Only 1 tray should be out at any time, and that needs to be the correct week. If you are ever not sure what week we are in, call the office and you will be instructed. The remaining weeks that are not the ones for this week should always be placed in a safe place but far away from this week since you, another CG or a family member may be confused. Remember, always look for the label and make sure you are using the correct week or call the office for clarifications. Before Week D is over, our nurse will have filled all 4 trays and then we will start again on Week A and restart the cycle.
VERY SIMPLE – EVERY SUNDAY, USE A NEW TRAY/ ORGANIZER. On Saturday night, when you have given your Client his/ her last medication reminder, that will mean that you will be done with that tray. The next day, you will need to get the next tray in the tray bin. If you are not sure where the other trays are or which of those trays to use, call the office. You will sometimes see that it is Saturday night and the Sunday box has medications in it. This does not mean that you continue giving medications from that same tray. You must still use the next tray in the medication cycle.
Personal Care Aides like yourself will deal with Patients who have diabetes. Diabetes often times requires that Patient do 2 things (1) Measure their Blood Sugar Levels (thru finger sticks) and (2) Administer Insulin via injection. Please listen carefully. Under NYS law and HISC policy, PCAs and HHAs and CNAs cannot do any of this. Only LPNs or RNs can do this. Our clients are all aware of this. However, you will come across a few who may ask you to cross that line and help them with this. It is important for you to know that you cannot do this. We do not want you to ever feel like you are going to upset a client who asks you to do this and so please call the office immediately. We assure you that we will deal with this in a way that assures that you are not in violation of the law and our policy as well as assure that our clients are happy
You may be wondering if housekeeping is part of the job of a PCA. Since a clean home is part of proper home care, it most definitely is. Often times, you have a 5 -12 to 24 hour shift and so there is plenty of time to do light housekeeping on a daily basis. Let’s discuss.
There are 8 areas of housekeeping that are important to keeping your Patient healthy at home, please understand them, embrace them and take pride in doing them as it is one of the many reasons you are providing quality home care to your Patients. 1. Cleaning the bathroom and kitchen sinks, 2. Dusting, 3. Keeping the toilet sanitized 4. Washing the dishes 5. Vacuuming 6. Making the bed 7. Laundry 8. Throwing out the garbage.
Note: many clients have housekeepers, many don’t. Do not assume they do. If they do, do not assume that you are not supposed to help. The patient’s home is your responsibility as well and so you should take a particular pride in keeping it free of germ and smell (even if the housekeeper does not). Please take pride in this and initiate these tasks. Every POC for every Patient of HISC includes this task and so on a daily basis the basics such as keeping the bathroom and kitchen clean and throwing out the garbage must be done daily. Other things like laundry can be done more sporadically. You should never be spending more than 20% of your day doing any of this since we are not a housekeeping service but please expect to spend approx 15-20% doing this type of work. There are no exceptions. If you feel uncomfortable with this, please let us know now as we do not want any misunderstandings.
Going to the doctor’s office is very important. There are a few simple rules to always remember. First of all, always let the office know of upcoming doctor’s appointments since we will often times need to fax them important information. Then, always remember to be dressed and groomed especially nice that day (appropriate hair, clean scrubs, HISC ID) and make sure the client is bathed, dressed and groomed nicely (remember that their appearance is a reflection of your service and our organization). Often times, we will ask that you take the Patient Binder with you. Once you are there, please call our office to see if someone from our office wants to talk to the doctor. If there are any recommendations or new medications that are being prescribed, it is VERY important that we be informed immediately.
Going to the doctor’s office is very important. There are a few simple rules to always remember. First of all, always let the office know of upcoming doctor’s appointments since we will often times need to fax them important information. Then, always remember to be dressed and groomed especially nice that day (appropriate hair, clean scrubs, HISC ID) and make sure the client is bathed, dressed and groomed nicely (remember that their appearance is a reflection of your service and our organization). Often times, we will ask that you take the Patient Binder with you. Once you are there, please call our office to see if someone from our office wants to talk to the doctor. If there are any recommendations or new medications that are being prescribed, it is VERY important that we be informed immediately.
Going to the doctor’s office is very important. There are a few simple rules to always remember. First of all, always let the office know of upcoming doctor’s appointments since we will often times need to fax them important information. Then, always remember to be dressed and groomed especially nice that day (appropriate hair, clean scrubs, HISC ID) and make sure the client is bathed, dressed and groomed nicely (remember that their appearance is a reflection of your service and our organization). Often times, we will ask that you take the Patient Binder with you. Once you are there, please call our office to see if someone from our office wants to talk to the doctor. If there are any recommendations or new medications that are being prescribed, it is VERY important that we be informed immediately.
Thanks for being patient and carefully listening to these important topic of elder care, they are very important. I am sure you noticed that the tone of some of these slides often took a tone of being very serious, often times focusing on the negative realities of what can happen. It is important to know that elder care is a profession and like all professions, there are situations that can lead to problems. The more we educate ourselves as professionals, the better job we can do to avoid common problems and to best serve the seniors we work with while at the same time developing a good career in this ever growing industry. Education is the key to success in any profession and at Home Instead Senior Care we will continue to educate you so that you can be the best caregiver possible. Please now go to our Human Resources Manager and let her know that you finished this set of slides. She will give you a little test that will touch upon many points we just reviewed. If you feel that it would be beneficial to repeat these slides (or any sections in particular) before taking the test, feel free to ask her and she will be happy to make that happen. Similarly, if you have any questions, feel free to raise them with her as well. Thanks again on behalf of all of us at Home Instead Senior Care.
