Competency In-House Trainingand Orientation Program

• Understanding the HIPAA Privacy Rule
• Protecting the privacy of individually identifiable health information and standards for the security of electronic personal health information (PHI)
• Confidentiality of health information
• Authorization exceptions
• Reasonable safeguards and incidental disclosures
• Telephone messages, email, and faxing
• Minimum necessary disclosure of PHI
• Sharing information with family and visitors
• Patient rights to access their health information

A valid written authorization is required for the disclosure of protected health information except in emergency situations and special cases as defined by law. Authorization exceptions include:

• Emergency care
• Procurement organizations for cadaveric organ, eye, or tissue transplantation
• Disclosures required by law (e.g., public health department for communicable diseases)
• Vulnerable adult or child abuse reporting
• Health oversight agencies such as the Pennsylvania Department of Health
• Agencies mandated by court order or search warrant
• Reporting certain types of wounds (such as gunshot) or injuries to law enforcement
• Information requested by a coroner, medical examiner, or funeral director regarding a deceased patient
• Information requested by law enforcement to avert a serious threat to health or safety

Telephone messages may be left if reasonable safeguards are used to minimize unintentional disclosure of PHI. Because messages may be heard by someone other than the patient, care must be taken not to leave any information that may disclose or imply information about specific medical treatment, tests, or conditions unless it is very urgent that the patient be notified.

HIPAA allows caregivers to release some basic information without the patient's prior authorization. This is considered directory information and includes:

• Patient's name
• Condition only (e.g., the patient is doing well)
• Location in the facility
• Religion (given to clergy or community faith leaders only)

• Irritable (gets upset easily)
• Angry (loses temper)
• Sad (tearful)
• Withdrawn (does not want to talk)
• Confused (does not understand what is happening)
• Memory problems (forgets or repeats conversations, medications unfilled or not being taken)

• Falls
• Wandering (leaves home, gets lost)
• Kitchen hazards (fire, leaves stove on)
• Nutrition (not enough or too much food)
• Driving

• Difficulty moving (getting out of a chair, walking across the room)
• Difficulty getting in and out of the bathtub
• Difficulty getting to the toilet
• Problems preparing meals
• Dirty and cluttered house (expired food, laundry piling up, neglected home repairs)

• Gloves, gowns, masks, face shields, and eye goggles must be worn if there is any possibility that you could come into contact with blood or other body fluids. Use good judgment when wearing personal protective equipment.
• Handwashing is the most important method of preventing the spread of infection. If accidental exposure to blood or other body substances occurs, hands must be washed thoroughly and immediately.
• Sharps such as used needles, razors, or broken glass must be disposed of properly. Contaminated broken glass should not be handled, even with gloved hands — it should be swept or vacuumed up for disposal.

1. 1Remove all jewelry.
2. 2Turn on the faucet using a paper towel.
3. 3Wet your hands and apply liquid soap.
4. 4Work soap into a lather and scrub hands for at least two minutes.
5. 5Keep hands at a lower angle than your elbows to prevent dirty water from running back onto your arms.
6. 6Interlace your fingers to clean between them.
7. 7Scrub your fingernails with a nail brush.
8. 8Dry your hands with clean paper towels.
9. 9Turn off the faucet using a clean paper towel.

• When you first arrive at your client's home
• Before handling clean linen or a client's meal tray
• Before going on a break and before leaving your shift
• Before and after drinking or eating
• After using the bathroom
• After coughing, sneezing, or blowing your nose
• After picking up an object from the floor
• After removing disposable gloves, including when replacing a torn glove
• After touching your hair or applying makeup or lip gloss
• After touching anything that may be considered dirty, especially objects contaminated with blood or body fluids

1. 1Through the air — the person becomes infected when they breathe contaminated air.
2. 2Through contact with an infected person or objects the person has used.
3. 3When feces containing a pathogen contaminates food or water that is then consumed by another person.
4. 4When blood or body fluids enter the bloodstream of a non-infected person. Bloodborne pathogens are not found in sweat or tears, but are most likely found in blood, semen, vaginal secretions, wound drainage, cerebrospinal fluid (CSF), amniotic fluid, and breast milk.
5. 5Through needlesticks, cuts from contaminated glass, and splashes or sprays of contaminated body fluids.

1. 1Wash hands often.
2. 2Wash produce before cutting, cooking, or eating.
3. 3Wash utensils and cutting boards after each use.
4. 4Keep kitchen surfaces clean.
5. 5Keep raw meat and ready-to-eat foods separate.
6. 6Cook food to proper temperatures.
7. 7Refrigerate food promptly to below 40°F.
8. 8Pay close attention to use-by dates.

• Check through the letterbox, windows, and back of the house to see if it is accessible.
• If you cannot see the client, check with neighbors.
• If the neighbor cannot help, telephone the office and the Home Care Manager will inform you of further action.

• Call 911.
• Call the Home Care Coordinator or Owner.
• If you know of a key holder nearby, go to them — contact the office when you reach them.

• Call 911.
• Call the office or the Home Care Coordinator or Owner.
• DO NOT TOUCH ANYTHING. Someone will come to assist you at once.
• If the client lives in an assisted living facility, notify the facility.

• If a client falls and may be injured, they must not be moved unless they are in serious and imminent danger (e.g., fire, drowning, traffic accident). Make them comfortable and call an ambulance.
• If a client is known to be prone to falls or collapse, this should be reflected in the risk assessment and a contingency plan should be devised.
• If a client collapses or is taken seriously ill, call 911 and make the client as comfortable as possible. Paramedics may advise you of action to take while awaiting their arrival.
• Call the Home Care office or Owner, who will arrange for your subsequent visits to be covered while you stay with the client or send someone to relieve you.

• Time/Service Sheet must be legible at a minimum to the individual providing care
• Assisting with Self-Administered Medications Records
• Client's name on each page of the recipient's record
• Consumer's service plan documents signed by the patient
• Date on which each entry is made
• Date(s) on which the health service is provided
• Length of time spent with the client if payment depends on time spent
• Signature and title of the person from whom the recipient received the service

You may see frequent and unexplained bruises, burns, cuts, or injuries. The client may be overly afraid of the parent, friend, or family reaction to misbehavior. Physical neglect is a family member, friend, or caregiver's failure to give the client food, clothing, hygiene, medical care, or supervision.

If the client you care for must rely on others for daily care, they may feel a loss of control over their life. They may feel frustrated or helpless at times. Their personality and behavior may change because of the emotional and physical changes they're experiencing. A person who has always had a difficult personality may become even more difficult under the stress of an illness or disability. If you can recognize the reasons a person is difficult and learn methods to cope, it will help you both maintain a healthier relationship and get through trying times.

• You cannot always control the other person's behavior, but you can control your response to it.
• Focus your response on the behavior; avoid blaming it on the client's personality or condemning them as a 'bad' person.
• Do not take the angry behavior personally.
• You are doing the best that you can do in a difficult situation; blaming yourself won't help solve the problem.

• Remain calm; speak slowly and clearly.
• Avoid approaching the resident from the side or back.
• Don't downplay their feelings; allow the client to express feelings (if talking reduces agitation).
• Saying 'It's no big deal' won't help — it may make them angrier. Try: 'You seem really frustrated. What can we do next time to make it better?'
• Let them talk about their anger: 'What's making you feel so bad?' or 'You seem upset, can I help?'
• Respect demands that may seem petty to you but seem very important to them.
• Find something to agree about: 'Yes, the mail carrier hasn't been coming as early as he used to.'

Encourage the person to bathe themselves as much as possible. They may be able to do all but wash their feet or back, or they may only be able to hold a washcloth while you do the rest.

• If bathing is difficult, do it only as often as necessary.
• Most people don't need a daily bath. Make sure that the hands, face, and genital area are washed every day.
• Have all supplies ready before starting a bath.
• Keep the room comfortably warm.
• Respect the person's privacy. Keep them covered when possible.
• Wear latex gloves anytime you may come into contact with bodily fluids or feces.

• Make sure they have grab bars.
• Make sure they have a non-slip bathmat.
• Ask the client to sit on the edge of the tub. Then put both of their legs into the tub before they stand up.
• Reverse the process when they are getting out.

• Make sure the tub has a bench.
• Make sure the bath area has a hand-held shower attachment.

• Use an electric shaver when shaving a patient — it's safer and easier.
• Put dentures in the client's mouth before shaving him.
• Have him in a sitting position if possible.

• Be flexible. Wearing a bra or pantyhose may not be important to clients, especially if it's an added hassle.
• Allow enough time for the client to do as much as they can for themselves.
• Let the client choose what to wear. You can lay out two choices to simplify this for someone who is confused.
• Be sure shoes or slippers are well-fitting and do not have gum soles, which can cause people to trip.
• Consider easy-to-use clothes with large front fasteners (zippers or Velcro), elastic waistbands, and slip-on shoes.
• To minimize stress on a person's weak side, put the painful or weak arm into a shirt, pullover, or jacket before the strong arm. When taking them off, take out the strong arm first.

People who are ill or who must stay in bed or in a wheelchair are at risk for pressure ulcers, sometimes called bed sores. Pressure ulcers are a serious problem, but in most cases, they can be prevented by following these steps:

• Make sure the person is eating a healthy diet and getting plenty of fluids. Well-nourished skin is healthier and less likely to break down.
• Keep the skin clean and dry.
• Clean off urine or feces immediately with soap and water. Wear disposable latex gloves.
• Use disposable bed pads to keep the linen dry, if the person is incontinent.
• Check the skin regularly for red areas. Make this a routine part of bath time.
• Every 2 hours, change the position of a client who is bed- or wheelchair-bound.
• Avoid dragging the person when you move them in bed. Friction can cause skin breakdown.
• Apply lotion to dry skin regularly (except between the toes, where it can cause fungal growth). Give a light massage while rubbing in the lotion.

• Remove pressure from the area immediately.
• Clean and dry areas soiled with urine or feces. Wear disposable latex gloves.
• Do not massage the area.
• Recheck the skin in 15 minutes. If the redness is gone, no other action is needed.
• If redness does not disappear after 15 minutes, consult your health care professional.
• If a blister or open area develops, contact your health care professional immediately.

• Clean teeth at least once a day.
• Check dentures regularly for cracks.
• Remove dentures for cleaning and store in liquid when out of the mouth.
• Have dentures checked if they aren't fitting properly (a common cause of eating problems).

• Wash the client's hair in the kitchen sink if the tub or shower is too difficult.
• Consider using one of the dry shampoo products found in drug stores if hair washing is impossible.
• If hair must be washed in bed, you can make a simple device to catch the water by making a U-shaped towel pad and putting it inside a large plastic bag. Place the open end of the U over the edge of the bed where it can drain into a bucket.

• Relieves stress and anxiety
• Improves and/or maintains muscle strength
• Improves circulation
• Decreases problems with digestion and elimination
• Improves appetite

• Gait belt and/or other walking aids, like a cane or walker. A gait belt (sometimes called a transfer belt) provides the DCW with secure points to hold onto while assisting clients in walking and transfer activities.
• Non-slip, properly fitting footwear.

1. 1Familiarize yourself with the expectations and requirements of the service plan. Contact your supervisor if you need clarification.
2. 2Ensure the client can safely wear a gait belt.
3. 3Communicate the procedure to the client before you begin.
4. 4Apply non-skid, properly fitting footwear.
5. 5Have the client's walking aid available, if required.
6. 6Apply the gait belt.
7. 7Make sure the client has their feet firmly on the floor.
8. 8Use an underhand grasp on the gait belt for greater safety.
9. 9Assist the client to a standing position.
10. 10Walk behind and to one side of the client during ambulation. Hold onto the belt from directly behind. Support the weaker side, if applicable. Right side: stand between the 4 and 5 o'clock positions. Left side: stand between the 7 and 8 o'clock positions.
11. 11Let the client set the pace. Walk in step with the client, maintaining a firm grasp on the gait belt.
12. 12Watch for signs of fatigue.

The handle of the cane should be at a height equivalent to where the client's wrist of their strong hand would fall if their hand was placed at their side when standing upright. The client should use the cane on their strong side, and the DCW should walk on the client's weak side for assistance.

The correct walker height is determined the same way as for a cane. When assisting a client with a walker, it is important that the client stay inside the frame. Make sure it has been properly fitted. The DCW should always walk on the client's weak side to provide additional support.

When preparing food for your patients, it's important to follow a number of safety precautions and maintain healthy food choices.

• Use whole foods whenever possible (fresh fruit, vegetables, minimally processed grains).
• Avoid frying and convenience foods. Steamed and baked foods are healthier alternatives.
• Avoid heavily processed products like sugary cereals and white bread when possible.
• Find out how the client likes their food prepared, including spices (assuming no health considerations contraindicate them).
• Watch what your client eats. A pattern of eating less than usual may signal a problem to report.
• Store fresh milk, eggs, and similar items in the refrigerator. Store meat on the bottom shelf to avoid drip contamination.

• Promotes independence
• Builds a helping relationship
• Provides stimulation, relaxation, and increases sense of worth

• Cook food only until tender to protect nutrients.
• Use a toaster oven or oven to prepare more than one food at a time.
• Use a double boiler to cook two items at once.
• Use fresh fruits and vegetables.
• Serve eye-appealing foods.

• Use contrasting colors and textures.
• Arrange foods attractively.
• Serve small portions, but allow for second servings.
• Be alert to a poor appetite — it may signal illness, depression, dissatisfaction with food, improper mouth care, chewing problems, or medication side effects.

• Wear clean clothes and/or apron.
• Always wash hands before handling food.
• Wear gloves if you have a cut or infection on your hands.
• Avoid coughing or sneezing around food.
• Clean workspaces before and after preparing food.
• Use clean dish towels and dish cloths.
• Use hot water and soap to wash utensils.
• Never taste and stir food with the same spoon.
• Put warm foods in the refrigerator immediately.
• DO NOT use damaged cans with bulging ends.
• Avoid eating raw eggs. NEVER use cracked eggs. NEVER undercook eggs.
• Use cooked meat, poultry, fish, and baked dishes within three to four days.
• DO NOT use foods that have become moldy.
• Keep hot foods hot (above 140°F) and cold foods cold (below 40°F).
• Use food within the recommended time. DO NOT refreeze food.

• Suggest going to the bathroom on a frequent, scheduled basis. Rushing after the urge strikes will increase the chance of accidents. Every 2 hours is too often for most people; start with every 3–4 hours.
• Make sure the hallway and bathroom are well-lighted.
• Remove throw rugs, which could trip someone.
• Make sure the client has grab bars and/or use a raised toilet seat for more ease getting on and off the toilet.

• Remember that accidents are very embarrassing for the patient.
• Stay calm and reassure them that it's 'okay.'
• Keep a matter-of-fact approach: 'Let me help you get out of these wet things.'
• Monitor them for urinary tract infections. Any fever lasting more than 24 hours should be reported.

• Suggest the client see their doctor for a thorough evaluation and treatment recommendations.
• Establish a regular schedule for using the toilet.
• Avoid caffeine, alcohol, citrus juice, or other bladder irritants.
• Offer 6–8 glasses of fluids every day to prevent strong urine that can irritate the bladder.
• Find out if the client is taking any medications that affect the bladder. Common over-the-counter products like aspirin and Excedrin contain caffeine, which stimulates the bladder.
• Be aware that incontinence can trigger skin breakdown — pay special attention to skin care.

• Offer foods high in fiber (fruits, nuts, beans, vegetables, bran, most cereals). Add high-fiber foods gradually if the client isn't used to them.
• Make sure there is adequate liquid in the diet — 6–8 glasses each day (unless otherwise instructed by the physician).
• Encourage daily exercise to stimulate bowel activity.

• Include cranberry juice in the diet to help control urine odor.
• Protect the mattress with rubber or plastic sheets. Consider a breathable, washable layer like sheepskin between the sheet and the waterproof layer.
• Remove soiled bed linens and clothing quickly. If you can't launder them immediately, rinse them in cold water.
• Soak stained items in dishwashing detergent to loosen stains.
• Clean bedpans, urinals, and commodes with household cleaners.
• Clean soiled areas on furniture with a mild dilution of cold water and white vinegar.
• Protect furniture with disposable or other waterproof pads.
• Always wear your latex gloves.