PROXY CAREGIVER WORKSHOP

OWNERS, ADMINISTRATORS AND EXECUTIVE DIRECTORS

DEFINE THE ROLE OF THE PROXY CAREGIVER

DEFINE LICENSED HEALTHCARE FACILITIES VS. LICENSED RESIDENTIAL FACILITIES

STATE THE DIFFERENCES BETWEEN PERSONAL CARE AND HEALTH MAINTENANCE SERVICES/ACTIVITIES

DISCUSS THE KEY COMPONENTS OF AN INFORMED CONSENT FOR PROXY CARGIVERS

BE ABLE TO INTEGRATE PROXY CAREGIVERS INTO FACILITY OPERATIONS

DISCUSS THE COMPONENTS OF A BACK-UP PROXY CAREGIVER SERVICE PLAN

DISCUSS WITH POTENTIAL OR CURENT RESIDENTS HOW PROXY CAREGIVERS ARE USED IN THE FACILITY

IDENTIFY THE TRAINING REQUIREMENTS FOR PROXY CAREGIVERS

DISCUSS THE TRAINING REQUIREMENTS FOR PROXY CAREGIVERS THAT ADMINISTER MEDICATIONS TO SPECIFIC RESIDENTS

EXAMINE AN EXAMPLE OF A MEDICATION ADMINISTRATION CURRICULA THAT CAN BE USED TO TRAIN PROXY CAREGIVERS

IDENTIFY MEDICATIONS THAT ARE PROHIBITED FROM BEING GIVEN BY A PROXY CAREGIVER

DISCUSS THE DIFFERENCES BETWEEN PROXY CAREGIVER AND MEDICATION AIDE

SERVICES THAT ARE REQUIRED BY RESIDENTS

PERSONAL CARE

SERVICES

EATING, BATHING,

GROOMING, DRESSING

ACTIVITIES OF DAILY LIVING

TRANSFERS, TOILET USE,

EATING, BATHING, BED

MOBILITY

HEALTH MAINTENANCE

ACTIVITIESHB 1040

UNLICENSED PERSON

QUALIFIED THROUGH TRAINING;

KNOWLEDGE AND SKILLS; COMPETENCY

BASED

TRAINED BY A LICENSED HEALTHCARE

PROFESSIONAL

HEALTH MAINTENANCE ACTIVIITES

WRITTEN INFORMED CONSENT BASED ON PHYSICIAN ORDERS

PLAN OF CARE

A PROXY CAREGIVER IS AN UNLICENSED PERSON WHO HAS BEEN DETERMINED QUALIFIED TO HAVE THE NECESSARY KNOWLEDGE AND SKILLS ACQUIRED THROUGH TRAINING BY A LICENSED HEATHCARE PROFESSIONAL TO PERFORM DOCUMENTED HEALTH MAINTENANCE ACTIVITIES INCLUDING SPECIALIZED PROCEDURES, FOR AN INDIVIDUAL WITH A DISABILITY WHO HAS DELEGATED TO THE DESIGNATED PROXY CAREGIVER THE PERFORMANCE OF SUCH HEALTH MAINTENANCE ACTIVITIES THROUGH EXECUTION OF A WRITTEN INFORMED CONSENT BASED ON WRITTEN PHYSICIAN ORDERS BY THE INDIVIDUAL WITH A DISABILITY OR LEGAL GUARDIAN

HEALTH MAINTENANCE ACTIVITIES ARE THOSE LIMITED ACTIVITIES THAT, BUT FOR A DISABILITY, A PERSON COULD REASONABLY BE EXPECTED TO DO FOR HIMSELF OR HERSELF.

SUCH ACTIVITIES ARE TYPICALLY TAUGHT BY A LICENSED HEALTHCARE PROFESSIONAL OR CAN BE TAUGHT DIRECTLY TO THE RESIDENT.

DOES NOT INCLUDE ACTIVITIES THAT REQUIRE COMPLEX OBSERVATIONS OR CRITICAL THINKING.

CAN BE SAFELY PERFORMED AND HAVE REASONABLY PRECISE, UNCHANGING DIRECTIONS; AND HAVE OUTCOMES OR RESULTS THAT ARE REASONABLY PREDICTABLE.

WHAT IS MEANT BY “COMPETENCY-BASED

TRAINING”?

TRAINING THAT IS TIED TO AN INDENTIFIED SET OF SKILLS

AND KNOWLEDGE REQUIRES INDEPENDENT

DEMONSTRATION AND DOCUMENTATION

ACCEPTABLE LEVEL OF PERFORMACE OF A TASK OR

ACHIEVEMENT OF AN OUTCOME

WRITTEN EVIDENCE OF SATISFACTORY

PERFORMANCE ON INITIAL AND ANNUAL SKILLS

COMPETENCY DETERMINATIONS

UTILIZE CHECKLIST DEVELOPED BY DCH OR LICENSED HEALTHCARE

PROFESSIONAL

TEST THE KNOWLEDGE AND OBSERVATION OF THE SKILLS

NECESSARY TO DO THE SPECIFIC HEALTH MAINTENCE

ACTIVITY IN ACCORDANCE WITH STANDARDS OF CARE

COMPETENCY BASED SKILLS CHECK-OFFS

HEALTH MAINTENANCE ACTIVITIES ARE TAUGHT BY AN ATTENDING

PHYSICIAN, REGISTERED NURSE, PHYSICIAN ASSISTANT, ADVANCED

PRACTICE NURSE, PHARMACIST

OR DIRECTLY TO THE RESIDENT

HIMSELF/HERSELF

THESE HEALTH MAINTENANCE ACTIVITIES ALLOW RESIDENTS TO REMAIN IN THEIR LIVING ENVIRONMENT OF CHOICE ONCE THEIR CARE REQUIREMENTS GO BEYOND PERSONAL CARE SERVICES

LICENSED HEALTHCARE PROFESSIONALS

NOT ALLOWED UNDER PROXY CAREGIVER REGULATIONS

COMPLICATED WOUND CARE

IV MEDICATION ADMIN

CENTRAL LINES

INITIAL DOSES OF IM OR SQ MEDICATIONS

WHERE CAN PROXY CAREGIVERS BE EMPLOYED?

RESIDENTIAL FACILITES--YES

• PCHs AND ALFs

• COMMUNITY LIVING ARRANGEMENTS

• RESIDENTIAL DRUG ABUSE TREATMENT

EDUCATION PROGRAMS

• TRAUMATIC BRAIN INJURY FACILITES

PRIVATE HOME CARE PROVIDERS

HEALTHCARE FACILITIES--NO

• HOSPITALS

• RESIDENTIAL MENTAL HEALTH FACILITIES

• NURSING HOMES

• MEDICARE-CERTIFIED HOME HEALTH AGENCIES

EXAMPLES OF HEALTH MAINTENANCE ACTIVITIES

CATHETER CARE

MEDICATION ADMINISTRATION

BLOOD GLUCOSE MONITORING

RANGE OF MOTION

EXAMPLES OF HEALTH MAINTENANCE ACTIVITIES

SPLINT APPLICATION

SIMPLE DRESSING CHANGE

OSTOMY CARE

HOW ARE PROXY CAREGIVERS HIRED?

FACILITY FOLLOW FACILITY HIRING

PROCEDURE

APPLICATION, CRC, TB SCREENING

DRIVING RECORD, IF APPROPRIATE

ORIENTATION

COMPETENCY BASED TRAINING

DOCUMENTATION IN FILE

RESIDENTCRC, TB SCREENING, DRIVING

RECORD

EVACUATION PROCEDURES

ENSURE THERE IS A PROCEDURE IN PLACE TO PROTECT OTHER RESIDENTS FROM HARM BY PROXY CAREGIVERS NOT UNDER THE CONTROL OF THE FACILITY

DOCUMENTATION IN FILE

WHAT HAPPENS WHEN THE PROXY CAREGIVER CANNOT PROVIDE SERVICES?

ILLNESS

FAMILY EMERGENCY

CHILL ILL

INCLEMENT WEATHER

CAR TROUBLE

PROXY CAREGIVERS VS CERTIFIED MEDICATION AIDES

ASSISTED LIVING FACILITIES

• ASSIST WITH OR SUPERVISE SELF-ADMINISTRATION OF MEDICATIONS TO RESIDENTS THAT ARE CAPABLE OF SELF-ADMINISTRATION. CANNOT ADMINISTER MEDICATIONS

• CAN PERFORM OTHER HEALTH MAINTENANCE ACTIVITIES

• MEDICATION AIDES

PERSONAL CARE HOMES• CAN ADMINISTER MEDICATIONS

IF PROPERLY TRAINED

• CAN PERFORM ADDITIONAL HEALTH MAINTENANCE ACTIVITIES

• CAN ASSIST/SUPERVISE MEDICATIONS TO RESIDENTS THAT CAN SELF-MEDICATE

WHAT SYSTEMS MUST BE IN PLACE TO IMPLEMENT A PROXY CAREGIVER PROGRAM

POLICY/PROCEDURE

PHYSICIAN ORDERS

INFORMED CONSENT

PLAN OF CARE

TRAINING CURRICULA

SKILLS CHECK-OFFS

POLICIES AND PROCEDURES

SCOPE OF THE HEALTH MAINTENANCE ACTIVITIES THAT ARE

PERFORMED BY THE PROXY CAREGIVERS

NOTIFICATION PROCEDURES THAT WILL BE UTILIZED WHEN THE PROXY CAREGIVER OBSERVES A CHANGE IN THE RESIDENT’S CONDITION THAT MAY NEED FURTHER EVALUATION/TREATMENT

THERE IS A CHANGE IN THE PLAN OF CARE

SAFETY AND SECURITY PRECAUTIONS (CRC, TRAINING)

THE MANNER IN WHICH PROXY CAREGIVERS ARE SUPERVISED; FREQUENCY OF RE-EVALUATIONS

BACK-UP PROXY CAREGIVERS; QUALIFICATIONS OF THE LICENSED HEALTHCARE PROFESSIONALS

MANNER IN WHICH RESIDENTS CAN CHANGE PROXY CAREGIVERS

ADMISSION AGREEMENT

AFTER JANUARY 8, 2013, MUST STATE WHETHER FACILITY ALLOWS PROXY CAREGIVERS

IF PROXY CAREGIVERS ARE ALLOWED, THEN MUST STATE WHETHER OR NOT THERE WILL BE ANY ADDITIONAL CHARGES

MEDICATION POLICIES/PROCEDURES REQUIREMENTS

ADDRESS PROCEDURES FOR RECEIVING MEDICATIONS

RECONCILING MEDICATIONS RECEIVED AGAINST THOSE ORDERED

MEDICATION STORAGE

PROCEDURES FOR MANAGING MEDICATIONS

PROCEDURES FOR DISCONTINUED MEDICATIONS

PROCEDURES FOR DISPOSAL OF MEDICATIONS

TRAINING REQUIREMENTS

TRAINING CURRICULA DEVELOPED BY A LICENSED HEALTHCARE PROFESSIONAL THAT ENSURES THAT THE PROXY CAREGIVER DEMONSTRATES THE HEALTH MAINTENACE ACTIVITY CORRECTLY AND SAFELY

LEARNING OBJECTIVES THAT RELATE SPECIFICALLY TO THE HEALTH MAINTENANCE ACTIVITY TO BE PERFORMED

CONTENT KNOWLEDGE AND SKILLS THAT ARE REQUIRED TO ACCOMPLISH THE LEARNING OBJECTIVES

LEARNING OBJECTIVES THAT WILL BE UTILIZED TO PROVIDE INSTRUCTION ON KNOWLEDGE AND SKILLS REQUIRED

SATISFACTORY AND INDEPENDENT COMPLETION OF THE REQUIRED SKILLS COMPETENCY CHECKLIST RELATED TO THE SPECIFIC ACTIVITY TO BE PERFORMED BEFORE AN APPROPRIAELY TRAINED LICENSED HEALTHCARE PROFESSIONAL

TRAINING REQUIREMENTS

SKILLS COMPETENCY CHECKLIST FORMS MUST INCLUDE ALL THE REQUIRED

INFORMATION SET FORTH IN THE REGULATIONS AND REQUIRED BY THE SPECIFIC RESIDENT

SATISFACTORY EVIDENCE OF ROUTINE EVALUATIONS OF CONTINUED SKILLS COMPETENCIES BY AN APPROPRIATELY LICENSED HEALTHCARE PROFESSIONAL AT LEAST ANNUALLY IF NOT ASSESSED MORE FREQUENTLY AS SPECIFIED ON THE WRITTEN PLAN OF CARE

A SCORE OF 75% OR GREATER ON THE TEST OF FUNCTIONAL HEALTH LITERACY (TOFHLA) USED AS AN ASSESSMENT TOOL TO INDIVIDUALIZE NECESSARY TRAINING FOR THE SPECIFIC SKILLS

MEDICATION ASSISTANCE RECORD

NAME OF THE RESIDENT

ANY KNOWN ALLERGIES

NAME, TELEPHONE NUMBER OF THE HEALTHCARE PROVIDER

THE NAME, STRENGTH AND SPECIFIC DIRECTIONS OF EACH MEDICATION

TIME/DATE MEDICATIONS ARE TAKEN OR REFUSED

MEDICATION RESOURCES FOR PROXY CAREGIVERS

CHANGES IN RESIDENT CONDITION

CHANGES IN RESIDENT’S MEDICATIONS

CHANGES IN RESIDENT’S PLAN OF CARE

CHANGES IN HEALTH MAINTENANCE ACTIVITIES

INTRODUCE CONCEPT TO MEDICAL DIRECTOR,

PHYSICIANS AT QA MEETING

DISCUSS THE CONCEPT OF “AGING IN PLACE”

DEVELOP POLICIES TO ADDRESS SAFETY,

TIMELY NOTIFICATION AND DOCUMENTATION,

AA

INTRODUCE PROXY CAREGIVERS CONCEPT

TO RESIDENTS/FAMILIES

AND STAFF

DISCUSS HOW PROXY CAREGIVERS WILL BE

UTILIZED IN THE FACILITY

FEES FOR HEALTH MAINTENANCE ACTIVITIES

QUESTIONS

Alfreda Bivins RN Consultant

678-576-8790

alfreda@fivestarresourcegroup.com