Clients receiving Personal Care Service have conditions that limit their ability to provide basic care for themselves. They may need assistance in the home with bathing, dressing, feeding and other activities of daily living including assistance with household cleaning and the maintenance of a safe home.
Clients living at home who are unable to independently meet their own personal care needs and have a physician's order for the care.
The Waiver Program pays for Personal Care Services when the care is "medically necessary" and ordered by the Client’s physician.
A caregiver is someone who has been specially trained to perform or assist with Personal Care needs under the supervision of a Field Supervisor.
Personal Care refers to the activities most healthy individuals provide for themselves every day.
Clients receiving Personal Care Services are either elderly or adults with disabilities who wish to remain at home instead of going to a nursing home. All Clients will have certain functional limitations preventing them from being independent with their own personal care. Sometimes Clients are very frustrated, depressed or even angry at their lack of independence.
Personal Care is provided in the Client’s home. A Care Plan will tell you the location where the care is to be provided. It is important to remember that you are a guest in the Client’s home and you must be respectful of his /her home and personal belongings.
You will be provided with a Care Plan that tells you exactly which tasks to perform, observe or assist the Client with. The Care Plan will also specify when you are to provide the care and how long you are to be in the home. The Field Supervisor will make a visit every month to make sure the Client’s personal care needs are being met and that the plan of care is being followed. During this visit, the Field Supervisor will also conduct an evaluation to see if any changes are needed in the Care Plan.
Your supervisor will make out a Care Plan that will tell exactly which tasks to perform, observe, or assist the Client with. It is very important to follow the Care Plan exactly and if you do not understand something, please ask questions.
In addition to completion of an approved course, a Caregiver needs special personal characteristics such as:
Communication occurs when one person sends a message of information, idea or emotion to another person. Good communication requires us to be skillful at sending and receiving messages. Although speech is the most common method of communication, nonverbal messages are also forms of communication.
Sending the message is only half of the process. If the person receiving the message cannot understand the message, it is of no value to them. It is important to use the communication method best suited for the person receiving the message.
Listening and receiving the message is the other half of the process. It is important to listen with your ears and eyes.
What is the person saying? What is he doing while he is talking? Does he make eye contact? Does he look nervous? Angry? Sad? Happy? Confused?
Listen to what each Client is saying, instead of thinking about what you are going to say next. A good listener has patience and asks questions when they do not understand what is said.
"Do you know Mrs. Jones down the street? I think she has a Caregiver too. Is she going to have to go to the nursing home?"
Possible response: “Yes I do know Mrs. Jones, but according to today’s laws, I am not allowed to discuss that.”
"I'm glad you were the one to come today. I don't like that other girl. I think she stole my ring."
Possible response: “I’m glad I am here today, too. What makes you think the other girl stole your ring? Would you like for me to report that to your Case Manager?”
Sometimes a Client's behavior and attitude may change during an illness. The Client may respond to stressful situations by becoming angry, withdrawing, or crying easily. Fear is often the underlying emotion when a person reacts in an angry or irritable way.
Remember the following tips for dealing with difficult people:
Always face the person when you are talking to them. Try to keep your hands away from your face so they can see your lips and your expressions. Try to sit close to the person you are talking to.
You do not need to talk loud or shout. Talk clearly, without mumbling, and try not to talk too fast.
Make sure there is adequate light in the room. Most people with hearing difficulties rely on seeing the person talking to them to help them communicate.
Turn the radio or television down or off. Background noise is a major hindrance for people who have hearing difficulties. Ambient noise from an air conditioner or fan can make it difficult for someone with a hearing difficulty even when persons with normal hearing do not notice it.
While all of us struggle to communicate effectively, persons with a hearing loss face a difficult challenge understanding what is being said when others do not recognize there is a problem.
Vital Signs are the measurement of temperature, pulse, respiration and blood pressure, which indicates the functioning of body systems and may help the health care workers to identify numerous types of problems. The Caregiver should wash their hands before and after any procedures. The Caregiver should wear gloves when assessing the Client’s temperature orally and rectally.
Elimination of waste from the body is important to maintain health and function. Urine is liquid waste that is produced in the kidneys. The urine travels down a tube called a ureter to the bladder where it is held until it is eliminated. When the bladder is full, the brain signals the muscles of the urinary tract to release urine from the body. The urine travels from the bladder down another tube called the urethra until it reaches the outside of the body.
A catheter is a tube inserted in the urethra to drain the urine from the bladder. The urine is collected in a drainage bag outside the body. It is important that the urine in the bag not be allowed to backup because this may send urine back into the bladder causing an infection.
Always keep the bag lower than the bladder.
Notify your nurse supervisor immediately if:
An incontinent person is unable to control the passage of urine out of his/her body. It is very important that incontinent Clients are kept clean and dry to prevent skin breakdown. When assisting a Client with voiding, make the following observations:
Feces are solid or liquid waste produced from the breakdown of food in the body. Digestion begins in the mouth where food is chewed and mixed with saliva. The food travels down a long tube called the esophagus into the stomach. The food travels from the stomach into the small intestine where digestive juices finish the job of breaking down the food.
Incontinence means that a person is unable to control the emptying of their bowels. These Clients may wear adult diapers or have special pads on their bed. Incontinent Clients require frequent cleaning and changing since fecal material is very harsh on the skin.
Constipation occurs when the Client has hard feces and/or it is difficult to expel bowel movements. Toileting is normally a private matter. Clients may be embarrassed at needing assistance.
When you assist a Client with toileting, observe the following:
Always wash your hands before and after assisting an Client with toileting.
Assist the Client with hand washing if they need help.
Always clean the Client from front to back.
Use good body mechanics and safety precautions when helping the Client get in and out of the bathroom.
An important part of your job is to help the Client be as independent as possible. This means teaching Clients to care for themselves, and encouraging them to get back into old routines of self-care as soon as they have the strength if they are able to accomplish this.
Before you begin any procedure or task, explain to the Client exactly what you will be doing. Ask if they would like to use the bathroom or bedpan first. Provide the Client with privacy and let them make as many decisions as possible about when, where, and how a procedure will be done.
The skin is our largest body system and does several jobs.
The skin protects our internal organs from injury and infection by providing a barrier. Oil glands secrete an oily substance that keeps the skin lubricated and provides a protective film.
The skin helps regulate body temperature by controlling the loss of heat from the body. Sweating or perspiring is a mechanism that the skin uses to cool the body. Chill bumps are the method the body uses to retain heat.
Skin breakdown is caused by pressure, friction, and shearing. Pressure sores occur when a person sits or lies on a bony prominence. A bony prominence is an area where the bones are close to the skin surface. These areas have a thin layer of skin and a decreased blood flow. Pressure is exerted from the body's weight against the bone, which causes the tissue to become pressed between the bone and another surface (bed, chair, catheter, body part etc).
Decubitus ulcers are areas where the skin has been injured due to pressure, friction, or shearing. Decubiti are often referred to as bedsores because they often occur in bed bound Clients. When Client is confined to a bed or chair; the weight of their body puts pressure on the skin over their bony prominence. Pressure causes a decrease in blood flow or circulation to these areas. As a result, a decubitus is formed.
Signs of Decubiti:
Change positions every two hours or more frequently if needed.
Giving a bath cleans the Client's skin, stimulates circulation, and allows time for observing the condition of the skin. Many Clients will be able to assist with their bath and may choose to get in the tub or shower. The amount of assistance they require will vary from Client to Client. A bed bath is reserved for those Clients who are too ill or weak to get in the tub or shower.
Perineal care refers to washing and drying thoroughly of the genital area. The female genital area includes the urinary opening, the vagina, and the rectum. The male genital area includes the penis, scrotum and rectum. When a Client is incontinent, he/she cannot control his/her bowel and or bladder. Urine or stool on the skin can cause skin break down to occur.
Never leave a Client alone while in the bathtub.
Never use bath oils. They make the tub slippery and can cause a fall.
Equipment needed: wash cloth, soap, bath towel, deodorant, body lotion, bath mat, chair, Client's clothing
A shampoo cleans the hair and scalp, improves circulation to the scalp, and improves the Client's appearance. As a Caregiver, you may be asked to assist Clients with shampooing their hair.
Grooming is brushing the teeth, combing the hair and shaving.
You can make a shampoo kit using three towels, a plastic garbage bag, and a basin for catching the dirty water.
Roll each towel and put one inside the three closed sides of the bag.
Place the bottom rolled edge under the Client’s neck (if not contradicted).
Place the open end into a basin and follow the procedure above for a bed shampoo.
Oral hygiene or mouth care is the cleaning of the mouth, gums, tongue and teeth or dentures.
Oral care does the following:
Equipment needed: water, cup, emesis basin, towel, toothbrush, toothpaste, mouthwash.
Personal care aides may be asked to assist with cleaning and filing a Client's fingernails and toenails. This procedure helps keep the nails clean, prevents abrasions from scratching, and improves the Client's appearance. Remember, you are not allowed to cut or trim an Client's fingernails or toenails. If a Client's nails need trimming, notify your supervisor.
A clean-shaven face adds to the Client's comfort and well-being. Some Clients may be able to shave themselves with minimal assistance. They may require assistance getting up in a chair or gathering equipment. Other Clients may need you to shave them. They may use a disposable razor or an electric razor. Electric razors are safer and easier to use; however they should not be used while Clients are receiving oxygen.
Certain Clients may not be permitted to shave or be shaved. Never shave a Client unless you have been instructed to do so by your supervisor. This procedure is for shaving a Client with a disposable razor.
Equipment needed: basin of hot water, shaving cream, disposable razor, towel, wash cloth, aftershave, and powder.
Personal Care Aides may be asked to assist Clients with dressing. The amount of assistance needed will depend on the Client’s condition and limitations. Your Care Plan will tell you whether or not you will need to assist the Client with dressing. Some Clients may have an occupational therapist working with them. The therapist may be trying to encourage independence with dressing.
Remember to allow the Client to assist with dressing as much as they are able.