Continuing Education

EMERGENCY GUIDELINES

In the event of an emergency, the area shall be secured.

If the client is on hospice, DO NOT call 911; first contact the hospice company, then the family, and the Caring Hearts office.

If the client is not on hospice, call 911 first, then the client's family, then the Caring Hearts office.

*NOTE: Any DNR (Do Not Resuscitate) orders and relevant documents must be prominently displayed in order to be available to emergency and hospice personnel.

Caregiver will call Caring Hearts at 801-597-0498

CARING HEARTS will call the family with status and disposition of the emergency. (This is why the client’s family information must remain current).

Natural Disaster: Remain calm, stay with the client and provide reassurance, contact the client’s family and the Caring Hearts office.

Any questions regarding unspecified emergencies or abnormal situations should be directed to the Caring Hearts office.

REPORTING ABUSE: To report abuse, neglect, or exploitation of senior citizens, call Adult Protective Services (APS) at 1-800-371-7897.

CARE NOTES PROTOCOL

Timesheets are to be filled out and submitted every Saturday at the weeks end to the administrator for your client. There are 3 administrators:

Send to Sandra 801-597-0498

If you are not sure which one oversees the care at your client you can text Nathan to ask.

Each client home will have a care binder that contains timesheets. These timesheets must be filled out daily. The timesheet has fields for employee and client names, client addresses, and phone numbers. It also indicates a general list of items that the employee may spend their time completing each day. These items are to be filled out as tasks are completed. In addition, the employee will indicate that they had a minimum of 6 hours continuous sleep and had an hour minimum personal time. Once a week is completed, the timesheet will be sent to an administrator to ensure their time is recorded.

If you do not have timesheets, you are still expected to send a report of the days you worked in a text message or a phone call, also to the payroll coordinator

It is critical to the continuity of care to keep notes of your daily care of your client. You will use the “PCS Notes” forms to accomplish this. You’ll fill in the client’s name and address, as well as your name at the top. Then you’ll check a box for each service provided, for each day of the week. At the bottom there is a section where you can add additional notes if there are tasks or events out of the ordinary that should be reported. Then you’ll sign your name at the bottom

Payroll:

A work week runs from Sunday-Saturday
Checks are sent out every other Friday, and a pay period ends the Saturday before payroll
In order to be paid you have to have your time sheets turned in every Saturday by midnight

PCS notes/Timesheets: it is critical to your pay that you turn in your timesheets as soon as you are finished with that client for the week.

Be sure you fill out all of the information on the timesheets, including the top section
Get the client signature at the bottom of the timesheet on your last day of the week (if the patient is sleeping or unable to write their name, mark their signature section with an “X”.

How to turn in timesheets:

text: you can text a picture of the timesheet to 1-801-597-0498(send each timesheet separately)

email: you can scan and email, or take a picture and email it to conciergecare.idaho@gmail.com

be sure to send a separate email for each patient timesheet
the “subject” line should be: client's name and date of last shift on the timesheet

fax: 1-208-232-5123

no cover sheet
send each page as a separate fax

How to report 24 hour shifts: Instead of filling in the “time in” and “time out” on your timesheet, you will put “1 shift” in the “total hours” section for the day you arrived on shift.

ie: if you arrived on Tuesday and left on Wednesday, you would write “1 shift” in the Tuesday column

PROFESSIONALISM

maintaining a professional relationship with your clients

Concierge Care and its employees are in a position of trust in every homes we enter. Caregivers and all other employees are to treat clients and their family members with respect and kindness. Caregivers will adapt to best meet the needs of the family, but it is central to the success of the caregiver and the company to ensure that the client is always the priority. If there is another family member present in the home of a client (such as a spouse or a child), the caregiver is expected to only provide care for the family member that has a care plan. Any care being requested for family members outside the care plan should be reported to an administrator.

- Caregivers should under no circumstances request to receive any of the client's property upon their death. This is unprofessional and disrespectful to the families we serve. If it is found that you have done this, you will immediately be removed from any further shifts at that client.

Some examples:

Always having a positive attitude
Being neatly dressed and groomed
Arriving on time or a few minutes early to every shift
Communication: this includes listening to the client as well as speaking to the client. Always speak politely and professionally never discuss your personal life or problems with the client
While doing personal care with the client always explain the care you are doing. This will help the client feel more comfortable.
Provide care only for those who have a care plan. If others in the home request assistance, contact the administrator as soon as possible to make him aware of the request. Then if the family agrees to add them to the care plan, the administrator will take care of the process and let you know if/when you can also provide care for others in the home.

Maintain a Professional Relationship with your employer

Some Examples

Consistently follow policies and procedures
Documenting and reporting
Asking questions if you do not know or understand
participating in training meetings the employer offers to maintain and expand your knowledge
Taking directions or criticism without getting upset
Being neatly dressed and groomed
Always arriving on time

Communication

Communication is a critical part of a Companion Aide

Body Language

Body language often speaks as plainly as words. Body movements, facial expressions, and posture can express different attitudes or emotions. Always be aware of our body language.

Barriers to Communication

Communication can be blocked or disrupted in many different ways. The following information will help you learn how to deal with and avoid these barriers.

If the client does not hear you. Stand directly facing the client. Some clients that are hard of hearing are able to read lips. Ensure that you are at the same level as the client. (i.e., if the client is sitting, sit next to them or crouch down so you are at their level.) If the client wears a hearing aide, ensure that it is turned on and in place correctly. Also try speaking a little slower than you usually do. This will help the client better understand what you are trying to tell them.
If the client is difficult to understand: Take the time and listen carefully to what they client has to say. Ask the client to repeat or rephrase sentences as needed. Be patient and listen.
Avoid asking “why” when talking to the client: This can cause the client to feel as though you are second guessing them it can also make the client feel upset or defensive.
Don't give advice to a client: Never offer our personal opinion to the client. The client and family members are in charge of making important decisions, if they feel they need advice they will ask help from a doctor or Nurse. or other professional resources.
Never ignore a client's request: Ignoring a request can indicate laziness or lack of care/compassion. if you feel that you cannot accommodate a request, pass the information along to a supervisor, and explain this to the client.

Medication Safety

In Concierge Care policy, personal care aides are authorized to assist with medication administration. This means that medication must be pre-prepared in order for a personal care aide to administer to the client. There are no exceptions to this requirement. Another person must fill the pill box for the client, and when you remind the client to take their medication you cannot touch it at all. You can dump it out of their pill organizer into a small cup, or onto the client's hand, but you cannot touch it. Watch this video on Medication Safety: Medication Safety

Coping with a Combative Client

Such behavior includes kicking, hitting, pushing and verbal attacks.

Understanding the behavior: In general, combative behavior is not a reaction to you. Do not take it personally. This behavior may come from a person’s personality or their medical condition. Changes in routine can also be upsetting to a client
Reporting: Always report such behavior to your supervisor and document it. Even if the behavior is not offensive to you it is important for the management to be aware of this behavior
Leave the client alone if it is safe to do this: The client may need time to cool off or calm down. Giving them time alone may resolve the combative behavior. Only Do this if the client is not at risk of harming himself.
maintain a safe distance: When a client is upset and combative. Always keep a safe distance from them. i.e., arm's length away or out of their reach. Be sure that you are close to the door, don’t allow yourself to get trapped in a room with a combative client.
Don’t Respond to verbal attacks: Responding to attacks can make the situation escalate, especially if the client has an altered mental status. i.e., If the client's combative behavior is caused because of confusion. Responding can often make them more confused, causing the situation to get worse.
Call Administrator: if you feel that the behavior is getting out of control. Always call the Administrator 801-574-4420

Coping with Inappropriate Behavior

Such behavior includes asking personal questions, requesting visits on the caregiver's personal time. This also includes inappropriate sexual comments made to the caregiver by the client.

Reporting: Always report behavior that you feel may be inappropriate. If you feel uncomfortable doing this over the phone. Call and make an appointment with the administrator. Reporting is the only way to protect yourself, and it does not violate the client’s privacy.
Responding to personal questions: The client may not realize that they have crossed the professional boundary. A good way to redirect is to say, “I am sorry, but I really can’t talk about my personal life on the job, it’s against Company Policy.” When doing this you are redirecting but in a polite way that will not make the client feel uncomfortable.
Responding to inappropriate sexual behaviors: Always address the behavior directly saying, “that makes me very uncomfortable.” If the client continues, tell them you will have to leave if the behavior continues. Call and report any behavior that makes you uncomfortable. 801-574-4420

Infection Control

Transmission of most infectious or contagious diseases can be prevented by washing your hands.

When to wash your hands.

After touching a surface that may be contaminated with any body fluid
When arriving at a client’s home
Before and after touching a client
before and after meals or work in the kitchen
Every time you remove glove

When to wear gloves

anytime you might touch blood
Performing or assisting with mouth care
Performing or assisting with care of the perineal areas
Handling body fluids
Performing personal care on a client whose skin is not intact
Assisting a client with personal care when your skin is not intact (cuts or sores)

Watch this video on Infection Control

Principles of good body mechanics

Caregivers need to use good body mechanics to avoid injury.

Body Alignment: Keeping your body in good alignment will help prevent injury when helping a client. When you stand up straight, a vertical line could be drawn right through the center of your body and your center of gravity. When the line is straight the body is in alignment.
Lifting: When lifting or carrying an object by keeping the object in front of you, pointing your feet and body in the direction you are moving, and avoid twisting at the waist. Bending your knees when lifting an object lowers your center of gravity. This gives you more stability and you will be less likely to fall or strain the working muscles.
Base of support: A base of support is the foundation that supports an object. A person who is standing has a greater base of support.
Lifting a heavy object from the floor: To lift a heavy object from the floor, spread your feet apart and bend your knees. Using the strong large muscles in your thighs, upper arms and shoulders lift the object and pull it close to your body, to a point level with your pelvis. Do not twist when you are moving an object. Always face the object or person you are moving. Pivot your feet instead of twisting at the waist.
Helping a client sit up, stand up or walk: your feet should be about 12 inches or hip width apart, one foot in front of the other and knees bent. your upper body should stay upright and in alignment. Never try to catch a falling client. In the event of a client falling, assist them to the floor to a level area. If you try to prevent the fall you can injure yourself.
Making a bed or any job that requires bending: If a task requires bending, always use a good stance, bending your knees to lower yourself rather than bending at the waist. If possible, raise objects up to a comfortable working position. (i.e., a hospital style bed that is able to rise up and down.)
Tips to avoid strain or injury: Use both arms when lifting. Pushl, slide or pull objects rather than lifting or pulling. Teach or prompt your client in how to help you with transfers to promote good body mechanics. let the client know what they can do to help during the transfer. Never attempt to lift an object or a client that you feel you cannot handle, report to your administrator if you feel you need additional training with a client.

Guidelines for lifting, holding or transferring a client

Explain to the client what you will do during the transfer
Always have the client do as much as possible to help with the transfer
Read the care plan. The care plan offers additional client information that will help the caregiver. Additional training may be required in some situations.
If the client is capable, have them place their hands on the bed or chair they are transferring from and to push with their arms to assist with standing. Offer support if needed.
Use counting to help cue the client when the transfer is happening. Examples we are going to stand on the count of three. This will allow the client to be ready for the transfer.
Assistive devices such as walkers or canes used by the client provides excellent stability, always ensuring safety by staying near the person.
When transferring, watch for signs and complaints of dizziness and fatigue. Allow time for the client to sit down if needed.
Watch for obstacles in the client's path. Encourage the client to look up rather than down at his/her feet.

Follow the company policies and procedures, always call the administrator if you are unsure of what to do.

Common types of accidents within the home of elderly clients

Falls are the most common injuries among the elderly they are also the most serious because their bones are so fragile.

Fall Factors: Factors that can increase the risk of falls within a client's home are: clutter, throw rugs, exposed electrical cords, slippery floors, stairs and poor lighting. Personal conditions that can contribute to falls are loss of vision, unsteady gait, weakness and other medical conditions.
Preventing falls: Clear all walkways of clutter. Immediately clean up spills on the floor. Providing stand by assistance to clients with an unsteady gait during ambulation. Never try to catch a falling person, this is likely to cause injury to yourself as well. Instead, lower the falling person safely to the floor.
Poisoning: Elderly people may have diminished sense of taste and smell due to aging or medical reasons. As a result they are at risk of ingesting spoiled food. Caregivers should check the refrigerator and cabinets for foods that are spoiled.
Choking: To prevent choking, caregivers are to cut food in bite sized pieces for older clients. Clients should eat in an upright position to avoid choking.
Fire safety guidelines: Do not leave the dryer on when you leave the home of a client. Turn off space heaters when no one is home or everyone is asleep.

In case of fire RACE is a good rule to follow:

Remove clients from danger
Activate 911
Contain fire if possible
Extinguish or call fire department to extinguish

Identifying basic human need

Although people differ in their genetic composition, all people have the same

basic physical needs and psychological needs. As a caregiver you will need to

ensure that physical and psychological needs are met

Basic physical needs: Basic physical needs include: food and water, protection and shelter, activity, sleep and rest, safety and comfort. Activities of daily living, such as eating, toileting, bathing and grooming are the ways we meet most of our crucial physical needs
Psychological needs: Psychological needs include: love and affection, acceptance by others, security, interaction with other people, accomplishments and self esteem. you should do what you can to help your client meet their psychological needs.

Responding to the emotional needs of your clients and their families

The following are tips that will help you when clients or family members come to you with problems or needs.

Listen: Sitting quietly and letting someone talk or cry may be the most help you can give in some situations.
Offer Support and Encouragement: When offering support, avoid using cliches or common phrases or false hope.

Assisting with Activities of Daily Living

Hygiene and grooming activities, as well as dressing, preparing meals and eating are called activities of daily living. Before you begin any procedure or task

always explain to the client what you will be doing.

Assistance with Bathing: When bathing a client, always follow the care plan to ensure what type of bath they will have; bed bath,sponge bath,shower, or tub bath. Never give a client a tub bath unless the care plan states to do so. Also refer to the care plan of when to bathe the client and how often. Elderly people’s skin is very sensitive, be careful not to wash the skin too vigorously. Regulate the temperature of the bathing area, the temperature should be warm. Never leave a client alone in the shower/tub unless advised to do so in the care plan. Never use bath oils, they cause the skin to become slippery and make the transfer difficult.

Bathing assistive devices: Tub chair, shower chair, or bath bench is a sturdy chair/bench designed for placement in the bathtub. This chair helps client who are unable to get down into the tub or is too weak to stand in the shower. Safety bar or grab bars are often installed near the tub and around the toilet to allow the client to have something to grab on to while transferring.

Assisting with activities with daily living for a client with Alzheimer's disease: you will use the same procedures for personal care and ADL'S for clients with Alzheimer’s disease as you will with other clients. there are a few general principles that will help you give clients with Alzheimer’s the best care.

Develop a routine and stick with it. Being consistent is very important with working with clients who are confused and easily agitated.
Promote self care. Helping your clients to care for themselves as much as possible will help them cope with this disease.
Schedule bathing when the client is least agitated. Be organized so that the complete bath can be quick.

The Human Body

Noticing and reporting changes in your clients are very important, the changes

you notice could be signs of a significant problem.

Observing the skin: During daily care, the client’s skin should be observed for changes, any significant changes should be reported to your administrator immediately. Examples of these changes are: rashes or scales, bruising, cuts, boils, sores, wounds, abrasions, swelling and any skin that appears different from normal.
Range of motion: While doing range of motion exercises you should report/document any changes in ability to perform routine movements and activities. And any pain during movement, not ROM exercises are never done past the point of pain.
Unusual Behaviors: Observe clients carefully and report any unusual behavior.

This may include:

shaking or trembling
inability to speak clearly
disturbance or change in vision or hearing
changes in eating patterns or fluid intake
bowel and bladder changes
violent behavior

The Urinary System: The urinary system has two vital functions: it eliminates waste and it maintains the water balance in the body. The body must maintain a proper fluid balance between water absorbed in the body and waste fluids that are released from the body. Some clients may need their intake and output measured. Intake is the amount of fluids taken in and output is the amount of fluids put out in urination. Always offer clients plenty of fluids throughout the day/time you are with them.

urinary Tract Infection (UTI): A UTI causes inflammation of the bladder and the ureters, resulting in a painful burning sensation during urination and frequent feeling to urinate. To avoid infection women should wipe the perineal area from the front to back after bladder and bowel elimination. Please report any changes in the client’s urination such as; urinating frequently or in small quantities or if the urine is cloudy. Acting promptly on these symptoms and signs can help the client get the appropriate treatment for the UTI.
Signs of Urinary Tract Disorder:

Weight loss or gain
swelling in the upper or lower extremities
painful urination or burning in the upper or lower extremities
changes in urine such as cloudiness, odor, or color
changes in frequency and amount of urination
incontinence/dribbling
inadequate fluid intake
pain in the kidney or back region.

Urinary Incontinence: Cleanliness and good skin care is very important with incontinent. If good skin care is not maintained the client may develop a rash or skin breakdown from the skin being on a wet surface for long periods of time.

Dehydration: Many older people may not feel thirsty and may not be aware that they are dehydrated. Always encourage fluid while with the client. Dehydration can cause constipation, weight loss, dry skin, infection, dizziness and weakness.
Diarrhea: Bacterial and viral infections, microorganisms in food and water, irritating foods and certain medications can cause diarrhea. A diet of bananas, rice apples and tea/toast, is often recommended when diarrhea is a problem.
The Skin Hair and Nails: The skin, hair and nails change with age. Skin is thinner and more fragile. The texture of the hair may change, nails become harder and more brittle.

The following tips will help you maintain the hair, nails and skin:

1. Reduce tub baths to twice a week- dry skin can become more irritated and itchy if elderly clients take a tub bath too often, because it can cause dry skin. most elderly people need a complete bath only twice a week

2. Apply Moisturizing lotions- When applying moisturizing lotions be aware the elderly client’s skin is very fragile and can tear easily. it also may be helpful to take off any jewelry such as rings that could tear the skin.

Musculoskeletal Care: Older client’s muscles are not as strong as they once were. Bone may become more brittle; joints stiffen and become more painful, overall function of the muscles may decrease. To prevent further loss of physical and mental capacities, encourage clients to perform range of motion exercises that they are capable to do with in the guidelines of the care plan. Encourage clients to make decision sand dress themselves with assistance when necessary.
Mental Function: As we age we lose some ability to think logically and quickly. The following Tips will help you care for clients with memory loss:

Suggesting to write things down or to make a list about things they want to remember.
Take an interest in your client's past experiences when they reminisce by asking to see photos or to hear stories.
Help the client find hobbies or activities to participate in. This will help their self esteem and also help them remain active.

Changes in vision, hearing: Changes in hearing and vision can be a frustrating and emotional experience for elderly clients. Always be patient with clients with these problems.

The following tips will help you with a client that has vision and hearing changes:

offer reading options, many books and magazines are available in large print. Also books on tape may be an option they are offered at the library and federally funded programs and are free of charge.
Keep client’s eyeglasses clean. Keep hearing aides in and make sure they are on and that the battery is working properly.
Be sure lights are on before a client enters a room.
If your client is having a hard time hearing you, try speaking in a low pitched tone of voice. For some people lower pitched tones are easier to hear.
Watch for signs of disorientation or confusion about time and place. This may occur in new surroundings or as a result of infection and medication. Situations like these must be documented.

Circulatory System: As we age our hearts pump less efficiently. Older people may need more rest to reduce demand on the heart. Poor circulation in the extremities causes the feet to feel cold. Be sure your clients wear slippers or shoes and socks. Avoid using hot water bottles or heating pads on an older person, they may not realize they are being burned until it is too late.
Psychological:

Depression: Depression is a very common among the elderly, but is not a normal sign of aging. Observing and reporting the signs and symptoms is the best way to help a client. Signs and symptoms include:

Loss of appetite
Difficulty sleeping
acting moody or withdrawn
changes in appearance, speech movement and behavior

Living habits and attitudes that help promote good mental and physical health

Help the client develop a routine for the day. Structuring the day around meals, activities, rest and self care. This will help fight depression.
Respect the needs for privacy and social interaction. When visitors come by or call, let your client visit in privacy and do not try to participate in the conversation. Treat visitors respectfully.

Guidelines for Housekeeping

An important job is household management, maintaining order and cleanliness is a vital part of home care.

Before you begin cleaning, refer to the care plan to be sure specifically described duties are completed first. Use cleaning materials and methods that are approved by the clients.
Write out detailed and daily /weekly schedules. These schedules will be a useful guide until a routine is established.
Maintain a safe environment. mop up spills immediately. Put cleaning equipment back in the proper places after use.
Use housekeeping procedures and methods that promote good health. Many diseases may be transmitted through improper food handling, dishwashing, hand washing and unclean bathrooms or kitchens.
Clean up and straighten up after every activity. Spills that have dried are difficult to remove later.
change bed linens as needed and to the client's preference. Clients that spend much or all of their time in bed, careful bed making is essential to their comfort, cleanliness and health.

Sheets that are wrinkled or bunched up may prevent the client from resting or sleeping well
Microorganisms thrive in moist, warm environments, so bedding that is damp or unclean may encourage infection and disease.
Clients who spend long hours in bed are at risk for pressure sores. Sheets that do not lie flat under the client's body increase the risk of pressure sores.

Watch this video on Infection Prevention: Infection Prevention

Always value the work you have chosen to do and remember that it is very important. It will help the clients to live with independence and dignity versus living without. Few jobs have the challenges and rewards of home care!

CLIENT RIGHTS AND HANDLING OF COMPLAINTS

Your clients have rights which include, but are not limited to the following:

To be informed of rights and obligations prior to admission.
To be informed of all services offered by Concierge Care prior to admission.
Advised of the services and procedures to be provided by Caregiver prior to services being received.
Honest, ethical relationship with Concierge Care
The agency and its employees will protect and promote these rights for every client.
Courteous, respectful treatment, privacy and freedom from abuse and neglect.
Free from discrimination because of race, creed, color, sex, national origin, religion, sexual orientation and diagnosis.
To be assured that personnel who provide care demonstrate competency through education and experience to carry out the services for which they are responsible.
The right to receive proper identification from the individual providing personal care services.
His/Her property is to be treated with respect.
Confidentiality with regards to information about his/her health, social and financial circumstances.
Confidentiality concerning what takes place in his/her home
Information will only be released with his or her prior consent, and the consent may be revoked at any time in writing from the client.
Upon written request to access information in his/her own record the agency shall provide such access within 48 hours of the request being received by the agency.
Voice opinions and grievances regarding services provided that is, or fails to be provided, or lack of respect for property by anyone who is providing services on behalf of the agency
If the client or family member has a concern that is not promptly resolved after speaking with Concierge Care, they may file a grievance. The grievance may be written or verbal and should be direct to :

Concierge Care

2750 Birdie Thompson Dr

Pocatello ID 83201

All complaints made by a client or client’s family/guardian/advocate regarding care services that is or fails to be furnished, or anyone who is providing services on behalf of Concierge Care, must document both the existence of the complaint and the resolution of the complaint.
To be informed of Concierge Care decision and right not to provide services to, or discharge any client whose environment, refusal of services offered, or other factor preventing the ability of providing safe care.
In accordance with Concierge Care policy, as the client, you have the right to be afforded the opportunity to participate in the planning of personal care services, including referral to health care institutions or other agencies, and to refuse to participate in experimental research.
To be fully informed of services and related charges for which the client or a private insurer may be responsible, and to be informed of all changes in charges.
To be informed of any changes in the Care Plan that has been initiated by CARING HEARTS.
Client has the right to refuse services.
Client has the right to terminate services at given time.

Concierge Care maintains files of all documentation of complaints submitted. Concierge Care also maintains on file for a minimum of five years all incident reports or reports of unusual occurrences (e.g. falls, accidents, significant medication errors, etc.) that affect the health, safety, and welfare of its clients. Documentation required to be maintained shall include what actions, if any, the provider took to resolve clients' complaints and to address any incident reports or unusual occurrences required to be retained.

All complaints are required to be recorded on the “complaint Log”. This log, along with any additional documentation from complaints, shall be kept by Concierge Care for a period of 5 years after the complaint has been resolved. Action taken by Concierge Care is documented on the complaint log.

All incidents/accidents are required to be reported to Concierge Care by filling out the “incident report form” within 24 hours of the incident. These reports, along with any other documentation in connection with the incident, shall be kept by Concierge Care for a period of 5 years after the incident has been resolved.

TB EXPOSURE REPORTING

Tuberculosis, or TB, is an infectious disease caused by bacteria. It is spread by the person with TB in their lungs by coughing, laughing, singing, speaking sneezing, and then inhaling that air. It generally affects the lungs but can cause disease anywhere in the body. All employees shall have a negative TB test within 6 months prior to hire date, or within 2 weeks after hire date. The bacteria may infect anyone, at any age. General symptoms of TB disease include feeling sick or weak, having weight loss, fever, and/or night sweats. The symptoms of TB of the lungs may include coughing, chest pain, and/or coughing up blood. Other symptoms depend on the part of the body that is affected. TB is treated with antibiotics.

DRUGS AND ALCOHOL USE

The use of drugs or alcohol prior to or during a shift will not be tolerated. Use of illegal substances at any time will result in termination (ie: Marijuana, Cocaine, Opiates, Amphetamines, Phencyclidine (PCP)).
If there is reasonable suspicion of use, the employer will detail the event and see that a drug test is administered.
Additional testing will be administered as required by federal and local laws.
Refusal to comply with a drug test will result in immediate termination.

EMPLOYEE EXPECTATIONS:

Strive for a positive attitude.
Neatly dressed and groomed.
On time for all shifts.
Excellent communication.
Strive to follow state and employer standards

*for further questions about employee expectations and duties, see “Job Description” in care binder

ETHICS, CONFIDENTIALITY AND CLIENT’S RIGHTS

REPORTING REQUIREMENTS FOR SUSPECTED ABUSE, NEGLECT OR EXPLOITATION

As a caregiver, you shall not abuse, neglect, exploit or maltreat clients in any way, whether through acts or omissions or by encouraging others to act or by failing to deter others from acting. Duty to Protect Clients' Health and Safety. If the Provider becomes aware that a client has been subjected to any abuse, neglect, exploitation or maltreatment, the Provider's first duty is to protect the client's health and safety.

You have a duty to Report Problems and Cooperate with Investigations. You’ll document and report any abuse, neglect, exploitation or maltreatment and exploitation, and cooperate fully in any investigation conducted by DHS, law enforcement or other regulatory or monitoring agencies.

If you see abuse, neglect or exploitation, you shall immediately report abuse, neglect, exploitation or maltreatment by contacting the administrator, who will then contact the local Regional Office of the appropriate DHS Division or Office. During weekends and on holidays, Providers shall make such reports to the on-call worker of that Regional Office.

The administrator will report any abuse or neglect of disabled or elder adults to the Adult Protective Services intake office of the Division of Aging and Adult Services.

All applicable staff will make all reports and documentation about abuse, neglect, exploitation, and maltreatment available to appropriate DHS personnel and law enforcement upon request.

You will use the PCS NOTES form to document any client injury (explained or unexplained) that occurs on the Providers' premises or while the client is under your care and supervision, and the administrator shall report any such injury to supervisory personnel immediately. All applicable staff will cooperate fully in any investigation conducted by DHS, law enforcement or other regulatory or monitoring agencies. If the client's injury is extremely minimal, the Provider has 12 hours to report the injury. The term "extremely minimal" refers to injuries that obviously do not require medical attention (beyond washing a minor wound and applying a band-aid, for example) and which cannot reasonably be expected to benefit from advice or consultation from the supervisory personnel or medical practitioners.

DRUG-FREE WORKPLACE

Policy

Drug use by any employee, which impairs judgement or performance poses a great threat to client safety. Therefore, all employees of Concierge Care, on or off duty, are required to refrain from the use or possession of illegal drugs (including but not limited to): Marijuana, Cocaine, Opiates, Amphetamines, Phencyclidine (PCP) .

I. SUMMARY OF DRUG-FREE WORKPLACE PROGRAM

In a commitment to safeguard the health of our employees and to provide a safe and productive working environment for everyone, we have established a Drug-Free Workplace Program.

As a condition of employment, employees may not manufacture, sell, possess, use, distributed, dispense or purchase alcohol beverages, controlled substances, or illegal or illicit drugs during working hours, while on client property, or while operating agency or client vehicles and/or equipment. Off-duty use detectable during working hours is also prohibited. Further, the Federal Drug-Free Workplace Act requires that any conviction under a criminal drug statute for a violation occurring in the workplace must be reported to the agency. Convicted employees must provide notice to the administrator within five calendar days after such conviction. Failure to report a conviction will result in automatic discharge of the employee whenever discovered. A conviction means a finding of guilt, including a plea of nolo contendere or imposition of a sentence or both by a judicial body.

Any employee violating the Concierge Care Drug-Free Workplace Program will be subject to discipline up to and including termination of employment. In addition, any employee who consumes, manufactures, sells, possesses, distributes, dispenses, or purchases any substance used to become intoxicated or “high” during working hours, while on agency or client property, or while operating agency or client vehicles and/or equipment will be subject to discipline up to and including termination of employment for the first offense.

Concierge Care shall perform random, unannounced on-site evaluations of employees, to confirm that employees are following the Drug-Free Program. The Agency will not pay for drug tests not required or for employee assistance/rehabilitation treatment programs.

The agency has established a Drug-Free Workplace Program which all employees must review as part of new employee orientation and the contents of which is posted on CARING HEARTS employee blog (caringemployees.blogspot.com). The program includes information about the dangers of drug abuse in the workplace (see Appendix 2), the agency’s policy on maintaining a drug-free workplace, and the penalties that may be imposed on employees for drug abuse violations. Employees are required to adhere to the CARING HEARTS Drug Free Workplace Program as a condition of employment. The agency may change and update this Drug-Free Workplace Program as desired. Nothing in this program is intended to create a contract between the agency and any employee. Employees are hired and remain employed in an at-will status.

2. Employee Drug Testing

Employee: “Employee” means any person who works for salary, wages, or other remuneration for an employer. Types of drug testing for employees include:

a. Post-Accident Testing

b. Reasonable Suspicion Testing

Employees will be tested if an accident results in an injury to the employee or another person and requires outside medical attention, or when the employee is determined to have caused or contributed to an accident.

Employees will be tested if involved in an accident resulting in physical damage to agency or client property, product, equipment, or machinery.

Employees will be tested any time there is an accident by a driver of a motorized vehicle including personal vehicles used while conducting agency or client business.

3. Reasonable Suspicion Testing: Employees will be tested when there is a reasonable suspicion

that an employee is using or has used drugs.

“Reasonable Suspicion Drug Testing” means drug testing based on a belief that an employee is using or has used drugs in violation of the agency’s policy drawn from specific objective and articulable facts and reasonable inferences drawn from those facts in light of experience. Among other things, that facts and inferences may be based upon:

Observable phenomena while at work, such as direct observation of drug use or of the physical symptoms or manifestations of being under the influence of a drug.

Abnormal conduct or erratic behavior while at work or a significant deterioration in work performance.

A report of drug use, provided by a reliable and credible source.

Evidence that an individual has tampered with a drug test during his or her employment with the agency.

Information that an employee has caused or contributed to or been involved in an accident while at work. See Post-Accident Drug Testing for further details.
Evidence that an employee has used, possessed, sold, solicited, or transferred drugs while working or while on the agency’s premises or while operating agency vehicles, machinery or equipment.

If drug testing is conducted based on “reasonable suspicion”, the agency shall promptly detail in writing the circumstances which formed the basis of the determination that reasonable suspicion existed to warrant the testing. A copy of this documentation shall be given to the employee upon request.

a. Follow up Testing: In the course of employment, if an employee enters an employee assistance program for drug-related problems or a drug rehabilitation program, he or she must submit to follow up testing. The employee must successfully complete the treatment program to be eligible for continued employment. The agency will require the employee to submit to follow-up testing. Such testing will be unannounced and occur at least once a year for a two-year period after completion of the treatment program.

b. Additional Testing: Additional testing may also be conducted as required by applicable state or federal laws, rules, or regulations, or as consequences of a Confirmed Positive Drug Test Result

IV. Consequences of Positive Drug Test

1. Job Applicant – If an applicant’s test is confirmed positive, the applicant will not be

considered for employment at that time and will be informed that he or she has failed to meet

employment screening standards. The applicant will not be considered for employment for a

period of six (6) months. A new employment application must be completed before an applicant

will be reconsidered.

2. Employee – Violation of the agency’s Drug-Free Workplace Program or violation with

evidence of use, sale, possession, distribution, dispensation, or purchase of drugs or alcohol on

agency premises or during working hours will result in immediate termination. Terminated

employees may also forfeit unemployment compensation benefits.

4. An injured employee with a confirmed positive drug test result may also forfeit medical and

indemnity benefits under workers compensation.

V. Consequences of Refusing to Submit to a Drug Test

1. Job Applicant: An applicant refusing to be drug tested will be disqualified from further

employment consideration and the employment process will be terminated. The applicant will

not be considered for employment for a period of six (6) months, and will be required to submit

new hiring paperwork.

2. Employee: Any employee who refuses to submit to a drug test may be discharged from

employment or otherwise disciplined by the agency. Terminated employees may also forfeit

unemployment compensation. If injured, the employee may also forfeit worker’s

compensation medical and indemnity benefits.

VI. Procedures

The following will generally apply.

a. A “chain of custody” form will be given to the employee or job applicant to document the handling and storage of a specimen from the time it is collected until the time of disposal. This form links the individual to the specimen sample. It is written proof of everything that happens to the specimen while at the collection site and the laboratory.

b. Any applicant or employee who refuses to cooperate with the directives set forth in

the drug testing procedures or policy, or fails to report for drug testing as required, or attempts

to tamper, contaminate, or switch a sample will be considered to have violated the drug testing

policy and will be subject to termination from employment or ineligible for employment.

c. Employees will have signed an “Applicant Drug Testing Acknowledgement of Receipt and Understanding” and “Applicant Drug Testing Consent Agreement”.

d. When an employee is required to undergo post-accident or reasonable suspicion testing, the employee will be placed on administrative leave, without pay, and not permitted to return to work pending the results of the drug test or investigation.

e. The agency will not discharge, discipline, refuse to hire, discriminate against, request or require rehabilitation of an employee or job applicant on the sole basis of a confirmed positive test result that has not been verified by a confirmation test.

f. An employee will not be discharged, disciplined, or discriminated against solely upon

the employee voluntarily seeking treatment, while employed by CARING HEARTS for a

drug-related problem if the employee has not previously tested positive for drug use, entered an

employee assistance program for drug-related problems, or entered a drug rehabilitation

program.

VII Confidentiality

All information, interviews, reports, statements, memoranda, and drug test results, written or otherwise, received or produced by the agency as a result of this drug testing program are considered confidential communications. Unless authorized by state laws, rules or regulations, the agency will not use, release, or disclose such information in any private or public proceedings, except as permitted by Law, without written consent signed voluntarily by the person tested. Information on drug testing shall not be released or used in any criminal proceedings(s) against the employee or job applicant. The agency, agent of the agency, or laboratory conducting a drug test may have access to employee drug testing information when consulting with legal counsel with actions brought under or related to its defense in a civil or administrative matter or as compelled by an administrative law judge, a hearing officer, or court of competent jurisdiction pursuant to an appeal taken under this section or as deemed appropriate by a professional or occupational licensing board in a related disciplinary hearing.

The Voluntary Report of Relevant Information is a confidential report for the administrator. This form permits individuals to list all prescription and non-prescription drugs that they are currently using or have used in the past month, as well as any other information they consider relevant to the test. This information permits the administrator to properly analyze test results. This form must be provided to the administrator. The form is attached hereto as Appendix 1. Providing information will not preclude the administration of the drug test but shall be taken into consideration in interpreting any positive, confirmed test result. This form also provides notice of the most common medications by brand name or common name and chemical name which will be tested for and which may alter or affect a drug test. A list of brand name or common name as well as chemical name which alter or affect a drug test is part of Appendix 1.

Drug Testing will be administered by a laboratory certified by the U.S. Department of Health and Human Services licensed by the Agency for Health Care Administration, for the purpose of determining the presence or absence of a drug or its metabolites.

All drug test results are reviewed by the a licensed physician with knowledge of substance abuse disorders, laboratory testing procedures, and chain of custody collection procedures. The licensed physician verifies positive, confirmed drug test results, and has the necessary medical training to interpret and evaluate an employee’s positive test result in relation to the employee’s medical history or any other relevant biomedical information.

CARING HEARTS will inform an employee or job applicant in writing of a positive test result within five (5) working days after notification from the physician and the consequences of such results. The agency will provide a copy of the test results to the employee or job applicant upon request.

A job applicant or employee who receives a positive, confirmed test result may contest or explain the result to the physician within five (5) working days after receiving written notification of a positive test result. If the employee’s or job applicant’s explanation or challenge is unsatisfactory to the physician, the physician shall report a positive test result back to the agency.

The job applicant or employee may contest the drug test result pursuant to law or rules adopted by the Agency for Healthcare Administration.

If a job applicant or employee fails to contest or explain the positive test result within the five (5) working days, the job applicant will not be eligible for employment and may reapply after six (6) months, and an employee will be terminated for “violation of the drug-free workplace program.”

A job applicant or employee has the responsibility of notifying the drug testing laboratory of any administrative or civil action. The result of a drug test may appeal to an applicable court.

During the 180-day period after written notification of a positive test result, the employee or applicant who has provided the specimen will be permitted to have a portion of the specimen re-tested, at the employee’s or job applicant’s expense, at another laboratory, licensed and approved by the Agency for Health Care Administration, chosen by the employee or job applicant.

Job applicants and employees have the right to consult with the physician for technical information regarding prescription and non-prescription medication. An applicant or employee found to be using a prescription drug belonging to someone else or misusing prescription or non-prescription drugs may be terminated for illegal drug use. Any employee sent for drug testing during the course of employment shall receive Appendix 1, included elsewhere in this package, prior to drug testing for any reason. The employee may send the completed form directly to the physician indicated on Appendix 1.

If drug testing is conducted on reasonable suspicion, the agency shall promptly detail in writing the circumstances forming the basis of the determination that reasonable suspicion existed to warrant testing.

III. Searches

A. The agency reserves the right to conduct routine and “on the spot” searches and inspections of all vehicles, offices, briefcases, desks, totes, backpacks, boxes, packages, containers, lockers, coolers, or other items on agency or client property in furtherance of this policy. Individuals may be requested to display personal property for visual inspection upon agency request.

B. The agency has the right to conduct “on–the-spot” searches and inspections of employees or other persons leaving any CARING HEARTS facility or client home, including boxes, packages, employee purses, briefcases, desks, backpacks, totes, lunch bags, coolers, lockers, large and/or unusual items, or other personal items on agency property to ensure drugs and alcohol do not enter or effect the workplace or in violation of any part of this policy.

C. The agency reserves the right to conduct “on-the-spot” searches and inspections of its employees or other persons if the agency has “reasonable suspicion” such employees or other persons are in violation of any part of this policy.

D. Failure to consent to a search or display for visual inspection will be grounds for termination.

E. Routine and “on-the-spot” searches of an employee’s personal property will take place only in the employee’s presence. All searches under this policy will occur with discretion and consideration for the employee involved.

F. Under no circumstances will an employee drive an agency vehicle or a personal vehicle on company business after the consumption of alcoholic beverages, illegal drug, or legally prescribed drug that impairs the employee’s judgment and/or ability to drive.

APPENDIX 1

Concierge Care VOLUNTARY REPORT OF RELEVANT INFORMATION TO MEDICAL REVIEW OFFICER

Employees and job applicants may list any information on this form they consider relevant to their drug test, including identification of currently or recently used prescription or nonprescription medication or other relevant medical information. This form is confidential and must be turned into the physician conducting the drug test.

I, ____________________________________________, voluntarily report that I have used the following drugs in the last month:

__________________________ Used Last: _______________________________

Over-the-Counter and Prescription Drugs which could alter or affect drug test results

Alcohol: All liquid medications containing ethyl alcohol (ethanol). Please read the label for alcohol content. As an example, Vick’s Nyquil is 25% (50 proof) ethyl alcohol, Comtrex is 20% (40 proof), Contact Severe Cold Formula Night Strength is 25% (50 proof) and Listerine is 26.9% (54 proof)

Amphetamines: Obetrol, Biphetamine, Desoxyn, Dexedrine, Didrex, Ionamine, Fastine Barbiturates Phenobarbital, Tuinal, Amytal, Nembutal, Seconal, Lotusate, Fiorinal, Fioricet, Esgic, Butisol, Mebral, Butabarbital, Butalbital, Phenrinin, Triad, etc.

Benzodiazepines: Ativan, Azene, Clonopin, Dalmine, Diazepam, Librium, Xanax, Serax, Tranxene, Valium.Verstran, Halcion, Paxipam, Retoril, Centrax Benzoylecgonini

Cannabinoids: Marinol (Dronabinol, THC)

Cocaine: Cocaine HCL topical solution (Roxanne)

Methadone: Dolphine, Metadose

Methaqualone: Not legal by prescription.

Opiates: Paregoric, Parapectolin, Donnegal PG, Morphine, Tylenol with Codeine, Emprin with Codeine, APAP with Codeine, Aspirin with Codeine, Robitussin AC, Guiatuss AC, Novahistine DH, Novahistine Expectorant, Dilaudid (Hydromorphine), M-S Contin and Roxanol (morphine sulfate), Percodan, Vicodin, Tussiorganidin, etc. Phencyclidine Not legal by prescription

Propoxyphene Darvocet, Darvon, N, Dolene, etc.

Due to the large number of obscure brand names and constant marketing of new products, this list cannot and is not intended to be all-inclusive.

OTHER RELEVANT INFORMATION:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________ __________________________________________ Date Signature

APPENDIX 2 CARING HEARTS Drug-Free Workplace Program

THE EFFECTS OF DRUGS AND ALCOHOL IN THE WORKPLACE

Alcohol and drug abuse by employees causes many expensive problems for business and industry ranging from lost productivity, injuries, absenteeism, fatalities, theft and low morale, increased health care costs, legal liabilities, and workers’ compensations costs.

In compliance with this policy, the agency is providing you with the following information on the effects of alcohol and drugs on general health and workplace performance.

Drugs are chemical and because of their chemical structures can affect the body in different ways. Most abused drugs directly or indirectly target the brain and actually change how the brain performs its job. The impact of drug abuse can be far-reaching, affecting almost every organ in the human body.

Injuries

More deaths, illnesses and disabilities stem from substance abuse than from any other preventable health condition.

Effects of Alcohol Abuse on Health

Alcohol abuse can lead to high blood pressure, pancreatitis, enlarged and weakened heart, congestive heart failure and stroke. Binge drinking can be associated with atrial fibrillation, a problem with the rate of rhythm of the heartbeat.

Alcohol abuse increases the risks of cancer. For women, even moderate drinking can increase chances of developing breast cancer by 10%. Although alcohol can make you feel energetic or uninhibited, it is actually a depressant. Alcohol shuts down parts of the brain. When the amount of alcohol in your blood exceeds a certain level, your respiratory system slows down markedly, and can cause a coma or death because oxygen no longer reaches the brain. This is referred to as alcohol poisoning. Daily alcohol intake may impact the ability of adults to produce and retain new cells, reducing new brain cell production by nearly 40%. Alcohol abuse is related to cirrhosis of the liver, fetal alcohol spectrum disorder (FAS), malnutrition, ulcers, hepatitis, among other things. Poorer outcomes from surgical procedures due to alcohol’s effects on the person’s health, malnutrition, and the depressive effects of alcohol on the body. Heavy drinking affects the body’s ability to stop bleeding because the liver has difficulty producing the proteins that cause clotting. Alcohol abuse can result in brain damage, slower thinking, poor judgment, unsteadiness and slurred speech. Alcohol doesn’t mix well with many prescription drugs.

EFFECTS OF DRUG USE ON YOUR HEALTH

Drug use can:

Weaken the immune system, increasing susceptibility to infections. Cause cardiovascular conditions ranging from abnormal heart rate to heart attacks. Injected drugs can also lead to collapsed veins and infections of the blood vessels, heart valves and death. Cause nausea, vomiting and abdominal pain. Cause the liver to have to work harder, possibly causing significant liver damage or liver failure. Cause seizures, stroke, and widespread brain damage that can impact all aspects of daily life by causing problems with memory, attention and decision-making, including sustained mental confusion and permanent brain damage. Produce global body changes such as breast development in men, dramatic fluctuations in appetite and increases in body temperature, which may impact a variety of health conditions.

EFFECTS OF DRUG USE ON THE BRAIN

Although initial drug use may be voluntary, drugs have been shown to alter brain chemistry, which interferes with an individual’s ability to make decisions and can lead to compulsive craving, seeking and use.

All drugs of use – nicotine, cocaine, marijuana, and others – affect the brain circuit, which is part of the limbic system. The limbic system combines higher mental functions and primitive emotion into one system. Drugs cause unusually large amounts of dopamine to flood the brain. This flood of dopamine is what causes the “high” or euphoria associated with drug abuse.

Behavioral Problems Associated with Drug and Alcohol Abuse

Paranoia Aggressiveness Hallucinations Addiction Impaired Judgment Impulsiveness Loss of Self-Control Slowed Reaction Time

Effects of Drug Abuse on Birth Defects and Fetuses

The use of illicit drugs may pose various risks for pregnant women and their babies. Some of these drugs can cause a baby to be born too small or too soon, or to have withdrawal symptoms, birth defects or learning and behavioral problems. Additionally, illicit drugs may be prepared with impurities that may be harmful to a pregnancy.

Prescription Drugs: There is always a level of risk when using any drug including prescription or over-the-counter medications. It’s important to follow your doctor’s advice when taking prescription drugs and discuss any side-effects and how this might impact on your work.

Individuals who abuse depressants, including benzodiazepines, tranquilizers, barbiturates and sedatives, place themselves at risk of seizures, respiratory depression and decreased heart rate. Stimulant abuse can cause high body temperature, irregular heart rate, cardiovascular system failure and fatal seizures. It can also result in hostility or feelings of paranoia. Individuals who abuse prescription drugs by injecting them expose themselves to additional risks, including contracting HIV (human immunodeficiency virus), hepatitis B and C and other blood-borne viruses.

Use of controlled substances with a valid prescription is not prohibited. Nevertheless, if such use during work impairs the employee’s judgment, reaction time or work performance, the employee must report his/her use to the vice president for human resources or the director of human resources. Where and when appropriate, reasonable accommodation will be provided for such prescription use.

EFFECTS OF DRUG USE ON THE WORKPLACE

In addition to the above effects caused by alcohol and drug abuse, the use of Club Drugs, Cocaine, Hallucinogens, Heroin, Inhalants, Marijuana, Methamphetamine or Meth, Steroids, and Synthetic Drugs contribute significantly to work-related performance problems.

Areas of work that may be impacted by alcohol or drug abuse in the workplace include:

Low productivity and self-initiative Poor judgment and effectiveness Safety – carelessness, lack of initiative, poor coordination, poor and impaired judgment, blurred vision, hallucinations, and impulsiveness, and lack of self-control Security and loss issues Poor public trust and perception Behavioral work problems including instability, arguments, fighting Increased costs associated with increased absenteeism, accidents, and the increased loss and need for loss prevention

Let your supervisor or manager know if you suspect that you are working with someone who has a problem with or is impaired by alcohol and/or drugs or if you have a problem with alcohol or drug abuse.

SEXUAL HARASSMENT

Concierge Care policy prohibits discrimination in employment against any otherwise qualified person because of sex, pregnancy, childbirth, pregnancy-related conditions, sexual orientation, or gender identity. Sexual harassment is generally considered discrimination based on sex.

Sexual orientation defined. “Sexual orientation” means an individual’s actual or perceived orientation as heterosexual, homosexual, or bisexual.

Gender identity defined. “Gender identity” has the meaning provided in the Diagnostic and Statistical Manual (DSM-5). Under the law, a person’s gender identity can be shown by providing evidence, including medical history; care of treatment of the gender identity; consistent and uniform assertion of the gender identity; or other evidence that the gender identity is sincerely held, part of a person’s core identity, and not being asserted for an improper purpose.

“Sexual harassment” is defined in the state Labor Commission's regulations as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:

• Submission to the conduct is made a term or condition of an individual's employment;

• Submission to or rejection of the conduct is used as the basis for an employment decision affecting the individual; or

• The conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating a hostile, intimidating, or offensive work environment.

If you feel you are being harassed or discriminated against, you have the right to make it known. You can directly talk directly to our administrator or send him a message regarding the situation. We will do everything we can to correct the situation. If needed we will support you in contacting the policy and state authorities.

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