The Home Health Aide Handbook - Hartmanonline
The HomeHealth AideHandbookJetta Fuzy, RN, MSWilliam Leahy, MDfourth editionGrrowingcarregiverrss
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iiAcknowledgmentsManaging EditorSusan Alvare HedmanDesignerKirsten BrowneProductionThad CastilloPhotographyMatt Pence, Pat Berrett, Art Clifton, and Dick RuddyProofreadersKristin Calderon, Kristin Cartwright, and Joanna OwusuSales/MarketingDeborah Rinker, Kendra Robertson, Erika Walker, and Belinda MidyetteCustomer ServiceFran Desmond, Thomas Noble, Angela Storey, Eliza Martin, andJeff BrownWarehouse CoordinatorChris MidyetteCopyright Information 2015 by Hartman Publishing, Inc.1313 Iron Ave SWAlbuquerque, New Mexico 87102(505) 291-1274web: hartmanonline.comemail: orders@hartmanonline.comTwitter: @HartmanPubAll rights reserved. No part of this book may be reproduced, in any form orby any means, without permission in writing from the publisher.ISBN 978-1-60425-056-5PRINTED IN THE USA
iiiNotice to ReadersThough the guidelines and procedures contained in this text are based onconsultations with healthcare professionals, they should not be consideredabsolute recommendations. The instructor and readers should followemployer, local, state, and federal guidelines concerning healthcare practices.These guidelines change, and it is the reader’s responsibility to be aware ofthese changes and of the policies and procedures of his or her healthcareagency.The publisher, author, editors, and reviewers cannot accept any responsibilityfor errors or omissions or for any consequences from application of theinformation in this book and make no warranty, express or implied, withrespect to the contents of the book. The publisher does not warrant or guarantee any of the products described herein or perform any analysis in connection with any of the product information contained herein.Special ThanksA very warm thank you goes to our insightful reviewers:Candace S. Barth RN, BSNJunction City, WISusan Meier, RN, BSNGloucester Township, NJNelson Wood, RN, BSN, CRRNNew Hartford, NYGender UsageThis textbook utilizes the pronouns he, his, she, and hers interchangeably todenote care team members and clients.
vContentsPageI. Defining HomeHealth ServicesTopicSpecial PrecautionsPage30Transmission-Based Precautions 31Home Health Care1Safety and Body Mechanics34Payers1Principles of Body Mechanics34Purpose of Home Care1Accident Prevention36Agency Structure2Travel Safety40HHA’s Role3Emergencies42The Care Team4Medical Emergencies42The Care Plan5Disaster Guidelines49Chain of Command6Policies and Procedures7Professionalism8Legal and Ethical Aspects10II. Foundation of ClientCareCommunication16Barriers to Communication17Oral Reports17Documentation19Telephone Communication21Infection Prevention22Home Care Bag22Spread of Infection22Standard Precautions23Personal Protective Equipment(PPE)27III. UnderstandingClientsCulture and Family53Basic Human Needs53Cultural Differences54Families55Body SystemsCommon Disorders/Observingand ReportingHuman Development565766Stages/Common Disorders66Aging69Death70Hospice Care73
viTopicPageTopicPageIV. Client CareOxygen159Maintaining Mobility, Skin, andComfortIVs16075Positioning75Transfers and Ambulation78Range of Motion Exercises86Skin Care92Comfort Measures94Personal Care ProceduresBathing9798Grooming105Oral Care113Toileting118Vital Signs123Temperature124Pulse130Respirations132Blood Pressure132Pain134Height and Weight135Special Procedures137V. Special Clients,Special NeedsDisabilities and Mental Illnesses 162Disabilities162Mental Illnesses163Special Conditions167Arthritis168Cancer169Diabetes172CVA or Stroke175Multiple Sclerosis (MS)178Circulatory Disorders179HIV and AIDS183Dementia186Alzheimer’s Disease (AD)187Chronic Obstructive PulmonaryDisease (COPD)192Tuberculosis (TB)193Hip or Knee Replacement194Intake and Output (I&O)137Catheter Care140Ostomy Care143VI. Home Managementand NutritionCollecting Specimens144The Client’s EnvironmentNon-Sterile Dressings149Housekeeping197Warm and Cold 8197
viiTopicProper NutritionPage211Nutrition211Special Diets219Planning and Shopping224Preparing and Storing225Managing Time and Money231Managing Time231Work Plan232Client’s Money233VII. Caring for YourselfContinuing Education234Stress Management235Your Career237VIII. nt Names/Numbers256Community Resources257
viiiProcedurePageProceduresWashing hands (hand hygiene)26Putting on (donning) gown andremoving (doffing) gown27Putting on (donning) mask andgoggles28Putting on (donning) gloves29Removing (doffing) gloves30Performing abdominal thrusts forthe conscious person44Responding to a heart attack48Assisting a client to sit up on sideof bed: dangling77ProcedurePageShampooing hair106Combing or brushing hair108Providing fingernail care109Providing foot care110Shaving a client111Providing oral care113Providing oral care for theunconscious client114Flossing teeth115Cleaning and storing dentures116Reinserting dentures118Assisting client with use of abedpan119Transferring a client from bedto wheelchair80Assisting a male client with aurinal121Helping a client transfer using aslide board81Assisting a client to use aportable commode or toilet123Transferring a client using amechanical lift82Measuring and recording oraltemperature126Assisting a client to ambulate83Measuring and recordingrectal temperature127Assisting with ambulation for aclient using a cane, walker, orcrutches85Measuring and recordingtympanic temperature129Assisting with passive range ofmotion exercises88Measuring and recordingaxillary temperature129Giving a back rub96Helping a client transfer to thebathtubMeasuring and recordingapical pulse13199Helping the ambulatory clienttake a shower or tub bath100Measuring and recordingradial pulse and counting andrecording respirations132Giving a complete bed bath102
ixProcedurePageProcedurePageMeasuring and recording bloodpressure (one-step method)133Putting elastic stockings on aclient182Measuring and recording weightof an ambulatory client135Cleaning the bathroom203Doing the laundry206Making an occupied bed209Making an unoccupied bed211Assisting a client with eating230Measuring and recording heightof a client136Measuring and recording intakeand output138Observing, reporting, anddocumenting emesis139Providing catheter care141Emptying the catheter drainagebag142Providing ostomy care143Collecting a sputum specimen145Collecting a stool specimen145Collecting a routine urinespecimen146Collecting a clean catch(mid-stream) urine specimen147Collecting a 24-hour urinespecimen148Changing a dry dressing usingnon-sterile technique149Applying warm compresses151Administering warm soaks151Assisting with a sitz bath153Applying ice packs153Applying cold compresses154Providing foot care for thediabetic client174
xWelcome toHartman Publishing’sHome Health AideHandbook!We hope you will happily place this little referencebook into your purse, backpack, or your home carevisit bag and leave it there so you will have it availableat all times as you go about your day-to-day duties asa home health aide. This handbook will serve as aquick but comprehensive reference tool for you to usefrom client to client.Features and BenefitsThis book is a valuable tool for many reasons. Itincludes all the procedures you learned in your homehealth aide training program, plus references toabbreviations, medical terms, care guidelines for specific diseases, and an appendix where you can writedown important names and phone numbers. For certified nursing assistants moving to home care, wehave included information on making the transitionfrom facilities to homes. In addition, this book contains all of the federal requirements for home healthaides, so it can also be used in a basic trainingprogram.
xiWe have divided the book into eight parts andassigned each part its own colored tab, which youwill see at the top of every page.I. Defining Home Health ServicesII. Foundation of Client CareIII. Understanding ClientsIV. Client CareV. Special Clients, Special NeedsVI. Home Management and NutritionVII. Caring for YourselfVIII. AppendixYou will find key terms throughout the text. Expla nations for these terms are in the Glossary section ofthe Appendix of this book. Common Disorders,Guidelines, and Observing and Reporting are alsocolored for easy reference. Procedures are indicatedwith a black bar. There is also an index in the back ofthe book. We will be updating this guide periodically,so don’t hesitate to let us know what you would liketo see in the next handbook we publish. Contact us atHartman Publishing, Inc.1313 Iron Avenue SWAlbuquerque, NM 87102Phone: (505) 291-1274Fax: (505) 291-1284Web: hartmanonline.comE-mail: orders@hartmanonline.comTwitter: @HartmanPub
xiiBeginning and ending steps incare proceduresFor most care procedures, these steps should be performed. Understandingwhy they are important will help you remember to perform each step everytime care is provided.Beginning StepsWash your hands.Handwashing provides for infectionprevention. Nothing fights infectionlike performing consistent, proper handhygiene. Handwashing may need tobe done more than once during a procedure. Practice Standard Precautionswith every client.Explain the procedure to client,speaking clearly, slowly, anddirectly. Maintain face-to-facecontact whenever possible.Clients have a right to know exactlywhat care you will provide. It promotesunderstanding, cooperation, and independence. Clients are able to do morefor themselves if they know what needsto happen.Provide privacy for the client.Doing this maintains the client’s rightto privacy and dignity. Providing forprivacy is not simply a courtesy; it is alegal right.If the bed is adjustable, adjustbed to a safe level, usually waisthigh. If the bed is movable, lockbed wheels.If the client has an adjustable bed,locking the bed wheels is an importantsafety measure. It ensures that the bedwill not move as you are performingcare. Raising the bed helps you to remember to use proper body mechanics.This prevents injury to you and to theclient.
xiiiEnding StepsReturn bed to lowest position.Lowering an adjustable bed providesfor the client’s safety.Wash your hands.Handwashing is the most importantthing you can do to prevent the spreadof infection.Document the procedure andyour observations.You will often be the person whospends the most time with a client, soyou are in the best position to note anychanges in a client’s condition. Everytime you provide care, observe the client’s physical and mental capabilities,as well as the condition of his or herbody. For example, a change in a client’s ability to dress himself may signala greater problem. After you have finished giving care, document the careproperly. Do not record care before it isgiven. If you do not document the careyou gave, legally it did not happen.In addition to the beginning and endingsteps listed above, remember to followinfection prevention guidelines. Even ifa procedure in this book does not tellyou to wear gloves or other PPE, theremay be times when it is appropriate.
HOME HEALTH CAREI. Defining Home HealthServicesHome Health CareHome health aides (HHAs) provide assistance to the chronically ill, theelderly, and family caregivers who need relief from the stress of caregiving. Many home health aides also work in assisted living facilities, whichprovide independent living in a homelike group environment, with professional care available as needed. As advances in medicine and technology extend the lives of people with chronic illnesses, the number of people needing health care will increase. The need for home health aides willalso increase.PayersAgencies pay HHAs from payments they receive from these payers: Insurance companies Government programs like Medicare and Medicaid Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Individual clients or family membersThe Centers for Medicare & Medicaid Services (CMS) is a federal agencywithin the U.S. Department of Health and Human Services. CMS runsthe Medicare and Medicaid programs at the federal level.Medicare pays agencies a fixed fee for a 60-day period of care based on aclient’s condition. If the cost of providing care exceeds the payment, theagency loses money. If the care provided costs less than the payment, theagency makes money. For these reasons, home health agencies must payclose attention to costs. Because all payers monitor the quality of careprovided, the way in which work is documented is very important. CMS’payment system for home care is called the home health prospective payment system or HH PPS.Purpose of Home CareOne of the most important reasons for offering health care in the homeis that most people who are ill or disabled feel more comfortable athome. Health care in familiar surroundings improves mental and physical well-being. It has proven to be a major factor in the healing process.1
2AGENCY STRUCTUREAgency StructureClients who need home care are referred to a home health agency bytheir doctors. They can also be referred by a hospital discharge planner, asocial services agency, the state or local department of public health, thewelfare office, a local Agency on Aging, or a senior center. Clients andfamily members may also choose an agency that meets their needs.Once an agency is chosen and the doctor has made a referral, a staffmember performs an assessment of the client. This determines how thecare needs can best be met. The home environment will also be evaluated to determine whether it is safe for the client.Home health agencies employ many home health aides (HHAs) and certified nursing assistants (CNAs or NAs). The services provided dependon the size of the agency. Small agencies may provide basic nursing care,personal care, and housekeeping services. Larger agencies may providespeech, physical, and occupational therapies and medical social work.Common services provided include medical-surgical nursing care, including medication management, wound care, care of different types oftubes, and care for different diseases. Services also include intravenousinfusion therapy; maternal, pediatric, and newborn nursing care; nutritiontherapy; medical social work; personal care; medical equipment rentaland service; pharmacy services; and hospice services. All home healthagencies have professional staff who make decisions about what servicesare needed (Fig. 1-1).Executive DirectorMedical nal AdvisoryBoardIntermittent VisitServices ManagerPrivate DutyServices ManagerOffice ManagerSupervisorSupervisorBillers/SchedulerFiling ClerkReceptionistRN Case Managers/Care CoordinatorsNurses (RN, LPN/LVN)Therapists (PT, OT, SLP)Social Service (MSW)Home Health AidesRN Case Managers/Care CoordinatorsNurses (RN, LPN/LVN)Therapists (PT, OT, SLP)Social Service (MSW)Home Health AidesClientsFig. 1-1. A typical home health agency organization chart.
HHA’S ROLEHHA’s RoleAn HHA may be assigned to spend a certain number of hours each dayor week with a client to provide care and services. While the client careplan and assignments are developed by the supervisor or case manager,input from all members of the care team is needed. All HHAs are underthe supervision of a skilled, licensed professional: a nurse, a physicaltherapist, a speech-language pathologist, or an occupational therapist.Working in Clients’ HomesIn some ways, working as a home health aide is similar to workingas a nursing assistant. Most of the basic medical procedures andmany of the personal care procedures will be the same. However,some aspects of working in the home are different: Housekeeping: An HHA may have housekeeping responsibilities,including cooking, cleaning, laundry, and grocery shopping, for atleast some clients. Family contact: An HHA may have a lot more contact with clients’family members in the home than she would in a facility. Independence: An HHA will work independently. A supervisor willmonitor her work, but the HHA will spend most hours workingwith clients without direct supervision. Thus, the HHA must be aresponsible and independent worker. Communication: Communication skills are important. An HHAmust keep herself informed of changes in the client care plan. Shemust also keep others informed of changes she observes in theclient and the client’s environment. Transportation: An HHA will have to get herself from one client’shome to another. She will need to have a dependable car or beable to use public transportation. An HHA may also face badweather conditions. Clients need care—rain, snow, or sleet. Safety: An HHA needs to be aware of personal safety when traveling alone to visit clients. She should be aware of her surroundings, walk confidently, and avoid dangerous situations. Flexibility: Each client’s home will be different. An HHA will needto adapt to the changes in environment. Working environment: In home care, the layout of rooms, stairs,lack of equipment, cramped bathrooms, rugs, clutter, and evenpets can complicate caregiving. Client’s home: In a client’s home, an HHA is a guest. She needsto be respectful of the client’s property and customs.3
4HHA’S ROLE Client’s comfort: One of the best things about home care is that itallows clients to stay in the familiar and comfortable surroundingsof their own homes. This can help most clients recover or adaptto their condition more quickly.An HHA is part of a team of health professionals that includes doctors,nurses, social workers, therapists, and specialists. The client and client’sfamily are considered a very important part of the team. Everyoneinvolved will work closely together to help clients recover from illnessesor injuries. If full recovery is not possible, the team will help clients do asmuch as they can for themselves.The Care TeamClients will have different needs and problems. Healthcare professionalswith different kinds of education and experience will help care for them.This group is known as the care team. Members of the healthcare teaminclude the following:Home Health Aide (HHA): The home health aide performs assignedtasks, such as taking vital signs. The HHA also provides routine personalcare, such as bathing clients or preparing meals. Daily personal caretasks such as bathing; caring for skin, nails, hair, and teeth; dressing; toileting; eating and drinking; walking; and transferring are referred to asactivities of daily living (ADLs). Assisting with ADLs is a major part ofthe HHA’s responsibilities. HHAs spend more time with clients thanother care team members. They act as the “eyes and ears” of the team.Observing and reporting changes in a client’s condition or abilities is avery important duty of the HHA.Case Manager or Supervisor: Usually a registered nurse, a case manageror a supervisor is assigned to each client by the home health agency. Thecase manager, with input from other team members, creates the basiccare plan for the client. He or she monitors any changes that areobserved and reported by the HHA. The case manager also makeschanges in the client care plan when necessary.Registered Nurse (RN): In a home health agency, a registered nurse coordinates, manages, and provides care. RNs also supervise and trainHHAs. They develop the HHA’s assignments.Doctor (MD or DO): A doctor’s job is to diagnose disease or disabilityand prescribe treatment. A doctor generally decides when patients needhome health care and can refer them to home health agencies.
a home health aide. This handbook will serve as a quick but comprehensive reference tool for you to use from client to client. Features and Benefits This book is a valuable tool for many reasons. It includes all the procedures you learned in your home
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1-5 Senior Enlisted Aide Community Manager Duties pg 11 1-6 Location and Contact Information pg 11 . UNITED STATES NAVAL ACADEMY THE WHITE HOUSE STATE DINING ROOM. 10 CHAPTER 1 ENLISTED AIDE OVERVIEW: 1-1. Enlisted Aide Management . Is a position that advises and manages all aspects of the Navy Enlisted Aide Program. 1-5. Enlisted Aide .
If the facility has an approved nurse aide temporary emergency waiver, the applicant must be trained and certified within four (4) months of hire date. Category: List any CNA training received in the past by type of training: Long Term Care Aide (LTCA), Home Health Aide (HHA), Adult Day Care Aide (ADCA), Residential Care Aide (RCA)
