PERSONAL CARE

        Personal Care services is the provision of "hands-on" assistance to a client in his/her own home with personal hygiene and functional activities of daily living that an individual cannot perform independently. Activities include bathing, dressing/undressing (including assistance in the application and removal of previously self-applied personal appliances and adaptive devices), feeding, toileting, grooming, transfer, ambulation and assistance with medications.

        In general, personal care service will only be authorized for those clients whose primary need for "hands on" personal care, as reflected in the care plan, has been established. In addition, some degree or amount of personal care must be provided during each home visit. Should incidental or supplemental home maintenance tasks (such as laundry, shopping or housekeeping) be reflected in the care plan as a secondary need, the personal care worker may perform these activities without displacing existing or available informal supports. Again, the primary need for personal care must be established and provided in some fashion during each home visit by the provider agency.

Activities

        Bathing: assistance to the client with bathing in the tub, shower or bed. (Totally dependent, bedridden clients who are unable to direct the bathing activity by the personal care worker, and/or are unable to provide any assistance in washing themselves or are unable to move independently in bed are not appropriate for bathing by a personal care worker. However, when care is under nurse management, a personal care worker can augment the medically supervised care as long as the personal care tasks are limited to those allowed under the personal care definition).

        Skin Care: the routine application of lotion to unbroken uninfected, non-diseased skin surface.

        Mouth Care: assistance in care of teeth and mouth including care of dentures.

        Dressing: includes assistance with clothing as well as application of previously self-applied prostheses.

        Grooming: includes hair care, shaving, cleaning and filing of nails. (The diabetic client’s toenails may not be cared for by the personal care worker).

        Toileting: includes assistance with transfers on and off commode or toilet, emptying commodes and catheter bags.

        Ambulation/Transfer: includes steadying support and supervision to assist with walking and transferring.

        Change of position or Turning Client: does not include range of motion exercises, except when such care is under nurse management.

        Feeding: which may also include mashing of food for easier management and/or assistance in preparation and serving a meal.

        Medication: Aide can remind client to take medication, but client must be able to self-administer medications.

        Observation: reporting of changes in client conditions and needs as observed during performance of personal care.

        Instruction to Informal Caregivers: in the delivery of the above-listed activities.

        Respite to Informal Caregivers: from the provision of the above-listed activities.

        Personal care service may also include provision of supplemental housekeeping service as long as the primary service rendered is for personal care. These activities may include:

        Washing dishes and clean up after meal preparation;

        Making beds and linen change for the client;

        Shopping only if the client has an account at the store.  There can be no exchange of cash, gift cards, etc. between client and aide.  The aide can not transport the client under any circumstances.

        Washing the client’s personal laundry;

        Light housekeeping essential to maintaining a healthful living environment for the client

        Preparing and serving nutritious meals

        Assistance with home 

TRAINING

        Basic training of 40 hours must be completed within the first three months of employment.

Training shall be given in an organized course and include content related to:

a. orientation to the service;

b. interpersonal skills and understanding family relationships;

c. working with older persons;

d. personal care and rehabilitative care skills;

e. care of the home and personal belongings;

f. safety and accident prevention;

g. home, time and money management;

h. food, nutrition and meal planning.

        For each broad area of the training an appropriate professional shall provide instruction. A registered nurse (RN) must provide the skills training in personal care techniques.

        Evidence in proficiency in skills and completion of training course shall be documented in the personal care worker’s personnel file.

        No personal care service may be rendered by a personal care worker prior to demonstration of his/her competency in performing the specific service assigned.

        The requirement for completion of the 40-hour training requirement may be waived if the personal care worker:

        Provides documentation of completion of related training that includes demonstrated competency in all skill areas;

        Is able to demonstrate to the provider agency competency in all skill areas included in the required basic training and that observation of the competency is documented.

        In-service training shall be ongoing at a minimum of two hours each quarter. In-service training is in addition to the basic 40-hour requirement.

SUPERVISION

        All persons providing personal care must be adequately and appropriately supervised.

        Contractor must provide a Registered Nurse (RN) as part of the provision of personal care services:

a. an RN must be responsible for supervision of the personal care worker;

b. the RN must be licensed to practice in the Commonwealth of Pennsylvania;

c. the RN must have one year of related experience in home care or in supervision.

        Direct supervision of the personal care worker includes:

a. giving written and oral assignments and directions which include specific instructions on how care is to be rendered and how and what changes in the client’s condition must be observed and reported;

b. establishing schedules;

c. monitoring job performance-effective performance includes but is not limited to:

1. arriving at and leaving the client’s home when scheduled;

2. satisfactory accomplishment of tasks outlined in the care plan and in the worker’s written assignment;

3. being aware of changes in client’s needs and reporting these changes to the supervisor;

4. client satisfaction with personal care worker’s performance.

        Supervisory visits by a registered nurse must be made to a client’s home every 90 days to monitor the personal care worker’s performance and to identify changes in client’s condition/situation and their impact on the care plan. Reports of these supervisor visits using AAA forms will be forwarded to the care management unit of the AAA as appropriate. The personal care worker is not required to be present during the supervisory visit.

RECORDS AND DOCUMENTATION

        Records shall be maintained for each individual for whom the service is provided and shall be maintained in a confidential manner. All entries by the personal care worker and the supervisor shall be signed and dated.

        The record must contain:

a. Data that identify the client

b. Current care plan

c. The written assignment to the worker

d. Personal care worker daily log of service which indicates arrival and departure time and specific services provided

e. Workers’ comments and observations concerning the client’s condition and his/her response to service including the reporting of changes and/or problems to the supervisor

f. A record of supervisory visits

g. Statements of any change in client’s condition as observed and reported by the personal care workers and acknowledged by the supervisor

h. Statements of follow-up taken by the supervisor, including reporting to the care management unit of the AAA

APPLICATION FOR SERVICE

        Application for client funding for personal care service will be made directly to the AAA. The AAA will retain responsibility for the initial assessment of need through its assessment unit.

        As a result of the initial AAA assessment, a detailed individual care plan will be developed for each recipient. Each plan will be developed with the informed consent, approval and assistance of the personal care client or family, who will have the opportunity to identify needed service activities, days and hours of service, etc. The AAA will then identify broad service parameters (maximum hours/week and/or specific days and times for those clients with intensive needs).

        The approved care plan will be forwarded to the contractor for implementation. Contractor will schedule service with the client in conformance with the approved care plan. Currently, client care plans range from one to fifteen hours/week, depending on individual client needs.

        All clients will receive a priority rating at the time of intake. In cases where resources do not permit immediate service delivery to all persons in need, the AAA will use this priority ranking to determine the order in which clients will be served. The original rating may be revised as a result of subsequent needs assessment(s).