Unit 1: Introduction to Aide and Agency Role
Minimum Number of Hours: Theory 4, Clinical 0

Statement of Purpose:

The purpose of this unit is to acquaint the student with the practice of home health care. The topics to be covered include: (a) Federal and State regulations governing home health aides,(b) purpose of home health care and roles of members of the home health care team, (c) the role and responsibility of the home health aides as a member of the team, and (d) communication with clients, families, team members, and community agencies.

Performance Standards (Objectives):

Upon completion of the four (4) hours of class, plus assignments, the learner will be able to do the following:

  1. Define the terminology.
  2. Identify State and Federal regulations and requirements for HHA certification.
  3. Describe the purpose and goals of home care.
  4. Identify members of the home health care team, their functions, and how they interact.
  5. Describe the role and responsibilities of the certified home health aide.
  6. Discuss common observations and documentation to be completed by the HHA.
  7. Describe key steps involved in the communication process and methods used in communication.
  8. Describe key steps to accommodate communication with clients who have hearing or speech disorders.
  9. Describe effective techniques for communication with home health team members.
  10. Describe ways to have effective communication in learning about your client.
  11. Describe how to access community agencies to meet client needs.
  12. Identify organizational and time management techniques for a daily work schedule.

Terminology:

abandonment
abuse
assault
battery
case management
certification
commission
community
confidentiality
Department of Health
Services(DHS)
Diagnostic related
Groupings (DRG’s)
Ethics

Health Care Financing
home health agency
home health aide
home health care
hospice
intervention
liability
malpractice
managed care
Medicaid
Medicare
negligence
occupational therapy
omission

 Omnibus Budget
Reconciliation Act (OBRA)
philosophy
physical therapy
policy
privacy
procedure
professionalism
protective services
respite care
social services
speech therapy
time management
Title 22

Learner Activities/Assignments:

  1. Written report/Home Health Agency Treasure Hunt (p. 22)
  2. Role-play scenarios involving paraprofessional conduct, ethical decision making, client rights and legal issues
  3. Learning Needs Assessment (p. 23)
  4. Charting exercise; students document possible care activities on sample agency forms
  5. Role-play – Communication (p. 26)
  6. Organization and time management assignment: Given sample HHA assignment, student provides plan for that day
  7. Map reading activity: Given several location, plot route for home visits (p. 27)

Teaching Strategies:

  1. Role-playing
  2. Guest speaker from home health care agency
  3. Field trip to a home health care agency
  4. Handout:
    • Potential Barriers to Effective Communication with the Client (p. 28)
    • Clients with hearing or speech difficulties (p. 24-25)
  5. Classroom lecture and discussion

References:

Balduzzi, S., & Spatz, A. (2005). Homemaker home health aide (6th ed.). Clifton Park, NY: Thomson Delmar Learning.

Birchenall, J.M., & Streight, E. (2003) Mosby’s Textbook for the home care aide (2nd ed.). St. Louis, MO: Mosby.

Sorrentino, S. A. (2004). Assisting with patient care (2nd ed.). St. Louis, MO: Mosby. Zucker, E. & Ebrite, L.J. (2006). Being a home maker/home health aide (5th ed.). Englewood Cliffs, NJ: Prentice-Hall.

 

 

Staff member of Home HealthWritten Test

CONTENT OUTLINE

SUGGESTED
LEARNING
ACTIVITIES
1. Define the terminology

Written Test

abandonment
abuse
battery
case management
certification
commission
community
confidentiality
Dept. of Health Services (DHS)
diagnostic related groupings (DRG’s)
ethics
Health Care Financing
Administration(HCFA)
home health agency
hospice
intervention
liability
malpractice

managed care
Medicare
Negligence
Occupational therapy
Omission
Omnibus Budget Reconciliation Act (OBRA)
philosophy
physical therapy
policy
privacy
procedure
professionalism
protective services
respite care
social services
speech therapy
time management
Title 22

2. Identify State and Federal Regulations and Requirements for HHA certification.
Written test
Applies for HHA
certification
Lecture listing
A. Federal – Center for Medicare and Medical Services –

  1. Definition and qualification of personnel (Section 484.4)
    • HHA – person who has met training requirement and completed a competency evaluation
  2. Training standards (Section 484.36)
    • Content to be included in HHA training
      1. Communication skills
      2. Observation, reporting, and documentation of patient status, and the care or service furnished
      3. Reading and recording temperature, pulse, and respiration
      4. Basic infection control procedures
      5. Basic elements of body functioning and changes in body function that must be reported to an aides’s supervisor
      6. Maintenance of clean, safe, and healthy environment
      7. Recognizing emergencies and knowledge of emergency procedures
      8. The physical, emotional, and development needs of and ways to work with the populations served by the HHA including the need for respect for the patient, his or her privacy and his or her property
      9. Appropriate and safe techniques in personal hygiene and grooming that include:
        • Bed bath
        • Sponge, tub or shower bath
        • Shampoo, sink, tub or bed
        • Nail and skin care
        • Oral hygiene
        • Toileting and elimination X. Safe transfer techniques and ambulation
      10. Normal range of motion and positioning
      11. Adequate nutrition and fluid intake
    • Training to be conducted by an agency with no outstanding sanctions involving HHA.
B. State – California Code of Regulations (Title 22- Division 5, Chapter 6, Article 5)

  1. Home Health Aide Training (Section 74747)
    • Content and skills to be included –
      1. Introduction
        • Definition, functions and responsibilities of a home health aide as a member of the health service team in a home health agency.
        • Interpretation of the importance of understanding the employing agency’s policies, including:
          1. Employment practices.
          2. Nursing policies and procedures.
          3. Supervision.
          4. Ethics and confidentiality.
      2. Interpretation of medical and social needs of people being served.
        • Basic simple description, in lay terms, of disease and its effect on the individual and the family.
        • Personal adjustment of the individual and his family to illness and disability.
      3. Personal care services
        • Personal care services include those supportive services which are required to help provide and maintain normal bodily and emotional comfort and to assist the patient toward independent living in a safe environment including at least:
          1. Assisting patients with personal hygiene.
          2. Assisting patient in self-care activities:
            • Bathing-tub, shower, bed.
            • Dressing and undressing.
            • Feeding.
          3. Assisting with mobility.
            • Getting in and out of bed, chair, wheelchair, and toilet.
            • Walking with or without devices.
            • Assisting with exercises as ordered.
            • Positioning.
      4. Cleaning and care tasks in the home which includes at least:
        • Home safety measures.
        • Economical cleaning materials and method of use.
        • Maintenance of cleanliness where dishes and food are stored.
        • Principles of general cleanliness of the environment.
        • Handling of laundry.
      5. Nutrition which includes at least:
        • Basic principles of diet.
        • Meal planning and serving.
        • Food purchasing.
        • Food preparation, sanitation and storage.
    • There shall be a minimum of 20 hours of clinical experience of which 15 hours are in personal services, 2 hours are in cleaning and care tasks, and 3 hours are in nutrition.
  2. Home Health Aide Certification (74745)
    • Certification by the Department of Health Services
  3. Denial, Revocation, Suspension of Certification,(Section 74749)
    • Failure to submit required application
    • Conviction of felony or crime related to fitness as HHA
    • Failure to submit evidence of qualifications
  4. Continuing education/In-service requirement
    • The home health aide must receive at least 12 hours of in-service training during each 12-month period. The in-service training may be furnished while the aide is furnishing care to the patient.

SUGGESTED
LEARNING
ACTIVITIES
  1. 3. Describe the purpose and goals of home health care.
  1. Home health care
    1. Purpose
      • Provides comprehensive services and care for homebound patients.
    2. Goals
      • cost-effective care
      • individual care
      • continuation of care
    3. Functions
      • client satisfaction
      • reduce cost
      • maintain lifestyle, relationships
      • encourage self-care and independence
    4. Trends
      • Medicare, Medi-Cal
      • Perspective Payment System (PPS)
      • Managed care
      • Hospice
      • Pay for Performance (P4P)
4. Identify members of the home health care team, their functions, and how they interact.

Learning Activity #1

Home Health Agency Treasure Hunt (p. 22)

Attends a home health team conference

Relate to specific agency
  1. Home health care team members and their function
    • Admin – responsible for HH agency personnel and services, directs agency activities
    • Client and family – consumer, recipient of care
    • Clinical Supervisor– responsible for day to day supervision of all clinical staff
    • Dietitian – counseling and instruction in nutrition, special diets and food
    • Home Health Aide – provides basic nursing and personal care for a client in the home under the supervision of a licensed nurse
    • Occupational Therapist – teaches disabled individuals how to manage activities of daily living
    • Physical Therapist – provides exercises and treatments to restore function and prevent disability
    • Physician – diagnosis, prescribes medical care for the client
    • Case Manager(RN) – assesses, plans, manages and evaluates care provided by team for clients.
    • Social Worker – helps clients and family having psychological or social problems with resources and counseling
    • Speech Language Pathologist – provides treatment to clients who have swallowing and speech disorders
    • Licensed Vocational Nurse – provides nursing care under the supervision of a registered nurse
  2. Team interaction and responsibilities
    • Provide care identified in care plan
    • Observe client’s response and update records
    • Communicate with other team members regarding client status, change, needs
    • Contribute to care plan and team conferences

SUGGESTED
LEARNING
ACTIVITIES
5. Describe the role and responsibilities of the certified home health aide.

Learning Activity #2

Role play – do’s and don’ts of HHA conduct

Example: Family member asks HHA to work weekend without agency knowledge.

Learning Activity #3

Needs Assessment (p 23)
  1. Role of HHA – provides care, simple nursing procedures and housekeeping
    • for ill or disabled clients in the home
    • specifics in agency job description
    • HHA important member of home care team
  2. Responsibilities of HHA
    • Importance of agency policies and procedures
      1. supervision
      2. employment practices
      3. agency policy and procedures
      4. nursing policy and procedures
    • Paraprofessional conduct
      1. qualities (caring, listening, respect)
      2. personal hygiene (bathing, appearance)
      3. uniform and identification
      4. work ethic (honesty, punctuality)
    • Legal and ethical aspects
      1. confidentiality – in accordance with the HIPAA regulations client medical information will only be disclosed to authorized persons. Patient will designate in writing who may receive information about their medical condition.
      2. malpractice – applies to licensed professionals – refers to not practicing within legal description of job performance
      3. negligence – forgetting of failing to carry out responsibilities or care
      4. privacy – assuring clients are not unnecessarily exposed during care
      5. clients rights – right to respect, privacy, information, appropriate care
      6. liability – improper use of clients equipment and household item, damage to client’s property

Refer to Resident Rights – NATAP Module 2 (Also see HHA Model Curriculum Unit 2 for Client Rights)

    • Care plan implementation
      1. personal care services – bathing, toiletries, shampoo
      2. cleaning and care tasks in home – client’s laundry, housekeeping in the immediate living environment
      3. nutrition services – encourage and serve special diets, assisting with eating
      4. inter-disciplinary referral for client needs, need for instruction regarding diet, information about medications

Show HIPAA video Demonstrates Para Professional Conduct in the home care setting

Functions within the role and responsibilities of an HHA

SUGGESTED
LEARNING
ACTIVITIES
6. Discuss common observations and documentation to be completed by the HHA.

Activity #4 Evaluation

Sample charting exercise: Using local agency forms to document care.
  1. Observation and documentation
    • Care and services summary – tasks to be done in home visit
    • Purpose of the client care plan – report/document changes in client status
    • Accidents/errors – damage to personal items, injury to clients, errors in care procedure
    • Abuse – evidence of psychological, physical, financial abuse or neglect caregiverver, e.g., fear, injury, lack of food and care

Review appropriate terminology and abbreviations (see Figure 1 Appendix) Refer to Observation and Charting- NATAP or DHS Module 15.

Evaluation

Written test
7. Describe key steps involved in the communication process and methods used in communication

Evaluation

Written exam

Review Communication and Interpersonal Skills- NATAP or DHS Module 3.

  1. Important steps in communication
    • Message
    • Receiver
    • Sender
    • Interpretation
  2. Methods used in communication
    • Verbal
    • Non-Verbal
    • Written
    • Electronic

Handout: Potential barriers to effective communication with the patient (p. 29)

Give examples of the 4 methods of communication.

Role play (optional)

Group discussion of each of the 5 barrier to communication
8. Describe steps key steps to accommodate communication with clients who have hearing and speech disorders.
 Communicates effectively with clients who have hearing or speech disorders
  1. Communication with a client with special problems
    • Hearing difficulties
      • face person at the same level in good light
      • use body language, gestures, consistent with what is being said
      • use short sentences
      • repeat if necessary
    • Speech/Language Problems
      • do not talk to adults clients as if they are a child
      • as questions that can be answered by “yes”, “no”, or short answers
      • allow client time to answer
      • encourage the client to use speech
      • use picture boards or paper and pencil if necessary

Handouts: Client with hearing or speech difficulties (p. 24 & 58)

SUGGESTED
LEARNING
ACTIVITIES
9. Describe effective techniques for communicating with HH team members.

Learner Activity #5

Communication Role-play (p.26)

Group discussion
  1. Effective communications skills
    • Telephone – Identify self, client, phone number, time, and situation when communicating with or leaving a message for a team member
    • Effective communication regarding client care and service – make notes, make sure communication is to appropriate person
    • Accurate, objective reports – get data first, write down first to organize if necessary, describe the change from normal, use appropriate terminology and abbreviations
    • Active listening – good communication begins with good listening
    • Respond with respect and tact

Evaluation

Clinical observation Uses effective communication techniques when relating to team members
10. Describe ways to have effective communication in learning about your client.
 Group discussion and role-play
  1. Learning about your client.
    • Ask how they prefer to be addressed.
    • Accept views and practices without stereotyping.
    • Build trust by helping them to feel comfortable.
    • Treat everyone with utmost respect, kindness, and consideration.
    • Be patient with them and listen with compassion.
    • Use certified interpreters when necessary.
    • Ask what they think and feel about a treatment to validate their feelings.

11. Describe how to access community agencies to meet clients needs.
 Utilizes community agencies to meet client needs
  1. Accessing Community Resources
    • local agencies and services
    • know what is available (ie., friendly visitors)
  2. Obtain information about agencies for client/family (e.g., brochure, phone number)
  3. Referral to team member – social worker
  4. Referral to protective services for abuse

SUGGESTED
LEARNING
ACTIVITIES
12. Identify organizational and time management techniques for daily work schedule.

Learning Activity #6

Given a sample assignment, provide plan for that day
  1. Plan daily work according to steps
    1. list tasks
    2. set priorities
    3. organize tasks, supplied, equipment and travel
  2. Implement the daily plan
    1. be prepared to adapt to changes
    2. whenever possible accommodate client’s preferences
    3. follow care plan
    4. function ethically – not “cutting corners” on client time or services
    5. adhere to agency policy and procedure
    6. maintain schedule or report problems
  3. Document and Report
    1. client care
    2. client safety needs
    3. accidents, errors and abuse
    4. time
    5. mileage
  4. Evaluate effectiveness of daily plan
    1. review plan
    2. modify for future
    3. confer with supervisor/manager

Learner Activity #7

Map Reading (p. 27)

Demonstrates organizational and time management skills

 

Unit 1: Introduction to Aide and Agency Role

Activity: Home Health Agency Treasure Hunt/Report

Upon completion of the first day of clinical experience, the student will submit a report detailing the following information:

  1. Name of agency
  2. Location of agency with nearest cross streets identified
  3. Name of Director of Home Health Aides or Home Health Aide Supervisor
  4. Protocol for home health aide assignment, i.e., how does HHA receive assignment for the day
  5. Protocol for contacting clients and scheduling visits
  6. Protocol for first visit to new client, i.e., the client has not received service before
  7. Contact person at agency and protocol for reporting client information throughout the day
  8. Protocol for reporting any emergency situation
  9. Name of three members of the home health agency not already named above and their role in the home health agency

 

Unit 1: Introduction to Aide Agency Role

Activity: Learning Needs List

This exercise is designed to provide the student with an opportunity to learn about home health care. The instructor will discuss the types of health and social problems encountered during the care of clients and their families. This base will allow the student to consider the knowledge and skills needed to provide service to the client in the home setting. The student will identify their personal knowledge and skill level and specify additional learning needs.

Discussion may include the following:

  • What tasks/ services do home health aides provide to clients? (List on a flip chart. Try to involve the students.)
  • Which of the home health aide tasks has the student performed at some time?
  • Which tasks would the student be comfortable doing?
  • In which home health aide tasks and activities does the student feel he or she needs more knowledge and skill?

Compare learning needs with areas of comfort.

Review the list, making reference to specific parts of the training program to identify where each item will be addressed. For example, if the item relates to personal care, the instructor could indicate that this will be discussed in Unit 3 and that there will probably be a field experience in which to practice the skill.

 

Unit 1: Introduction to Aide Agency Role

Handout: Communication with Individuals with Hearing Disorders

  1. Speak in a normal or lower tone of voice; do not shout. Hearing loss is usually most pronounced in the higher range of sound.
  2. If the individual has a “good” ear, try to position yourself toward that side when speaking. If hearing loss involves both sides then it is best to place yourself in front of the person at the same level.
  3. Reduce distracting noises, i.e., turn down the TV or radio, close doors.
  4. Make sure lighting is good. Avoid standing with light behind you or where there is glare.
  5. Get the individual’s attention first, using a technique such as a light touch on the arm.
  6. Avoid having gum or other material in your mouth when speaking. Make sure you do not cover your mouth or that your mouth is not covered when you are talking. Many people lip read to compensate for their reduced hearing.
  7. Speak at a normal rate or slightly slower. Do not exaggerate words. It can distort sound and lip positions that people rely on for lip reading.
  8. Use short complete sentences expressing complete thoughts. Avoid incomplete rambling sentences and complex words.
  9. Use expressions, gestures, and body language to help communicate information. Make sure that the nonverbal communication is consistent with the verbal information that is being given.
  10. Repeat information if necessary. It may help if different words are used to express the same idea.
  11. Write out important information for the client.

Unit 1: Introduction to Aide and Agency Role

Handout: Communication with individuals with Speech/Language Disorders

  1. Listen with your full attention when the individual is speaking.
  2. Acknowledge if you did not understand and politely ask the individual to repeat what they said.
  3. If you are unsure about what has been said, repeat the information to the individual and ask if it is correct.
  4. Watch the individual’s gestures, expressions, and body language during the conversation for cues to words or information.
  5. Talk to the individual as you would someone of the same age. If the individual is an adult, talk to them as an adult.
  6. Give the individual time to respond to questions or take part in the conversation. Avoid the tendency to provide words if a person has difficulty speaking.
  7. Make sure you include the individual having a speech/language disorder in the conversation if it is a group conversation. If you need information regarding the speech/language impaired individual, direct your questions to the individual rather than someone else.
  8. Ask questions that can be answered “yes” and “no”, or with short answers.
  9. If necessary, use pictures or word boards for communication.

Unit 1: Introduction to Aide and Agency Role

Activity: Communication Role Play

  1. Break the class into small groups or pairs.
  2. Each group/ pair is to role play for the class one of the following situations using good communication techniques:
    • A client’s friend phones the home when the HHA is present. The client is using the bathroom and asks the HHA to answer the phone and take a message.
    • The HHA is on his/ her way to a client’s home. En route, the HHA has a flat tire and calls the office to report the delay.
    • During the team conference, it is suggested that a new intervention should be made part of a client’s care. From working with the client, the HHA knows that this intervention would not be acceptable to the client. How should this be communicated to the team?
    • During a visit, the HHA identified that the client could use the services of the agency’s social worker. What communication should take place?
  3. Allow the groups/ pairs five to ten minutes to discuss their situation and plan their script.
  4. After each presentation, allow time for comments and further suggestions.

Unit 1: Introduction to Aide and Agency Role

Activity: Map Reading

  1. Prepare a list of “clients” to be seen for a day. List the names and addresses of the clients on a sheet of paper and any other activities or locations that might be included in an aide’s daily schedule.
  2. Break the class into small groups of three or five individuals.
  3. Give each group a copy of clients to be seen and other activities to be included, and a map of the area.
  4. Allow groups twenty to thirty minutes to locate the address on the map and plan routes to and between the addresses.
  5. A general discussion can be held after the activity to highlight key points of prioritizing activities, map reading techniques, alternate routes, and schedules.

Unit 1: Introduction to Aide and Agency Role

Handout: Potential Barriers to Effective Communication with the Client

  • Age
  • Gender
  • Physical or Mental Disability
  • Socio-Economic/ Education
  • Language

Age

  • Elderly may assume a problem is normal due to aging process
  • Adolescent may be sensitive about appearances and needing privacy

Gender

  • Patient may prefer to receive care from caregiver of same sex
  • Cultural values may prohibit touching from any member of the opposite sex

Physical/Mental Disability

  • Patient may have difficulty communicating or understanding the medical process or treatment due to a mental or physical disorder or handicap

Socio-Economic/Education

  • Financial hardships may keep a patient from seeking treatment
  • Cultural and religious groups may influence a patient’s decision for treatment o Lack of education can cause barriers to a patient’s understanding or ability to communicate

Language

  • Use a certified/trained Medical Interpreter or Language Assistant Line
  • Avoid using family members for medical interpretation, due to lack of knowledge and emotional involvement with family member

QuizzesStatus

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