CHAP Education for Orientation

1. CHAP Education for Orientation Revised 7/19/12

2. Topics Covered in this Inservice • Overall Responsibilities and Limitations • Communication Techniques • Client Rights • Observation of Client Status and Changes in Client Condition • Basic elements of body functions and changes in body functions • Standard precautions • Procedures for maintaining a clean, safe and healthful environment • Recognizing emergencies and appropriate response to an emergency • Care of clients served including the physical, emotional and developmental needs • Bathing and personal care techniques • Basic nutrition, meal preparation and fluid intake • Assisting clients to achieve maximum self reliance • The care of aged clients • Standards of supervision • Documentation of appropriate record • Advance directives rationale and implications

3. Additional Local Policies and Topics • Medical Device Reporting Act • Performance Improvement Policy • Infection Control Local Policies/ Procedures • Blood borne Pathogens, HIV/AIDs • TB Exposure Plan • Recognizing Signs of Abuse • Comprehensive Emergency Management Plan • Personal Care Competency Evaluation

4. A. Overall Responsibilities and Limitations What You Can Do as an HHA What you Can’t Do as an HHA • Bathing • Dressing • Grooming • Transferring • Toileting • Feeding • Companion Services • Wound Treatment or First Aid • Pick up Client if fallen • Administration of Medication • Climb ladders or tools • Heavy Yard Work • Cut fingernails, toenails, or hair

5. B. Communication Techniques • When communicating with office, clients, and coworkers, it is important to be: • Respectful • Professional • Timely • Much of the communication between office staff and field staff is via phone and/or through email using ersp messaging. Please check email daily, and respond as appropriate. Please return all phone calls based on voicemail message.

6. C. Client’s Rights / HIPAA Every client has the right to: • Know the name and contact information of the Comfort Keeper’s supervisor. • Be able to complain without fear. • Participate in developing plan of care. • Be treated with courtesy and respect. • Refuse services and be informed of consequences.

7. C. What is the Health Insurance Portability and Accountability Act of 1996 ? • Grants everyone in the United States a federal right to privacy. • Created a national standard for the privacy of health information. • Gave the federal government a way to regulate and enforce this right to privacy.

8. C. Definitions • A covered entity is any agency, facility, or business that provides care to the public. Our home health agency is a covered entity. • Health information is information the agency creates or receives that relates to a client’s past, present, or future health. This includes healthcare history and payment for that healthcare.

9. C. Definitions • Protected health information (PHI) is any information about a client’s health that our agency transmits or maintains. This includes information kept on paper or in computer databases. It also includes conversations about clients. • Identifiable health information is information that can be linked to a client through things such as a name, address, social security number, medical record number, or telephone number.

10. C. HIPAA Violations • Discussing client’s health information with your family/ friends; • Leaving papers or computerized medical records open at your desk, in a client’s home, or in your home; • Talking about the client’s health information in the presence of unauthorized family members or visitors • If you knowingly violate HIPAA, you could be subject to disciplinary action, including termination. Severe offenses could lead to large federal fines and prison sentences.

11. Complaints and Grievance Policy Purpose To ensure that an appropriate method is in place to provide clients, family members, staff, and all other parties associated with Comfort Keepers an opportunity to file a complaint on behalf of a client or client representative/ family member and ensure that complaints are properly investigated and appropriate actions are implemented to provide a prompt and equitable resolution.

12. Complaints and Grievance PolicyProcedure - Intake Complaints will be made in writing and will contain the following: • Name and address of individual filing; • Relationship of that person to client, if applicable; • Client’s name, if applicable, with medical record number; • Date and time the complaint was filed (must be filed within 15 days of alleged incident; • Detailed description of the alleged incident. • Administrative, discrimination, and employee issues will be handled by the Administrator or Alternate Administrator. • Direct care issues will be handled by RN or Administrator.

13. Complaints and Grievance PolicyProcedure - Intake Complaint Grievance Form Complaints Grievance Log

14. Complaints and Grievance PolicyProcedure - Investigation • The appropriate supervisor or designee will conduct a thorough but informal investigation allowing interested persons and representatives to present evidence relevant to the complaint. • The investigating individual shall issue a written decision to all concerned parties determining the findings, and the validity and resolution of the complaint no later than 15 days after its filing. • Reports of all complaints, including the investigative findings and the resolution, will be maintained by the Administrator for 7 years.

15. Complaints and Grievance PolicyCorrective Action / Complaint Resolution • Data collected from the complaints will be compiled and integrated into the Process Improvement process and reported to the governing body. • The Administrator will communicate to the complainant the findings and actions to be taken to resolve the complaint. • Reports will be produced as requested and trending will be identified. • Appropriate arrangements will be made to ensure that disabled persons are provided accommodations, if needed, to participate in this process. • For any grievance/complaint, the person reporting the issue may contact the office at any time, including during off hours. • In the event of a serious complaint/grievance, the on call person should contact the RN or Administrator to address the issue.

16. D. Observation of Client Status and Changes in Client Condition

17. E. Basic elements of body functions and changes in body functions

18. F. Standard Precautions • Infection prevention practices that apply to all clients regardless of suspected or confirmed diagnosis or presumed infection status. • Must be used every time you think you will come in contact with a client’s blood, body fluids (except sweat), non-intact skin, or mucous membranes.

19. F. Standard Precautions • Follow proper hand hygiene practices • Use personal protective equipment • Gloves, Masks, Gowns • Handle soiled client care equipment appropriately • Handle laundry appropriately • Handle sharps appropriately

20. F. Standard Precautions – Hand Hygiene • Clean hands are the single most important factor in preventing spread of infections. • Wash hands: • Immediately upon arriving at work, and just before leaving for home; • Before touching your mouth or eyes; • Before eating; • After using restroom; • After contact with another person’s body fluids. • Between direct contact with different people; • Before preparing, handling, or serving food; • Before/ after assisting client with personal care/ meals; • Whenever hands are visibly soiled; • Before and after using gloves; • Before/ after touching client’s intact skin • After wiping down surfaces, cleaning spills, or other housekeeping duties; and, • Remind/ assist clients in following same procedures.

21. F. Standard Precautions -Proper Hand-washing Technique • Wash hands with soap and water immediately, or as soon as possible, after contact with blood or other potentially infections materials. • If a sink is not readily accessible, use an alcohol-based hand rub, but wash with soap and water as soon as possible. • If there has been no occupational exposure to blood or other potentially infectious materials, and your hands are not visibly soiled, you can use an alcohol-based hand rub for routinely decontaminating your hands.

22. F. Standard Precautions –Personal Protective Equipment - Gloves • Wearing gloves reduces the risk of you getting an infection from clients. It also prevents the transmission of germs from you to the client. • You should wear gloves … • When you have cuts, rough skin, or scratches on your hands. • Whenever you think your hands will come in contact with blood, potentially infections materials, mucous membranes, or non-intact skin.

23. F. Standard Precautions –Personal Protective Equipment - Gloves • Circumstances requiring glove change: • When they are soiled and/or torn • When going from a dirty to clean procedure • Between each client and/or procedure

24. F. Standard Precautions – PPEMasks, Gowns, Goggles, Face Shields • Masks, Goggles, Face Shields • Designed to protect mucous membranes (nose, mouth, eyes) from splashing or spraying blood, body fluids, secretions, or excretions. • Gowns • Designed to protect your clothing and to keep contaminated fluids from soaking through to your skin.

25. F. Standard Precautions-PPEGeneral Rules • Use PPE that is appropriate for the task you are performing. • Remove PPE that is torn or punctured or has lost its ability to function as a barrier. • Remove PPE carefully to avoid contamination. • If you are accidentally exposed to a patient’s blood or other body fluids and are wearing PPE, remove the contaminated PPE. • Immediately wash any exposed skin with soap and water, or flush exposed mucous membranes of the eyes, mouth and nose. • Immediately contact supervisor to let her know what happened and complete a Comfort Keeper Incident Report.

26. G. Procedures for Maintaining a Clean, Safe, and Healthful Environment Fire Safety in client’s home • Encourage the client or family member to purchase smoke detectors and test them regularly. Test every 6 months. • Be on the lookout for: • Too many plugs in an outlet • Oxygen too close to heat source • Towels, curtains, other flammable materials close to stove • Make sure you and your client have an emergency exit plan • Know the location of any fire extinguishers and learn how to use them.

27. G. Procedures for Maintaining a Clean, Safe, and Healthful Environment General Safety Tips in Client’s Home • Keep electrical cords out of traffic area • Encourage client’s/family members not to use throw rugs • Make sure there is adequate lighting • Store medical supplies (including oxygen) in a safe, dry area • Have a backup plan in case of power failures Bathroom Safety Tips • Keep floor clean and dry • Ensure tub and toilet railings are secure • Place non-skid mats in the top • Make sure there is adequate lighting Bedroom Safety Tips • Ensure that bed is at a safe height for patient to get in and out of • Keep the client’s personal items within reach • Keep lamps and telephones within client reach

28. G. Procedures for Maintaining a Clean, Safe, and Healthful Environment Kitchen Safety Tips • Label and date all food containers • Do not use stove or oven for heating the home • Instruct client not to use the stove if he/she is wearing oxygen Entrance/Exit Area Safety Tips • Make sure there is adequate lighting • Ensure that steps have secure railings • Ensure that the walking surface is in good condition • Do not use the hall or stairway as a storage area. • You may need to ask the client/family member to remove clutter from halls or stairs. Talk with your care coordinator first if you think this may not be received well.

29. G. Procedures for Maintaining a Clean, Safe, and Healthful Environment Avoiding/Preventing Workplace Violence • Treat everyone with respect and refrain from engaging in abusive language, intimidation, threats, assaults, or fighting • Be alert for warning signs from a potentially violent person • Making threats, Talking about carrying weapons • Cursing or screaming, Pacing or restlessness • Making violent gestures • Report all real or suspected violence to your supervisor. • If you find yourself in a potentially violent situation, stay calm and remove yourself from the situation ASAP. • Report incident from a safe location.

30. H. Recognizing emergencies and appropriate response in an emergency

31. I. Care of Clients served including physical, emotional, and developmental needs, L. Assisting Clients to Achieve Maximum Self Reliance, and M. The Care of Aged Clients • Instead of “doing for” the client, we provide care by “doing with” the client, engaging their participation at their level of function. • Focus is on the mind, body, safety, and nutrition • Process includes communicating, interacting, and engaging with the client on a number of different services, from light housekeeping, to cooking, to personal care needs.

32. K. Basic Nutrition, Meal Preparation, and Fluid Intake A healthy diet helps to: • Build, repair, and maintain body tissues • Provide energy • Regulate body processes • Food gives us energy to carry out the day’s activities and is necessary to rebuild body tissue

33. K. Basic Nutrition, Meal Preparation, and Fluid Intake The process of aging effects dietary habits and patterns in several ways. Seniors have: • An increased incidence of protein-calorie malnutrition. • An increased need for nutrient-rich foods. • An increased need for fiber.

34. K. Basic Nutrition, Meal Preparation, and Fluid Intake The process of aging effects dietary habits and patterns in several ways. Seniors have: • A decrease in appetite without significant weight loss. • A decrease in metabolism and muscle mass; • A decrease in the need for as many calories, so their appetite decreases to compensate. • A decrease in the ability to digest fats with age. • Adecrease in their ability to smell or taste food because of normal aging, medications, and disease. Ill-fitting or painful dentures that can make eating difficult.

35. K. Basic Nutrition, Meal Preparation, and Fluid Intake Diseases such as Alzheimer’s or dementia, anorexia, depression, social isolation and failure to thrive which have a direct affect eating and nutrition.

36. K. Basic Nutrition, Meal Preparation, and Fluid Intake – Senior Food Pyramid

37. K. Basic Nutrition, Meal Preparation, and Fluid Intake • The best diet, one high in grain products, fruits and vegetables, and low in saturated fats and cholesterol, is based on the senior food pyramid. Limit foods that contain no nutrient value such as refined sugar, caffeine, and alcohol. • Water is vital to health and well being. It is necessary to drink 6-8 cups of water daily. The body needs water to digest, to flush and eliminate toxins, to maintain body temperature, and to prevent dehydration.

38. K. Basic Nutrition, Meal Preparation, and Fluid Intake When developing a menu of foods to be prepared, consider these key aspects: • Recommended servings from the food pyramid • Variety– A well-balanced diet consists of nutrients from many different kinds of food. No one food is perfect. • Texture– Combining crispy foods with smooth soft foods makes each texture seem more interesting. Unless the client is on a special diet and the texture of the food is controlled, try to choose different types of texture within each meal served. • Flavors – If all foods in the meal have a strong distinctive taste, they will compete with one another and overwhelm the client’s taste buds. Keep the strong-flavored foods as the spotlight and milder-tasting foods as the background in a meal. Season the food as the client prefers and their diet permits.

39. K. Basic Nutrition, Meal Preparation, and Fluid Intake When developing a menu of foods to be prepared, consider these key aspects: • Temperature – Cook the food at the correct temperature. Ask the client at what temperature they prefer their food. Not everyone enjoys food very hot or very cold. Some people like ice. Some do not. • Taste – Cook the meal to the taste of the client. Discuss with the client or family the spices they like and how they usually season their food. • Shape– Prepare the food with familiar shapes. Some families always slice their tomatoes, some cut them into chunks. • Color – Give each meal eye appeal by keeping the colors compatible. A sprig of parsley, radish roses, olives, or carrot curls may make an interesting dash of color to an otherwise drab-looking meal. • Cost – Most clients are not free to spend an unlimited amount of money on their food, so plan meals that are within their budgets and do not cause waste.

40. N. Standards of Supervision • All Comfort Keepers receive a performance evaluation on or around their 90th day, on the anniversary of their start date, and annually thereafter. • Care Coordinators/ Supervisors perform periodic onsite visits to client locations and observe Comfort Keepers on-the-job performance. • Visit purpose is to ensure Comfort Keeper is following plan of care • Care Coordinators/ Supervisors conduct 1:1 discussions as necessary, or upon request of the Comfort Keeper. • Periodic surveys to rate Comfort Keeper performance, Comfort Keeper satisfaction, and Client satisfaction are performed on regular basis. The results of these surveys are shared with the appropriate parties.

41. O. Documentation on Appropriate Record • Care Notes are required for all clients who receive personal care services, and for homemaker companion clients where long term care insurance is involved. • One Care Note per client, per Comfort Keeper, per week • Care Notes are due in the office no later than 10am Monday morning for the prior week’s work. • Additional detailed instructions on how to complete a care note are contained in the New Employee manual.

42. P. Advance Directives Rationale and Implications • Advance Directives are instructions written to healthcare providers before, or in advance of, the need for medical treatment. • The Patient Self-Determination Act (PSDA) requires home health agencies and other institutions receiving Medicare and Medicaid funds to do the following: • Have written policies and follow procedures regarding advance directives • Document in the medical record if a patient has an advance directive in place • Comply with state laws on Advance Directives

43. P. Advance Directives Rationale and Implications Advance directives include the following: • Living wills • Durable powers of attorney for healthcare, also called healthcare proxies • Do-not-resuscitate (DNR) orders • Anatomical gifts, such as organ or tissue donations

44. P. Advance Directives Rationale and Implications • A living will is a legal document that a person uses to make her wishes known regarding life-prolonging medical treatments. • A healthcare proxy enables a patient to appoint someone he trusts to make decisions about medical care if he cannot make those decisions himself. • A DNR is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.

45. P. Advance Directives Rationale and Implications • Advanced care planning helps ensure that family members, friends, and caregivers are all familiar with a patient’s wishes about the care he wants to receive, especially at the end of life. • It is important to honor and respect any advance directives and to not discriminate against patients who do not have advance directives. Home health agencies also cannot require a patient to have an advance directive.

46. Local Policies

47. Medical Device Reporting Policy

48. Objectives • After attending this training, attendees will … • Be knowledgeable of the Medical Device reporting regulation and purpose; • Be able to list the events that Comfort Keepers is required to report; and, • Be able to verbalize Comfort Keepers policy with regard to documentation and reporting of adverse events involving medical devices.

49. What is the Medical Device Reporting Act? • The Medical Device Reporting Act requires user facilities (including a private residence) to report the following: • Device-related deaths to the FDA and to the device manufacturer; • Device-related serious injuries to the manufacturer, or to FDA if the manufacturer is not known; and, • Submit a summary of all reports during this period to the FDA.

50. What is considered a Medical Device? • Examples of medical devices that are typically found in the home or facility where we are caring for a client include: hospital beds, patient restraints, ventilator, trapeze bars, defibrillators, wheelchairs, bedside commodes, shower chairs, walkers, oxygen concentrator, and bandages. • Generally, if it is used in medical practice and it is not a drug or biologic, it is a device.