D.Service Standards – Adult Day Health Service Personal Care

Issue Date: 3/27/07 / Rev Date: 9/29/11

The following policy shall be used for Personal Care (PC) standards with Adult Day Health Service (ADHS).

  1. MINIMUM STANDARDS FOR ADHS PC

A.AAA 1-B contracted comprehensive care (Dementia) ADHS providers who are also in the AAA 1-B DSP pool will use the AAA 1-B Community Support Services (CSS) assessment and authorization.

  1. Each ADHS program shall assure that staff are supervised by a qualified professional who is available during the hours that staff are providing PC services.
  1. BASIC PROGRAM REQUIREMENTS
  1. PC services are limited to the provision of or assistance with ADLs and IADLs. ADLs for an individual with a demonstrated need include:
  1. Eating/Feeding – The process of getting food by any means from the receptacle (plate, cups, glass) into the body. This activity describes the process of eating after food is placed in front of an individual.
  1. Toileting – The process of getting to and from the toilet room for elimination of feces and urine, transferring on and off the toilet, cleansing self after elimination, and adjusting clothes.
  1. Bathing – The process of washing the body or body parts, including getting to or obtaining the bathing water and/or equipment whether this is in the shower or tub.
  1. Grooming – The activities associated with maintaining personal hygiene and keeping one’s appearance neat, including care of teeth, hair, nails, skin, etc.
  1. Dressing – The process of putting on, fastening, and taking off all items of clothing, braces, and artificial limbs that are worn daily by the individual including obtaining and replacing the items from their storage area in the immediate environment.
  1. Transferring – The process of moving horizontally and/or vertically between the bed, chair, wheelchair and/or stretcher.
  1. Ambulation – The process of moving about on foot or by means of a device with wheels.

Note: PC service DOES NOT include:

  1. Medical services
  2. Services provided to persons other than the participant
  3. Money management
  1. PARTICIPANT RECORDS

Participant records must contain documentation of PC work performed by each worker. The worker or the supervisor must sign this documentation.

  1. PERSONNEL
  1. A qualified professional (see Operating Standards in Section C of this manual for allowable supervisor) must supervise all staff performing personal care activities and conduct at least one supervisory review per year with each worker. Documentation of supervisor review must include:
  1. Date of supervisory review
  2. Place of supervision
  3. Participant name
  4. Name of worker
  5. Skills/tasks observed and level of competence
  6. Signature of supervisor
  1. Personnel care staff shall receive a minimum of two in-service trainings per year.
  1. Workers shall be trained for each task to be performed. The supervisor shall approve tasks to be performed by each worker.
  1. Workers shall report any change in a participant’s condition to their supervisor promptly, and any significant changes to the AAA 1-B care manager as per the Operating standards in section C.

V.GENERAL POLICY REQUIREMENTS

A.CLOTHING

  1. Families may send in a separate set of clean clothes and bathrobe to be kept at the ADHS center site.
  1. Families may send in clean clothes on the participant, and provide an extra pair of undergarments and bathrobe.
  1. Families may send in another set of clean clothes and bathrobe the day of their bathing service.
  1. All items of personal clothing must be marked with participant’s name.
  1. A participant’s dirty clothes will be sent home the same day of his/her bath/shower.

B.ACCESSORIES

1.Center shall provide standard shampoo and mild liquid soap, such as Ivory or Dove.

2.Families may send special shampoo and soaps.

3.Hair dryer shall be available to dry participant’s hair after bathing/shampooing.

C.SAFETY

1.A shower seat attached to the wall of the shower that folds up onto the wall is highly recommended.

2.If no shower seat, an aluminum shower chair or plastic/PVC tubing chair is required.

3.Grab bars shall be installed in bathroom area according to the American National Standard Codes. Grab bars should be placed by the toilet, tub, and shower area. They are also useful where people dry themselves. Grab bars should be installed on walls reinforced with 2 x 4s or 2 x 2s running horizontally between wall studs. The American National Standard Codes suggest two horizontal sidewall grab bars, 24 inches in length, one placed at 33-36 inches above the floor and the other 9 inches above the tub rim.

4.Slip resistant tile in the shower is recommended. Shower area shall be kept dry. Mats inside and outside of shower to prevent falls shall be used.

5.A call light, phone, or other type of call system is recommended in the bathroom to alert other staff in cases of emergencies that might occur while showering/bathing a participant.

D.BATHING PROCEDURES

1.Water temperature of shower shall not exceed 105-120 degrees Fahrenheit.

2.Identify the participant to be bathed. Be sure to call the participant by name and introduce yourself (as appropriate).

3.Explain the procedure to the participant. If the participant has a fear of bathing/showering, work by redirection and/or any other means to make the beginning of this experience as enjoyable as possible.

4.Wash your hands.

5.Collect the following items:

a)Soap/shampoo

b)Washcloth

c)Two bath towels

d)Clean change of clothing

e)Deodorant or antiperspirant

f)Other toiletries as requested/required

6.Place all necessary items in the bathroom in the space provided or on a chair.

7.Place a rubber bath mat in the tub (if not already present), or on the shower floor area (be sure not to block drain).

8.Place a clean non-skid mat on the floor in front of the tub/shower area.

9.Provide for privacy.

10.If bathing, fill the tub halfway with water. Water temperature should be approx. 105 degrees (41 degrees C) but no more than 120. Be sure to test water temperature prior to entry. The ADHS center should be provided with a safety device at the main source of water supply that regulates temperature, however, it is the responsibility of the staff performing the task to make that “SELF TEST” prior to participant’s entry into the water.

11.Practice Universal Precautions (i.e., gloves, mask, plastic outer covering, etc.) as needed.

12.Encourage the participant to use the toilet.

13.Have a secure chair with arm supports available for dressing and undressing. Help the participant remove their clothing. Cover participant with bath towels, robe or the like to keep them from becoming chilled.

14.Help the participant to the bathing area, always being sure that the floor surface is dry and clear.

15.Have the participant hold on to one of the required “Grab-Bars” installed in the bathtub/shower area before allowing them entry into the water. At the same time, maintain a firm hold on the participant during the transfer process. If necessary, or requested, use a transfer belt and ask for additional help.

16.No participant should be in a tub of water or shower longer than 20 minutes.

17.Never leave the bathing area when the participant is in the water.

18.Help the participant with his/her bathing/showering requirements. In order to be completely cleaned in a shower chair, it may be necessary if possible, to have participant stand for a short period of time during the shower. Make sure the participant has a secure hold on the “Grab-Bars” and you have a secure hold on the participant. If necessary a shower can be accomplished with a transfer belt on. If standing is not possible, help the participant in leaning from side to side so a complete washing is ensured. Be sure to maintain their personal rights at all times. This is to include, but not be limited to: language, touch, and/or any other actions that could be deemed as degrading to the participant.

19.The participant should be treated with the utmost respect at all times. In doing so, it is required that the staff performing the task of bathing/showering or any other personal service, maintain a conversation during said task unless the participant prefers not to talk. Eye to eye contact shall be maintained as often as possible.

20.After a complete and thorough washing and rinsing, assist the participant to their feet in the tub. Once the participant has his/her footing, and has a firm grip on the required “Grab-Bars” installed in the bathtub/shower area, assist him/her with exiting. If necessary, use a transfer belt or ask for assistance.

21.Have the participant sit in the chair, wrap them in a towel or robe and allow them to adjust to the change of temperature and setting. Place a towel over their head; however, be sure not to cover up their entire face.

22.Help the participant dry off, pat gently.

23.Help the participant put on a clean set of clothing.

24.Give other grooming (as needed). Shaving only to be done with participant’s own electric shaver. No razors are to be used on AAA 1-B participants.

25.No toenail or fingernail clipping is to be done on AAA 1-B participants by ADHS staff. This service can only be performed by a podiatrist at the ADHS Center. If the ADHS Center has podiatry service available, the participant or the participant’s caregiver will have to approve this service and will be billed separately for this charge.

26.Assist the participant back to the main area of activity and be sure to compliment them on how nice they look.

27.Clean the tub/shower (solution of 10 parts water to 1 part bleach). Remove soiled items. Wash linens. Discard disposables.

28.Wash your hands.

29.Cite observations on the participant/worker log sheet which indicate (at minimum):

a)The condition of the participant’s skin

b)The amount of assistance needed

c)How well the procedure was tolerated

d)Any other concerns you may have (if appropriate)

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