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HEALTH-PRO (VA) IN-SERVICE EDUCATION

HEALTH-PRO Home Care, Inc.


In-Service Education
Completion Sheet

As a Home Care Aide, you are responsible for following the companys policy. Failure to follow the policies and
procedures will lead to an hourly pay cut or employment termination.

Employee Name:___________________________________________________________

Date of Hours of NOTES


TOPIC OF TRAINING In-Service In-Service
1. Bloodborne Pathogens /OSHA [RN | LPN] 1 Must be RN | LPN Instructed every year.

2. Universal Precautions and Infection Control [RN | LPN] 1 Must be RN | LPN Instructed every year.

3. Tuberculosis (TB) [RN | LPN] 1 Must be RN | LPN Instructed every year.

4. Documenting and Reporting 1

5. Timesheets and Progress Notes 1

6. Delivery Of Care in Home Settings 1

7. Employee Code Of Ethics 1

8. Employee Code of Conduct 1

9. Safe Transfers & Lifts 1

10. Accident Prevention 1

11. Elder Abuse and Neglect 1

12. Fall Prevention 1

13. Supervision of In-Home Providers 1

14. Confidentiality / HIPAA Policy 1

15. Validation of Competency Skills Policy [RN | LPN] 1 Must be RN | LPN Instructed every year.

16. Alzheimer's (Special Training) [RN | LPN] 1 Must be RN | LPN Instructed

17. Seizure Management (Special Training) [RN | LPN] 1 Must be RN | LPN Instructed

12 HOURS REQUIRED EACH YEAR

Statement:
I have received all of learning materials necessary to complete each training topic. I understand what is written in the materials and I will adhere to
all of the material's guidelines. I understand that each in-service is equivalent to one (1) credit hour.

Employee Signature:____________________________________________________________________________

This sheet should be used to track your yearly In-Service Dates and Hours.
HEALTH-PRO (VA) IN-SERVICE EDUCATION

1. BLOODBORNE PATHOGENS/OSHA

1. If you are exposed to a needle stick your first action is to:

a) report the injury immediately to supervisor or other staff


b) wash with soap and water
c) immediately seek medical treatment
d) put a band aid on the area

2. Fifty percent of the people with HBV infection are unaware that they have the virus:
a) True
b) False

3. The HBV virus can survive for up to one week in dried blood on surfaces, contaminated needles and instruments:

a) True
b) False

4. No vaccine is available for either HIV or Hepatitis C infections:

a) True
b) False

5. HCV is one of the leading causes of chronic liver disease and liver transplants:

a) True
b) False

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION

2. UNIVERSAL PRECAUTIONS AND INFECTION CONTROL

1. Standard precautions includes the use of: hand washing, appropriate personal protective equipment such as gloves,
gowns, masks, whenever touching or exposure to patients' body fluids is anticipated:
a) True
b) False

2. An RN would implement which type of transmission-based precautions for a client with herpes simplex virus?
a) Contact precautions
b) Droplet precautions
c) Airborne precautions

3. Universal precautions is an approach to infection control to treat all human blood and all human body fluids as if
they were known to be infectious for HIV, HBV and other bloodborne pathogens:
a) True
b) False

4. Hand washing is the single most important procedure for preventing infections:
a) True
b) False

5. Gloves should be worn during all patient contact, regardless of whether skin is intact or not:
a) True
b) False

6. Hands do not need to be washed after removing gloves unless there was a rip in the glove and your hands were
exposed to blood or body fluids:
a) True
b) False

7. If a piece of personal protective equipment is annoying or uncomfortable, you do not need to wear it.

a) True
b) False

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
3. TUBERCULOSIS

1. How do you get TB?


a) Through the air
b) Through sexual contact
c) Through contaminated food
d) Through blood
e) A and C

2. What makes TB different from other infectious diseases?


a) Symptoms are not always obvious
b) Symptoms come and go.
c) The disease may take years to become active
d) A and B

3. What are the symptoms of active TB?


a) Weight Loss
b) Night Sweats
c) Loss of appetite
d) All of the above.

4. How is TB diagnosed?
a) Chest X-ray
b) Sample of sputum
c) Skin test
d) All of the above

5. What is causing TB to become a serious public health problem?


a) The rise in number of people with HIV infection
b) Increasing number of immigrants from areas of the world where TB is prevalent.
c) An increasing number of homeless people
d) More people failing to finish their TB treatment
e) All of the above

6. Who should receive a vaccine for TB?


a) Infants
b) Teens
c) Adults under age 65
d) Adults over age 65
e) None of the above

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
4. DOCUMENTING & REPORTING
POLICY: Reporting/documenting unusual incidents/acute changes in patients condition requiring immediate
attention.

You, as Home Care Aid (HCA), are an employee of HEALTH-PRO Homecare and you represent our company
even if you are a daughter or a son or any other relative of the patient. As an employee of HEALTH-PRO
Homecare, you MUST strictly follow the rules and regulations, and company policy and procedures in order to
remain our employee: NO EXCEPTIONS!!!!

Hence, the employee (without exceptions) MUST report ALL the changes in the patients condition, including
but not limited to: Falls, Injuries (or other accidents) , 911 calls, ER, Hospitalization, changes in the name,
phone number, address etc., as soon as you find out.

PURPOSE: To ensure appropriate follow-up and decision-making of all staff Involved in the care of a patient
including Primary Care Physician (PCP).

PROCEDURE: All staff, HCA, LPN/RN, involved in a patient care, must report changes in patients condition not
only by documenting it in a timesheet or nursing note, but verbally to office staff within 24 hours of becoming aware
of this change.

Changes to be reported are: life threatening situations, falls/accidents, ER/Urgent Care visits, hospitalization, changes in
patient condition or home environment jeopardizing patients or patient family members safety. In a life threatening
situation, employee present during this emergency must call 911, if patients life is in danger.

Employee, who fails to verbally report and properly document the changes that may affect patient well-being, will be
given the first warning. Second warning within a 12 month period will result in an immediate termination.

By signing below you agree that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
5. TIMESHEETS AND PROGRESS NOTES

Purpose: To document completion and follow through by HCA with tasks assigned by RN Supervisor.

Guidelines for use:


To be completed by HCA every visit.
All assigned duties must be addressed as done (or a reason not done, i.e. patient refused.)

In order to receive your paycheck on Friday, a completed timesheet must be in our office on Monday before 5:00 PM
and/or the approval of Personnel Department that employees assignment and time checked in/out where employee
service visit and actual visit worked and forwarded to the Payroll Department. Paychecks cannot be issued without a
completed timesheet or proper Home Care Agency documentation. Home Care Agency documentation includes: Aide
Progress Notes and/or Nursing Progress notes. If you have any question about the paperwork that must be submitted in
order for you to be paid contact HEALTH-PRO Administration.

If an emergency arises and you are unable to mail or deliver your timesheets or documentation to HEALTH-PRO
Homecare, it is acceptable to contact the payroll representative on Monday and review the schedule completed the
previous week. Three incidents of timesheet or documentation not submitted on a timely basis will result in a decrease
in hourly pay or no longer being scheduled for assignment with HEALTH-PRO Homecare.

Instructions how to fill out the Timesheet/Progress Note:


1. There will be a separate assignment sheet for each client. Contact the office if you have any questions about
how to complete the form.
2. Complete client's name (included last name first).
3. Complete your name.
4. Complete week Start Date (Mondays date)
5. Complete week ending Date (Sundays date).
6. Complete date of visit (in/out) with AM/PM and total hours in home.
7. Obtain clients signature for every visit.
8. Complete HCA signature.
9. Check with an x each duty performed in appropriate day column per assignment in home. If duty assigned
and unable to perform note reason why in the progress notes. If a duty is required, check off the task on your
timesheet; if the client does not request the task and you complete the task, leave the task blank on your
timesheet.
11. Progress notes-to and observations - see joint visits be used for comments sample.
Also, document on your timesheet the communication with nurse, therapist, or telephone calls to office, the
changes in patient condition. If additional room is needed, document on separate progress note sheet - be sure
to note date and time and sign with your title. When reporting a change in client condition, be sure to
document who you spoke to, what you reported, and what you were told.

Submit HCA timesheet/progress notes by 5:00pm on Monday of every week for the previous working week (Monday -
Sunday).

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
6. DELIVERY OF CARE IN THE HOME SETTINGS

HEALTH-PRO Homecare, Inc. consistently strives to provide quality services to clients in accordance with the high
ethical standards while recognizing and respecting each client's rights. Care is provided under the direction of the
agencys RN supervisor. Our Vision, Mission Statement, Statement of Client Rights and Responsibilities, and Code of
Ethics are evidence of our commitment to our Standards and Quality.

SUBJECT: VERIFICATION OF PERSONAL CARE SERVICES

All aides are required to call the office to give at least a 48 hour notice of absents in order to ensure that the
client has coverage and does not miss their services.

Proper communication procedures must be followed by all home care aides. You must immediately call the
office and report if the following situations occur:
- You are running late for your shift
- You realize that you will not be able to cover a shift on a certain day
- An incident happened while you are at a clients home
- Client requests to perform services that are not in the HCA Plan of Care
- Client dismisses you before the end of the shift
- Client requests to provide services on non-scheduled day or time
- Client has a change of condition
Remember that you are only to perform services that are indicated in the Plan of Care. If a client requests
additional services HEALTH-PRO Homecare will have to re-assess the client and create a new/updated Plan of
Care before these additional services can be performed.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION

7. EMPLOYEE CODE OF ETHICS

HEALTH-PRO shall adopt and implement ethical standards to require workers to furnish services in an ethical,
professional, respectful, and legal manner and not engage in any unethical, unprofessional, disrespectful, or illegal
behavior including:
Consuming the consumers food or drink, or using the consumers personal property without his or her
consent.
Bringing a child, friend, relative, or anyone else, or a pet to the consumers place of residence.
Taking the consumer to the providers place of business without an appointment.
Consuming alcohol while furnishing a service to the consumer.
Consuming medicine, drugs or other chemical substances not in accordance with the legal, valid, prescribed
use and/or in any way that impairs the provider from furnishing a service to the consumer.
Discussing religion or politics with the consumer and others in the care setting.
Discussing personal issues with the consumer or any other person in the care setting.
Accepting, obtaining or attempting to obtain money or anything of value, including gifts or tips from the
consumer and his or her household members or family members.
Engaging the consumer in sexual conduct or in conduct that a reasonable person would interpret as sexual in
nature, even if the conduct is consensual.
Leaving the consumers home for a purpose not related to furnishing a service without notifying the agency
supervisor, the consumers emergency contact person, any identified caregiver, or the consumers case
manager (if applicable). Emergency contact person means a person the consumer or caregiver wants the
provider to contact in the event of an emergency to inform the person about the nature of the emergency.
Engaging in any activity that may distract the aide from furnishing a service, including:
a) Watching television or playing computer or video games
b) Engaging in non-care related socialization with a person other than the consumer (e.g. a visit from a person
who is not furnishing care to the consumer; making or receiving a personal telephone call; or sending or
receiving a personal text message or e-mail, unless its from the office)
c) Furnishing care to individuals other than the consumer
d) Sleeping
Engaging in behavior that causes or may cause physical, verbal, mental or emotional distress or abuse to the
consumer.
Engaging in behavior that a reasonable person would interpret as inappropriate involvement in the consumers
personal relationships.
Being designated to make decisions for the consumer in any capacity involving a declaration for mental health
treatment, power of attorney, durable power of attorney, guardianship or authorized representative.
Selling to or purchasing from the consumer products or personal items, unless the aide is the consumers
distant family member who does so only when not furnishing a service.
Engaging in behavior that constitutes a conflict of interest or takes advantage of or manipulates clients or
services resulting in an advantage for personal gain that has detrimental results for the consumer, the
consumers family or caregivers or HEALTH-PRO.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

______________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
8. EMPLOYEE CODE OF CONDUCT

At all times treat clients with courtesy, respect and full recognition of dignity and individuality. Client and
their families are, at all times, to be treated in a courteous and respectful manner. Address clients as Mr.,
Miss, Mrs., or Ms as applicable. Refrain from using a clients first name unless specifically requested to
do so.
Respond promptly to all reasonable requests and inquiries.
Arrive on time. Punctuality is a sign of respect and professionalism.
Honor your work commitment. Make plans and other personal commitments around your work schedule.
Dress in accordance with HEALTH-PRO Homecare dress code. Aides are required to wear uniformed nursing
scrubs, both top and bottom; this includes clean, matching, non-torn clothing both top and bottom.
If you arrive at a clients home and the individual appears not to be there, call the office. Do NOT go home
unless advised to do so by the office.
Aides must uphold privacy at all times. You are not to enter into nor explore other parts of a clients case with
anyone who is not directly related to the performance of your duties.
Confidentiality is of the utmost importance. You are not to discuss the personal affairs of a client with anyone
who is not directly responsible for the clients care and well-being.
Provide privacy during medical examinations and treatments, while attending to personal and bodily needs and
during visits with family and friends.
Do not discuss your own personal affairs, religious, cultural or political beliefs with clients.
You are a paid professional in a clients home, not a social visitor. It is unacceptable to smoke, use a clients
telephone or eat a clients food while in a clients home.
Do not bring any unauthorized individual to work with you. This includes family members.
HEALTH-PRO employees/contractors are to avoid getting involved in a clients financial affairs. Paying bills,
writing checks, etc; are not your responsibility. Do not accept money from a client for care provided; that
includes gasoline, etc.
Do not accept keys to a clients home without first receiving authorization from the office.
Never abandon a client, if your relief is late, contact the office immediately, DO NOT LEAVE!
The consumption of drugs while on a case, or prior to service delivery, is unacceptable, unless for medical
reasons. Use of alcohol or any other illegal substance while at work is grounds for immediate termination.
Never smoke in a clients home.
Do not accept gifts, tips or loans form clients. You are a professional. If a situation arises where you are
offered a gift, politely decline, and contact the office. Flowers or cards may be given during special occasions
such as birthdays, holidays, get well, etc; but should never exceed the amount of $25. It is understood that
gifts under these situations can contribute to a positive part of the clients care. Client and staff will be made
aware of this policy during their orientation. See HEALTH-PROs NO-GIFTS POLICY.
Make sure that the care you provide is commensurate with the Care Plan developed for each client. Any
variance from this plan must be documented in your daily notes, and communicated with the RN supervisor.
Communicate with us. We are here to help you. Any changes in a clients status must be reported immediately.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
9. SAFE TRANSFERS & LIFTS

One of the issues in healthcare is the frequent heavy lifting and repositioning of clients that exceed the lifting capacity
of most caregivers. Numerous studies have shown that training caregivers how to use proper body mechanics to lift
clients is not an effective prevention measure because lifting the weight of adult patients is intrinsically unsafe.

Because of the trend towards shorter hospital stays, patients who are being transferred to home environment or nursing
homes are becoming increasingly frail. Factors that contribute to the difficulty of lifting and moving a patient include
the size and weight of the patient, combativeness, and propensity to fall or lose balance. In addition, performing patient
transfers in the confines of small bathrooms and rooms cluttered with medical equipment, furniture, clothes, etc; works
against the caregiver being able to use good body mechanics.

When lifting or repositioning a patient in bed, the bed generally prevents the caregiver from bending his/her knees to
assume the proper posture for lifting. The forward bending required for many patient lifting and moving activities
places the caregivers spine in its most vulnerable position. Even under ideal lifting conditions, the weight of any adult
far exceeds the lifting capacity of most caregivers, 90 percent of whom are female.

These conditions contributes to the many occupational injuries suffered by caregivers every year. Because of the rapidly
expanding elderly population in the U.S., employment for nursing aides, orderlies, and attendants is continually
increasing.Due to the ongoing demand for skilled and non-skilled care services, musculoskeletal injuries to the back,
shoulder, and upper extremities of caregivers are expected to increase without proper education or training.

1) What are the two mistakes people sometimes make when lifting?
_________________________________________________________________________

_________________________________________________________________________

2) Give two ways to lift safely.


_________________________________________________________________________

_________________________________________________________________________

3) What are two things you should know about a patient before assisting the patient with a transfer?
_________________________________________________________________________

_________________________________________________________________________

4) When repositioning a patient in bed, adjust the bed to the lowest height.

True or False

5) Correct transfer techniques will protect you from injury:

True or False

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
10. ACCIDENT PREVENTION

For seniors, an accident can occur at any time in the home for various reasons. Here are some things to consider:
Lamps and light switches should be within reach of the bed. Lamps or switches located close to each bed will
enable people getting up at night to see where they are going.
Night lights should be used. This is especially important if your elderly loved one makes frequent trips to the
bathroom at night.
Ash trays, smoking materials, or other heat sources (heaters, hot plates, teapots, etc.) should be kept away from
beds and bedding. Burns are a leading cause of accidental death among seniors. Smoking in bed is a major
contributor to this problem. Among mattress and bedding fire-related deaths in a recent year, 42% were to
persons 65 or older. Remove sources of heat or flame from areas around beds.
Dont smoke in bed.
Check for proper use of electric blanket. Tucking in electric blankets, or placing additional coverings on top of
them can cause excessive heat buildup which can start a fire. Use electric blankets according to the
manufacturers instructions. Dont allow anything on top of the blanket while it is in use. This includes other
blankets or comforters, even pets sleeping on top of the blanket. Dont set electric blankets so high that they
could burn someone who falls asleep while they are on.
A working flashlight should be kept close to the bed in case electrical power goes out. Check the flashlight
regularly to see if the batteries are still good.
The telephone should be close to the elderlys bed. In case of an emergency, it is important to be able to reach
the telephone without getting out of bed.
Never go to sleep with a heating pad if it is turned on because it can cause serious burns even at relatively low
settings.

With a little planning, you can prevent accidents that should never happen.

1) There are many types of accidents. List at least three:

1. ___________________________ 2. _________________________ 3. ________________________

2) Fall can be caused by an unsafe environment or by loss of abilities. T or F

3) Injuries from fall are often very serious for elderly people since their bones are fragile. T or F

4) What environmental factors may raise the risk of falls?

a) Wet Floors
b) Sharp Edges
c) Poor Lighting
d) Poor Vision
e) All Except b

5) Why elderly people are at the greatest risk of burns?


____________________________________________________________________________________

____________________________________________________________________________________

6) In which position is it safer for a patient to eat to avoid choking?________________________________

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

_________________________________________________________ _____________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
11. ELDER ABUSE AND NEGLECT

No one wants to think of his or her family member being hurt or taken advantage of, but the truth is, older adults are
vulnerable to various types of abuse.

Information about elder abuse is vitally important if you oversee the care of a friend or relative. You will understand
how to identify various types of elder abuse and learn about some of the contributing factors as listed below.

Physical abuse: The use of physical force that might result in bodily injury, physical pain, or impairment. Physical
punishments of any kind were examples of physical abuse.
Sexual abuse: Non-consensual sexual contact of any kind with an elderly person
Emotional or psychologic abuse: The infliction of anguish, pain, or distress
Financial or material exploitation: The illegal or improper use of an elders funds, property, or assets
Abandonment: The desertion of an elderly person by an individual who had physical custody or otherwise had
assumed responsibility for providing care for an elder or by a person with physical custody of an elder
Neglect: The refusal or failure to fulfill any part of a person, obligations, or duties to an elder
Self-neglect: The behaviors of an elderly person that threaten his/her own health or safety. The definition of self neglect
excludes a situation in which a mentally competent older person who understands the consequences of his/her decisions
makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety.

Recognizing and Understanding Abusers


The overwhelmed: This group is well intentioned and generally qualified to provide care. When care needs exceed
what they can provide, they may abuse verbally or physically. They do not look for victims.
The impaired: This group is well intentioned but has problems that prevent them from delivering care. These
caregivers may suffer from mental or physical problems that serve as barriers to providing adequate care. They may be
unaware of the deficits in their care delivery. Neglect is more common in this group, and they may tend to control the
victim through abuse.
The narcissistic: These caregivers enter into caregiving relationships to meet their own needs. They are more likely to
steal from seniors and neglect them. They see the relationship as a means to an end and may be attracted to nursing
homes or centers where they can enter into relationships with vulnerable adults.
The domineering or bullying: This group may feel entitled to exert power and authority. They may have narcissistic
tendencies and often feel that the victim deserved the maltreatment. This type of offender may honor limits in other
settings and has insight into the nature of the maladaptive behavior.This type of offender is prone to neglect and
financial abuse. This type of offender may engage in sexual abuse.
The Sadistic: Offenders of this type often have sociopathic personalities and take pleasure in the mistreatment of their
victim. Their abuse of others allows them to have feelings of power and importance.

Elder Abuse Screening Questions


Has anyone at home hurt you? | Has anyone ever touched you without your consent?
Has anyone ever made you do things you didnt want to do? | Has anyone taken anything from you without asking?
Has anyone ever scolded or threatened you? | Have you ever signed any documents that you didnt understand?
Are you afraid of anyone at home? | Are you alone a lot?
Has anyone ever failed to help you take care of yourself when you needed help?

Physical Indicators of Elder Abuse


Physical Abuse: Bruises, wound, burns; unexplained, of various ages, patterns, well-defined shapes, immersion
pattern,
Rope or restraint marks on wrists or ankles, Traumatic alopecia or scalp swelling.
Psychologic abuse: Habit disorder (sucking, rocking), Neurotic disorders, Conduct disorder
Sexual Abuse: Genital or anal pain, itching, bruising, or bleeding, Venereal disease, Torn, stained, or bloody
underwear.
Neglect: Dehydration, malnutrition, Poor hygiene, inappropriate dress, unattended physical or medical needs,
Extensive pressure ulcers, Excoriations, Fecal impaction.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

__________________________________________________________ ________________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
12. FALL PREVENTION
Falls are a serious concern for older adults. Each year more than 30% of people over 65 fall. Most falls occur at home,
while people are performing everyday activities such as walking, climbing stairs or getting in or out of bed. Falls are the
leading cause of death from injury for older adults.
This in-service training teaches care aides how to reduce the risk of falls inside and outside of the home while
encouraging independence.
Teaching Points
1. The number of people over the age of 50 will increase over the next decade.
2. Falling is a serious public health problem among older adults because of its frequency, the morbidity associated with
falls, and the cost of the necessary healthcare.
3. Falls are ranked as the number one cause of injury related death for those over the age of 65.
4. Falls occur most frequently among older women.
5. The emotional factors associated with falls may increase the risk of future falls.
6. There are harmful consequences when the older adults associate themselves with stereotypes of old age.
7. Physical risk factors associated with falls increase with age.
8. Medications may increase the risk of falls for the elderly.
9. Safety-proofing the living environment has been shown to decrease the risk of falls for older adults.
Most falls occur at home. Risk factors are complex, but there are ways to help.
Families often play key roles in finding programs for their loved ones, modifying homes after recommendations from
a home visit, investigating information resources and encouraging safe behaviors to reduce risk, and talking with
healthcare professionals about how to prevent falls and increase mobility.
Alcohol use affects balance, and alcohol/drug interactions can increase risk for falls.
Evidence-based programs can reduce fall risk among older adults. These include interventions that address multiple
risk factors, including balance and exercise programs and home safety inspections when combined with other strategies.
Many older adults without support from family or friends rely on community resources. Churches, senior centers,
neighborhood organizations and other organizations can reduce fall risk for this population.
Chronic Disease Self-Management programs (called Living Well with Chronic Conditions in Wisconsin) can help
to identify people at higher fall risk and refer them to appropriate resources.
Factors that May Cause Falls
A fall may be caused by many different things. Certainly a cluttered walk area may cause a fall but improper nutrition
and lack of exercise may also cause a fall. The risk of falling also increases if medication levels are not correct or even
if you dont have the correct prescription in your glasses. Listed below are some of the risks for falling.

Vision- Macular Degeneration | Glaucoma | Cataracts | Diabetic Retinopathy |


Not wearing glasses or wrong prescription in lenses

Environment- Cluttered walk spaces | Low lighting | Slippery flooring | Lack of handrails and grab bars |
Out of reach cabinets and storage spaces | Unsecured area rugs | Unsecured electrical cords |
Unfamiliar environment

Medications- Blood pressure medications | Sedatives | Muscle relaxers | Mood medications | Diuretics |
Mixing medications and alcohol | Not keeping a record of your medications

Fear- Fear of falling often results in inactivity which leads to muscle weakness, increasing the risk of falling

Habits- Lack of exercise | Getting out of bed or a chair immediately | Not putting on glasses in the middle of
the night | Alcohol abuse | Standing in chairs to reach high places

Assistive Devices- Failing to use a prescribed, necessary assistive device may result in a fall |
Inappropriate shoes

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

__________________________________________________________ ________________________
Employee Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
FALL DEMOGRAPHICS (NORTH CAROLINA)

Demographics
Age (%)* Ages 30-39: (2.8)
Ages 40-54: (6.7)
Ages 55-64: (20.0)
Ages 65-74: (36.4)
Ages 75-84: (24.4)
Ages 85+: (7.5)
Missing Data: (1.9)

Gender (%)* Male: (7.5)


Female: (89.7)
Missing Data: (2.8)

Race (%)* White: (91.0)


Black: (4.2)
Missing Data: (3.9)

Living Situation (%)* Live in a house or apartment: (86.9)


Live in independent senior housing: (3.3)
Missing Data: (7.2)

Live with a spouse/partner: (50.6)


Live alone: (33.4)
Live with informal caregiver: (1.1)
Live with adult child: (5.0)
Live with a grandchild: (3.3)
Missing Data: (7.5)

Participation
Reasons for Participation** Never fallen, but want to protect self from falls: (15.3)
(%)* Never fallen, but have a fear of falling: (5.3)
Previously fallen: (38.9)
Fallen and have fear of falling again: (21.1)
Caregiver for someone at risk of falling: (4.7)
Caregiver for someone who fell: (5.6)
Caregiver for someone with a fear of falling: (1.7)
Seeking knowledge to be better caregiver: (13.9)
Missing Data: (8.3)

Fall Reports
Fall experience within last Never fallen: (23.1)
year (%)* 1-2 times: (32.8)
3-4 times: (6.9)
5+ times: (1.1)
Fallen, but not in past year: (27.5)
HEALTH-PRO (VA) IN-SERVICE EDUCATION

Missing Data: (1.7)

Limited activity due to a fall(s): (26.4)


Missing Data: (6.7)

Reported fall to a medical professional: (24.4)


Reported fall to a family/friend/neighbor: (56.7)
Reported fall to no one: (6.1)
Missing Data: (8.1)

Fear of Falling
Fear of falling (%)* Have a fear of falling: (49.7)
Missing Data: (8.9)

Have limited activities due to fear: n = 111 (30.8)


Missing Data: (6.1)

Visited a physical or occupational therapist to help prevent falls: (21.9)


Missing Data: (7.5)

Program Objectives
Program goals (%)* Better understand how to reduce fall risk: (87.2)
Missing Data: (11.9)

Plan to get eyes checked: (76.9)


Missing Data: (15.0)

Plan to modify home environment: (75.3)


Missing Date: (15.3)

Plan to review medications with medical provider: (70.3)


Missing Data: (16.9)

Plan to engage in physical activity: (83.6)


Missing Data: (13.6)

Know how to safely get up from a fall: (83.9)


Missing Data: (15.0)
HEALTH-PRO (VA) IN-SERVICE EDUCATION

13. SUPERVISION OF IN-HOME PROVIDERS POLICY

Supervision of in-home care providers will be available during all hours that in-home services are provided.

Purpose
To ensure the provision of quality services in the clients Home.

Procedure
1. All in-home care providers will demonstrate competency in all client care tasks to which they are assigned.
a. In-home aides and other allied health personnel subject to occupational licensing laws shall meet
competency testing requirements consistent with the regulations established by the appropriate
occupational licensing board.
1) The agency supervisor will be responsible for documenting that in-home care providers are competent
to perform client care tasks/activities to which they are assigned.
2) These individuals will perform delegated activities under the supervision of persons authorized by
state law to provide such supervision.
b. In-home aides and other in-home care providers, who are not subject to occupational licensing laws, are
only assigned to client care activities for which they have demonstrated competency to agency personnel.\
c. Demonstrated competency includes:
1) Correct demonstration of tasks to an appropriate professional.
2) Documentation of competency testing.
2. In-home aides and other in-home care providers are supervised by an appropriate professional.
a. A supervisory visit is made to each clients place of residence at least every three month, with or
without the in-home care providers presence.
b. The appropriate supervisor will make a visit to each client at least once a year when the in-home care
provider is providing care to the client.
c. The supervisory visit will include:
1) A review of the clients general condition
2) A review of the clients progress and response to the services provided by the in-home care
provider.
d. Documentation of supervisory visits will be maintained in Agency records and will contain, at a
minimum:
1) Date of the supervisory visit
2) Findings of the visit
3) Signature of the person performing the visit
e. Documentation of any corrective action for the in-home care provider will be documented in the
providers employee record.
f. Appropriate professional supervisors are available for supervision, on-site where services are provided
when necessary, during all hours that in-home services are provided.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

__________________________________________________________ ______________________
Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
14. CONFIDENTIALITY / HIPAA POLICY

The law, HIPAA regulations and our professional ethics require that each employee maintain the highest degree of
confidentiality (as delineated in 10 NCAC 18D) and HIPAA, Privacy and Security Provisions, when handling client
information and matters.

In order to maintain this professional confidence, no employee shall disclose, discuss or comment on client information
or leave unattended client information exposed to uninvolved coworkers, outsiders, including other clients, third parties
or members of ones own family, etc. which would clearly be a violation to HIPAA regulations.

Any disclosure of confidential information, except in the service of the client, will result in immediate discharge.
Protecting client and Agency information is the responsibly of every employee and we all share a common interest in
making sure it is not improperly or accidentally disclosed.

Due to the nature of our business, client and Agency confidentiality and HIPAA regulations this is strictly enforced. Do
not discuss the confidential business of our clients or Agency with anyone. Discussions regarding confidential client or
Agency business are strictly prohibited, unless an emergency situation dictates otherwise.

All telephone calls regarding a current or former client with our Agency must be forwarded to the Agency Director.
All telephone calls regarding a current or former employees position/compensation with our Agency must be
forwarded to the Agency Director.The Agencys address shall not be used for the receipt of personal mail.

I agree/adhere to this Confidentiality/HIPAA Policy and fully understand that I will be held personally accountable for
not applying confidentiality practices which could lead to disciplinary action or possible termination of my employment
with HEALTH-PRO.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

__________________________________________________________ ______________________
Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION
15. VALIDATION OF COMPETENCY SKILLS POLICY

HEALTH-PRO client care is provided by staff that is qualified and competent to assume the responsibilities of his or
her job and to perform assigned tasks. Each staff member's competency is assessed by his or her agency service
supervisor and/or an appropriate designated professional (other agency RNs |LPNs) during pre-employment screening,
after 90 days of employment and at twelve-month (12) intervals thereafter, and at any other time that further assessment
is warranted. Performance feedback is provided throughout the year by the employee's supervisor.

Procedure
The assessment of the staffs competency is an ongoing process that includes the following:
1. An assessment of each prospective employee's education, training and relevant experience is conducted by the
supervisor during the interviewing and hiring process.

2. An ongoing assessment of the new employee's ability to competently perform job responsibilities and tasks are
conducted throughout orientation. A written evaluation is completed at the end of orientation, at 90 days and
annually.

3. Competency of the staff is measured and documented prior to performing any new skills. Staff must also
demonstrate competency prior to providing nursing care or assigned tasks.

4. Each employee participates in education, training, and ongoing staff development designed to maintain and
improve the knowledge and skills appropriate to his or her assigned job. Staff will be checked off on
competencies by the service supervisor or assigned RN | LPN once it has been determined he or she is
competent in the task.

The Validation of Skills Checklist (Performance Criteria Form), located in the HEALTH-PRO manuals, must be
completed for each employee on an annual basis.

By signing below you are stating that you have read, understood and agreed to comply with the above policy.

__________________________________________________________ ______________________
Signature Date
HEALTH-PRO (VA) IN-SERVICE EDUCATION

16. ALZHEIMERS AND DEMENTIA CAREGIVER TRAINING

Facts About Alzheimer's

Alzheimer's disease is not a normal part of aging. It is a progressive and fatal brain disease that is the most
common form of dementia. Unfortunately, it is fast becoming one the greatest medical challenges facing
Americans.

Alzheimer's disease is the 6th leading cause of death in the United States. There are an estimated 5.3 million
Americans living with Alzheimer's today. The entire family is impacted; there are an estimated 10 million
family caregivers today.

Alzheimer's Online Care Training Courses

Liberty Healthcare of North Carolina has partnered with The Alzheimer's Association to bring free individual online
care training in dementia care. The courses are 30 - 45 minutes long and are offered in both English and Spanish. You
do need to sign up for free training through the Alzheimer's Association at http://www.alz.org/
HEALTH-PRO (VA) IN-SERVICE EDUCATION
17. SEIZURE MANAGEMENT

Overview

A seizure is an event in which there is a temporary change in behavior resulting from a sudden, abnormal burst of
electrical activity in the brain. If the electrical disturbance is limited to only one area of the brain, then the result is
a partial seizure. For example, the patient/student may experience confusion, loss of awareness, aimless
movements, or uncontrolled body movements. If the electrical disturbance affects the entire brain, the result is a
generalized seizure.

Epilepsy or a seizure disorder is a chronic condition that is characterized by recurrent seizures. Many
patient/students with epilepsy have more than one seizure type and may have other symptoms as well.

Some seizures may result from an acute medical illness (e.g., with a diabetic during a hypoglycemic episode) or an
acute injury (e.g., head injury) and cease once the illness is treated. Some children may have one seizure without
the cause ever being known.

Classification of Seizures

The following table summarizes the classification of seizures:

Generalized Seizures Clinical Manifestations


Tonic-clonic seizures The eyes roll upward, the patient/student loses consciousness, falls to
(formerly known as grand mal the ground, and becomes rigid as muscles tighten (tonic phase).
seizures; affects the entire brain) This is followed by jerking movements of the entire body as muscles
undergo rhythmic tightening and relaxation (clonic phase). During
Onset: any age this phase, the patient/student may become incontinent of stool and
urine as his/her muscles contract and relax. Breathing may be shallow
or even stop briefly, but renews as jerking movements end.
Generalized seizures usually last 1-2 minutes. After the tonic-clonic
phase, movement slows and is followed by drowsiness or deep sleep
that can last several hours (postictal state).

Absence seizures These seizures are characterized by a brief loss of consciousness with
(formerly called petit mal seizures, minimal or no alteration in muscle tone and sometimes go
lapses, or unrecognized. The seizures can be mistaken for daydreaming or
staring spells) inattentiveness.
Patient/students may:
Onset: age 4-12 Simply stare blankly for 5-10 seconds
Drop objects because of loss of muscle tone
Have minor movements such as lip-smacking
Experience twitching or slight hand movements
The patient/student will be unable to recall what happened
during these brief periods of blankness. If untreated, seizures may
occur many times a day. Seizures can be precipitated by fatigue, stress,
hypoglycemia, or hyperventilation.
HEALTH-PRO (VA) IN-SERVICE EDUCATION
Atonic seizures Manifested as a sudden, momentary loss of motor tone.
(also known as drop attack) The patient/student may or may not lose consciousness. A mild
atonic seizure may cause a sudden, brief head drop. During a more
Onset: age 2-5 severe atonic seizure, the patient/student may suddenly fall to the
ground, lose consciousness briefly, and then get up as if nothing
happened. If a patient/student has frequent atonic seizures, a
helmet is worn to prevent injury to the head or face.

Myoclonic seizures Characterized by sudden, brief contractures of a muscle or group of


muscles without loss of consciousness.
No postictal state.

Partial Seizures Clinical Manifestations


Simple Partial Seizures (focal Manifestations are dependent on the area affected and tend to be
seizures; affects just localized. The patient/student may, or may not, lose consciousness
one part of the brain) and may be aware of the seizure. For example, a patient/students
eyes or eyes and head turn to one side and the arm on that side may be
Onset: any age extended with the fingers clenched. The patient/student may appear to
be looking toward the closed fist.
It is important for an eyewitness to give a clear description of the
seizure, especially which body parts are initially involved, to aid in
diagnosis and treatment. Also, noting the circumstances that
precipitated the episode can help in treatment.
Patient/students may also experience a postictal stage after a partial
seizure. Simple partial seizures may spread and become generalized.
Consciousness is never impaired.

Complex Partial Seizures The most common type of seizures. These seizures often begin with
(psychomotor seizures) an aura or warning that the seizure is about to occur. Most
commonly, the aura is described as a strange feeling in the pit of
Onset: age 3and up his/her stomach that rises up to the throat. Often this sensation is
accompanied by odd or unpleasant odors or tastes, auditory or visual
hallucinations, or feelings of elation or strangeness. A patient/student
may cry or run for help. During this time, the patient/student is often
unaware of his/her environment and unable to respond to the
environment.
After the aura, the patient/student may suddenly become limp or stiff,
appear dazed, and confused and apathetic. The most obvious
behaviors may be lip smacking, repeating words,

Partial Seizures Clinical Manifestations


chewing, drooling, swallowing, and nausea and abdominal pain
followed by stiffness, a fall, and sleep.
Complex partial seizures may spread and become generalized.
Consciousness is always impaired.
HEALTH-PRO (VA) IN-SERVICE EDUCATION

Monitoring
The purpose of seizure monitoring is to protect the patient/student from injury during a seizure, to carefully observe
the seizure in order to provide information for the management of the seizure disorder, and to distinguish between
behaviors related to a seizure and those behaviors not related to it.

Monitoring provides the health care provider with the information needed to better manage the patient/students
medication. An increase in the number of seizures may indicate that the patient/student needs a change in
medication or that he/she is not receiving the prescribed medication. A change in medication may be needed
because of a change in the patient/students metabolism. In addition, antiepileptic medication may be toxic.
Therefore, any side effects from the medication should be documented and reported to the school nurse, family,
and/or health care provider. Careful monitoring of the patient/student can improve the management of seizures.

Signs of an Emergency
A series of consecutive seizures in which the patient/student does not regain consciousness is called status
epilepticus, which is a medical emergency. Immediate medical care is required. Seizures that last longer than 5
minutes require emergency medical services. Seizures lasting longer than 30 minutes can cause brain damage.
Status epilepticus can lead to respiratory failure, brain damage, and death. Therefore, it is critical that the
patient/student receive immediate medical attention.

Managing a Seizure
Managing a seizure in school consists of protecting the patient/student, observing the patient/student, and getting
medical assistance when needed. The procedures on the following pages are guidelines for managing a
patient/student having a seizure and what to do after the patient/student has a seizure.

Components of the Individualized Health Care Plan (IHCP)


Each patient/students IHCP must be tailored to the individuals needs. The following section covers the procedure
for managing a seizure and possible problems and emergencies that may arise.
It is essential to review it before writing the IHCP.
Note: Equipment, medication, and supplies are provided by the parents/guardians.

Asample seizure action planandseizure observation record (or seizure log)are available from
http://www.epilepsyfoundation.org/about/professionals/.

For a patient/student with seizures, the following items should receive particular attention:
Patient/students underlying condition and possible problems associated with the condition or treatment.
Type of seizures patient/student experiences and typical course of seizure.
Patient/students baseline or normal behaviors.
Whether patient/student experiences auras, or can anticipate when seizures may occur.
Behaviors that indicate a seizure may be about to occur.
Actions to take if the patient/student has a seizure.
Medications the patient/student is taking, including rescue treatments, and signs of adverse reactions or
toxicity.
Determining the need for seizure precautions, and what these precautions will be. Latex allergy alert.
Standard precautions.
HEALTH-PRO (VA) IN-SERVICE EDUCATION

Procedure for Managing a Seizure

If the patient/student has a seizure:


1. Remain calm.
No one can stop a seizure once it starts.
2. Time the seizure. Document all of the patient/students activity during a seizure: the time seizure began, the
time seizure ended, area of body where the seizure began, any movement of the seizure from one area of the
body to another, type of movements of the head, face, and/or arms.
3. Check for medical alert I.D. and follow the patient/students individualized health care plan (IHCP).

If applicable, provide seizure rescue treatment.


4. Have an adult stay with the patient/student during the seizure to monitor his/her progress.
5. Put on gloves, if available.
6. Place patient/student on side. If possible, put something flat and soft (like a folded blanket or jacket) under
patient/students head so the patient/student cannot bang against the floor.
This positioning prevents the tongue from blocking airway and helps the patient/student not to choke on
secretions.
7. Do not place anything in the patient/students mouth.
Padded tongue blades and airways are not accepted practice because they may induce vomiting, cause potential
damage to teeth, and may be aspirated.
8. Loosen tight clothing, especially around the patient/students neck.
9. If patient/student is standing or sitting, gently lower patient/student to the ground to avoid a fall. Clear the area
of anything that could hurt the patient/student. Do not attempt to restrain patient/student or use force.
Do not remove patient/student from a wheelchair unless necessary.
10. Do not give the patient/student any oral medications, food or drink during a seizure.
11. Provide emotional support.
12. Call (911) Emergency Medical Services if: Patient/student stops breathing.
Seizure lasts longer than 5 minutes.
This is patient/students first seizure.
Repeated seizures without regaining consciousness.
Patient/student cannot be awakened and is unresponsive to pain after seizure ends.
Pupils are not equal in size after seizure.
There is evidence of patient/student injury. Patient/student has diabetes or is pregnant.
Seizure occurs in water.
Parents request emergency evaluation.

Prepare school environment to be as safe as possible for the patient/student who has a history of seizures.
Be aware of the potential for head injuries with uncontrolled seizures. The patient/student may require a
lightweight helmet for head protection, especially for seizures that produce sudden changes in muscle tone (atonic,
myoclonic, akinetic). Prepare for potential problems associated with seizures. For example, if the patient/student
has copious secretions with a seizure, a bulb syringe or suction machine will need to be available.
Pathways and environments should be free of unnecessary objects. For example, unused toys, wheelchairs, storage
boxes, etc. should be removed from the environment.
Supervision during use of hazardous machinery or equipment (such as that found in a shop class) should be
available.
HEALTH-PRO (VA) IN-SERVICE EDUCATION

After a Patient/studenthas a Seizure:


1. After the seizure is over, clear secretions from the patient/students mouth with a bulb syringe or suction
catheter. Keep child on his/her side.
Do not try to clear the patient/students mouth until the seizure has ended.
2. Monitor patient/students breathing.
Check position of head and tongue. Reposition if head is hyperextended. If patient/student is not breathing,
activate the school emergency plan and begin rescue breathing.
3. Talk with patient/student to determine patient/students level of awareness.
Note if the patient/student is alert, confused, drowsy, etc. and document findings.
If patient/student remains unconscious after seizure is over, maintain open airway and assess breathing. If
necessary, beginrescue breathing or CPR.
4. Determine and document whether or not the patient/student is able to move arms and legs, or if there is change
in the patient/students ability to move.
5. Check for injuries and provide care, if needed.
6. Check for loss of control of urine and stool. Provide privacy.
Loss of control is very embarrassing to the patient/student. Clean the patient/student to make him/her more
comfortable.
7. Remain with the patient/student until they have regained full awareness of their surroundings. Make the
patient/student comfortable; allow him/her to sleep as needed. Do not give food or liquids until fully alert and
swallowing reflex has returned.
After the seizure, the patient/student may sleep for 30 minutes up to a number of hours (postictal period). Refer
to the First Aid Flow Chart for Seizures to determine the disposition of the patient/student post seizure.
8. Document the length of seizure, what happened during and after the seizure.
Notify school nurse, family, and/or health care provider as per the individualized health care plan (IHCP).
HEALTH-PRO (VA) IN-SERVICE EDUCATION

Make sure you call the HEALTH-PRO RN Supervisor


during or just after a Seizure has occurred.