18 Miss. Code. R. 2-2.13 - PERSONAL CARE SERVICES

A. Definition and Purpose

Personal care services are services to assist the functionally impaired elderly and disabled with activities of daily living (ADL). The activities of daily living are bathing, dressing, eating, toileting, transferring, ambulation and assistance with medications which are ordinarily self-administered by the client; assistance with food preparation and feeding; performance of household services essential to the client=s health and comfort in his/her home but not limited to.

B. Eligibility

Individuals 21 years and older who have functional, physical, or mental characteristics which prevent them from providing the service for themselves and who do not have an informal support network (family, friends, neighbors, etc.) capable of meeting their service needs.

C. Unit of Service

One unit of service equals one hour of direct service to, for or on behalf` of the client.

D. Minimum Program Requirements

All providers of personal care services under Title III, SSBG or other funds through contractual agreement with an Area Agency on Aging must adhere to the following minimum program requirements:

* All clients are to be entered into the State Approved Client Tracking System no later than 10 working days.

1. Service Activities - The Personal Care Worker shall have knowledge of and/or perform the following:

a. Human Growth and Development - Be knowledgeable of the aging process in order to assist the client in understanding his or her aging process and the changes that occur as he or she ages.

b. Personal Hygiene - Assist the client with the activities of daily living (ADLs) such as:

1) Bathing

2) Tub bath/shower

3) Sponge/partial bath

c. Shampoo and Groom Hair - Wash, brush, oil and comb the client's hair.

d. Ambulation - Assist the client in walking from one point to another.

e. Diversion and Recreation - Take the client's mind off the pain or discomfort he or she may be feeling, reducing boredom. If client has a cane, wheelchair or walker, encourage the client to use it.

f. Dressing - Assist the client in finding, preparing and putting on or taking off clothes.

g. Toileting - Help the client to understand the importance of regular elimination of body waste and assist client in using the commode, urinal or bedpan.

h. Feeding - Feed client in a position that does not prevent digestion of food and does not block airway or cause choking.

i. Oral Hygiene - Keep the client's teeth and gums clean and healthy, mouth refreshed and encourage regular dental check-ups. This helps to improve the client's appetite.

j. Bed Making B Change the bed linen with or without the client in the bed.

k. Sleeping and Rest Habits B Be aware of the sleeping patterns and rest habits of older people and encourage clients to take frequent rest periods.

l. Safety B The Personal Care Worker should be aware of overall protection of the household from predictable hazards and do everything possible to ensure a safe environment for the client, which includes being knowledgeable of:

1) Basic first aid and CPR;

2) Proper cleaning techniques;

3) The effects of medication on clients;

4) How to prevent burns, falls and fires and the types of accidents to which elderly clients are prone;

5) The phone numbers to contact emergency personnel;

6) How to recognize the signs of abuse, neglect and exploitation; and proper reporting protocol.

7) Diseases such as AIDS, tuberculosis, pneumonia and other infections, communicable or contagious diseases and proper disease prevention techniques.

m. Health- Encourage healthy lifestyles with good habits of eating, dieting and exercising. The personal care worker should be aware of the leading causes of death among the elderly such as cancer, strokes, diseases of the heart/heart attacks and others. Evidence suggests that heavy smoking, alcohol abuse, poor nutrition, improper exercise, and the lack of regular medical check-ups are associated with a variety of poor health conditions later in life.

n. Substandard Housing - Have a basic knowledge of existing county and city housing codes and be aware of the individual agencies' telephone number and process for making referrals for clients residing in substandard or inadequate housing.

2. Location of Service

Personal care services may be provided in the client's home.

3. Access to Services

a. A client may enter the service system at any point through an appropriate referral.

b. Priority shall be given to serving clients with the greatest need for the service.

4. Delivery Characteristics

The following guidelines represent the basis by which personal care services shall be provided. These guidelines serve as minimum instructions.

a. Voluntary Contribution - Clients shall be allowed to voluntarily contribute to the cost of the service. However, services will not be denied due to a client's inability to contribute.

b. Gloves and Masks - Personal care workers shall wear safety items such as gloves and partial facial masks when needed to prevent the spread of infections or diseases.

c. Service Hours - Personal care services shall be available at least five (5) days a week, preferably between 8:00 a.m. to 5:00 p.m.

d. Uniforms - Personal care workers shall wear uniforms. The uniform may consist of a smock top, a hospital scrub suit, lab jacket, apron, or whatever has been designated by the provider agency as a uniform. The uniform must be the same in color, style, and design for all the personal care workers. It is left to the discretion of the service provider to supply the uniform or have workers to purchase one. A personal care worker in a proper uniform has a professional appearance that makes the client feel more secure and enables the client to distinguish from other para-professionals entering the client's home.

e. Identification Badge -Personal Care Workers shall wear an Identification (ID) Badge or picture ID, which contains the agency name, the personal care worker's name and title. It is left to the discretion of the provider to determine how the badge is designed or obtained.

f. Confidentiality - Personal Care Workers shall maintain confidentiality of client information as indicated on the Consumer Information Form.

g. Case Record - The client case record shall consist of:

1) Consumer Information Form, which contains Confidentiality and Authorization Release;

2) Service Plan (non-case managed clients only);

3) Record of Contact (used for documentation of visits and other pertinent information); and,

4) Personal Care Activity Sheet.

h. Back-up System - The service provider shall provide a back-up system. A back-up system is vital during vacations, long periods of illness or death. The back-up system is a substitute, or an alternate means to ensure that the client is provided the service(s) on the service plan.

i. Reporting B Personal Care Workers shall report abusive behavior or situations to their supervisor immediately and document the behavior in the case record.

j. Harassment B Personal Care Workers shall not permit or tolerate sexual harassment or advances by clients. The worker must firmly state to the client or family member in the home that such behavior is not acceptable. If such behavior occurs, the worker should tell the client that such behavior will be reported to their supervisor and walk away. However, the worker shall handle the situation with diplomacy and tact but always refuse to participate in any sexual misconduct with the client.

k. Jewelry B Personal Care Workers shall limit the amount of jewelry worn into the client's home. A watch is the most appropriate piece of jewelry to wear. Dangling jewelry such as earrings, necklaces and bracelets should not be worn because they can catch on bedding and furniture, or the client may pull on them and injure the worker. A ring may scratch the client or become lost while performing tasks in the home. If these items are lost or damaged, they are not reimbursable by the provider or client.

l. Liability - The most important protection from liability for the personal care worker is to do exactly what has been prescribed on the care or service plan or instructed by the supervisor. When the worker follows the care or service plan or instructions of the supervisor, the provider agency assumes responsibility for the worker's actions.

m. Documentation - The worker shall write down on the record of contact any and all factual observations, contacts or visits with the client and actions or behaviors displayed by the client. This documentation is essential in determining if changes should be made in the care or service plan. It is also essential to show that certain tasks were performed on certain dates and times. Furthermore, the case record documentation is a valuable source of information in the event of legal action.

n. Waiting List - Each Area Agency on Aging (contracted or direct services) shall develop policy to ensure the provision of services to those eligible individuals in the greatest need waiting to receive assistance.

o. Coordination with Case Management - The personal care supervisor shall maintain regular and on-going communication with the case management provider. Such communication will keep both the worker and case manager abreast of the client status and help in deciding whether to continue or terminate services.

p. Termination of Clients - Clients receiving services shall be terminated based on the following criteria:

1) Death;

2) Relocation out of state or Planning and Service Area;

3) Increased informal or formal support, or a relative moving in to care for client;

4) Improved health status or condition;

5) Client becoming abusive and belligerent, including sexual harassment;

6) Client refuses service;

7) Client reports that he/she no longer needs the service and is able to manage activities of daily living;

8) Client is placed in a long term care facility; and,

9) Services are duplicated.

Any situation involving the above criteria must be reported to the personal care supervisor and documented in the client's case record.

5. Staffing

a. The provider agency shall ensure that the agency has an adequate number of full-time and part-time staff to cover the counties where services are available in the PSA.

b. There shall be at least one (1) supervisor for every twenty full-time equivalent (FTE) personal care workers.

c. The person responsible for supervision of the personal care workers shall have the following qualifications:

1) A Bachelor's Degree in nursing, a Registered Nurse (RN), or a related profession; or

2) A Licensed Practical Nurse (LPN).

6. Training

a. The provider agency is responsible for assuring that all workers and supervisors are in compliance with the Quality Assurance Standards.

b. The supervisor shall observe and evaluate the worker performing assigned tasks in the client's home annually.

c. The provider agency shall provide on-going in-service training that consists of a minimum of eight (8) hours per year. Such training can be conducted in intervals most convenient for the agency and staff, and can consist of work shops, conferences or academic course work related to the agency designated training material.

d. All personal care workers and supervisors shall receive orientation training provided by the agency prior to performing any assigned tasks relating to the program. Orientation training shall consist of:

1) Introduction to the agency and organizations in the aging network;

2) Introduction to community resources;

3) Review of the agency and Division of Aging and Adult Services policies, procedures and applicable service regulations;

4) Overview of the program history, intent, funding source and target population; and,

5) Worker responsibilities and tasks.

e. Employee background checks are required due to the increase in adult abuse, child abuse, terrorist acts and false or inflated information supplied by job applicants..

7. Case Record Retention

a. All client records shall be retained for four (4) years after a client has been terminated from the program.

b. If a client has been terminated and re-enters the system within four (4) years from the date of termination, the previous case-record shall be retrieved, updated and used.

c. All case records shall be maintained in an area that will protect confidentiality of information, protect from damage, theft and unauthorized inspection or use.

8. Monitoring, Evaluation and Reporting

a. The MDHS Office of Monitoring shall monitor the Area Agency Program annually with periodic reviews at the discretion of the Division of Aging and Adult Services.

b. The Area Agency on Aging shall monitor the service provider semi-annually.

c. The personal care units of service provided will continue to be reported on the Monthly Program Performance Report submitted to the Division of Aging and Adult Services and by the Area Agency on Aging.

9. Prohibited Service Activities

The personal care worker may be faced with problems while caring for a client and may be asked in the work place to perform tasks that are not part of the job description. If asked to perform a prohibited activity, the worker may reply, "I am not allowed to do that; the agency must give me permission before such work can be done." The worker shall not:

a. Use client's car;

b. Consume client's food or drink;

c. Use client's telephone for any reason other than an emergency or work-related activity;

d. Engage in the discussion of his/her personal problems or religious or political beliefs with clients;

e. Breach client's confidentiality;

f. Accept gifts or tips;

g. Bring friends, relatives, or other guests to the client's home;

h. Engage in consumption of alcoholic beverages in the client's home or prior to or during service delivery to clients;

i. Smoke in client's home;

j. Solicit money or goods from the client;

k. Perform or engage in yard maintenance;

l. Perform or engage in home repairs;

m. Administer medication or give injections;

n. Use illegal drugs;

o. Wear high or spiked heels;

p. Use abusive language in the client's home;

q. Engage in sexual misconduct with client;

r. Clean up after anyone except the client or the client's spouse if he or she cannot do so;

s. Engage in heavy cleaning;

t. Hang or launder curtains;

u. Wax hardwood floors; or

v. Move heavy furniture.

Notes

18 Miss. Code. R. 2-2.13

Older Americans Act of 1965, As Amended 2006 (Public Law 109-365), Section 373(e) (1)