Introduction to Level 1: Fundamentals** This is only a introduction and is not the entire training for Principles of Caregiving: Level 1 Fundamentals ITC
Overview Roles and Responsibilities Ethical and Legal Behavior Observing, Reporting and Documenting Communication and Cultural Competency Job Management Skills and Self-Care Infection Control Safety and Emergencies Nutrition and Food Preparation Home Environment MaintenanceBody Mechanics & Techniques for Maintaining Back Safety
Roles and ResponsibilitiesDirect Care and Support • An individual’s homeServices can be Provided • Group home at: • An assisted living facility. • Personal CareTypes of Services that are • Housekeeping/HomemakerOffered to Individuals and • Attendant Care Families in their Home • Respite • Older adults (over 60), Individuals who may • Persons with disabilities Receive Services • Children and adults with developmental disabilities
Roles and Responsibilities • Dress • EatActivities of Daily Living • Ambulate (Walk) (ADLs) • Toilet • Take care of hygiene needs (e.g., bathing, grooming) • Shop • Keep houseInstrumental Activities of • Manage personal finances Daily Living (IADLs) • Prepare food • Transport (e.g., driving) • Family Members • Support Coordinator An ISP Team • Agency representative Consists of: • Direct care worker • Supervisor • Primary care physician
Roles and ResponsibilitiesTraining Requirements for Direct Care Workers (DCW)• Agency’s orientation• Level 1 Fundamentals• Level 2 Developmental Disabilities• 6 hours continuing education per year• DDD requirements • Finger Print Clearance Card • Article-9 • CPR • First AidPositive Caregiver Traits• Respect for consumer privacy• Do not use consumers personal belongings• Recognize and respect the right of lifestyle• Keep personal life separate• Maintain safe conditions in work environment• Do not bring family or friends to consumers home
Roles and ResponsibilitiesBehavior that Shows High Professional StandardsInclude:• Carry out responsibilities of the job the best way you can• Get the training you need• Be dependable and reliable• Maintain a high standard of personal health• Have good hygiene and appearanceProfessional Standards Influence the RelationshipBetween the DCW and the Consumer• Their will be a trust and the consumer will be able to rely on you.• Services provided will keep them safe and independent.The Role of you Supervisor• The supervisor needs to inform the DSW of job expectations and responsibilities.
Ethical and Legal Behavior Definitions of Terms that Apply to Direct Care and Support• Abuse, intentional infliction of physical harm or unreasonable confinement.• Neglect, failing to provide services necessary to minimum physical or mental health.• Exploitation, the improper or unauthorized use of a person’s funds, property, or assets.• Fraud means that a person intentionally gives false information in order to make money or gain an advantage.• Assault is when an individual attempts or threatens to touch another individual in a harmful or offensive manner. Battery takes place when an individual harmfully or offensively touches another individual without their consent.• Abandonment is when a family or agency leaves an individual without care or support.• Negligence is when a personal injury or property damage is caused by your act or your failure to act when you have a duty to act.• Liability refers to the degree to which you or your employer will be held financially responsible for damages resulting from you negligence.• Invasion of property is revealing personal or private information without an individuals consent.• False imprisonment takes place when you intentionally restrict an individual’s freedom to leave a space.
Ethical and Legal BehaviorMandatory Reporting and how to Report:• When there is suspicion of abuse and neglect reports must be made immediately.• Failure to report is a misdemeanor.• Immediate danger call 911• Non life-threatening report to your supervisorRole and Purpose of a Service Plan• A plan is developed for each consumer that describes exactly what services should be provided.• It lists the tasks you should do for this individual.• If you fails to do all the tasks assigned you may put your client at risk.• Do no more and no less.Avoiding Legal Action• If you do more or less then the plan says you are failing to act, and may be found negligent.Consumer Rights• Considerate and respectful treatment and care.• Not be abused emotionally, sexually, or physically.• Provide proper service from the service plan.• Receipts or statements for their fee-based service.• Refuse treatment.• Privacy.• File a complaint with the agency.• Confidential handling of their personal information.
Ethical and Legal Behavior Why Privacy and Confidentiality • Our consumers won’t give out personal information unless there is trust, and if they give the information it will help us provide quality care. They are Important for Individuals need to know that any information given will be private. Confidentiality and the Legal Responsibility of the DCW to Safeguard Consumer Information. The Health Insurance Portability • This keeps the identifiable health information about our clients and Accountability Act of 1996 confidential. It explains how to maintain privacy and punishment for (HIPAA). anyone violating client privacy. Information that Should be Kept • All information about our clients is considered private or confidential. Confidential. Personal information, medical information.How to Maintain Confidentiality in • Speak quiet, close doors, make sure a person is a need to know. Never Conversations and on the leave personal information on an answering machine. Telephone. What to do in the Event of a • If there is a breach of confidentiality, inform you supervisor or privacy Breach of Confidentiality. officer.How Direct Care Professionals can • The rule is really common sense. You should only have access toPractice the “Need to Know Rule” confidential information that you need to know.
Ethical and Legal BehaviorNot Allowing a Person to Make Decisions About ServicesTakes Away from a Person’s Rights• By not allowing a person to make decisions about services will prevent improvement in their well being and makes the person more dependent.Documents used for Health Care Planning (AdvanceDirectives):• Living Will • Legal document that outlines the medical care an individual wants or does not want.• Durable Medical Power of Attorney • Legal document that designates another person to act as an agent or a surrogate in making medical decisions if the individual becomes unable to do so.• Pre-hospital Medical Directive (orange form / DNR – do not resuscitate) • Special form that is bright orange in color, notifies the paramedics and others that they do not want CPR.“Do Not Resuscitate.”• If the heart stops beating or breathing stops, the individual does not want to receive CPR under any circumstances.What Health Events the Orange Form Exclusively Covers.• The orange form only covers cardiac and respiratory arrest.
Observing, Reporting & Documenting The Purpose of • The purpose is to communicate any changes or status Reporting and that may be occurring with an individual and or family. DocumentingHow to Record Accurate • Make sure you only document things that you saw or did Information. yourself.The Difference Between • Facts are what exactly happened, said, and heard. Opinions are less useful because you may interpret a Documenting and situation one way, but another person may have a Reporting different opinion. The Importance of • Reporting is the verbal communication of observation Reporting Observed and actions. We report so we are not riskingChanges in Individuals. endangering the person, the agency, and yourself.
Communication & Cultural CompetencyThe Communication Process• It involves the sender (speaker), receiver (listener), message, and feedback.• The sender gives a meaningful message, the receiver then gives feedback back to the sender.The Difference Between Verbal and Non-Verbal Communication• Verbal communication uses words, and non-verbal communication does not use words. Examples are facial expressions, head movements, hand and arm gestures, touching, eye contact, or physical posturesEffective Communication• Effective communication happens when the intended meaning of the sender and the perceived meaning of the receiver are virtually the same.Barriers to Effective Communication• Poor listening skills, giving advice, making judgment, focusing on yourself, discussing your own problems or concerns, discussing topics that re are controversial such as religion and politics, or clichés.Aggressive Communication• Meeting needs of self and not othersPassive Communication• Meeting needs of others and not self.Assertive Communication• Meeting needs of both others and self.• This is the ability to say what you want to say, but still respect the rights of others.
Communication & Cultural Competency Problem-Solving Responding in a Respectful “Person First and Conflict Non-Threatening Interactions Language” Resolution Way Techniques• Do not talk down to a • Say people with • This will prevent the • Use listening skills person who has disabilities instead of individual from getting and therapeutic language difficulties, the handicapped or upset, and damaging communication use adult language, disabled. the relationship techniques. Listen don’t use baby talk, intently. Do not use adult words respond with anger. (briefs not diapers) Empathize. Put your choose adult books own emotions on hold and TV programs for your clients, let each person make choices, don’t decide for them.
Communication & Cultural Competency Impact of Culture on “Culture” a Person’s Needs and Preferences. • Behavior patterns, • Depending on their arts, beliefs, upbringing we communications, need to be actions, customs, sensitive as to how and values. They to work with the are linked to racial, individual. ethnic, religious, or social groups. Actions That “Cultural “Platinum Rule” Support Culturally Competence” Competent Care.• Treat others as • Acknowledges and • Acceptance, they want t o be values diversity adaptation, and treated. accommodates integration. differences by seeking a common vision. Diversity is viewed as strength.
Job Management Skills & Self-Care“Stress”• Stress is a person’s response to difficult situations.• If it effects your health are sleep it is negative, if it’s a motivator it is a positive stress.Causes and Effects of Unwanted Stress• Too much work, unrealistic deadlines, and financial pressures are negative.• The constant bombardment by stress-related chemicals and stimulation will weaken a person’s body.Appropriate Strategies for Coping With Stress and Reducing Work Related Stress• Strong social support, exercise, diet, rest, relaxation techniques, realistic expectations, positive self-talk, time-management, effective communication, realistic expectations.Practice Good Time Management• Prioritizing tasks, not procrastinating, leaving enough time to finish tasks.Strategies to Improve Organizational Skills• Planning ahead, prioritizing and makings lists and schedules.Notifying Supervisor When Unable to Report to Work as Scheduled• This is so the agency can send in a replacement DCW and avoid a NPS.
Job Management Skills & Self-Care“Boundaries”• Setting limits to personal involvement, feelings, and sharing of personal information. Honesty, reliability, respect for privacy and cultural differences.Rights of DCWs• File a complaint without the fear of retaliation.• Not be abused emotionally, sexually, or physically.• Work in a safe environment.• Provide input for changes to a client’s service plan.• Be informed when a client files a complaint against him or her.• A confidential investigation, a fair hearing, and be told the outcome when addressing complaints against him or her.• Receive timely payment for services including salary and mileage, where appropriate.Safety Tips for DCWs• Reliable transportation with plenty of fuel. Give office current address.• Alert consumer that you are coming.• Have accurate directions (a map).• Drive with windows closes and car doors locked.• Keep purse wallet in trunk.• Observe your surroundings.• Walk around a gathering of people.• Do not enter a home if the situation seems questionable.• Note your exits when you enter a client’s residence.• Be cautious when approaching pets.
Infection Control • Air, eating drinking utensils, dressings, food, How Germs Are Spread personal hygiene equipment, insects, water, direct contact, animals. Reduce the Spread of • Washing hands, washing fruit, covering the nose when coughing, good hygiene, wash cooking Infection utensils.The Most Effective Method for Reducing the Spread • Washing your hands. of Infection Individuals Who are at • Very young or elderly persons, on meds that suppresses the immune system, on prednisone, have HIV/AIDS, are greater Risk for Getting not eating healthy foods, sleeping enough, under increase Infections stress.
Infection ControlAppropriate Times to Wash One’s Hands• When arriving or leaving a client’s home.• If contaminated by blood or any other bodily fluids.• Before and after contact with a new client.• Before and after use of gloves.• After handling soiled linens or waste.• Before and after contact with any wounds.• After using the restroom.Proper Hand Washing Technique• Collect items needed for hand washing.• Remove all jewelry on hand, fingers, wrists• Turn on the water and adjust the temp.• Wet hands under running water.• Apply soap to hands.• Lather hands well, rub hands together in a circular motion, wash carefully between fingers, palms the back of hands, around jewelry.• Rub your fingernails against the palm of the opposite hand to push soap under the nails.• Wash hands for a minimum of 20 sec.• Wash a full hands distance up wrists as well.• Rinse off all soap thoroughly.• Dry hands with clean paper towel.• Use paper towel to turn off the water and to pen the restroom door if needed.• Drop paper towel in the trash container.
Infection ControlWhen Gloves Should Be Worn• Touching of blood or body fluids.• You are caring for cuts, sores, other skin openings.• There is possible contact with feces, urine, vomit.• Handling soiled clothing or linens.• Cleaning the bathrooms.How to Apply, Remove and Dispose of Gloves.• Wash and dry your hands.• Remove a pair of gloves from the glove box.• Use care when pulling gloves on.• Interlace fingers to remove wrinkles.• Double glove if your nails are long or if the glove will become heavily soiled.• From outside, pinch the rubber glove just below the cuff using your thumb and index finger to lift the glove away from your wrist area.• Using your middle and ring fingers, scoop the glove away from the wrist, pulling it off inside out. Ball that glove tightly into palm of gloved hand.• Now with ungloved hand slide your index and middle finger under the cuff of the other glove, pulling it off inside out. The firs glove you removed should now be inside the second glove.• Follow your agency’s policies in disposing of gloves.• Wash your hands following proper procedure.
Infection Control The Handling, Cleaning • Put on gloves, put linens in a plastic bag, take to and/or Disposal of Soiled toilet and rinse off the large solids in the toilet and Linen put back in plastic bag. Wash with bleach. • Use a purchased medical sharps container or a The Proper Disposal of heavy plastic or metal container. The container Sharps should be puncture-proof with a tight fitting lid.The Appropriate Dilution and • One part bleach to 10 pars water (1:10). Use of a Bleach Solution.
Infection ControlThe Symptoms of Hepatitis B and Hepatitis C• Flu-like, fever, lack of energy, dark urine, yellow skin and sclera, abdominal discomfortHIV, Its Symptoms and Its Transmission• Flue-like, fever, weight loss, rash diarrhea, night sweats, swollen lymph nodes.• Spread by having unprotected anal, vaginal, or oral sex with one who is infected. Sharing needles or syringes. A mother to their babies before the baby is born, during birth, or through breast feeding.Tuberculosis, Its Transmission• Cough, fatigue, weakness, fever, weight loss, night sweats, blood in sputum.• Transmitted airborne route.• High risk if you live in substandard housing, prisoners, IV drug abusers, has HIV/AIDS
Safety & EmergenciesCommon Emergency Situations• Fires, falls, injury.General Guidelines for Emergencies, Including When to Call 911.• Stay Calm, yell for someone to assist you, Do not leave, and keep individual’s airway open. Call 911 for emergency assistance if there is chest pain, shortness of breath, suspected heart attack or stroke, suspected heat stroke, non-responsiveness, confusion that is not common with individual, falls and can’t get up, fire, safety issues.Procedures for Calling 911• Stay calm, assess the client for responsiveness, call 911, state the nature of the emergency, state the location of the emergency, give your name and telephone number, remain on the line until dispatch tells you to hang up.Parts of an Individual Emergency Plan.• Name, address, phone. 2 Emergency contacts names and numbers. Hospital preference, physician, allergies, living will, CPR (yes or no), current medication.When to Contact the Family and/or the Supervisor.• Call after the paramedics have been called and the client is no longer in danger.Use the Service plan to Determine Risk Factors, and How to Assist the Person Receiving Services.• Identify nearest emergency exit. Emergency plan and practice leaving the building. Install smoke alarms. Have fire extinguisher. Live or sleep near an exit. Keep a phone near the bed.
Safety & Emergencies • Identify nearest emergency exit. Emergency plan andFire Safety Techniques practice leaving the building. Install smoke alarms. Have and Risk Factors fire extinguisher. Live or sleep near an exit. Keep a phone near the bed. Simulate (role-play) • Pull the pin, aim low pointing the extinguisher nozzle at the base of the fire. Squeeze the handle to release the the use of a Fire extinguishing agent. Sweet from side to side at the base Extinguisher of the fire. • Weakness of the lower body, problems with walking and balance, poor vision, diseases such as arthritis,Risk Factors For Falls diabetes, Parkinson’s disease, and dementia, medications or alcohol. Ways to Promote • Not flowing near open flames or a heat source. Don’t smoke near oxygen. 3ft away from space heater. Put up Oxygen Safety signs stating oxygen is in use. Secure oxygen tanks.
Nutrition & Food Preparation • Breads and cereals, good source of fiber.Food Groups and Nutrients • Fruits and vegetables, good source of fiber Proteins,Needed for a Healthy Diet • Dairy products, good source of calcium. • Fats and sweets, limited to small amounts. • If you have good eating habits and are well nourished,How Good Eating Habits Can you will have all the nutrients you need for energy and Increase Good Health good health. It speeds up healing, recovery from illness, and helps maintain health. Why Ingredients are Listedon the Food Label, and What • So we know what we are going to eat. Listed from highest the Order of the Ingredients to lowest by volume or weight. Means • A portion is the amount of food you put on a plate. “Portion” and “Serving” • A serving is a standard amount of food.
Nutrition & Food Preparation Plan a Menu Based on aPerson’s Individual Preferences • Note any food allergies, note any special diet orders.and/or Recommendations for a Modified Diet Nutrients that may have to be • Low-fat/low-sodium, diabetic, individuals who have had a Monitored for Certain Diets stroke, high fiber, lactose intolerant. • Washing hands, sanitizing surfaces, dishes and equipment. Proper Food Preparation and Store fresh meat in refrigerator, in freezer if keeping a few Storage days. Refrigerated leftovers need to be tossed after 3 days. • Food borne illness is transmitted to people by food orFood Borne Illness and Ways to beverages sometimes called food poisoning. Don’t eat raw Reduce Food Borne Illness fish and shellfish, raw milk or cheese, raw eggs, raw meat or poultry, raw sprouts, untreated fruit or vegetables juice.
Home Environment MaintenanceCare and Service Plans• The care plan or service plan usually lists general tasks, such as, clean the kitchen or wash clothes. It does not list the procedures. That is up to the DCW and the client.• Follow the service plan.• Make a list of tasks that need to be done according to the care plan.Client Rights• Show the same respect for the client’s property as you would for your own.• If there is something that does get damaged, do not try to hide it!• The client has a right to be a hoarder.• The client has the right to refuse service.Planning and Organizing Tasks• Follow the client’s directions when performing tasks, even if you know a better way.• Plans may also change depending on the client’s needs or health status.
Home Environment MaintenanceDishwashing• Hand wash dishes in the following order:• Glasses• Silverware• Plates and cups• Pots and pans• Rinse with hot water and allow to AIR DRYDishwasher• Run only full loads to conserve water, soap and power costs.• Do not interrupt the dry cycle to save money if sanitizing the dishes is needed.Bathroom• Wear gloves.• Clean from cleanest areas to dirtiest (toilet is considered the dirtiest).• Clean sink, countertops, and shower/tub with disinfectant (bleach solution 1:10 works well).• Use a brush to clean the toilet, and brush under the rim.
Home Environment Maintenance • Use a clean mop and change mop water frequently. Flush dirty water down toilet. • Vinyl: Use mild soap and rinse with clean warm water. • Ceramic floors: Use vinegar and water. Check with client if soap can be used. Floors • Carpets: Vacuum frequently. Be sure the bag does not • Empty trash on a daily basis to decrease mold and bacterial growth. • Rinse out and clean household trash containers with a bleach solution on a regular basis. Trash • If the client recycles, use appropriate recycle containers and empty into the removal appropriate recycle bins. Do not mix regular trash with recycle trash. • Be aware of the following issues that may affect how and what you clean: • Culture affects a person’s belief in how things are treated (e.g., money, time, animals).CULTURAL • Religious beliefs affect holiday observations, cooking, and cleaning and handling AND of religious artifacts.RELIGIOUS ISSUES
Body Mechanics & Techniques for Maintaining Back SafetyUsing correct body mechanics is an important part of a DCWs job because:• The individual with a disability depends on the DCW for hands-on assistance. If the DCW does not take care of his/her back with correct body mechanics, the DCW will not be able to provide that assistance.• Not using correct body mechanics puts the safety of the client and DCW at risk.• Some injuries cause permanent disabilities.Center of gravity over base of support.• It is important for the DCW to be aware of center of gravity over base of support in working with a client. Usually a person’s center of gravity is right behind a person’s navel (belly button). A good base of support is being in a standing position where the feet are slightly apart and knees slightly bent.Principles of body leverage.• Using leg and arm muscles is important, but so is applying body leverage. Mirror posture of the client. Use body as a whole and not just one part.Procedure: Lifting Objects with Good Body Mechanics• Start with good standing position; feet are shoulder width apart.• Keep knees bent slightly.• Keep your center of gravity (which is usually right behind the navel) over base of support (which is the proper stance the person is in).• Squat with the chest and buttocks sticking out. This position will keep your back flat.• When you squat down or squat back up, place your elbow or hand on your thigh or the counter to take some pressure off your back.• Use leg and upper body muscles when elevating/lowering an object, keeping body in alignment (keep your buttocks behind you, no twisting). Utilize the whole body to complete the task.
Fundamentals Principles of Caregiving: Fundamentals is the first part of the Principles of Caregiving series. It contains the material that is most likely needed by all direct care and direct support professionals. Additional training is available if you provide personal care or assistance with activities of daily living. Fundamentals and any one of the modules can be taken together in one class or they can be taken separately. Fundamentals should be completed first, and some review may be necessary before completing the additional module.Depending on the needs of your employer and the clients served, you may not need all the knowledge and skills presented in Fundamentals, but are encouraged to study the whole program. The Principles of Caregiving curriculum is designed to provide a well-rounded introduction to caregiving and direct supports, and you will be prepared to work for a variety of clients and employers.