A Caregiver Career

Caregiver

Certification Course

Copyright ****

Introduction

IT IS OUR INTENT TO PROVIDE YOU WITH THE MOST USEFUL INFORMATION AVAILABLE TO PREPARE YOU FOR A CAREER AS A CAREGIVER. WITH THIS IN MIND, THE LEARNING OUTCOMES FOR THIS COURSE ARE:

1. To ensure that students understand the basic responsibilities of being a caregiver.

2. To provide students with the basic tools and information they need to be successful as a caregiver.

3. To provide guidance and insight into the caregiver industry and the demands of being a caregiver.

4. To make the caregiver course as enjoyable thought provoking as possible.. INSTRUCTIONS FOR COMPLETING THE CAREGIVER CERTIFICATION COURSE COURSE AND RECEIVING YOUR CERTIFICATE:

1. Congratulations on purchasing the Caregiver Certification Course. You have taken the first step toward Caregiver Certification. 2. When you complete the training you will be ready to take the caregiver exam. The exam has 45questions and is pass/fail.

Table of Contents

Chapter 1: Residents Rights

Chapter 2: Communicating Effectively with Residents Chapter 3: Managing Personal Stress

Chapter 4: Preventing Abuse, Neglect and Exploitation Chapter 5: Controlling the Spread of Disease and Infection Chapter 6: Record Keeping and Documentation

Chapter 7: Service Plans

Chapter 8: Nutrition, Hydration and Food Services

Chapter 9: Assisting in the Self-Administration of Medications Chapter 10: Social, Recreational and Rehabilitative Activities Chapter 11: Fire, Safety and Emergency Procedures

Chapter 12: The Aging Process

Chapter 13: Assisting Residents with Activities of Daily Living (ADLs) Chapter 14: Vital Signs

Chapter 15: Medication Types

Chapter 16: Oral Hygiene, Grooming & Bathing

Chapter 17: Skin Integrity

Chapter 18: Resident with Dementia & Alzheimer s Disease Chapter 19: Communicating with Residents Unable to Direct Self-Care Chapter 20: Providing Services and Life Skills

Chapter 21: Managing Difficult Behavior-Residents Unable to Direct Self-Care Chapter 22: Developing & Providing Social, Recreational & Rehabilitative Activities for Residents Unable to Direct Self-Care

Chapter 23: Risk Management, Fall Prevention and Ambulation Chapter 1

Resident Rights

RESIDENTS RIGHTS TEND TO VARY FROM STATE TO STATE, BUT GENERALLY COVER THE SAME OR SIMILAR RIGHTS, THEY ARE: 1. The right to live in an environment that promotes and supports each resident s dignity, individuality, independence, self-determination, privacy, and choice. 2. The right to be treated with consideration and respect. 3. The right to be free from abuse, neglect, exploitation, physical restraints and chemical agents.

4. The right to privacy in correspondence, communications, visitation, financial and personal affairs, hygiene, and health related services. 5. The right to receive visitors and make private phone calls. 6. The right to participate or allow a representative or other individual to participate in the development of a written service plan/care plan. 7. The right to receive the services specified in the service plan/care plan, and to review and re-negotiate the service plan at any time. 8. The right to refuse services, unless such services are court ordered or the health, safety, or welfare of other individuals is endangered by the refusal of services.

9. The right to maintain and use personal possessions, unless they infringe upon the health, safety or welfare of other individuals in the facility. 10. The right to have access to common areas in the facility. 11. The right to request to relocate or refuse to relocate within the facility based upon the resident s needs, desires, and availability of such options. 12. The right to have financial and other records kept in confidence. The release of records should be by written consent of the resident or a representative, except as otherwise provided by law.

13. The right to review the resident s own records during business hours or at a time agreed upon by the resident and manager.

14. The right to review the assisted living facility s most recent survey conducted by the state s Department of Health Services, and any plan of correction (POC) in effect during normal business hours or at a time agreed upon by the resident and manager.

15. The right to be informed in writing of any change to a fee or charge before the change.

16. The right to submit grievances to employees, outside agencies, and other individuals without constraint or retaliation.

17. The right to exercise free choice in selecting activities, schedules and daily routines.

18. The right to exercise free choice in selecting a primary care provider, pharmacy, or other service providers and assume responsibility for any additional costs incurred as a result of such choices.

19. The right to perform or refuse to perform work for the assisted living facility. 20. The right to participate or refuse to participate in social, recreational, rehabilitative, religious, political or community activities. 21. The right to be free from discrimination due to race, color, national origin, gender, religion, and to be assured the same civil and human rights accorded to other individuals in the assisted living facility. Important things to remember…

Provide as much freedom to residents as possible, but also protect residents from their own bad decisions.

“Advance Directives” are instructions from the resident/client, family or physician which tell you whether or not a resident/client wishes to be resuscitated in the event of an emergency. This is commonly referred to as a DNR (Do Not Resuscitate) directive or order. The DNR is only concerned with resuscitation, or CPR. There is also what is referred to as “POLST” (Physician s Orders for Life-Sustaining Treatment). The POLST outlines the end of life treatments that someone does or does not want. The POLST may be a more viable option for a family if they are looking for more options concerning treatments for their loved one. Chapter 2

Communicating Effectively with

Residents

If you have an elderly relative or friend who has moved to an assisted living home, you know that your relationship has changed. Elderly people who are unable to live independently often have a chronic illness or some level of dementia that makes self-care and communication difficult.

As a caregiver, it's important to remember that while communication with the elderly may be more challenging, it s worth the effort. By maintaining a close and loving connection with an elderly person, you honor your relationship, and help to improve that person s quality of life.

HOW TO COMMUNICATE MORE EFFECTIVELY WITH THE ELDERLY Age-related decline in physical abilities can make communication more challenging, and without a doubt some illnesses make communication more difficult. Hearing loss makes you harder to understand, so be patient and speak more clearly to your residents. Likewise, be sure that you are facing the resident/client when you talk and avoid talking while you eat. Also check to see if an assistive listening device could improve communication by phone. Keep in mind that vision loss also makes it harder for the elderly person to recognize you, so don t take it personally. Some elderly people experience changes in speaking ability, and their voices become weaker, or harder to understand. Be patient when listening and be aware of when the elderly person gets tired and wants the visit to end. Some age-related memory loss is normal as people grow older, although people experience different degrees of memory loss. Most often, short-term memory is affected, making it harder for an elderly person to remember recent events. Keep this in mind, and practice patience. ALLOW YOUR RESIDENTS TO REMINISCE AND TO GRIEVE

When someone lives to be very old, it is impossible not to experience some feelings of significant loss. The deaths of relatives and friends, losing the ability to work and be independent, changes in health and finances, and being unable to make simple decisions can all affect an elderly person s self-esteem. These losses can create sadness, and grieving. Common responses to grieving are depression, social withdrawal, and irritability. As a caregiver you should look for these symptoms in your elderly residents and seek medical advice or counseling should the need arise. WAYS TO MORE EFFECTIVE COMMUNICATION

Be Respectful

Always respect the elderly person’s background, knowledge, and values. The resident may be a parent, grandparent, aunt, uncle and might be trying to convey an important message. Instead of waving the person off or deciding that communicating with the elderly person is not important, show respect by paying attention to what the person is saying. Demonstrate to the person that you value his/her opinion and treat them as you would want to be treated. Elderly people have feelings and emotions just like anyone else, so be empathetic.

Listen

Listen carefully to what the elderly person is saying. If there is a problem with his speech, perhaps you can offer a pen and paper so he or she can write their thoughts down on paper. Maybe the person has trouble articulating properly and you are unsure of what he/she is saying. Repeat what the resident said and be sure you understand the full request. Also, speak to the resident slowly and pronounce the words loud and clear. Remember that a resident may be agitated at not being able to get his thoughts across properly, so do what you can to help them out. Although some requests may be small, any request from the elderly resident is an important one. Set Boundaries

Set boundaries with your residents. Communicating effectively is also determined by what you allow and do not allow. Sometimes elderly people can become quite demanding. This may be caused by some sort of disability the person is experiencing. Be sure you exhibit control in the situation. Perhaps a demanding mother, relative or friend wants to be fed at a certain time or expects you to always be available for a doctor's appointment. Be nice yet firm when you make the resident aware that you have your own responsibilities to take care of; however, you will make time to help the resident out as needed.

Avoid Frustration

Avoid showing frustration in front of the resident. Communicating effectively works when both parties show appropriate body language. Although some elderly people can become abrasive and easily frustrated, it is important to remain calm even if it means staying quiet and counting slowly to ten. Try to refrain from crossing your arms, shuffling your feet, rolling your eyes and even sighing heavily. You are probably just as discouraged as the resident; however, make sure you understand that it is probably even more frustrating for the elderly resident being in his/her current situation or condition.

Chapter 3

Managing Personal Stress

Being able to cope with the strains and stresses of being a caregiver is part of the art of caregiving. In order to remain healthy so that we can continue to be “good” caregivers we must be able to see our own limitations and learn to care for ourselves as well as others. Equally important, is to make an effort to recognize the signs of caregiver burnout. In order to do this, we must be honest and willing to hear feedback from those around us. This is especially important for those caring for family or friends. Too often caregivers who are not closely associated with the health care profession get overlooked and lost in the larger context of health care and such things as the commotion of medical emergencies and procedures. Likewise, close friends begin to grow distant, and eventually the caregiver is alone without a support structure. We must allow those who do care for us, who are interested enough to say something, to tell us about our behavior, a noticed decrease in energy or mood changes. Caregiver burnout isn t like a cold; you don t always notice it when you are in its clutches. Very much like Post Traumatic Stress Syndrome, the symptoms of caregiver burnout can begin surfacing months after a traumatic episode. The following are symptoms we might notice in ourselves, or others might say they see in us. Think about what is being said and consider the possibility of burnout. SOME COMMON SYMPTOMS OF CAREGIVER BURNOUT INCLUDE: 1. Feelings of depression

2. A sense of ongoing and constant fatigue

3. Decreasing interest in work

4. Decrease in work production

5. Withdrawal from social contacts

6. Increase in use of stimulants and alcohol

7. Increasing fear of death

8. Change in eating patterns

9. Feelings of helplessness

WAYS TO PREVENT CAREGIVER BURNOUT

Strategies to ward off or cope with burnout are important. To counteract burnout, the following specific strategies are recommended:

1. Give yourself a pat on the back for what you are contributing to the life of the people that you are caring for. Whether or not you are a caregiver out of love or obligation, you are adding a dimension of quality and dignity to the person s existence that might not otherwise occur.

2. Keep track of your own physical and medical well-being. Exercise regularly and eat as healthy as possible.

3. Avoid using drugs and/or alcohol as a remedy, or as a replenishment for fatigue. 4. Avoid unrealistic expectations of yourself, the people that you are caring for, and others who assist with care. Have the courage to be imperfect. 5. Whenever possible, get a minimum of six (6) hours sleep a night. Eight (8) hours of sleep is preferable.

6. Give yourself an opportunity to recharge your batteries in some way. 7. Never feel guilty about taking time for yourself. 8. Be prepared to reach compromises with your time and effort as well as that of the people that you are caring for.

9. Learn to accept help and to respect the fact that others may provide assistance in ways that are different from yours. They may also demonstrate care and concern differently.

10. Get suggestions and ideas from other caregivers. 11. Find humor in caregiving. Likewise, seek out friends and others who are upbeat, and who will listen to you when you need a boost.

By acknowledging the reality that being a caregiver is filled with stress and anxiety, and understanding the potential for burnout, caregivers can be forewarned and guard against this debilitating condition.

As much as it is said, it still cannot be said too often. THE BEST WAY TO BE AN EFFECTIVE CAREGIVER IS TO TAKE CARE OF YOU!

Chapter 4

Preventing Abuse, Neglect, and

Exploitation

When you place your family member into a care home the last thing you expect to happen is for them to be the victim of abuse, neglect or exploitation. The sad fact is, it happens. As caregivers, it's your job to do everything you can to prevent and report abuse, neglect or exploitation if you have reasonable grounds to believe that has occurred at your facility. The key is to be “reasonable” and don't assume anything. In other words, get the facts first before you move forward with any report of abuse, neglect or exploitation to your supervisor. At the same time, be diligent, and have common sense enough to step forward in a situation where time is critical. Of course, follow your facility policy, but don't be shy about stepping forward to do the right thing. Remember, it's your job to protect your residents. ABUSE (to treat in a harmful way):

Typically, in the care home setting abuse can be defined as the “intentional infliction of physical harm, injury caused by negligent acts or omissions, unreasonable confinement or sexual abuse or assault.”

Indicators of abuse may include any skin bruising, pressure sores, bleeding, failure to thrive, malnutrition, dehydration, burns and bone fractures.” Since definitions of abuse vary from state to state, it is our intent to provide you with a basic definition as a framework for understanding this offense within the context of caregiving. NEGLECT (to pay too little attention to):

Generally, in the care home environment neglect is defined as “a pattern of conduct without the person’s informed consent resulting in deprivation of food, water, medication, medical services, shelter, cooling/heating or other services necessary to maintain minimum physical or mental health.”

Signs of neglect may include dehydration, malnutrition, signs of excess drugging or lack of medication or other misuse of medical treatment.” Since definitions of neglect vary from state to state, it is our intent to provide you with a basic definition as a framework for understanding this offense within the context of caregiving. EXPLOITATION (to take advantage of):

Most states define exploitation something along the lines of this: “Exploitation is the illegal or improper use of an incapacitated or vulnerable adult or his resources for another’s profit or advantage.”

Signs of financial exploitation may include disparity between income/assets and lifestyle, unexplained or sudden inability to pay bills, inaccurate or no knowledge of finances, fear or anxiety when discussing finances, or unprecedented transfer of assets to others.” As with abuse and neglect, definitions of exploitation vary from state to state; therefore, it is our intent to provide you with a basic definition as a framework for understanding this offense within the context of caregiving. CAREGIVER DUTY TO REPORT

Most states have reporting requirements for healthcare workers who observe or have knowledge of abuse, neglect and exploitation. Generally, physicians, hospital interns, a resident, surgeon, dentist, psychologist, social worker, peace officer, or other persons who have the responsibility for the care of an incapacitated or vulnerable adult and who has a reasonable basis to believe that abuse, neglect or exploitation has occurred must make an immediate report to a peace officer or protective services worker. CRIMINAL PENALTIES THAT CAREGIVERS CAN POTENTIALLY FACE CONCERNING ABUSE, NEGLECT OR EXPLOITATION:

Criminal penalties vary from state to state for failure to report abuse, neglect or exploitation. A caregiver who fails to report such crimes under circumstances likely to produce death or serious physical injury may be charged accordingly. Likewise, if any person such as a caregiver, causes a vulnerable adult to suffer physical injury, or having care or custody of a vulnerable adult, causes or permits the person or health of the vulnerable adult to be injured or placed in a situation where the person or health of the vulnerable adult is endangered you may be found guilty of a felony. Criminal intent for these crimes ranges from “intentionally”, “knowingly”, “recklessly”, or

“criminal negligence.” Please see your state s criminal penalties as they do vary. Chapter 5

Controlling the Spread of Disease &

Infection

One of the most important aspects of environmental safety is infection control. Each assisted living home facility must have an infection-control committee to write and approve policies and procedures and to monitor the infection-control program. As a caregiver you have a responsibility to understand and to follow your facility infection control policies and procedures. By doing so, you protect the residents, yourself, your family, and your fellow workers from the possibility of acquiring an infection. SOME IMPORTANT TERMS RELATED TO INFECTION CONTROL

INCLUDE:

1. Organism — any living thing

2. Microorganisms (commonly called germs) — tiny living things seen only with a microscope (Fig. 2-11)

3. Pathogenic — causing disease

4. Non-pathogenic — not capable of producing disease 5. Infection — invasion of the body by a disease-producing (pathogenic) organism 6. Aseptic — free of microorganisms

GUIDELINES FOR INFECTION CONTROL:

Hand Hygiene

Hand hygiene is widely acknowledged to be the single most important activity for reducing the spread of infection.

However, evidence suggests that many healthcare workers do not decontaminate their hands when they need to nor use the correct technique. Hand hygiene must be performed immediately before each and every episode of direct resident contact and after any activity or contact that could potentially result in hands becoming contaminated.

REMEMBER: Wash your hands “before” and “after” providing care for a resident. PERSONAL PROTECTIVE EQUIPMENT (PPE)

Selection of personal protective equipment (PPE) must be based on an assessment of the risk of transmission of microorganisms to the resident, and the risk of contamination of a caregiver s clothing and skin by the resident s blood, other body fluids, secretions or excretions.

Disposable gloves and aprons are used to protect both the caregiver and the resident from the risks of cross infection. In certain circumstances it may be necessary to wear other PPE, such as a mask and/or goggles/visor. These should be worn when recommended by infection control personnel.

Disposable Gloves

Gloves are required when contact with blood or body fluids or non-intact skin is anticipated. They should be single use and well-fitting. Sensitivity to natural rubber latex in patients, caregivers must be documented, and alternatives to natural rubber latex gloves must be available. Gloves are not a substitute for hand hygiene. Gloves must be discarded after each care activity for which they were worn in order to prevent the transmission of microorganisms to other sites in that individual or to other residents. Washing gloves rather than changing them is not safe and therefore not recommended. Hands should always be decontaminated following removal of gloves. Disposable Plastic Aprons

Disposable plastic aprons should be worn whenever there is a risk of contaminating clothing with blood or other body fluids, or when a resident has a known infection. A disposable plastic apron should also be worn during direct resident, bed-making, or when decontaminating equipment.

The apron should be worn as a single-use item, for one procedure or episode of patient care, and then discarded as clinical waste as soon as the intended task is completed. Hands should be washed following this activity. Aprons must be stored so that they do not accumulate dust that can act as a reservoir for infection. Masks, Visors and Eye Protection

These should be worn when a procedure is likely to cause splashes with blood or body fluids into the eyes, face or mouth or when it is recommended by infection control personnel when a communicable disease is suspected. It is rare that such protection is necessary in a care home. However, such protective equipment should be stored in the home in case of an emergency.

GENERAL CARE HOME CLEANING

Care homes should be cleaned and kept clean to the highest possible standards simply because residents, their families and the general public have a right to expect the highest standards of cleanliness. Caregivers should be aware that standards of cleanliness are often seen as an outward and visible sign of the overall quality of care provided. Individuals are likely to have significant concerns about the quality of care available in premises that are not kept clean.

A key component of providing consistently high-quality cleaning is the presence of a clear plan setting out all aspects of the cleaning service and defining clearly the roles and responsibilities of all those involved, from managers through care staff to domestics. Where cleaning services are provided by private contractors this plan should also set out management arrangements to ensure the provider delivers against the contract.

Contracting out the cleaning service does not mean contracting out responsibility, and managers will need to ensure there are suitable arrangements in place to monitor the standards being achieved and to deal with poor or unsatisfactory performance.

Important things to remember…

1. When in doubt, wash your hands again!

2. Dispose of soiled linens properly.

3. Dispose of sharps (needles, diabetic lancets, etc.) properly 4. Oh, did we mention to Wash Your Hands!

Chapter 6

Record Keeping and Documentation

As a caregiver you are responsible for record keeping and documentation keeping. As such, you must keep any and all resident records confidential and in a safe and secure area. You are not permitted to release confidential resident information to any unauthorized parties. Further, you have an obligation to the resident, the assisted living facility and yourself to properly and adequately document, and to keep resident records private. With this in mind, most states require that caregivers document the following: 1. Changes in level of care

2. Incidents

3. Doctor's Communication

4. Pharmacy Communication

5. Representatives/Relative Communication

6. Actions taken to ensure continuous and consistent care 7. ADL S (Activities of Daily Living)

THE ABOVE IS REQUIRED DOCUMENTATION. IN ADDITION, YOU MAY BE DELEGATED TO DOCUMENT THE FOLLOWING:

1. Environmental Control (i.e., tap water temperature, home temperature, etc.) 2. Fire Drills (usually done quarterly or semi-annually) 3. Other facility records

4. Any other documentation which you would reasonably consider to be important to document.

Important things to remember…

1. Remember, you will never cause harm to anyone by over documenting . 2. If in doubt go ahead and document.

3. Always protect the resident s medical information. It is confidential and not open for discussion to anyone other than authorized persons. 4. If in doubt you can always ask your supervisor. 5. Last but not least, DOCUMENT, DOCUMENT, DOCUMENT! Chapter 7

Service Plans

A service plan is a written agreement between the resident and his/her doctor that is designed to help the resident manage their health day-to-day. States vary as to what is required in a service or care plan. Below, we provide you with guidelines for service plans and their implementation. Be aware that you should always check with your state s requirements for service plans.

TYPICAL REQUIREMENTS FOR SERVICE/CARE PLANS ARE AS FOLLOWS:

1. Is initiated the day a resident is accepted into the assisted living facility; 2. Is completed and on file within a specified amount of time (usually 14 days) upon the resident s date of acceptance into the facility. IS DEVELOPED WITH ASSISTANCE AND REVIEW FROM:

1. The resident or representative.

2. The manager or manager s designee (this will most likely be YOU). 3. A nurse, if the resident is receiving nursing services, medication administration or is unable to direct self-care.

4. The resident s case manager, if applicable.

5. Any individual requested by the resident or the representative. If applicable and necessary, any of the following: caregivers, assistant caregivers, the resident s primary care provider, or other medical practitioner. GENERALLY, A SERVICE PLAN SHOULD INCLUDE THE FOLLOWING: 1. The level of service the resident is receiving. 2. The amount, type, and frequency of health-related services needed by the resident.

3. Each individual responsible for the provisions of the service plan. TYPICALLY, A SERVICE/CARE PLAN SHOULD BE SIGNED AND DATED BY:

1. The resident or the representative.

2. The manager or the manager s designee.

3. The nurse, if a nurse assisted in the preparation or review of the plan. 4. The case manager, if a case manager assisted in the preparation or review of the plan.

THE SERVICE CARE PLAN MUST BE UPDATED:

Generally, if there is a significant change in the resident s physical, cognitive, or functional condition a resident's service plan must be updated based upon the resident s level of care. Updates for service plans can range from 3-12 months and vary from state to state.

USE THIS SECTION FOR ANY NOTES YOU HAVE

Chapter 8

Nutrition, Hydration, Exercise

& Food Services

Nutrition, along with hydration and exercise comprise what is commonly referred in the caregiver industry as the “Key 3”, or “Big 3” as they are sometimes referred to. Oftentimes it is malnutrition that prompts a family member to start looking for a care home to place their loved one in. This is generally because most elderly people do not cook nutritional meals for themselves.

Frequently, when a resident enters a care home in an undernourished state, generally their health will improve simply because of the more nutritious meals that are prepared in the home. To help this process along we recommend the following as it relates to nutrition:

THE FIRST KEY: NUTRITION

1. Use variety: Everyone gets tired of the same food day after day or week after week. One explanation from malnourished residents stems from the fact that many elderly residents opt for a few of their favorite foods, which limits their intake of vital nutrients.

2. Moderation: Do not overload a resident s plate with food. Not only is this generally wasteful, but it is unnecessary and expensive to the owner of the home.

3. Temperature and Texture: Food with different texture and colors can make for an interesting menu. Depending on the time of year, it may be more or less appropriate to serve a hot or cold meal.

THE SECOND KEY: HYDRATION

One of the aging changes that occur as we get older is our inability to recognize that we are thirsty. This is commonly referred to as our thirst mechanism. With this in mind, without adequate fluids your residents are predisposed to the following: Dry Skin Constipation Lethargy Dizziness

Indigestion Urinary Tract

Infections (UTIs)

Bad Breath Confusion

To prevent such ailments, ensure that residents are taking in at least 64 ounces of water each day. This is equal to about eight 8-ounce glasses of water. Important things to remember…

Keep in mind that some conditions such as congestive heart failure (CHF) require that you restrict intake of water for a resident with this condition. The specific amount of water for a resident should be annotated in the resident s care plan as outlined by the resident s doctor.

Because a

Contact this candidate