AGING & DISABLED HOME HEALTH CARE 2

AGING & DISABLED HOME HEALTH CARE

HOME HEALTH AIDE SERVICES
Defined at: CFR 484.36 (Federal Regulation) and 410 IAC 17-14-(Rule I/14 Section 1(g) through Rule #14 -1(n) (State Rules)

EXAM QUESTIONS
1. With the exception of licensed health professionals and volunteers, home health aide training and competency evaluation or competency evaluation requirements apply to all individuals who are employed by or work under contract with the Agency and who provide "hands-on" patient care services regardless of the title of the individual.
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2. It is the "function" of the aide that determines the need for training and competency evaluation or competency evaluation.
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3. Home health aides are selected on the basis of such factors as the following: (Select the 1 correct answer)
a. Sympathetic attitude toward the care of the elderly and sick populationb. Ability to read, write and carry out directionsc. Maturity and ability to deal effectively with the demands of the jobd. All of pie above
4. Home health aides function independently and do not have to be closely supervised.
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5. Home health aides may be certified if the following requirements are met. Select the one correct answer.
a. The aide has completed the required 75 hour training course and successfully completed the competency evaluation program that meets the requirements of CFR 484.36.b. The aide has successfully completed the competency evaluation program that meets the requirements of CFR 484.36.c. Both a and b are correct answers
6. Once the aide successfully meets the certification requirements the certification is good for life
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7. The home health aide must complete training and/or competency training in what areas of personal care. (Check all that apply)
a. Communication skills
b. Changing a Foley catheter
c. Performing BP checks
d. Reading and recording temperature, pulse, and respiration
e. Universal Precautions
f. Basic elements of body functioning & changes in function
g. Reporting changes in body functioning to the supervisor
h. Basic infection control measures
i. Determination of the need to implement the Emergency Plan
j. Maintain a clean, safe, and healthy environment
k. Recognize emergencies, and have knowledge of emergency procedures
l. Knowledgeable of the physical, emotional, and developmental needs of clients
m. Observation, reporting and documentation of patient status and the care or service furnished
8. The training, testing, and supervision of home health aides is performed by or under the supervision of a RN with 2 years nursing experience, at least 1 year of which must be in the provision of home health.
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9. The home health aide only has to demonstrate competency on the elements as listed in CFR 484.36(a)(1)
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10. Other individuals may be used to provide instruction under the supervision of a qualified registered nurse.
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11. The home health aide applicant must pass a written test as a part of the home health aide competency evaluation.
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12. The home health aide must be able to demonstrate the following-skills: (Check all that apply)
a. Bed bath
b. Foley catheter change
c. Administration of medication
d. Sponge, tub, or shower bath
e. Shampoo, sink, tub, or bed
f. Nail, and skin care
g. Blood Glucose checks with a glucometer
h. Oral hygiene
i. Toileting and elimination
j. Dressing changes to wounds
k. Safe transfer techniques and ambulation
l. Normal range of motion
m. Application of prescription cream
n. Adequate nutrition and fluid intake
o. Administration of eye drops
13. The Agency must maintain documentation to demonstrate that the requirements of this standard are met.
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14. An individual may furnish home health aide services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in CFR 484.36
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15. The guidance for home health aide certification, supervision, and training is based on the federal regulation at CFR 484.36
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16. An LPN can perform the required home health aide supervisory visits.
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17. Home health aides are required to complete 12 hours of in-service training every calendar year based on date of hire.
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18. A minimum of 8 hours of the required in-service training must be on the following topics:
19. A home health aide continuing education program may be offered by any organization except a home health agency that has a probationary home health agency license.
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20. It is not necessary for the training of home health aides to be performed by or under the general supervision of a registered nurse.
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21. The home health agency must maintain sufficient documentation to demonstrate that the continuing education requirements are met.
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22. Home health aides must complete their training in the first month of their employment as a home health aide providing care to clients/patients.
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23. The home health aide shall be entered in and be in good standing on the state aide registry.
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24. Agency management staff has 3 months from date of employment to register the aide on the state registry.
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25. If the home health agency issuing the proof of the aide's achievement of successful completion of a competency evaluation program is not the employing agency, it is not necessary for the employing agency to keep a copy of the competency evaluation documentation in the home health aide's employment file. The employing agency just needs to verify the aide's standing on the state aide registry.
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26. The home health aide receives his/her client care assignments from the LPN.
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27. The home health aide may be assigned to perform tasks not included in the original competency evaluation as these tasks additional tasks will be reviewed on a quarterly basis by the management staff.
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28. The home health aide must report any changes observed in the client's/patient's condition and needs to the supervising RN or registered therapist.
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29. A registered nurse or therapist in therapy only cases, shall make the initial visit to the client's/patient's residence and make a supervisory visit at least every (30) days, either when the home health aide is present or absent to observe the care, to assess relationships, and to determine whether goals are being met.
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30. A home health aide is not considered competent in any task for which he or she is evaluated as "unsatisfactory". The aide must not perform that task without direct supervision by a licensed nurse until after he or she receives training in the task for which he or she was evaluated as "unsatisfactory" and passes a subsequent evaluation with "satisfactory".
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31. The competency evaluation must be performed by a registered nurse.
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32. It is the responsibility of the HHA to ensure that aides are proficient to carry out the client/patient care they are assigned, in a safe, effective, and efficient manner.
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33. As a part of the survey process, a sample of home health aides used by a particular HHA will have their files reviewed for documentation of compliance with the training and competency evaluation or competency evaluation requirements.
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34. A mannequin may be substituted for a "live" client/patient for the home health aide competency demonstration process.
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35. Define assist with medications that are normally self-administered"

PERSONAL CARE ATTENDANT TEST
Choose ONE correct answer for each multiple-choice question. Read carefully and enter the correct answer on the answer sheet.

COMMUNICATION SKILLS:
1. Communication is defined as:
a. Exchanging information with othersb. Stating your feelings and factsc. Writing or drawingd. Giving your opinion
2. Body language is:
a. A way of communicating feelings by using the body positioning, facial expressions and the eyesb. Only used by clients to tell their doctors what is causing them problemsc. Only used by persons who are deafd. Only used by persons who cannot speak
3. When a client, caregiver, or co-worker makes you angry, you should:
a. Tell him/her your true feelingb. Respond sharplyc. Think before answering and respond tactfullyd. Leave the room
4. A client accuses you of stealing ten dollars. You have not taken the money, but the client does not believe you. What should do?
a. Ask the other personal care attendant for the client if they took the moneyb. Ask the client why you are being accusedc. Offer to give the client the ten dollarsd. Notify your agency supervisor
5. Mr. Jones makes you uncomfortable because of sexual statements and an occasional misplaced hand. How would you handle this situation?
6. When speaking to a client who is hard of hearing and does not wear a hearing aide, you should:
a. Face the client when speaking to him or herb. Speak as loud as you must in order to be heardc. Speak slowly and clearlyd. All of the.above
7. The client with dementia
a. Loses the ability to make judgmentsb. Loses the ability to perform self-carec. May be angry, restless, or irritabled. All of the above
8. Clients sometimes express religious beliefs with which the personal care attendant does not agree. In dealing with these situations, which should the attendant use as a guide?
a. Clients have a right to their own beliefs, which should be respectedb. Clients should be told not to discuss their beliefs with aidesc. Personal care attendant should explain their beliefs to clientsd. Personal care attendant should pretend to have the same beliefs that clients have

OBSERVATION, REPORTING, AND DOCUMENTATION
9. The client tells you he has had a red rash for three days. What should you do?
a. Tell him not to worry about itb. Put an antibiotic cream on itc. Report it to your supervisord. Tell him he may be allergic to fruit
10. After arriving to care for Mr. Jones, he complains he has had severe cramping pains in the calf of his left leg for the last three hours. You call your supervisor to report this and then record on your documentation notes:
11. The principles of documenting your care include:
a. If a task is not charted, it is assumed not to have been doneb. If you make a charting mistake, draw a line through the mistake and write errorc. You may not chart activities performed by other personneld. All of the above
12. It is your responsibility as a personal care attendant to:
a. Do what ever the client wants even if it is not on the assignment sheetb. Make necessary changes in the service plan/assignment sheetc. Report changes in the client's condition to the supervisord. All of the above
13.A client complains that he has fallen three times in the past two days. Which of the steps should you take?
a. Ask the client when and what happened when he fellb. Report the falls to your supervisorc. Check the client for possible injuryd. All of the above
14. It is Mrs. Kelly's bath day, but she states she is in too much pain to take the bath. What should you do?
15.A personal care attendant is way behind in seeing all of the assigned clients. She decides to skip part of the care of her last client. She documented that the care was given as assigned. This is an example
a. Fraudb. Unethical behaviorc. Lyingd. All of the above
16. When a client complains of pain, what should the personal care attendant do first?
a. Ask the client to describe the painb. Call the client's doctorc. Tell the client what medication works for you when you have paind. Change the client's position
17. Which of the following incidents in a mentally ill client should you report immediately?
a. Talking to and hearing voicesb. Neglect of one's personal appearancec. Skipping or stopping medicationsd. All of the above
18. Mrs. Rand, who has diabetes and takes insulin regularly, tells the personal care attendant that she feels very nervous and jittery. What should the PCA do?
a. Take her temperatureb. Call her doctorc. Have her lie down on the bedd. Call the supervisor immediately

INFECTION CONTROL
19. During a visit you need to wash your hands:
a. Before you give physical care to the clientb. After you empty a bedside commodec. Before you leave the client's homed. All of the above
20. In what situations should gloves be used?
a. When emptying a urinary drainage bagb. When the client has been incontinent of stoolc. When the client has a draining woundd. All of the above
21. When soiled linen is removed from the client's bed, it should be:
a. Shaken, then foldedb. Folded hem to hemc. Held away from one's clothesd. Inspected for any tears
22. Which of the following best describes standard Precautions?
a. Used only for client's with the Human Immunodeficiency Virus (that causes AIDS) or Hepatitis B Virusb. Used only for clients with airborne diseases such as tuberculosisc. Used when providing care for all clientsd. Used only if you have a cold or the flu
23. In caring for a client with HIV/AIDS, you must practice which of the following Standard Precautions?
a. Wear gloves at all times when caring for the clientb. Wear a gown when handling linens that contain body fluidsc. Dispose of body wastes in a leak-proof containerd. All of the above

BODY FUNCTIONS AND CHANGES
24. Mrs. Snodgrass tells you that she hasn't had a stool since your last visit five days ago. What should you do?
a. Give her an enemab. Notify your supervisorc. Tell her to drink more prune juiced. Tell her to increase the fiber in her diet
25. Mrs. Jones is an 82-year-old who lives alone. She returned home yesterday after surgery for a fractured hip and rehabilitation in an extended care facility. When doing care, which of the following is the most important to report to your supervisor?
a. The wound is red and oozing yellow drainageb. Complaints of the wound itchingc. Client not wanting to take her pain pilld. The dressing is loose on one end of the incision
26. Mrs. Smith complains of constipation when you are there. Which of the following should you do?
a. Encourage her to spend as much time lying or sitting as possible to ease the discomfortb. Limit her fluidsc. Tell her to take an extra laxatived. Ask Mrs. Smith how much fiber and liquids she is taking in her diet
27. Mrs. Seevers has Alzheimer's disease. Her caregiver reports that Mrs. Seevers has been trying to leave home at all hours. What would you do?
a. Restrain client in a chairb. Lock the client in her roomc. Stay with the client and report the behavior to your supervisord. Have the caregiver give the client extra medication before you leave the home
28. Mr. Jones, a client with dementia, is becoming very agitated. Which of the following suggestions would be helpful in this situation?
a. Stay calmb. Offer diversion or entertainmentc. Be agreeabled. All of the above

MAINTENANCE OF A CLEAN, SAFE ENVIRONMENT
29. Part of your duties as a personal care attendant is to assure a safe home environment. This includes:
a. Proper infection control with good hand washingb. Electrical and fire safetyc. Clear walkways; no throw rugs; stairs, halls and exits free from clutterd. All of the above
30. When a grease fire occurs, you can;
a. Use a fire extinguisher to put out the fireb. Smother it out with a lidc. Pour baking soda over the fired. All of the above
31. Which laundry product is also a disinfectant?
a. Fabric softenerb. Liquid pre-washc. Bleachd. liquid stain remover
32. When working in a kitchen it is important to practice good safety. Which of the following is NOT an appropriate safety measure?
a. Clean all spills immediatelyb. Refrigerate warmed food only after it has cooledc. Keep drawers and cupboards closedd. Air dry dishes after washing them, instead of drying with a towel
33. To prevent accidental poisoning of children and adults with cognitive impairments which of the following actions is best?
a. Keep poisons locked upb. Keep an antidote ready in case someone takes a poisonc. Have an emergency number to call by the phoned. Have the physician's number near the phone
34.A client is receiving oxygen through a nasal tube. You would perform all of the following safety precautions except:
a. Make sure there are no kinks in the tubingb. Turn off the oxygen at mealtimec. Give oral hygiene as directed by your supervisord. Post a sign and do not allow smoking in the client's room

EMERGENCY PROCEDURES
35. In case of a fire in the home, what is the best procedure to follow?
a. Tell the client to be calm, call the fire department, and then take the client out of the houseb. Get the client and yourself out of the house and call the fire departmentc. Try and put the fire out yourselfd. Call your supervisor and the fire department, then leave the house
36. In case of an emergency, the MOST important number to call is:
a. A family memberb. The doctorc. The emergency medical serviced. Your agency
37.A client is choking on some object that is caught in his airway. Before any first-aid measures are applied, find out:
a. If the client's pulse is over 80b. If the client can swallow liquidsc. If the client can speak or coughd. If the client's respirations are less than 20
38. You arrive at a client's home that lives alone. He does not answer the door when you knock and the door is locked. What do you do first?
a. Call the emergency medical serviceb. Call the client's familyc. Call the agency and report your findingsd. Go to the next client
39.A client suddenly complains of intense, squeezing pain in the chest that goes down the arm. The client is sweating profusely. The personal care attendant should:
a. Call for emergency help immediatelyb. Massage the client's chest and armc. Assist the client back to bedd. Call the agency to report your findings
40. While giving a bath in a shower chair, the client suddenly gasps and becomes unresponsive. The personal care attendant who is CPR certified should:_
a. Yell for caregiver assistanceb. Leave the client and call 911c. Lower the client to the floor of the tub, yell for the caregiver to call 911 and initiate CPR if indicatedd. Tell the caregiver to stay with the client while you call 911 and your supervisor
41. As a personal care attendant, what can you do for a client's minor burn as an emergency procedure?
a. Use cool water over the burned areab. Apply butter on the burned areac. Cover the area with a dry dressingd. All of the above

DEVELOPMENTAL NEEDS
42. Which is not a common reaction of children to stress?
a. Nightmaresb. Playing quietly with their favorite toysc. Aggressive acting out behaviord. Bedwetting
43. Mrs. Smith, age 85, does not like to eat. To encourage her to improve the amount she eats, you should:
a. Give her extra helpings on pretty platesb. Make the surroundings and conversation pleasant while serving her only one thing at a timec. Give her a balanced diet even if she does not like all of the foodd. Serve small helpings of foods that she likes in pleasant surroundings
44. You are caring for Johnny, a 7 year old, with cerebral palsy. He is showing sign of aggression and shouting at you. What can you do to change that behavior?
45. Mr. Marsh has Alzheimer's disease. You assist him twice a week with bathing, as he can no longer perform activities of daily living independently. You are very frustrated because he grabs onto you or the washcloth during the bath. What can you do to prevent this?
a. Tell him in a loud voice to stopb. Restrain his arms and hands during the bathc. Tell the supervisor that there needs to be 2 attendants assigned, so that you can do the bathd. Give him something to hold during the bath
46. Mrs. Ramirez lives with her son and his two teenage children. Her hospital bed is in the living room because there is no bedroom space for her. The family keeps walking through this area while you are assisting with her bath. What can you do to give the client privacy?
a. Tell everyone to stay out while you are giving her bathb. Tell the family that you are about to start the bath in five minutes and after that time no one may come in until after the bathc. Make arrangements with the family on when to give the bath to help promote the need for privacyd. All of the above
47.Mr. and Mrs. Williams, both in their 70s, are distressed about changes that are affecting their lives. Which of the following would not be stressful?
a. Positive relationships with family and friendsb. A change in Social Security benefitsc. One of them is diagnosed with a terminal illnessd. Moving from their home to a retirement community
48. Which is an example of confidential information?
a. Is a former bank president in townb. Was a professional athletec. Has AIDSd. All of the above
49. Which of the statements is true about any client with disabilities?
a. They are sick and should be treated as suchb. They need as much help as you can givec. They need to be as independent with self-care as possibled. They need repeated instruction to do a task
50. Mrs. Thomas had a stroke six months ago, which resulted in right-sided weakness along with difficulty in swallowing and speaking. Due to these problems she cries easily and gets angry with you frequently. How can you help ease her anxiety?
a. Be patient and assist her in methods to express herselfb. Tell her to stop feeling sorry for herself and to try harderc. Tell your supervisor that you do not want to work with Mrs. Thomas any longer.d. You do all of the talking
51. Which of these statements about the elderly is true?
a. They cannot changeb. They can learn new thingsc. They want to become dependent on othersd. They do not enjoy meeting new people
52. The ability to make observations is even more important when working with infants and young children than it is when working with adults. The main reason for this is that infants and young children:
a. Do not like to be told what to dob. Are usually sicker than adultsc. Enjoy human contact more than adultsd. Cannot explain how they feel
53. When basic needs of clients, no matter what age, are met, the client will feel:
a. Aggressiveb. Discouragedc. A sense of well-beingd. A sense of insecurity
54. In caring for a dying client, which of the following guidelines should not be followed?
a. Keep the client clean and dryb. Avoid false cheerfulnessc. Speak in a normal toned. Assume the client cannot hear you

PERSONAL CARE
55. Urinary leg bags are used for:
a. Catheterized male clientsb. Catheterized clients who are up and out of bedc. Catheterized clients who are confined to bedd. Catheterized clients who have a decreased urinary output.
56. When assisting with a bath, how often should the water be changed?
a. As often as needed to have warm, clean water at all timesb. Once is all that is necessaryc. Only after the client washes the perineal aread. Only after the client has washed the front half
57. Which of the following is the most appropriate practice to promote good skin care in the elderly?
a. Keep the skin clean and well-moisturizedb. Apply alcohol to moist areas of the skinc. Wash daily with scented soapsd. All of the above
58. Why is it important that a client have good mouth care?
a. Bacteria in the mouth can cause tooth decay and gum infectionsb. The saliva in the mouth is the source of stomach juicesc. Poor oral hygiene causes more saliva to be maded. Poor oral hygiene interferes with the sense of smell
59. The personal care attendant is helping Mrs. Elden with her bath. Mrs. Elden prefers to wash her perinea! area herself. Which of these measures should the PCA take?
a. Have Mrs. Elden use cold water only in washing her perinea! areab. Have Mrs. Elden use no soap when washing her rectal areac. Remind Mrs. Elden to wash front to backd. Remind Mrs. Elden to wash back to front
60. You are to assist Mr. Stone into the shower. To be sure the water is not too hot, what should do?
a. Ask Mr. Stone to place his hand in the shower to test the water temperatureb. Use half hot water and half cold water to ensure the proper water temperaturec. Allow the shower run for 1/2 hour so that it reaches room temperatured. Test the water temperature on your inner wrist
61. Mrs. Willow's Foley catheter is attached to a drainage bag. The drainage bag should always be kept
a. Below the level of the bladderb. At the level of the bladderc. 12 inches above the level of the bladderd. 3 feet above the level of the bladder
62. An elderly client occasionally wets his trousers. What should you do?
a. Give him fluids with his meals onlyb. Avoid giving him coffee and teac. Tell him if he urinates on himself, he will have to wear diapersd. Encourage him to go to the bathroom at least every two hours

SAFE TRANSFER TECHNIQUES AND AMBULATION
63. You are assisting your client in a transfer when he suddenly becomes weak and begins to fall. You should:
a. Quickly grab a chair and seat the clientb. Call for helpc. Help the client gently to the floord. Carry the client back to bed
64. You need to get Mrs. Jones from the bed to the wheelchair. She has left-sided weakness due to a stroke. Which step would you do first to insure a safe transfer?
a. Have Mrs. Jones put her arms around your neck and lift her to a sitting positionb, Place your arms under Mrs. Jones' armpits and swing her to the wheelchair in one smooth movec. Assist Mrs. Jones to the edge of the bed and allow her to get her balanced. Stand on Mrs. Jones' left side, bend at your waist, keep your knees locked and lift on the count of the three
65. Mrs. Alexander was in a car accident and sustained multiple fractures one month ago. She is now being cared for in her home. Her right leg is still in a cast. When you ambulate this client with her walker, where would you stand?
a. On her left side to support her strong sideb. On her right side slightly behind herc. Behind herd. In front of her so that you can move either way to her strong side or weak side if needed
66. Before helping a client into or out of a wheelchair, which of these actions is necessary?
a. Have the brakes unlocked and leave the foot rests downb. Lock the brakes and fold the foot rests upc. Have the brakes unlocked and the foot rests upd. Lock the brakes and leave the foot rests down
67. A client has had a stroke and has left-sided weakness. The client can walk with assistance of a cane. It is best for the personal care attendant to assist this client by walking:
a. Directly in front of the clientb. Directly in back of the clientc. On the client's left sided. On the client's right side
68. A client who has been in bed wants to get up in a chair. You assist him to sit on the edge of the bed. The client says, "I'm dizzy." What should you do?
a. Rub the client's feetb. Help the client to a standing position and see if the dizziness goes awayc. Put a cool compress on the client's headd. Support the client in a sitting position and wait a minute or so to see if the dizziness goes away

NORMAL RANGE OF MOTION AND POSITIONING
69. A client lying on his back has slid down in bed and needs help moving up in bed. To start this, the client should, if possible:
a. Raise himself on his elbowsb. Separate his legs widelyc. Arch his backd. Flex his knees and push with his heels
70. To prevent pressure sores in the elderly, you should:
a. Change the client's position every two hours if they are unable to do so themselvesb. Get the client out of bed if they are allowed to do soc. Ensure adequate nutrition with special emphasis on proteind. All of the above
71. Which of these statements describe good body mechanics?
a. Carry heavy objects as far from your body as possibleb. Bend the knees when lifting an object off the floorc. Bend over at the waist when lifting an object from the floord. Lift rather than push a heavy object

NUTRITION
72.A normal newborn should be fed:
a. On a rigid 4 hour schedule, day and nightb. Every 2-3 hours, whether hungry or notc. On a scheduled determined by the personal care attendantd. At least every 4 hours or on demand
73. Which food is appropriate on a low salt diet?
a. Butterb. Hamc. Chickend. Canned soup
74. The four basic food groups are:
a. Bread, cereals, meat and dairy productsb. Fruits, vegetables, dairy products and meatc. Meat, dairy products, fruits/vegetables and breadd. Bread, fruits/vegetables, meat and poultry
75. Which of these fluids is highest in protein?
a. Vegetable brothb. Lemonadec. Tomato juiced. Eggnog
76. When clients do not have enough fluids, they may develop which of these problems?
a. Diarrheab. Swellingc. Constipationd. Dandruff

ASSISTING WITH SELF-MEDICATIONS
77. Which statement is incorrect?
a. The personal care attendant may get a pill bottle from a cabinet and bring the bottle to the client at the client's requestb. The personal care attendant should observe and document if the client takes his/her medicationc. If the nurse or family forgets, the personal care attendant may take the right dose of medication out of the bottle and give it to the client with Alzheimer's diseased. The personal care attendant may help clients to remember to take their medications.
78. The personal care attendant should:
a. Remind clients to take their medicationsb. Document and report to their supervisor if the client refuses to take their medicationsc. Give the client water or other liquid, if allowed, to help in swallowing the medication(s).d. All of the above

THE FOLLOWING ARE TRUE OR FALSE STATEMENTS.
79. The most important measure to prevent the spread of disease is hand washing.
a. trueb. false
80. Beliefs and practices differ in cultures and often include what medical treatments may be accepted.
a. trueb. false
81. The food eaten in a culture is influenced by where they live, the kinds of foods that grow there and their religious restrictions.
a. trueb. false
82. As a personal care attendant, you can help clients meet their spiritual needs by accepting how clients express their beliefs.
a. trueb. false
83. Diarrhea can cause dehydration and other serious complications and should be reported.
a. trueb. false
84. Smoking in bed is fine for anyone who is not confused.
a. trueb. false
85.A personal care attendant encourages her client to be as independence as possible.
a. trueb. false

AGING & DISABLED HOME HEALTH CARE
AFFORDABLE HOME CARE

TRANSFER TRAINING

HHA & PCA TRAINING
Target Audience: Personal Care Attendant & Home Health Aides
TOPIC: BASIC PRINCIPLES OF PROPER PATIENT TRANSFER TECHNIQUES
• Use lifts, transfer boards, adjustable beds, and gait belts
• Medicare may cover the cost of a lift or hospital bed for a bed-bound patient in the home setting. A 2002 study, "An ergonomic comparison between mechanical and manual patient transfer techniques" found that "manual patient transfer and repositioning techniques are a significant cause of low back injuries," and showed that using lifts placed less stress on the low back than manual patient transfer techniques.
• Promote patient independence during transfers. In "Evidence-Based practices for safe Patient Handling and Movement," Registered Nurse Audrey Nelson and Medical Assistant Andrea Bapiste state, "Patients should be encouraged to assist in their own transfers and handling aides and should be used whenever possible."
• Some patients are capable of performing their own transfers using a mechanical lift.
• Learn proper body mechanics. It will lower the risk of injury prevention.
GENERAL TRANSFER TECHNIQUES
• It is best to lift with the knees and avoid twisting the back.
• Although it is sometimes impossible to avoid lifting, it helps to get as many people as possible to help with the bigger lifts that sometimes are necessary.
• Keeping the neck and back in alignment with the feet and shoulder width apart is a good general rule to follow when attempting to lift patients.
• Never lift at the waist.
• Try to get the weight as close to the body as possible to make carrying it easier on the back.
• Always explain to the patient what you plan to do.
• The healthcare worker should steer clear of any twisting motion.
• If the patient starts to fall, ease the patient down onto the closest surface. Then reposition yourself and the patient before continuing the transfer.
• Keep your back straight because discs can tolerate compressive loads when the back is straight; discs are weaker when you lift in a flexed position.
• Maintain the neutral curves of the spine and keep the spine aligned, moving smoothly as you complete the transfer process.
• Keep stress off of the spine and keep an imaginary line to maintain the curves in your balance.
• Prior to the actual transfer prepare the transfer method and determine the patient's ability to assist

AGING & DISABLED HOME HEALTH CARE
AFFORDABLE HOME CARE

TYPES OF TRANSFERS
1. Complete Independence
a. If walking, patient safely approaches, sits down on a regular chair, and gets up to a standing position from a regular chair. Patient also safely transfers from bed to chair. (No helper)
b. If in a wheelchair, patient approaches a bed or chair, locks brakes, lifts foot rests, removes arm rest if necessary, and performs either a standing pivot or sliding transfer (w/o a board) and returns. The patient performs this activity safely. (No helper)
2. Modified Independence
a. The patient requires an AD such as a sliding board, a lift, grab bars, or a special seat/chair/brace/crutches; or the activity takes more than a reasonable amount of time; or there are safety considerations. In this case, a prosthesis or orthosis is considered an AD if used for the transfer (Helper)
3. Supervision or Setup
a. The patient requires supervision (e.g. standby, cueing, coaxing) or setup (positioning sliding board, moving foot rests, etc.) (Helper)
4. Minimal Contact Assist
a. The patient requires no more help than touching and performs 75% or more of transferring tasks. (Helper)
5. Moderate Assistance
a. The patient requires more help than touching or performs 50-74% of transferring tasks. (Helper)
6. Maximal Assistance
a. The patient performs 25-49% of transferring tasks. (Helper)
7. Total Assistance
a. The patient performs less than 25% of transferring tasks (Helper)

TRANSFER TECHNIQUES
4 types of wheelchair transfers
a. Standby assist
b. Assisted standing pivot
c. 2-person lift
d. Hydraulic lift
2. Assisted standing pivot transfer
a. For those with limited mobility.
b. Use transfer belt
c. Move wheelchair to a 45-degree to bed or chair on the patient's strong side.
d. You will:
i. Move footrests out of the way
ii. Be sure that the wheels are locked
iii. Have patient sit on the edge of the wheelchair seat
iv. Have patient push down on the arms to assist in rising
v. Bend knees, grasping transfer belt with both hands.
vi. Rise with the patient close to you
vii. Make sure patient is not dizzy.
viii. Pivot toward the chair until patient can feel table behind thighs
ix. Ask patient to reach out and hold onto the chair with both hands .
x. Assist patient to sit down
3. Base of support
a. Foundation on which a body rests or stands; when a person is standing, the feet and the space between them define the base of support. Standing with feet wide apart enlarges the base of support. Narrow bases are unstable-like standing on one foot. It's important for both staff and patients. Wide bases of support create stability.
4. Lifting
a. Done by bending and straightening the knees with a straight back.
5. Principles of Lifting:
a. Let the patient do as much as possible—this will minimize the trauma to the patient and avoid stress on the employee.
b. Stand with feet apart creating a wide base of support.
c. Patient's center of gravity should be held close to the employee's center of gravity.
d. Use transfer belt around patient's waist.
e. Let the legs do all the lifting.
f. Avoid trunk twisting.
g. Have patient stand slowly to reduce chance of orthostatic hypotension.
h. Ask the patient if they are doing ok?
i. Ask patient to take it slow deep breaths.
6. Rolling patients
a. Always roll patient toward you.
b. Provide positioning wedges to support patient comfortably

PATIENT/CAREGIVER SAFETY IS THE #1 GOAL
lents often require assistance with transferring in and out of bed and from one surface to another. Health care workers are at risk of injury if proper body mechanics are not used during these transfers.
JED MOBILITY
Patient Grouping: This is for patients who spend a lot of time in bed and cannot get in and out of bed without assistance.
Procedure:
• If the patient has a hospital bed, raise the height of the bed to your waist height to avoid bending over and placing a strain on your back. If the patient does not have a hospital bed there needs to be a recommendation for the rental or purchase of a hospital bed.
• Assist the patient move to the side of the bed by rolling him/her toward you.
• Support the patient at the shoulders and buttocks area.
• To transfer from laying down to sitting, instruct the patient to push off the bed with his elbow while you reach underneath his knees and assist him with bringing his feet over the edge of the bed.
• Squat down as you lower his feet toward the floor.
PERSON BED MOBILITY
Puuent Grouping: For patients who spend a lot of time in a hospital bed with their heads elevated. This position causes )atients to slide down over time and assistance is required to re-position them. Bed mobility maneuvers should be performed with two people whenever possible. It is also necessary when providing care for very debilitated patients who do not have the strength to reposition themselves in the bed and require the assistance of 2 healthcare workers.
Procedure:
• Lower the head of the bed until the patient is lying flat.
• Raise the height of the bed to your waist height to avoid bending over.
• Ask the patient to help, if possible, by bending his/her legs and pushing or by pulling on the sides rails.
• Everyone involved in the lift should work in unison.
• There should be one person on either side of the bed.
• With a straight back and bent knees, the healthcare workers get as close to the patient as possible.
• The healthcare workers grasp the sheet edge positioned under the patient at his/her shoulders and hips.
• Count to 3 and lift and slide the patient up in bed to reposition the patient.
• The healthcare worker should shift their weight from one foot to another instead of twisting with the back.
SIT TO STAND TRANSFER
Patient Grouping: This is for patients who require human assistance to transfer from a sitting to standing position.
Equipment needed: Gait Belt
Procedure:
• Place a gait belt around the patient's waist to provide something for you to hold onto.
• Do not hold the patient by the armpit as this can cause damage to his/her shoulder.
• instruct the patient to scoot forward toward the edge of the seat until his/her feet are flat on the floor then place his/her hands on the armrests of the chair or next to his/her sides on the bed.
• Stand facing the patient, bend your knees and hold each side of the gait belt.
• Rock the patient back and forth three times (counting 1, 2, 3) then, on three, instruct the patient to push up with his/her arms as you pull him/her close to your body as you move into a standing position.
STAND PIVOT
Patient Grouping: Patients who need assistance to rise from a sitting to standing position. It is appropriate for patients who can support 75% of their weight but need physical assistance for balance, or have difficulty picking their feet up to take steps to transfer from one surface to another
Equipment Needed: Gait Belt
PROCEDURE:
• Perform the sit to stand transfer.
• Continue to hold each side of the gait belt and hold the patient close to your body.
• Take small steps and rotate your body until the patient's back is facing the seat he/she is moving to.
• Slowly squat and lower him/her into a seated position.
JDING BOARD TRANSFR
Patient Grouping: The sliding board transfer is used for patients who are unable to bear weight on their legs.
Equipment Needed: Sliding Board, Wheelchair, Gait Belt
PROCEDURE:
• The patient is in a sitting position on the bed.
• Position the wheelchair close to the bed at an angle off 30-45 degrees.
• Lock the wheels and remove the nearest armrest and move the footrest out of the way.
• Raise or lower the bed to level of the wheelchair.
• Instruct the patient to lean to the side and place a sliding board (smooth side up) under the patient's buttocks on the stronger side of his/her body.
• Position the opposite end of the slide board on the seat surface of the wheelchair pointing toward the opposite back corner. Rest the edge of the board against the front of the large chair wheel closest to you.
• Push downward on the board to prevent pinching when the patient returns to an upright sitting position with his hip and thigh on the board.
• Place a gait belt around the patient's waist if needed for added stability.
• ' Be sure the patient has both feet on the floor before you start, and explain each step to him.
• Assist the patient with shifting his/her weight from side to side by squatting in front of the patient and holding each side of the belt as he/she scoots sideways along the sliding board.
• If you need to assist, stand with one foot between the patient's 2 feet and put your arms around him. Bend at the knees and hips, then push while lifting to gradually side him across the board.
• Make the transfer slowly, through a series of leaning and sliding movements.
• Once the patient is in the wheelchair, help the patient shift his/her body weight to the side and remove the sliding board from underneath his/her buttocks.
TRANSFER TO A CHAIR
Patient Grouping: Patients who need the assistance of one healthcare worker with transfers from bed to chair, wheelchair to toilet, etc.; and the patient is able to walk with assistance of one healthcare worker.
Equipment needed: Gait belt, chair
Procedure:
• Place the chair facing the bed or at a 45 degree angle to the bed.
• Remove everything from the transfer area to prevent slips or falls.
• Position the chair at the same height as the bed or wheelchair you are transferring the patient to.
• If the transfer is to a wheelchair remember to lock the wheels of the chair and make sure the footrests are moved out of the way.
• Make sure the side rails of the bed are lowered.
• Raise the head of the bed to the highest position the patient will tolerate.
• If available secure a gait belt around the patient's waist while lying on their back.
• Assist the patient turn toward you to lie on their side (in a modified fetal position) with knees bent.
• The employee places one arm underneath the patient's torso and the other arm over the patient's legs, behind the knees.
• The employee instructs the patient to help lift up at the count of 3.
• On 3, the employee will swing the patient's legs over the edge of the bed while at the same time lifting the torso. The momentum built up from the legs will assist the employee in safely bringing the patient to a sitting position
• Once the patient is upright (sitting on the edge of the bed) have the patient set there for at least 10 seconds to ensure the patient is not dizzy.
• Put your arms around the patient's torso and help him move to the edge of the bed.
• If possible, have the patient place both feet flat on the floor.
• The employee positions one foot in front of the patient's toes and braces their knee in front of the patient's leg.
• If the patient is able, ask him/her to put one hand over your shoulder.
• Ask the patient to place his/her hands on the edge of the bed and push off.
• Keep your knees slightly bent. As the patient pushes off, straighten your knees and hips, lifting the patient.
• Once upright, the patient will grab the healthcare worker around the shoulders and the healthcare worker will reach around the patient's waist, firmly grasping the gait belt.
• With both patient and healthcare worker's legs positioned a shoulder-length apart, they pivot their bodies using small steps until standing directly in front of the chair keeping your back as straight as possible.
• Ask the patient to grasp the arms of the chair or wheelchair when he/she feels the chair against the back of his/her legs.
• Keep your back straight and flex your knees as you lower the patient into the chair bending at the knees and using your legs for support.
• Make sure the wheels of the new patient destination are locked, if transferring from a chair to wheelchair.
ALTERNATE METHODS
• Use a transfer belt (also called a gait belt) around the patient's torso to assist with the transfer.
• For larger patients or for added stability, 2 people may assist with this transfer. In this case, one person assists the patient swing his/her legs over the side of the bed while the other helps raise him/her into a sitting position.
• The 2 caregivers support the patient between them as they lift and pivot him/her until his/her back is to the chair, then both assist the patient to lower into the chair.
Transfer of the Patient from a Chair to a Toilet
Patient Grouping: Patients who are unable to complete toilet transfer independently
Equipment needed: Gait Belt
As important as the actual lifting technique is the earning of the "trust" and "cooperation" of the patient in the chair and ensuring that his or her dignity is preserved at all times. If a person is able to rise with only partial assistance, this ways the best option.
PROCEDURE:
• Maneuver the wheelchair so that the patient is facing the toilet. Position the person's feet under his or her body.
• Stand in front of the wheelchair, facing the patient, with your back to the toilet. Grabbing the back of the pants or belt, lift the person to his or her feet.
• Keeping the patient's weaker knee between your legs, pivot him or her around in front of the toilet.
• Always transfer the patient's weight towards his or her stronger side.
• Gently lower the patient onto the toilet seat and help remove his or her clothing.
Safe Patient Lifting
Patient Grouping: Patients who cannot transfer themselves with assist and need the full assist of the employee.
Equipment needed: Gait Belt
Procedure:
• Support the patient when attaching the gait belt.
• Have the patient sit up and as close to the edge of the chair or bed as possible and lean the patient forward.
• Transfer any special padding or equipment from the chair to the patient's new destination.
• Cross the patient's arms across his/her chest.
• Place your arms under the patient's upper arms and hold onto his wrists.
• Ask the patient to assist you by flexing his knees and pushing on the count of three, if the patient is able to do so.
• Place your feet against the patient's feet prevent any slipping by you or the patient.
• Gently lift the patient's torso and firmly press your knees against the patient's knees, keeping the patient close to your body.
• Position the patient in the chair or bed and replace the armrest, if applicable.
• Center the patient on the bed or chair and reposition the padding and gait belt as necessary.
• Straighten the tubing of any urine-collecting devices and place the bag below the level of the bladder.
• Lock the wheels in place, if the patient is being transferred to a wheelchair.
• Replace the footrests, if applicable.
• Make sure the patient is comfortable before leaving the room or continuing with what you were doing.
PEDIATRIC PATIENTS:
Patient Grouping: Pediatric Patients
• Health care workers who work with the pediatric population frequently lift patients to move them from one surface to another.
• To lift a child who is lying in bed, raise the height of the bed to waist-height.
• Place one arm under the child's shoulders and the other under his/her hips.
• Slide the child close to your body.
• Hold the child against your body as you lift and move.
• Squat as you lay the child onto the other surface.
WHEELCHAIR TO VEHICLE
Patient Grouping: Patients requiring transfer assistance into a vehicle
Equipment Needed: Wheelchair and Gait Belt and the potential for the need of a 2nd healthcare worker
• Recline the back of the car seat as far as it will go.
• Position the wheelchair at an angle to the car.
• Lock the wheelchair brakes and remove the armrest.
• Place the transfer board under the patient's thigh, with the other end solidly resting on the car seat and angled toward the center of the seat,
• If able, the patient slides himself across the transfer board to the car. Once there, the patient leans on the back of the seat while positioning his/her legs.
• Use a gait belt for stability and security.
• The healthcare worker may need an assistant to help the patient complete the transfer.
• The 2" healthcare worker lifts both of the legs and swings them together into the vehicle, positioning the patient's feet on the floor.
• Fasten the seat belt before returning the seat back to an upright position.
EQUIPMENT TRANSFERS
• Health care workers often have to transport and lift equipment throughout the work day.
• Injury can occur from improper body mechanics during these lifts.
• Store equipment at waist height as much as possible to reduce stresses on the lower back from bending over or backwards to reach up.
• Lift equipment by using your forearms around the sides of the machine and bring the equipment as close to your body as possible.
• If the equipment is not at waist height, use a step ladder or squat down rather than bending at the waist.
• If equipment must be moved across long distances, use a wheeled cart for transport..
References: Mayo Clinic, OSHA, Therapist contributions at eHow.

AGING & DISABLED HOME HEALTH CARE
COMPETENCY CHECK OFF ON TRANSFER TECHNIQUES IN THE HOME SETTING
VICE DEMONSTRATED COMPETENCY STAFF MEMBER REQUIRES FURTHER TRAINING
BED MOBILITY
SIT TO STAND
STAND PIVOT
SLIDING BOARD
CHAIR TO TOILET
SAFE LIFTING
PERSON LIFT
BED TO WHEELCHAIR
WHEELCHAIR TO
SUB TRANSFER BENCH
USE OF GAIT BELT
TO ASSIST WITH TRANSFER

Emergency Preparedness
Purpose
The purpose of this Emergency Operations Plan is to provide planning, training and establish preparedness to respond to the effects of potential emergencies whether they are man-made or natural disasters.
Definitions
A Disaster - The occurrence or imminent threat ofwidespread or severe damage, injury, or loss of life or property resulting from a natural or man-made cause, such as fire, flood, earthquake, wind, storm, wave action, oil spill or other water contamination, epidemic, air contamination, infestation, explosion, riot, hostile military or paramilitary action, or energy emergency.
B Mitigation - A process in which sustained actions are taken to reduce or eliminate long-term risk from natural and man-made hazards or disasters. Activities include coordinating with state agencies, private sector, and the public following disasters and emergencies.
C Preparedness - Preparing for the potential of a disaster through education and training, integration with community resources, developing disaster response plans, organizing response and recovery activities, and conducting exercises.
D Recovery - Activities implemented during and after a disaster designed to return an agency to its normal operations as quickly as possible.
E Response - Actions taken immediately before, during or after an impending disaster to address the immediate and short-term effects of the disaster. These are the details of the plan given for others to follow in order for the emergency plan to be successful.
Policy
A The administrator, supervising nurse, the disaster coordinator and the alternate disaster coordinato will be involved with developing, maintaining and implementing the agency's emergency preparedne and response plan.
B Agency will utilize an Emergency Preparedness Plan in the event a situation occurs that could potentially affect the needs for its services or its ability to provide those services. Agency employees and contractors will be educated regarding the emergency preparedness and response plan and their responsibilities in executing the plan upon hire and annually thereafter.
C The effectiveness of the Emergency Preparedness Plan will be evaluated at least annually and after each actual disaster/ emergency response. The annual internal review will consist of testing the response phase of the emergency preparedness and response plan in a planned drill, if not tested during an actual emergency response. A drill may be limited to the agency's procedures for communicating with staff.
D Agency will designate an employee by title, and at least one alternate by title, to act as the agency's disaster coordinator. This will be documented is in the Emergency Preparedness Response and Plan Manual.
E Staff will follow the "Staff Emergency Preparedness Plan" in the event of a seen or unforeseen emergency.
F. Agency will create a "Hazard Threat Analysis" to identify the potential disasters from natural and man-made causes most likely to occur in the agency's service area. These threats that may potentially create a risk include, but not limited to: tornados, flash floods, chemical spills or incidents, severe ice storms/blizzards, terrorism, lightening, nuclear power plant incidents, hurricane or tsunami and wild fires.
G Agency will develop a "Continuity of Operations Planning" to ensure needs of agency, staff and patients arc met.
H Agency will maintain documentation of compliance with the required elements, required forms and agency policies in the Emergency Preparedness Response and Plan Manual.
I Agency will make a good faith effort to comply with the policies during a disaster. If the agency is unable to comply with any of the policies, it will document attempts of staff to follow procedures outlined in the agency's emergency preparedness plan.
J Agency will not participate in community emergency preparedness plans or exercises but may utilize community resources as needed during an emergency or disaster.
K Agency will assist the patient as necessary with registering for disaster evacuation assistance through 211 services provided by the Texas Information and Referral Network.
L Agency staff will counsel a patient on disaster preparedness during the admission process and as changes are noted.
Procedure
A. Emergency Preparedness Planning for Natural and Manmade Disasters
1. The Hazard Vulnerability Analysis tool will be completed by agency leaders to identify the level of risks and preparedness for a variety of hazardous events that might affect the agency and ability to provide services.
2. A current list of contact information for staff, staff family members, vendors, emergency services, hospitals and other appropriate community resources will be maintained
3. Agency leaders will develop the Continuity of Operations Planning to address the following:
a. Emergency financial needs;
b. Essential functions for patient services;
c. Critical personnel, roles and responsibilities: and
d. How to return to normal operations as quickly as possible.
4. Administrator or designated administrative staff will maintain a current phone list for staff and all applicable contact numbers (home phone, cell phone, pager numbers, and contact numbers of family/friends if employee is unreachable in event of emergency and establish
a communication tree or chain. This list will be maintained in the Business Emergency Plan and staff will be responsible to provide current and updated information. Communication tree will communicate with the following:
a, Leaders and owners, if applicable
b. Staff;
c. Patients or someone responsible for a patient's emergency response plan;
d. County and city emergency management officials if needed during and after an event;
e. State and Federal emergency management entities ifwarranted by the nature of the event; and
f. Other applicable entities (i.e. DADS, Emergency Medical Services or other health care providers).
5. Patient Care and Communication
a. Upon admission to Agency, directly following an emergency response, and on an ongoing basis the following will be assessed: and
i. The patient's condition and needs for triage prioritization,
ii. The patient's location for potential natural and/or industrial disaster (to include tornadoes, hurricanes, winter storms/blizzards, nuclear power plant disaster, floods, chemical toxicity, pollution, and fire, etc.).
6. Patient Triage
a. Agency will maintain a current list of patients categorized into groups based on services provided to the patient by the agency, need for continuity of services being provided, and availability of someone to assume responsibility for a patient's emergency response plan if needed by the patient. Patients will be categorized by, but not limited to, the following:
i. Class I - Lifethreatening (or potential) requiring ongoing medical treatment to prevent a life threatening episode. Unable to withstand any interruption in power supply. Unable to evacuate/transport self. No readily available caregiver or caregiver unable to provide needed care. Appropriate arrangements to transfer to an acute care facility will be made by the agency in collaboration with the local county or city authorities (fire department, police, and sheriff), the patient/family and the physician.
ii. Class II - Not immediately life threatening but patient may suffer adverse effect without service (i.e. new insulin-dependent diabetic unable to self-
inject insulin, IV medications, or sterile wound care with large amounts of drainage). Visits may be postponed 24-48 hours with minimal adverse effect. Unable to transfer/transport self or no transportation available from caregiver. Appropriate arrangements may be made if necessary. to send patient to a facility that can meet their needs. This will be done in
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