Aging & Disabled Home Health Care 3

Aging & Disabled Home Health Care

Affordable Home Care

collaboration with the patient/family, physician, and local or city authorities.
iii. Class 111 - Services may be postponed 48-72 hours without adverse effect on the patient (i.e. new insulin-dependent diabetic able to self-inject, cardiovascular and/or respiratory assessments, or sterile wound care to a wound with minimal to no drainage). Transportation available from family, friends, volunteers or caregiver.
iv. Class 1V- Services may be postponed 72 hours or more without adverse effect on the patient (i.e. routine catheter changes or postoperative with no open wound). Willing and able caregiver readily available or patient independent in most AD L's. Transportation available from family, friends, volunteers or caregiver.
b. Staff will assess the availability of someone to assume responsibility for the patient's emergency response plan if needed by the patient during the admission process and at any time this information changes.
c. Staff will identify a patient who may need evacuation assistance from local or state jurisdictions and a list ofvendors who supply each patient's medical supplies will be obtained and kept in the patient's chart. This will be documented in the Patient Information Emergency/ Disaster Preparedness and Plan.
d. In the event of an emergency, staff will be able to readily access a patient's triage category documented in the list of patients with all categories listed. The list of patients with all classes noted will be documented in the "on call list" or in other documentation that is easily retrieved.
e. The patient disaster triage class will be reviewed and updated as condition or situation warrants but not less than every 60 days. The updated class will be documented on the OASIS and updated Patient Emergency Information Sheet. Changes will be communicated to staff for any changes made.
f. Upon admission, the agency will provide and educate on the Patient Information & Emergency/Disaster Preparedness Plan which will address how to handle emergencies in the home related to a disaster. The patient will sign acknowledging receipt of counseling on emergency preparedness and written materials and information provided. The patient admission packet will include but not limited to the following:
i. List of community disaster resources that may assist a patient during a disaster, including the Transportation Assistance Registry available through 211 Texas, and other community disaster resources provided by DADS, local, state, and federal emergency management agencies. An agency's list of community disaster resources will include information on how to contact the resources directly or instructions to call 211 for more information about community disaster resources.
ii. Materials that describe survival tips and plans for evacuation and sheltering in place;
b. Clinical staff is responsible for educating patients on how to handle emergencies in the home related to a disaster.
9. The Disaster Coordinator/Alternate or designee will monitor disaster-related news and information, including after hours, weekends and holidays, to receive warnings of imminent and occurring disasters. The following methods may be utilized:
a. Local and regional news media through television and radio;
b. Internet;
c. Emergency broadcast channels, weather channels;
d. Government authorities; or
e. Internal agency communications.
10. Patient will receive calls or visits from clinical staff with information for needed preparation or instructions for potential disasters or emergencies that are imminent.
11. Patient, caregivers and staff will receive education on any new or potential emergencies that may affect patient care and services.
12. An emergency supplies storage area will be maintained at the Agency office for employees during the time period that they are working in the event of an emergency and will be updated and maintained by the Disaster Coordinator! Alternate.
13. Mitigation
1. Administrative Staff Responsibilities for Mitigation
a. Administrator will maintain a backup staffing plan and ensure adequate staff is available to provide care to patients if agency is not able to provide services to its patients during an emergency.
b. Administrator will ensure a test of the emergency preparedness plan is conducted if no actual disasters have occurred at least annually.
2. Clinical Staff Responsibilities for Mitigation
a Clinical staff will participate in the drill annually to test the call tree and to identify opportunities to improve documented in the critique of the drill or actual disaster.
3. Patients who are vulnerable to particular conditions will be identified with proactive actions taken to reduce risk which may include but not limited to:
a. Increasing monitoring of patient and home environment during certain conditions such as heat wave, drought or winter storms;
b. Providing education to patient and caregivers on measures to keep cool in heat wave, keep warm during winter storms or other safety measures; or
c. Providing utility companies with a list of potentially vulnerable patients in the event of power failure.
iii. Identification of person or persons responsible to assist with evacuation in the event of an emergency/ disaster and names of family/ friends who may be contacted by agency in an emergency;
iv. Identification ofpatient's current status with 211 registry, requested assistance with 211 registry, declination of 211 registry and completion of 211 registry; and v. Patient's responsibilities and actions and responsibilities of agency staff during and immediately following an emergency are provided in the admission packet.
g. The patient-specific emergency/disaster preparedness plan will be documented in the patient's medical record and communicated to Agency staff. Agency will maintain a copy in patient's folder in the home as well.
h. Agency will make appropriate referrals to assure continuation of care. This will include but not be limited to: •
i. Life-supporting equipment (DMEprovider, electric/gas company);
ii. Life-sustaining medication and/or nutrition (Pharmacy, Infusion Company); and
iii. Appropriate emergency response systems to assist patient as appropriate.
i. Agency will not physically evacuate or transport a patient. Agency staff will not be sent into hazardous areas or continue to operate in hazardous conditions.
7. Administrative Staff Responsibilities for Emergency Preparedness Planning for Natural and Manmade Disasters:
a. The Administrator or designated administrative staff will coordinate services with local, state, federal emergency management agencies and with any other healthcare providers or medical suppliers.
b. The Administrator or Disaster Coordinator/Alternate will maintain adequate medical supplies in the event of anticipated disasters or suppliers available to provide equipment and medical supplies in the event of disasters.
c. The Administrator or designated administrative staff will ensure security and safety of physical facilities which may include maintaining proper functioning fire safety equipment, ensuring exits are accessible, locks are functioning, information on utilities shutdown is readily accessible if applicable and supplies for shelter in place or power failures are available (duct tape, bottle water, nonperishable snacks, flashlights, candles, etc.),
d. The management staff will ensure that the patients are appropriately triaged and that this is communicated to agency staff,
8. Clinical Staff Responsibilities for Emergency Preparedness Planning for Natural and Manmade Disasters
a. Clinical staff will participate in emergency preparedness drills, in-services and orientation related to safety, security or emergency preparedness and in a multidisciplinary critique of each actual disaster or drill.
4. Patients and caregivers will be assisted on admission with developing a home emergency plan and provision of materials to assist in planning which are left in home folder.
c. Technological/Utility Failures /Mitigation
1. Administrator or designee will install and provide adequate protection of electronic records including anti-virus software and backup of documents including:
a. Delegation of task for back-up of data on a daily basis;
b. Education of staff on security of electronic records utilizing passwords to access records;
c. Maintenance of adequate supplies in event of power failures (clinical records in paper format, etc.).
2. Clinical staff will be compliant with accessing electronic records with passwords and will not share or provide passwords to others. Clinical staff will comply with changing passwords per agency policy.
D. Response Phase
1. The Administrator or Disaster Coordinator/Alternate will initiate and terminate the response phase.
2. The Administrator or Disaster Coordinator/Alternate determines facility safety and continued operations or if alternate site will be utilized.
3. The Administrator or designee will establish links to local emergency operations centers to determine a mechanism by which to approach specific areas within a disaster area in order for agency staff to reach patients. This will be communicated to staff
4. Clinical staff will communicate with means available. If the primary modes of communication with phone or cell phone calls fail, other methods may be used:
a. Texting;
b. Satellite phones;
c. Internet technologies, email; or
d. CB radios or HAM radio, if available.
5. Local radio and/or television stations will be contacted by the Agency as a method of communicating with the patient population and staff, as appropriate.
6 If no means of communication is available, then all staff members who can safely travel will report to the office if operational or alternate site if office is not operational for assignments.
7. The Administrator will determine ifstaffing is needed to provide or assist with services to its patients from another agency (Back-Up Staffing Contract)
8. Patient visits will be coordinated by the Director of Nurses or Alternate using the triage codes. Scheduled visits may be curtailed but attempts will be made to contact all patients/ caregivers.
9. Supplies will be delivered as needed and will be conserved during an emergency with only required amount used for each visit. Office staff will keep track supplies availability and delivered.
10. Each nurse or aide making home visits to patients must check in with the Agency office and get assignments. After completing assignments or for any problems that have occurred, office will be notified. Any new assignments will be made at that time. When the nurse has completed the list of patients assigned to them, they will be assigned to specific patients from the regular case load to complete that day's schedule. At least one administrative staff
member or the Disaster Coordinator/ Alternate will be present at the designated check in site. The Director of Nurses or Alternate will further assign Agency employees or contractors as they arrive and coordinate the staff members.
a. Calls will be made for prearranged transportation of patients in need of evacuation.
b. Before entering a patient's home, staff will determine if there is a safety issue possible gas leak, exposed electric wire, etc.). Assess the situation and report to an Emergency Supervisor, who will report to the county emergency planners for proper emergency personnel to secure that site.
c. If the patient is unharmed but the home is damaged or unsafe and the telephone system is working, arrangements for the patient's transportation will be made.
d. Patients who relocate to a new location will be tracked with contact information including all necessary telephone numbers.
e. Contact the Disaster Coordinator or administrative staff at office if other arrangements need to be made or contact county emergency planners for transportation to an alternate care facility if other arrangements cannot be made.
f. If the patient is injured and needs transport, contact an Emergency Management System for arrangements to be made through the county emergency planners for transport to a hospital/emergency room/triage site. Notify the Disaster Coordinator/ Alternate or administrative staff office of transport location.
g. If roads are blocked and alternate routes are not available, contact Disaster Coordinator or administrative staff at office of inability to reach an area.
11. Physicians will be notified ofpatient status after coordination with Disaster Coordinator,who will assign designated staff to contact all physicians with reports of their patients EMS may be activated as needed.
12. The agency will not continue to provide services to patients in emergency situations that are beyond the agency's control and that make it impossible to provide services (i.e. roads are impassable or patient relocates to a place unknown to the agency).
13. Office staff, if available, will assist with office phones for communication from patients.
a. Patients may contact staff by calling the office number.
b. If the office is not operational, the calls will be handled by the "on call" nurse.
c. If the answering service or the paging service is not operational, the agency will call forward to cellular "on call" phone.
14. The Disaster Coordinator or Alternate will notify EMS or local authorities assisting in disaster as needed to assist patients for evacuation.
15. The Disaster Coordinator or Alternate will document all aspects of disaster with times,staff, patient and physician contact and any other pertinent information. Information will be documented when agency is not able to comply with any of the requirements of the emergency plan and attempts of staff to follow procedures outlined in the agency's emergency preparedness and response plan. Information will be utilized to critique disaster for opportunities to improve.
16. Clinical staff will utilize clinical paperwork when computers are not available and ensure paperwork is submitted per policy. An abbreviated assessment can be completed to assure the patient is receiving proper treatment and to facilitate appropriate payment.
E. Recovery Phase
1. The Administrator or Disaster Coordinator/ Alternate will initiate and terminate the Recovery phase.
2. The Director, in conjunction with the Disaster Coordinator/ Alternate will review all activities that were part of the disaster response and will develop a Disaster Recovery Plan to include:
a. Response actions taken;
b. Necessary modifications to plans and procedures;
c. Training needs; and
d. Recovery activities to date.
3. Any incidents that occurred will be documented and action plans will be developed depending on the disaster.
4. The Administrator or Director of Nurses will meet with local emergency response providers to review the disaster response and formulate ongoing plans if applicable.
5. Administrator or designee will initiate counseling for staff, patients or caregivers as necessary by Medical Social Worker, Support Groups or outside community resources. Agency will monitor patient and staff needs for ongoing and preventative care and professional counseling.
6. The Director will assure patient continuity of care by assigning appropriate staff to:
a Review back-up staffing plans for effectiveness if utilized;
b. Ensure that all patients are placed back on schedule and receiving care;
c. Follow up on patient care or any patient transfers or discharges;
d. Notify physician of patient status;
e. Review on call logs, and
f. Assist patient/family with updating their emergency/ disaster preparedness plan, if appropriate.
7. All office and patient supplies will be replenished.
8. The Administrator or designee will coordinate report from Disaster Coordinator or Alternate. Report will be utilized for interdisciplinary critique and evaluation of disaster plans and response. Action plans and person to be responsible will be initiated.
9. The Administrator or designee will evaluate availability of staff for continued patient needs and possible new patients. New patient admissions may be halted if deemed necessary.
10. The Administrator or designee will determine location of operations. If relocation is necessary, ISDN will be notified by fax, email or telephone with all required information.
11. . The Administrator or owner will detennine damages to facility, equipment or property and assign staff to inventory supplies and reorder supplies. Damaged supplies or equipment will be separated from stock.
12. Insurance claims and plans for recovery of facility will be initiated as soon as possible by the Administrator or owner.
13. The Administrator or designee will ensure financial expectations are met with payroll through established means.
14. Clinical staff will continue to meet patient needs through visits or phone calls and continue to coordinate services with the Director of Nurses.
15. Office staff will reproduce clinical records from existing electronic records is possible if needed (written records will not be reproduced).
16. The Disaster Coordinator or Alternate will notify DADS when possible of disaster and other information as required.
F. Patient Records
1. Agency staff members will not jeopardize their own safety for the purpose of removing office contents (e.g., medical records, personnel files) when a disaster has occurred at an Agency site.
2. If an Agency site is affected, Agency Director will determine ifthe removal of medical,personnel and financial records is necessary.
3. Written patient records damaged during a disaster will not be reproduced or recreated, except from existing electronic records. Records reproduced from existing electronic records will include the following:
a. Date the record was reproduced;
b. Agency staff member who reproduced the record; and
c. How the original records was damaged
4. In the event of an imminent emergency /disastdr,:where a-possibility may exist, that patient will be leaving service area, patients may reoeive..atopy of their clinical record to ensure continuity of care if a signed -authorization for release of clinical record is obtained
5. In the event of an emergency/ disaster, where patients may be evacuated or transferred,Protected Health Information may be shared with other healthcare providers or emergency response teams as appropriate to health and safety of patients as allowed by applicable law.
G. Notification
1. Agency will notify ISDH Home and Community Support Services by fax or e-mail, within five (5) working days following temporary changes resulting from the effects of an emergency or disaster. If fax and e-mail are not available, notifications will be provided by telephone, but must be provided in writing as soon as possible.
a. License number for the place of business and the date of temporary relocation;
b. Physical address and phone number of the temporary location; and
c. The date an agency returns to a 'place of business after temporary location.
2. If temporarily expanding the service area to provide services during a disaster;
a. License number and revised boundaries of the original service area;
b. The date of temporary expansion; and
c. The date an agency's temporary expansion of its service area ends.
Community Resources
1. Agency may elect to utilize any, but not limited to, the following community or national resources in an emergency:
a. American Red Cross, United Way, FEMA, CDC, area churches, other community organizations that support victims of a disaster.
Emergency Management Review
1. Agency will complete an internal review of the emergency response plan at least annually and after each actual emergency response to evaluate its effectiveness and update the plan as needed. Annual review will be documented on the "Emergency Preparedness Plan Review and Checklist" as part of the Annual Agency Evaluation.
2. As part of the internal review, an Agency must test the emergency response phase of the emergency preparedness and response plan in a planned drill if not tested during an actual emergency response. A planned drill can be limited to the agency's procedures for communicating with staff.
3. After each actual disaster or a planned exercise, a multi-disciplinary team including management and staff will evaluate effectiveness and update emergency plan as needed to improve processes.
4. The Disaster/ Drill Critique form will be utilized to evaluate the processes and effectiveness ofthe Emergency Preparedness Response and Plan.
Surge of Infectious Patients as a Potential Emergency
1. Agency will implement the Pandemic Influenza Plan for a potential surge of infectious patients located in the Emergency Preparedness Manual.
Disaster Resources Websites:
1. Hurricane Information: ://www. dads. state. /preparedness /hurricanes. shtm
2. Shelter in place, family disaster plan, business information. etc ...: http: //
Personal Care Basics
• Client's needs for assistance with personal care can change from day to day, depending on how they are feeling. Involve the client in determining how much care you will be providing or assisting them with at each visit.
• Know your limitations and Agency Policies. Generally, Personal Care Assistants are to "assist" with personal care only and if completer personal care is required, a certified HHA must provide this care.
• Be aware of your client's personal preferences concerning their personal care.
• Before you begin and task, explain to the client what you are doing.
• While providing personal care, it is important to observe the client for any changes in behavior, condition, or level of activity.
• Some clients may be influenced by culture or religion in their personal hygiene practices and habits, you will need to adjust care accordingly.
• Assure safety and comfort.
• Your demeanor and way in which you assist with personal care can either reinforce the feelings of being valued or can cause the client to feel de-valued.
Assisting a client with bathing
Types of baths:
• The partial bath- used when the client does not need a complete bath or for some reason is not able or allowed to take a complete bath. You may be asked to assist the client in the areas that are hard for him to reach.
• The tub bath- make sure you follow the service plan when determining if the client can take a tub bath. In a tub bath, you may be asked to assist the client into the tub and assist in areas that are hard to reach.
• The shower- is utilized for clients who can bathe themselves. The client may have a shower chair to help them bathe.
Guidelines for bathing
• Allow the client as much privacy as is safe.
• Make sure you put towels or bath mats down to ensure proper footing while getting into and out of bath.
• If assisting with bathing, wash from cleanest area to dirtiest.
• ALWAYS check water temperature before allowing client to get into water. Water should be approximately 105 degrees.
• While assisting with the bathing process, observe the client's skin integrity.
• For a tub bath, it is easier for a client to get out of the tub if you drain the tub first.
Nail Care
• Clean and trim fingernails and toenails as needed.
• Review your service plan before trimming nails.
• Check the feet of a client a with diabetes or circulatory issues daily. Do not trim nails of those with compromised circulation or diabetes.
• Generally, it is easier to trim nails after soaking in a basin or bath.
• Clip nails straight across. A softened cuticle can be pushed back with an orange stick, if indicated on service plan.
• Use care not to injure skin when clipping nails.
Revised 5/30/2018
Consequences that may result from toenail care or neglected toe nails
Examples of problems:
• Nails too long or too short
• Inappropriate angle of trim
• Nicks/cuts
• Pain/immobility
• Infection
No nail care on diabetic patients!!!!!!!
Oral care challenges in the older adult
• With age, saliva production decreases which can lead to increased tooth decay and infection. Clients without the manual dexterity to provide proper oral care can be especially vulnerable to mouth problems.
• Gum tissue recedes with age which can make more prone to infections.
• Poor oral hygiene can lead to poor appetite and weight loss.
• Poor oral hygiene has also been associated with heart disease and the development of pneumonia.
Oral Care
• Oral hygiene involves cleaning the mouth, gums, and teeth or dentures.
• Proper oral care will help remove food particles and assist in preventing tooth decay or serious dental problems.
• Oral hygiene prevents sores and bad breath and keeps mucous membranes from becoming dry and cracked.
Revised 5/30/2018

Quiz: Personal care

1. There is no need to explain what procedure you are doing before you do it. The patient should already know. T OR F
2. Poor oral hygiene can lead to poor appetite and weight loss? T OR F
3. When performing oral hygiene on your patient it is important to brush the patient's gums as well as the teeth/dentures? T OR F
4. It is ok for a patient to ask you help them wash areas that is hard for them to reach? T OR F
5. When bathing a patient, you start with the dirtiest area and move towards the clean area? T OF F
6. HHA's are permitted to do nail care on diabetic patients? T OR F
Revised 5/30/2018

HIPRA In Home Care

What is HIPAA?
Health Insurance Portability and Accountability Act of 1996 (HIPPA), was signed into legislation back in the 90's. ... HIPAA has specifications that ensure the confidentiality and privacy of protected health information. If you don't know already, HIPAA is very important to everyone, including you.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 contains the following three major provisions: Portability. Medicaid Integrity Program/Fraud and Abuse. Administrative Simplification.
What is considered a breach of HIPPA?
A breach of protected health information ("PHI") is defined as the acquisition, access, use, or disclosure of unsecured PHI, in a manner not permitted by HIPAA, which poses a significant risk of financial, reputational, or other harm to the affected individual.
Examples of HIPFIA violations:
1. Employees disclosing information — Employees' gossiping about patients to friends or coworkers is also a HIPAA violation that can cost a practice a significant fine. Employees must be mindful of their environment, restrict conversations regarding patients to private places, and avoid sharing any patient information with friends and family.
2. Medical records mishandling — Another very common HIPAA violation is the mishandling of patient records. If a practice uses written patient charts or records, a physician or nurse may accidentally leave a chart in the patient's exam room available for another patient to see. Printed medical records must be kept locked away and safe out of the public's view.
3. Lost or Stolen Devices — Theft of PHI (protected health information) through lost or stolen laptops, desktops, smartphones, and other devices that contain patient information can result in HIPAA fines. Mobile devices are the most vulnerable to theft because of their size; therefore, the necessary safeguards should be put into place such as password protected authorization and encryption to access patient-specific information.
4. Texting patient information — Texting patient information such as vital signs or test results is often an easy way that providers can relay information quickly. While it may seem harmless, it is potentially placing patient data in the hands of cyber criminals who could easily access this information. There are new encryption programs that allow confidential information to be safely texted, but both parties must have it installed on their wireless device, which is typically not the case.
5. Social Media - Posting patient photos on social media is a HIPAA violation. While it may seem harmless if a name is not mentioned, someone may recognize the patient and know the doctor's specialty, which is a breach of the patient's privacy. Make sure all employees are aware that the use of social media to share patient information is considered a violation of HIPAA law.
6. Employees illegally accessing patient files - Employees accessing patient information when they are not authorized is another very common HIPAA violation. Whether it is out of curiosity, spite, or as a favor for a relative or friend, this is illegal and can cost a practice substantially. Also, individuals that use or sell PHI for personal gain can be subject to fines and even prison time.
7. Social breaches - An accidental breach of patient information in a social situation is quite common, especially in smaller more rural areas. Most patients are not aware of HIPAA laws and may make an innocent inquiry to the healthcare provider or clinician at a social setting about their friend who is a
Revised 6/8/2018
patient. While these types of inquiries will happen, it is best to have an appropriate response planned well in advance to reduce the potential of accidentally releasing private patient information.
8. Authorization Requirements - A written consent is required for the use or disclosure of any individual's personal health information that is not used for treatment, payment, healthcare operations, or permitted by the Privacy Rule. If an employee is not sure, it is always best to get prior authorization before releasing any information.
9. Accessing patient information on home computers — Most clinicians use their home computers or laptops after hours from time to time to access patient information to record notes or follow-ups. This could potentially result in a HIPAA violation if the screen is accidentally left on and a family member uses the computer. Make sure your computer and laptop are password protected and keep all mobile devices out of sight to reduce the risk of patient information being accessed or stolen.
10. Lack of training - One of the most common reasons for a HIPAA violation is an employee who is not familiar with HIPAA regulations. Often only managers, administration, and medical staff receive training although HIPAA law requires all employees, volunteers, interns and anyone with access to patient information to be trained. Compliance training is one of the most proactive and easiest ways to avoid a violation.
How do we maintain confidentiality?
Confidentiality is the protection of personal information. Confidentiality means keeping a client's information between you and the client, and not telling others including co-workers, friends, family, etc.
Why is it important to maintain patient confidentiality?
Patient confidentiality is one of the most important pillars of medicine. Protecting the private details of a patient is not just a matter of moral respect, it is essential in retaining the important bond of trust between the doctor and the individual.
Can you qo to jail for violations of HIPPA?
Like the HIPAA civil penalties, there are different levels of severity for criminal violations. The minimum penalty is $50,000 and up to one year in jail. Violations committed under false pretenses require a penalty of $100,000 and up to five years in prison.
Revised 6/8/2018

H I PC A Quiz:

1. HIPPA stands for: Health Insurance Portability and Accountability Act.
2. It is okay for me to post on facebook about how my day went at work?
3. I could go to jail for HIPPA violations?
4. PHI stands for: protected health information
5. Any employee who violates the HIPPA may be subject to discipline and termination of employment with the Agency.
Revised 6/8/2018
1. TB is caused by:
a. virus
b. bacteria
c. infection
2. You can spread TB by:
a. Shaking someone's hand
b. Kissing
c. Sneezing/coughing on someone.
3. The Main organ TB affects is the:
a. Stomach
b. Lungs
c. Gallbladder
4. TB can be fatal if not treated properly?
a. True
b. False
5. Our Company requires yearly TB tests on all employees?
a. True
b. False

A & D Home Health Care


The Certified Occupational Therapy Assistant, under the supervision of Registered Occupational Therapist, shall:
- assist the Occupational Therapist in providing specifically assigned service activities in accordance with a written therapy plan based upon a physician's orders and in accordance with established policies and procedures
- participate in and assist the Occupational Therapist in developing and reviewing the initial and comprehensive assessments of a patient's needs and the individualized care plan, and subsequent quarterly reviews
- perform all other related duties as assigned by the Registered Occupational Therapist.
- Ensure that visit information regarding therapy services rendered are accurately sent to the Agency in a timely manner
Demonstrate knowledge of and:
- Attend participate in, and complete all mandatory in-service education/training as required by the state regulations.
The Certified Occupational Therapy Assistant shall possess:
- as a minimum, an Associate's Degree as a Occupational Therapy Assistant from an accredited college or university
- a current, unencumbered certification to practice in this state as a Certified Occupational Therapy Assistant
- a current, unencumbered driver's license in this state.
One (1) year of experience providing occupational therapy services to residents in a health care setting is preferred.

A & D Home Health Care

Page 2 of 2

• The Certified Occupational Therapy Assistant shall be able to:
• Move intermittently throughout the day
• Cope with the mental, emotional and physical stresses of the position
• Relate to and work with ill, disabled, elderly, emotionally upset, and, at times, hostile patients.
• See and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met
• Lift, push, pull and move a minimum of fifty (50) pounds be in good general health and demonstrate emotional stability.
I have reviewed my job description and agree to perform all duties mentioned to the best of my ability; I understand that my job duties may change as the needs of the agency change. I further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.



Clinical Supervisor/RN Case Manager
Performs skilled nursing functions in accordance with the federal, state, and local laws and within the guidelines of his/her professional organization and Agency.
All functions shall be performed in accordance with the established policies and practices and state Nurse Practice Act. The LPN/LVN delivers care to clients as delegated by the RN Case Manager.
• Graduate of an accredited school of professional nursing.
• Current license to practice as a Licensed Practical Nurse/Licensed Vocational Nurse in the state(s) of employment.
• Minimum of one (1) year experience in an acute care setting or equivalent experience.
• CPR certified.
• Demonstrated written, verbal, and interpersonal communication skills.
• Licensed driver with automobile insured in accordance with state and/or Agency requirements and in good repair. Has a good driving record.
1. Provides professional nursing care as defined in the nurse practice act and under the direction of a Registered Nurse. Communicates appropriate status/condition changes to the RN per agency guidelines.
a. Provides skilled nursing visits for clients as directed by the RN Case Manager. Follows the care plan established by the Registered Nurse.
b. Recognizes and reports changes in client condition to the Case Manager and physician, as directed.
c. Communicates information on a timely basis, consistent with Agency policy and urgency of the situation. Communicates verbally, as needed, and through complete and accurate documentation in the clinical record.
d. Scope of clinical practice includes personal care services, monitoring and reporting findings, medication administration and monitoring, client teaching, emergency intervention, and nursing services within professional scope of practice and as delegated by the Case Manager.
2. Promotes personal safety and a safe environment for clients and coworkers.
a. Demonstrates knowledge of safety/infection control practices by compliance with policies and procedures.
b. Recognizes and responds appropriately to potentially unsafe situations.
c. Demonstrates safe practice in the use of equipment.
d. Makes recommendations on improvement of safety.
e. Seeks education/training or assistance with areas of concern
3. Performs job in compliance with Agency policies and procedures and professional and community standards.
a. Accepts responsibility for professional nursing role.
b. Follows applicable state and federal laws and agency standards.
c. Maintains confidentiality in all aspects of the job.
d. 1) Refrains from discussing client or staff identities, conditions, or circumstances in public or with others who do not have a legitimate interest in the person.
e. Participates in the development, implementation, and evaluation of the Agency Quality Improvement Program and pertinent activities.
4. Participates in coordination of home care services, attends meetings as required, and follows reporting guidelines.
5. Performs other related duties and responsibilities as deemed necessary.
See ADA Requirements. I have read and understand the above job description of the Licensed Practical/Vocational Nurse.



• Must have a Masters Degree from a Social Work accredited by the Council on Social Work Education.
• One (1) year of Social Work experience in a health care setting. Must be able to function in an independent fashion and have considerable maturity of judgment.
• Communicates significant information regarding patients with other members of a health care team and makes necessary recommendations and suggestions to improve the Plan of Care.
• Collaborates with the physician and other members of the health team to develop a Plan of Care.
• Assessment of psychological, emotional and/or economical factors affecting patient's limitations and potential for and/or lack of improvement
• Initial evaluation visit, interim evaluations (as deemed necessary) and discharge evaluation from Social Services are required documentation
• Assessment of patients needs for long term care including home and family situation, exploring alternatives to in home care arrangement for placement
• Counsel patient, caregiver regarding long term planning and decision making.
• Clinical notes should be written each visit and include progress, or lack of, specific plans, goals, anticipated length of service, referrals made and follow up on referrals
• Identify, high risk indicators potentially endangering patients and provide intervention reports situation to Case Managers and proper authorities
• Provide brief therapy to facilitate improved coping, adjustment, management, and compliance to medical regimen
• Attends staff meetings, participates in in-services, case conferences and Quality Assurance Performance Improvement activity as required
• Prepares clerical and progress notes and submits them in a timely manner to the office
"I have reviewed my job description and agree to perform all duties mentioned to the best of my ability; I understand that my job duties may change as the needs of the agency change. I further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.


To provide, under the general supervision of the director of nursing and according to established policies and procedures of the agency, diagnostic evaluations and treatment to assigned patients, to help patients reach maximum performance level, and to use these skills to the fullest to function in the community within the limits of their capabilities. Under general supervision, to establish own priorities and work plan to conform with agency policies and procedures. Supervise certified occupational therapy assistants and occupational therapy aides in patient treatment.
1. Administers and writes evaluations of assigned patients in accordance with agency policy and procedures.
2. Maintains timely and accurate patient records and reports.
3. Provides consultation in areas such as environmental design, adaptive equipment, proper positioning of patients to prevent contractors and splinting.
4. Designs and administers therapy plans of care, based upon physician's orders & to increase patients' levels of functioning. Uses therapeutic exercises and activities to improve or maintain strength, range of motion, and fine-motor coordination. Instructs patients in adapted techniques and use of adaptive equipment for meal preparation, home management, dressing, feeding, and other self-care skills. Trains patients in the use of upper-extremity prosthetic devices to resume previous daily routines. Participates in home assessments.
5. Provides therapy for neurological integration; administers sensor-motor integration treatment techniques and visual perceptual-motor remediation programs. Uses activities to increase developmental levels of patients. Designs and provides individualized therapy for adult learning-disabled patients.
6. Designs and fabricates splints as specified by doctors' prescriptions; designs and/or fabricates slings and adaptive equipment to meet the needs of patients and/or their families.
7. Administers treatment programs to traumatic brain-injured patients. Uses activities to improve judgment skills, reality orientation, and organizational skills.
8. Provides prevention therapy to maintain functional skills; instructs patients in energy conservation, joint protection, safety techniques for sensory loss, and transferring and visual field deficits; instructs patients' families in personal care for patients, especially proper transfer techniques to avoid back strain.
9. Administers prevocational program to prepare patients to return to or enter a work setting. Provides activities to assess patients' organizational skills, attention spans, cognitive abilities, coordination (fine and gross-motor), and adaptive-equipment needs.
10. Keeps abreast of research and new techniques. Attends appropriate professional and educational meetings.
1. Graduate of accredited occupational therapy program with bachelor's degree or equivalent.
2. Current registration through the American Occupational Therapy Association.
3. One year of experience preferred.
I have reviewed my job description and agree to perform all duties mentioned to the best of my ability; I understand that my job duties may change as the needs of the agency change. 1 further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.



Provides Physical Therapy services to patients as directed by the plan of treatment and in line with the philosophy, objectives and policies of the agency. Supervises Physical Therapy Assistants and maintains responsibility for the implementation and follow-through of PT procedures.
Licensed as, a Physical Therapist by the State of Virginia, has graduated from a PT curriculum approved by the American Physical Therapy Association or the Council of Medical Education and Hospitals of the AMA and a minimum of one year experience as a Physical Therapist.
• Assists the physician in evaluating patient's level of function, establishing treatment plan and goals.
• Performs initial evaluations within 48 hours of referral and re-evaluations every 30 days, as appropriate coordinating plan of care with the physician as needed.
• Prepares clinical and progress notes and required summaries, as appropriate.
• Revises the plan of treatment and contacts the physician for change in plan of care.
• Advises and consults with patient's family and other health care staff.
• Coordinates care with agency DON and other staff as appropriate.
• Observes, records and reports any changes in the patient's condition and updates the agency on changes in the patients status or schedule changes.
• Supervises the Physical Therapy Assistant including but not limited to, informing the PTA of new patients, scheduling supervisory visits and co-signing PTA documentation.
• Instructs patient and/or family in use of equipment safe patient management and home therapy programs as needed.
• Provides staff in-services when required.
• Participates in chart reviews, case conferences peer review and QA/PI activities when required.
• Communicates effectively with patient, caregivers and families as well as agency staff.
• Provides quality and appropriate care and reports issues or concerns to the DON /Administrator.
Assures that all tasks are performs in a timely manner.
• Performs other duties as assigned.


• Able to effectively perform and prioritize multiple functions or tasks.
• Able to stand, bend, stoop, kneel, lift and reach freely.
• Able to read and interpret instructions related to patient care.
• Has transportation to travel to assignments.
• Has current driver's license and car insurance.
• Maintains annual TB test. CPR certification and other required documents and submits them to HR.
I have reviewed my job description and agree to perform all duties mentioned to the best of lily ability; I understand that my job duties may change as the needs of the agency change. I further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.



The Registered Nurse is responsible for the delivery of patient care services through coordination, implementation, and supervision of the patients. The registered nurses follows the POT and supervises the staff delivering care. The Registered nurse participates in quality improvement activities within the Agency promoting overall compliance with State and Federal guidelines and professional standards of practice.
• Must be a registered nurse with a public health, home health care, or hospital background
• Must have at least one year clinical experience
• Must be able to hear and speak in a manner understood by most persons.
• Must be able to travel to prospective patient's place of residence
• Must be able to stoop and bend; must be able to lift and transfer patients
Demonstrates leadership and provides direction to members of the patient care team through case management of patient home health episode of health care. Case management of patient services includes:
A. Intake and coordination of a referral from an acceptable referral source
B. Initial in home evaluations and/or assessment
C. Establish the patient's individualized treatment and medical record baseline
D. Collaborate with physicians, other agency staff and contract services to coordinate and implement the POT
E. Supervise the implementation of the POT and the quality of care delivered to the patient
F. Provide in home supervision of Home Health Aide Services at least every 14 days for patient receiving aide services and document the visit in the medical record
G. Provide supervision of LVN's assigned to patient caseload, through directing the implementation and evaluating the effectiveness of the nursing care and patient's plan of treatment
H. Re-evaluate the patient plan of treatment at least every 60 days and when there is a change in the patient condition, after a hospital stay, and a time of discharge revising the Plan of Treatment as needed to achieve patient goals.


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I. Documents direct patient services, coordination and collaboration with physician and other disciplines or provides in the care of the patient, ensuring document is complete, and complies with acceptable home health standards and Agency policy.
J. Facilitates active and effective communication with team members as demonstrated through leadership of patient case conferences staff education or in services, and timely clinical decisions which provide guidance in the delivery of patient care.
K. Documentation is timely and meets professional standards of practice, establishes compliance with state regulations and Medicare conditions of participation.
L. Reviews caseload charts documentation at least every 60 days to ensure compliance assess patient progress and effectiveness of care delivery in meeting patient goals.
• Provides patients and staff supervision 24 hours a day when assigned on-call
• Collaborating with leadership/management team and office staff to facilitate timely office processing of paperwork and personnel information
• Actively participates in Agency quality improvement activities
• Promote the Agency and services to the public and participate in physician and community education related to services provided by the agency as registered
• Performs other duties as assigned
• Maintains responsibility to develop professional self attend seminars, and identify self -learning needs, collaborates with agency leaders in meeting learning needs
I have read and understand my job description.



• The speech pathologist is a member of the American Speech and Hearing Association, is certified by the association and is eligible for membership
• A Master's degree in speech pathology or its equivalent
• At least one (1) year of supervised work experience with adult patients
• Licensed, registered, or certified by the State in which the speech pathologist reside or practices
• Provides treatment as ordered by the attending physician
• Evaluates patient's speech and language abilities and detects, assesses, and evaluates the patient's level of function
• Plans and provides rehabilitation services for speech and language disorders
• Assists in developing and updating the plan of treatment
• Observes, reports and records type of treatment and patient's response to it; reports progress and/or regression to the physician and the company
• Submits to the physician and the company written reports of the patient's progress at the designated intervals of every thirty (30) days and at discharge using the appropriate forms.
• Utilizes community resources and company personnel by proper referral
• Selects and administers diagnostic and therapeutic techniques and material for patient evaluation and treatment purposed
• Instructs, teaches, supervises and counsels other health team personnel and family members in methods of assisting the patient in improving, correcting, and/or accepting his or her disabilities
• Instructs, teaches, and supervises the family in the patient's total speech therapy program
• Attends paramedical service meetings and combined paramedical and nursing service meetings
• Participates in in-service education
• Participates in staff development activities
• Evaluates the home environment and makes appropriate recommendations,
• Performs other duties as assigned
• Participate in Quality Assessment Performance Improvement activities as assigned
I have reviewed my job description and agree to perform all duties mentioned to the best of my ability; I understand that my job duties may change as the needs of the agency change. I further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.



• Bachelor's Degree from an accredited school in Speech Language Pathology
• Must have 25 hours direct observation
• Must have 25 how direct supervision
• Must possess a Indiana License for Speech Assistant
• Report to Supervising Speech Therapist on a consistent basis regarding caseload
• Carry our Plan of Care that was developed by the Licensed Speech Therapist
• Prepare, record and document session on a daily basis
• Participate in QT activities when required
• Other duties as assigned by Licensed Speech Therapist
I have reviewed my job description and agree to perform all duties mentioned to the best of my ability; I understand that my job duties may change as the needs of the agency change. I further agree to notify my immediate supervisor if I am unable to complete any of my job duties in a timely manner.


Please check the areas in which you have experience:
Home Care Positions Held:
Nursing Supervisor
Case Manager
Visit Nurse
Private Duty Nurse
Assessment Skills
• Neurological System
• Cardiovascular System
• Pulmonary System
• Gastrointestinal System
• Genitourinary System
• Integumentary System
• Musculoskeletal System
• Metabolic System
• Behavioral Assessment
• Pain Assessment
• Medication assessment and management
• Pulses (apical, radial, pedal)
• Edema assessment and management
• Blood Pressures
• CPR and airway management
• Tracheostomy care
Basic decubitus ulcer care:
• Positioning to relieve pressure areas
• Wash with soap/water
• Air dry skin/ulcer
Nutritional skills:
• Preparation of foods on low-sodium diet
• Preparation of food on diabetic diet
• Feeding patients with chewing/swallowing problems
Use/care of Hoyer lift
Cast care
Collecting specimens
• Urine
• Stool
• Sputum
• Other:
Updated January 14, 2018
Approved by Governing Body on: 02/09/18
Approved by the Medical Director on: 04/18/18
• Trach Tube Change
• Tracheal Suction
• Oxygen administration
• Use of inhalers
• Pulse Oximeter
• Ventilator Care
• Insertion
• Care
• Enteral feedings
• Insertion
• Care of Gastrostomy Tube
• Ostomy Care
• Gastric Suction
Skin Care
• Sterile Dressing Change
• Non-sterile Dressing Change
• Application of Skin Barriers
• Measurement and staging of wounds
• Wound Care Procedures and treatment options
• Sterile Dressing Change
• Enema administration
Updated January 14, 2018
Approved by Governing Body on: 02/09/18
Approved by the Medical Director on: 04/18/18
• Bowel Program
• Removal of fecal impaction
• Colostomy/Ileostomy Care
• Insertion
• Irrigation
• Tube Care
— Suprapubic catheters
— Ileodiversion Care
• Venipuncture
• Central Line Blood Sampling
• Sputum
• Urine
• Stool
• Wound
• Accucheck
• IV Starts
• Central Line Care
— Portacath
— Hickman
— Groshong
— Triple Lumen
Updated January 14, 2018
Approved by Governing Body on: 02/09/18
Approved by the Medical Director on: 04/18/18
— Epidural Catheters
• Peritoneal Dialysis
• Shunt Care
• Medication Set-ups
• Dietary Teaching
• Range of Motion Exercises
• Transfers
• Hoyer Lifts
• Psychiatric
• Pediatric
— Infants
— Toddlers
— School Age
— Adolescent
• Spinal Cord Injured
• Blind
• Deaf
• Aphasic
• Hospice
• Iminunosuppressed
Updated January 14, 2018
Approved by Governing Body on: 02/09/18
Approved by the Medical Director on: 04/18/18
• Completed Admission with OASIS data collection:
• Developed Physician Plan of Care (485/487)
• Developed Home Health Aide Care Plan
• Supervised unlicensed personnel
• Documentation of skilled visits
Updated January 14, 2018
Approved by Governing Body on: 02/09/18
Approved by the Medical Director on: 04/18/18


Notify Agency Immediately

Patient #/Employee Title:
Condition Before Incident
01 Alert02 Confused03 Sedated04 Disoriented05 Unconscious06 Agitated07 Other
Brief description of incident (No opinions, facts only; include name &
address of any witnesses):


Type of Incident
01 From Bed02 From Chair03 From Commode04 From Equipment05 Ambulating06 Slipped07 Other
Reason Incident Occurred
01 With Assistance02 W/O Assistance03 Half Rails Up04 Full Rails Up05 PT Lowered Rails06 Climbed Over Rails07 Rails Down08 Removed Restraints09 Improper Footwear10 Floor Condition11 Fainted12 Lost Balance13 Weak14 Violated Activity Orders15 Incontinent16 Other
Type of Incident
08 Dosage09 Route10 Unordered11 Duplication12 Omission13 Wrong Med14 Time Given15 Other
Reason Incident Occurred
17 Transcription18 Labeling19 Patient ID20 Documentation21 Stop Orders22 Missing Meds23 Too Early24 Too Late25 Container Contents26 Calculation27 Illegible28 Unconfirmed Order29 IV Mixture30 Dispensing31 Late Delivery32 Other
Treatments &
Diagnostic Test
Type of Incident
16 IV Injection17 Patient Care18 Improper Diet19 Omitted20 Duplicated21 Incorrect22 Other
Reason Incident Occurred
34 Technique35 Patient ID36 Time/Sequence37 Documentation38 Fail to check orders39 Fail to follow orders40 Inappropriate Specimens41 Other
Revised 1/28/2018
Type of Incident
23 Hot Pads & Packets24 Electrical25 Shower/Bath26 Friction27 Radiation28 Chemical29 Other
Reason Incident Occurred
42 Faulty Equipment43 Unprotected Exposure44 Overexposure45 Improper Handling46 Lack of Supervision47 Temperature Extreme48 Other

Incident Results

01 Non-apparent02 Aggravate previous cond.03 Allergic reaction04 Asphyxia05 Broken tooth06 Bruise07 Burn08 Concussion09 Confusion10 Deceased11 Dislocation12 Fracture13 Infectious disease14 Inhalation15 Internal injuries16 Laceration17 Puncture18 Shock19 Sprain20 Strain21 Strangulation22 Stroke23 Exposure24 Other
Treatment YesNoRefused
If yes,

Body Part

01 Abdomen02 Ankle03 Arm04 Back05 Buttocks06 Chest07 Elbow08 Eye09 Face10 Finger11 Foot12 Hand13 Had14 Internal organs15 Knee16 Leg17 Neck18 Shoulder19 Skin20 Toe21 Wrist22 Other
Revised 1/28/2018

Supervisor Investigation

Severity Code:
0 No Injury
1 Insiignificant (First Aid, no physician significant)
2 Minor (Reqquires treatment, i.e.sutures,physician visit,etc
3 Major (fractures, permanent injury requiring ongoing care, loss of work, hospitalization)
Grave (Death)
Report Communicated/Filled with the following organiztions;
Area Council on Aging
Adult Protective Services
Child Protective Services
Police Department
Name/Contact Person
Revised 1/28/2018


Date/time of the suspected abuse and/or neglect:
Name/Title/Address/Telephone Number of person making the report:
Report Communicated/Filled with the following organiztions;
Area Council on Aging
Adult Protective Services
Child Protective Services
Police Department
Name/Contact Person
Date of Contact