The Home Health Aide

You must participate in class discussions in the Discussion Board. This is a state requirement. You cannot pass the course without taking part in the Discussion Board.

Please read all the material below. There is no text book for this course. All information is in the online materials. Read all of the lessons and keep track of the hours you spend on this course. You will be asked for your total hours when you fill out the Course Evaluation at the end of the class.

The following link is a short YouTube video that will give you an overview of a Home Health Aide's duties.

• Home Health Aide Duties
  

The Home Health Care Team works with physicians to bring modern home health to patients in the comfort of their home. Home care delays or eliminates the need for care in a hospital or long-term care facility, provides preventive medicine, and is typically less costly than inpatient care. It encourages a high degree of participation from the patient and/or family member receiving care. Receiving care at home brings rest and reassurance to patients and their loved ones. Home Health Agencies must be licensed with the state.

Services offered to home health patients include:

• Case management
• Disease state management and education
• Community referrals
• Rehabilitation services
• Restorative care
• Supportive counseling
• Pediatric care
• Intravenous therapy
• Pain management
• Wound and Ostomy care
• Cardiac assessment and monitoring
• Diabetes management
• Nutrition counseling

Referrals and requests for services are accepted from family members, patients, hospitals, nursing homes, physician offices, and clinics and community agencies. A doctor's order is needed before home health services can begin.

Orientation to Home Care

Functions of the Home Health Aide may include many duties as outlined in the care plan. Some of these functions are:

• Recording care and observations on the client’s record.
• Measuring vital signs and weight.
• Assist with toileting needs.
• Assist with oral care.
• Assist with eating.
• Assist with transfer of client from bed to chair and vice versa.
• Assist with repositioning a client.
• Remind clients to take medications on schedule.
• Reinforce or change unsterile simple dressings.
• Assist with care of ostomy bags or urinary drainage bags.
• Measure and record intake and output.
• Assist with grooming
• Make beds and change bed linens.
• Assist with walking and other prescribed exercises.
• Assist with applications of prosthetic devices.
• Assist with rehabilitation measures.
• Assist with skin care.
• Apply elastic support hose.
• Notifying case manager of any notable change in the client's condition.

Situations for Home Health Aides to avoid

 Do only what and exactly what your case manager instructs you to do! There are some situations you should recognize and avoid.

• Doing more than is assigned. Practice saying "no" in a tactful way, encouraging the client to contact the case manager if more services are wanted. When you do something that was not assigned, you are assuming responsibility (liability) for these acts. and your agency is no longer responsible.
• Doing less than is assigned. This may put the client in danger and lead to a charge of negligence, which means "an action or lack of action that leads to an accident or injury."
• Doing hasty, careless, or poor-quality work. You have received training in the proper way to carry out your work activities. It is your responsibility to work carefully. Sometimes, even with the greatest amount of care being taken, accidents happen: A valuable vase breaks while you are dusting it or a client falls. If you have been carrying out your assigned duties and exercising a reasonable amount of care, you usually are not held liable for the damage or injury that results; agencies carry liability insurance to cover these types of accidents.
• Using your car for work activities. This applies to transporting a client in your car, even when you are taking the client to the doctor's office or just out for a ride, without letting your car insurance company know. If an accident occurs, you might be liable for the resulting damage and you may be required to personally pay for those damages if you do not have proper coverage. Be sure your driver's license is current and in good standing, that your car is in good repair, and that you have your agency’s approval to take clients in your car. Also, check to see if you will be paid or reimbursed for the use of your car by your agency (usually given as a reimbursment based on mileage). Before employing an individual, some agencies will require that the Home Health Aide has a valid driver's license, car, and proper automobile insurance.
• Failing to do accurate and daily reporting and documentation. You are in a hurry and decide not to chart today on your client, but plan to do it the next day when you will have more time. The client's daughter comes to visit her mother and sees that nothing is written on the chart that day and immediately assumes that no one was there to care for her mother. The daughter becomes quite upset over this incident, which could have easily been avoided, and calls the home health agency.
• Failing to act in an emergency. You should know what the emergency plan is for each client in your care, and you should be prepared to follow it. In a life-threatening situation, call 911 if available in your area. If 911 service is not available, call for an ambulance before calling your case manager. There are few exceptions before calling an ambulance in an emergency. In some cases the family wants to be notified first before calling an ambulance. This information should be clearly stated in the client's care plan. Some agencies may require you to be CPR/first aid certified before you are hired. Do not try to perform first aid or cardiopulmonary resuscitation (CPR) if you have not been trained to do so.
• Attempting to do things that are beyond your abilities. It is okay to say, "I don't know how to do that. Let's see if we can get someone who does." You are not employed as a nurse, a plumber, an electrician, or a counselor...do not try to be one.
• Injuring yourself or the client by doing something you are not assigned or adequately trained to do. If you have been assigned to do something you do not feel comfortable doing, ask for more training. Trying to do something without assignment and adequate training, such as moving a client with a Hoyer lift, can leave you liable for injury or damage that results.
• Failing to report unsafe working conditions that later cause injury to you or another Home Health Aide. Do not take unnecessary risks. Follow the agency procedures for reporting.

Organizational Skills

A successful aide possesses good organizational skills. An aide must manage time well to be able to complete all the tasks required in an allotted shift. The instructions may include light housekeeping, laundry and ironing, meal preparation, shopping/running errands, and personal care of the client. The aide will have to decide the best way to plan each day's activities. This will require flexibility, practical judgment, and time organization. Some pitfalls to avoid are:

• Not replacing or ordering supplies when needed from your case manager
• Watching television
• Jumping from one task to another and one room to another without organizing priorities
• Putting off unpleasant tasks because they are disagreeable
• Talking to friends on the telephone, texting, browsing the internet, or doing personal business
• Stopping frequently for a cup of coffee or rest

An aide's job is to make the family comfortable and to assist them, not to change their lifestyle. Remember, as a Home Health Aide, you are a guest in the client's home.

Everyone should follow the golden rule - treat others as you would like to be treated. This helps to establish good interpersonal relationships.

Client's Rights

• Every client shall be treated with consideration, respect, and full recognition of the client's dignity and individuality.
• Every client shall receive care, treatment, and services that are adequate, appropriate, and in compliance with relevant federal and state law.
• Every client has the right to be free from mental and physical abuse.
• Every client shall be informed of these rights in writing and in language the client can understand.
• Every client who is responsible for a fee for service shall be given a statement of the services available by the agency and related charges.
• Every client shall participate in the development of the plan of care and discharge plan and be informed of all treatments, when and how services will be provided, and the name and functions of any person and affiliated agency providing care and services.
• Every client has the right to refuse treatment after being fully informed of and understanding the consequence of such actions.
• Every client shall be informed of the procedure for submitting complaints to the agency. If the client is not satisfied by the agency response, the client may complain to the state Department of Health and Social Services.
• Every client shall have the right to recommend changes in policies and services to agency staff, the area office representatives of the department, or any outside representative of the client's choice free from restraints. interference, coercion, discrimination, or reprisal.
• Every client shall receive respect and privacy, including confidential treatment of client records, and the right to refuse release of records to any individuals outside the agency.
• Every client has the right to privacy.
• Every client has the right to request change of caregiver.
• Every client has the right to be informed of the state consumer hotline telephone number.

Home Health Aide's Rights

As an employee of an agency or your client, you also have rights. Examples of your rights are:

• The right to take pride in a job well done.
• The right to make suggestions and complaints within designated channels without fear of retaliation.
• The right not to be abused physically, verbally, or sexually by clients.
• The right to recommend care plan changes designed to facilitate care delivery and reduce caregiver stress.
• The right to be informed when complaints concerning client treatment are alleged against you.
• The right to a fair hearing with your case manager.
• The right to a confidential investigation.
• The right to be informed of the investigation’s outcome.
• The right to be paid for your services by your agency for a predetermined salary and mileage for travel.
• The right to attend continuing education programs offered by your agency at no cost to you.
• The right to work in a safe environment.

Confidentiality

As you have been taught as a CNA, you know confidentiality is very important. A few of your clients might live in a senior high-rise, and often clients are curious about who else in the building has a Home Health Aide, or what is wrong with that person. You are not allowed to tell another client that you are even caring for someone else in the building. You might suggest your client to talk to his or her neighbor to find out the information.

HIPAA (Health Insurance Portability and Accountability Act) went into effect in April 2003. This act mandates that all of your client’s health information-oral, paper or electronic- be protected and confidential. If records are in your car, make sure the car is locked, and that information is not visible, when you leave it. Keep all records secure at all times. 

Working with People

I would like to add to the presentation regarding stress. Stress is a big issue for everyone. We should learn all we can on how to deal with stress and how to help our clients deal with stress. Please read this commentary.

Recognizing Stress

Which of these is stress?

• You receive a promotion at work.
• Your car has a flat tire.
• You go to a fun party that lasts till 2:00 a.m.
• Your dog gets sick.
• Your new bedroom set is being delivered.
• Your best friend and his wife come to stay at your house for a week.
• You get a bad case of hay fever.
• All of the above.

  All of these are stress!

If you are used to thinking that stress is something that makes you worry, you have the wrong idea of stress. Stress is many different kinds of things: happy things, sad things, allergic things, physical things. Many people carry enormous stress loads and they do not even realize it!

What is stress?

We are all familiar with the word "stress". Stress is when you are worried about getting laid off your job, or worried about having enough money to pay your bills, or worried about your mother when the doctor says she may need an operation. In fact, to most of us, stress is synonymous with worry. If it is something that makes you worry, then it is stress.

Your body, however, has a much broader definition of stress. To your body, stress is synonymous with change. Anything that causes a change in your life causes stress. It doesn't matter if it is a "good" change, or a "bad" change, they are both stress. When you find your dream apartment and get ready to move, that is stress. If you break your leg, that is stress. Good or bad, if it is a CHANGE in your life, it is stress as far as your body is concerned.

Even imagined change is stress. (Imagining changes is what we call "worrying"). If you fear that you will not have enough money to pay your rent, that is stress. If you worry that you may get fired, that is stress. If you think that you may receive a promotion at work, that is also stress (even though this would be a good change). Whether the event is good or bad, imagining changes in your life is stressful.

• Anything that causes change in your daily routine is stressful.
  
• Anything that causes change in your body health is stressful.
  

Let us look at several types of stress -- ones that are so commonplace that you might not even realize that they are stressful.

• Emotional Stress
  
  • When arguments, disagreements, and conflicts cause CHANGE in your personal life, that is stress.
    
• Illness
  
  • Catching a cold, breaking an arm, a skin infection, a sore back; These are all CHANGES in your body condition.
• Pushing Your Body too Hard
  
  • A major source of stress is overworking yourself. If you are working (or partying) 16 hours a day, you will have reduced your available time for rest. Sooner or later, the energy drain on your system will cause the body to fall behind in its repair work. There will not be enough time or energy for the body to fix broken cells or replace used up brain neurotransmitters. CHANGES will occur in your body's internal environment. You will "hit the wall," "run out of gas". If you continue, permanent damage may be done. The body's fight to stay healthy in the face of the increased energy that your are expending is major stress.
    
• Environmental Factors
  
  • Very hot or very cold climates can be stressful. Very high altitude may be a stress. Toxins or poisons are a stress. Each of these factors threatens to cause CHANGES in your body's internal environment.
    
• The Special Case of Tobacco Use
  
  • Tobacco is a powerful toxin! Smoking destroys cells that clean your trachea, bronchi, and lungs. Smoking causes emphysema and chronic bronchitis, which progresses to slow suffocation. The carbon monoxide from cigarette smoking causes chronic carbon monoxide poisoning. Tobacco use damages the arteries in your body, causing insufficient blood supply to the brain, heart, and vital organs. Cigarette smoking increases the risk of cancer 50 fold.
  • Chewing tobacco or snuff is no safe haven. It also damages your arteries, and it carries the same cancer risk. (Cancers of the head and neck are particularly vicious, disfiguring, and deadly).
    
  • Tobacco is a powerful source of added stress to one's life. It poisons the body with carbon monoxide, and causes the physical illnesses of emphysema, chronic bronchitis, cancer, and arterial damage.
    

Hormonal Factors

Puberty

The vast hormonal changes of puberty are severe stressors. A person's body actually CHANGES shape, sexual organs begin to function, and new hormones are released in large quantities. Puberty, as we all know, is very stressful.

Pre-Menstrual Syndrome

Once a woman passes puberty, her body is designed to function best in the presence of female hormones. For women past puberty, a lack of female hormones is a major stress on the body. Once a month, just prior to menstruation, a woman's hormone levels drop sharply. In many women, the stress of sharply falling hormones is enough to create a temporary OVERSTRESS. This temporary OVERSTRESS is popularly known as Pre-Menstrual Syndrome (PMS).

Post-Partum

Following a pregnancy, hormone levels CHANGE dramatically. After a normal childbirth, or a miscarriage, some women may be thrown into OVERSTRESS by loss of the hormones of pregnancy.

Menopause

There is another time in a woman's life when hormone levels decline. This is the menopause. The decline in hormones during menopause is slow and steady. Nevertheless, this menopausal decline causes enough stress on the body to produce OVERSTRESS in many women.

Taking Responsibility for Another Person's Actions

When you take responsibility for another person's actions, CHANGES occur in your life over which you have little or no control. Taking responsibility for another person's actions is a major stressor.

Allergic Stress

Allergic reactions are a part of your body's natural defense mechanism. When confronted with a substance which your body considers toxic, your body will try to get rid of it, attack it, or somehow neutralize it. If it is something that lands in your nose, you might get runny eyes and sneeze. If it lands on your skin, you might get blistery skin. If you inhale it, you'll wheeze. If you eat it, you may break out in itchy red hives all over your body. Allergic reactions are a definite stress, requiring large changes in energy expenditure on the part of your body's defense system to fight off what the body perceives as a dangerous attack by an outside toxin.

Your Stress Scale

Stress Scale for Adults

In the following table you can look up representative changes in your life and see how much stress value each of these changes is adding to your life. Note any item that you may have experienced in the last twelve months. Then, total up your score.

(Adapted from the "Social Readjustment Rating Scale" by Thomas Holmes and Richard Rahe. This scale was first published in the "Journal of Psychosomatic Research", Copyright 1967, vol.II p. 214. It is used by permission of Pergamon Press, Ltd.)

Total Score ___________________________

Stress Scale for Youth

Total Score _____________________________________

We have asked you to look at the last twelve months of changes in your life. This may surprise you. It is crucial to understand, however, that a major change in your life has effects that carry over for long periods of time. It is like dropping a rock into a pond. After the initial splash, you will experience ripples of stress. And these ripples may continue in your life for at least a year.

So, if you have experienced total stress within the last twelve months of 250 or greater, even with normal stress tolerance, you may be OVERSTRESSED. Persons with Low Stress Tolerance may be OVERSTRESSED at levels as low as 150.

OVERSTRESS will make you sick. Carrying too heavy a stress load is like running your car engine past the red line, or leaving your toaster stuck in the "on" position, or running a generator past maximum permissible power. Sooner or later, something will break, burn up, or melt down.

What breaks depends on where the weak links are in your physical body. And this is largely an inherited characteristic.

Here are the common "weak links" and the symptoms of their malfunction.

• Brain OVERSTRESS
  
  • Fatigue, aches and pains, crying spells, depression, anxiety attacks, sleep disturbance.
    
• Gastrointestinal Tract
  
  • Ulcer, cramps and diarrhea, colitis, irritable bowel.
    
• Glandular System
  
  • Thyroid gland malfunction.
    
• Cardiovascular
  
  • High blood pressure, heart attack, abnormal heart beat, stroke.
    
• Skin
  
  • Itchy skin, rashes.
    
• Immune System
  
  • Decreased resistance to infections and neoplasm.
    

We have known for a long time that OVERSTRESS could cause physical damage to the gastrointestinal tract, glandular system, skin or cardiovascular system. But only recently have we learned that OVERSTRESS actually causes physical changes in the brain. One of the most exciting medical advances of our decade has been an understanding of how OVERSTRESS physically affects your brain. We now know that the fatigue, aches and pains, crying spells, depression, anxiety attacks, and sleep disturbances of OVERSTRESS are caused by brain CHEMICAL MALFUNCTION.

Checklist for Handling Overstress

• To Reduce Your Stress Load:
  

-----Reduce the pace of change in your life.
-----Reduce the social obligations.
-----Reduce work or school obligations.
-----Postpone changes in your living situation
-----Say "No" more often, and don't be afraid to ask for help.
-----Eliminate possible food or environmental allergens.
-----Reduce environmental toxins.
-----Get enough sleep, and make sure you have a restful sleeping environment. Stay away from bright electronic screens at least an hour before bedtime.

• Get Off the "Roller Coaster":
  

-----Diet: Take a multivitamin, mineral, or trace element preparation; stabilize your blood sugar; eat more fresh vegetables.
-----Exercise: Twenty minutes to two hours, a minimum of three times a week.
-----Stop Your Pick-Me-Ups (coffee, energy drinks--consult your physician as needed)
-----Stop Your Put-Me-Downs (sleeping pills, anxiety medications--consult your physician)

• Do a "Rest For Your Mind" Activity:
  

-----Exercise
-----Recreational reading/audio books, arts, crafts, music
-----Dance
-----Meditation
-----Yoga
-----Biofeedback
-----Self-Hypnosis
-----Religious counseling or prayer

• Help Your Body Clock Re-Set Itself:
  

-----Set regular sleep times
-----Avoid time zone shifts or rapid changes in your work shift
-----Use daylight spectrum fluorescent lights to set your body clock's "awake time".

• Visit A Physician:
  

-----Check for hidden illness

• Visit a Counselor:
  

-----Obtain help with self relaxation and general psychological counseling.

• If You Just Can Not Make Enough Happy Messengers (What your brain normally produces):
  

-----Have your doctor prescribe for you a brain chemical re-balancer

Home Management

I would like to add to the presentation that most accidents occur at home and many of them are preventable, so it is important that your client’s home is as safe as possible. Most accidents occur in the bedroom or bathroom. According to the National Safety Council, at least 4 million people are injured each year in home accidents. This means that about 1 person in 50 suffers some kind of injury as a result of an accident that occurs in the home. Here are some helpful tips.

• Bathroom Safety
  
  • A light switch near the bathroom door will prevent you from walking through a dark area. Install a night light. Inexpensive lights that plug into outlets are available. Consider replacing the existing switch with a "glow switch" that can be seen in the dark.
    
    Electrical appliances and power cords can cause shock or electrocution if they come in contact with water. Keep power cords away from these areas, and keep devices unplugged when not in use.
    
  • Wet soapy tile or porcelain surfaces are especially slippery and may contribute to falls. Apply textured strips or appliqués on the floors of tubs and showers. Use non-skid mats in the tub and shower, and on the bathroom floor.
    
    Grab bars can help clients get into and out of their tub or shower, and can help prevent falls. Check existing bars for strength and stability.
    
  • Water temperature above 120 degrees can cause tap water scalds. Always check water temperature by hand before entering bath or shower. Taking baths, rather than showers, reduces the risk of a scald from suddenly changing water temperatures.
    
    Grandparents should use child-resistant vials if they are able to. Although grandparents may get traditional easy-to-open closures by asking their pharmacist for them, the child-resistant vials should be used whenever children are around.
    
    Store all medicines separately from household products, and store all household chemical products away from food. Keep items in their original containers. Leave the original labels on all products, and read the label before using. Always leave the light on when giving or taking medicines. The nurse will clean out the medicine cabinet periodically and safely dispose of unneeded medicines when the illness for which they were prescribed is over. Clients should turn on a light at night and put on their glasses to read labels when they need to take medicine.
    
• Bedroom Safety
  
  • Lamps or switches located close to each bed will enable people getting up at night to see where they are going. Rearrange furniture closer to switches or move lamps closer to beds. Install night lights and leave clear paths around and between furniture.
    
    Use electric blankets according to the manufacturer's instructions. Don't 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.)
  • Don't set electric blankets so high that they could burn someone who falls asleep while they are on. Teach clients to never go to sleep with a heating pad if it is turned on because it can cause serious burns even at relatively low settings.
    
  • In case of an emergency, it is important to be able to reach the telephone without getting out of bed.
    
  • Do not smoke in bed. Smoking in bed is a major cause of accidental fire deaths in homes.
    
  • Locate heaters or other fire sources at least three feet from the bed or window drapes to prevent fires.
    

As a CNA you learned about fire safety. I would like to refresh your mind on the procedure below. Do you remember the word RACE?

Always remember: client safety and your safety is the first thing you should consider!

Watch the following slideshows.

Remember, no one is in the home to monitor your infection control or safety efforts. You must develop a code of ethics to uphold these matters even when alone and no one is watching. It is your responsibility to keep yourself and the client as safe as possible.

Click into Labs to play games and test your knowledge of Infection Control.