Island Home Nursing Orientation Manual

Here is everything you need to know to get off to a good start working with us. Please read this manual carefully and call if you have any questions.

We know that this is a long manual - we tried to be as complete as possible and to answer your questions even before you thought of them. Most of it is common sense, however, and should be fairly easy to remember. You might want to keep it in your car for your first few jobs, until you learn our way of doing things.

Our goal as an agency is to provide quality home care. We take every job seriously, no matter how small. We do the best we can because we find personal satisfaction in trying our best. It's more fun than doing sloppy work. We want employees who share this belief.

Medicare does not pay for the services of Island Home Nursing, nor do most insurance companies. Most people pay for us out of their own pockets. They expect high quality care, and that's what we are committed to giving them. There are many things that make us a quality agency: The speed and the ease of finding help, the insurance and bonding we provide, the 24 hour call service, etc. But the most important aspect of that quality to the client is YOU!

When you are competent, honest, pleasant, reliable, and willing to work, clients will be happy with you and our service. They will use us and recommend us to others, generating more work for you and other employees.

We are committed to the concept that we all work together, watching out for and helping each other to do a good job. We're committed to having quality employees and believe that in order to get them we must pay them decently and treat them with respect. If there's something you think we can do better, let us know. Our job is to make it as easy as possible for you to do yours.

Island Home Nursing does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services.

TO TURN YOUR TIMECARDS IN ON TIME !

TO KNOW OUR POLICIES AND FOLLOW THEM.

A big part of this is reading this manual carefully and to read the newsletters. The main way we have of communicating policy changes is in the newsletter. Reading the newsletter is required.

Not following our policies, whether deliberately or through not knowing what they are, can be grounds for termination.

TO KEEP YOURSELF CURRENT ON CAR INSURANCE, EVALUATIONS, ETC.

TO BE PUNCTUAL AND RELIABLE.

No matter how charming and technically competent you are, if you can't be trusted to show up and show up on time, we won't use you.

TO BE AWARE OF WHAT YOU DON'T KNOW AND ASK FOR HELP.

We can give you information over the phone or in person. Never do something you do not have experience doing without calling the office first. We can do teaching here in the office or in the home when needed. We also have a procedure manual for your use.

NOT TO WORK UNDER THE INFLUENCE OF ALCOHOL OR DRUGS.

TO REMEMBER THAT WE, NOT THE CLIENT, ARE YOUR EMPLOYER.

We, not they, are responsible for what you do and how you do it. If a client tells you to do or not do something and you think that maybe a dangerous choice, you must call the office. We try to respect the clients wishes whenever possible, but sometimes we just cant.

TO BE CONSCIOUS OF SAFETY ISSUES AND TO USE GOOD BODY MECHANICS IN YOUR WORK.

Do not do tasks that have the potential for causing you injury. Alert us to safety problems.

TO BE COURTEOUS AND PROFESSIONAL TO ALL WHILE WORKING.

TO LET US KNOW WHEN YOU MAKE A MISTAKE.

We all make mistakes. Unless it's an especially bad one (no shows without a really good excuse), it won't be held against you as long as you generally fulfill your responsibilities and do not make that mistake again. If you feel yourself or someone else has made a mistake, please let us know so we can straighten it out.

TO CALL THE OFFICE IF YOU BREAK ANYTHING IN THE HOME.

Your evaluation is an ongoing process with several components. The first three months you work are considered a probationary period. During that time you are establishing your reputation as an employee. We will be monitoring many aspects of your performance, especially how reliable you are, your attitude towards work, how well you do your job, and how clients, families, and others feel about you as a caregiver. Sometime during the first of three months you will come into the office for an evaluation. After that, you will have yearly office evaluations, as well as in-the-home supervisory visits.

Problems that arise regarding your performance during your probationary period and thereafter will be subject to Disciplinary Actions. These may include: verbal warnings, written reprimands, in-office counseling, and/or termination. Which actions are taken are at the discretion of the Care Supervisor, who will consider your work history and the seriousness of the problem in making her decision.

CLIENT RIGHTS

The client has the right to be treated with dignity and respect. He/she has the right to make the final decisions regarding his/her care and to have those decisions respected, even if the decision endangers his health. The client has the right to:

FREEDOM FROM ABUSE

Never try to force a client, physically or verbally, to do anything against his or her will - even for his own good. Never restrain a client without a doctor's order, even for his own safety. It is not only morally wrong, but a crime (Assault and Battery) as well. Attempting gentle verbal persuasion is OK. If you are concerned about a client's welfare, call the office.

PRIVACY

Respect the client's right to privacy with visitors, on phone calls, and in general. Some clients will want you to remain close by, others will prefer that you keep your distance when you aren't working with them. Be sensitive to their cues (or just ask them).

CONFIDENTIALITY

It is illegal to discuss a client's situation with anyone not directly concerned with his/her care. This includes your husband, children, and best friend. Please don't identify your clients by name. Give your family our office numbers and tell them to call the office if they need to contact you. Confidentiality is especially important on Whidbey Island, where it sometimes seems that everyone knows everyone else. Put yourself in the client's place: would you want everyone to know intimate details about your life and health?

PROTECTION FROM FINANCIAL ABUSE

Never accept any gift of money or property from the client or client's family. Never borrow money or property from the client. You may not accept a bequest from a will or trust from a client or their family. If you become aware of any such bequest, you must notify the office immediately. Never discuss your personal financial problems with a client. Violating any of these policies is grounds for termination.

GRIEVANCE PROCEDURE

If the client has a complaint about IHN service, instruct them to call the office and talk to one of the administrators. If they are not satisfied, they have a right to an in person meeting, which will be arranged at their convenience. If they are still not satisfied, they may call: State clients: 1-800-585-6749 (Northwest Regional Council) and ask for Kim Dooley; private clients: the state hotline 1-800-633-6828.

THERAPEUTIC RELATIONSHIPS

As a paid caregiver, you need to understand that your relationship with your clients is a professional one, not a personal one. Does this mean that you should be cold and unfriendly to clients? Of course not. Establishing a warm, caring relationship with your clients is as much a part of your job, and just as important, as giving a bath.

So what's the difference between a friendship and a Therapeutic Relationship? The main difference is that in a therapeutic relationship your whole focus is meeting the mental and emotional needs of the client and his/her family-- your emotional needs don't enter in to the equation. Crossing the line by treating the client as a friend rather than a valued client will damage your Therapeutic Relationship- you won't be able to do as good a job with the client. The following table below highlights some of the differences.

WHAT'S DIFFERENT?	ORDINARY FRIENDSHIP	THERAPEUTIC RELATIONSHIP
Care about the client.	Yes	Yes
Expect to be treated with respect	Yes	Yes
Listen to clients religious and political ideas.	Yes	Yes
Expect to get your emotional needs met	Yes	NO
Talk about your personal problems	Yes	NO
Borrow money, buy or sell items	Yes	NO
Discuss YOUR religious and political ideas	Yes	NO
Accept gifts, including bequests	Yes	NO
Take children or spouse to client's home	Yes	NO
Give out your phone number	Yes	NO

Turning a professional relationship into an ordinary friendship is a violation of ethics and may be grounds for termination if the violation is severe. In a professional Therapeutic Relationship you must keep in mind that you are part of a team that includes other IHN caregivers, the IHN office staff, the clients doctor, and any other health professionals involved in the client's care. Your job is to work with and support the team in its efforts to maximize the client's well being.

You also want to be careful to protect yourself from any accusation that you are taking emotional or financial advantage of a vulnerable person. If you have any questions whether a certain action would be appropriate, call the office.

THE IMPORTANCE OF COMPANIONSHIP

"Provide companionship" is often written on Care Plans and Employee Instructions. Have you ever stopped to wonder exactly what that means? It's one of those phrases that can mean different things to different people. Here are some thoughts about what providing companionship to Island Home Nursing clients means.

Most of our clients are fairly isolated socially. They need to feel that someone cares about them. Serious clinical depression affects many elderly persons, especially those whose health isn't good. They may seem gruff, not needing anything from you; they may not even realize how lonely and depressed they are; still, trying to establish a human connection with them is as important as washing their dishes.

What are some ways of doing this? Try a simple, sincere "How are you today?" followed by a pause while you listen to show you are interested in the answer. You can comment on the weather. But the best Never-Fail Ice-Breaker I've found is the question "How long have you lived on the Island? It's not such a personal question that anyone is likely to take offense, but it can lead to all kinds of interesting conversations. If the person has lived here for 50 years you can learn all about life on the Island long ago. If they have lived here only a few years, you can find out about their lives in other places. From there it's a simple jump to hearing about their families, jobs, and life experiences.

At the end of our lives we are often so restricted in our activities that the main pleasure left is reliving memories out loud to an interested person. This can be a gift you give to them and also a gift you give to yourself, as you will often hear wonderful, tragic, and funny stories that you will never forget.

Many other things besides talking can provide companionship activities- going for a walk, helping piece a quilt, playing cards, and cooking together are only a few examples.

How much time to spend in companionship activities will vary with each job. Often there is so much to do in so little time that little time can be spared; other times the client may not be open to much conversation. But try always to take at least a few minutes to give the client a chance to make an emotional contact.

As you work with your clients you will notice changes in their condition. Sometimes they will get better. Other times you will notice a change for the worse. This section will tell you what to do about such changes.

CHANGES FOR THE WORSE

EMERGENCY CHANGES

In most instances, if a client appears to be critically ill, do not call the office first. Go straight to calling 911. Some danger signs that may indicate a client who is critically ill are: copious bleeding, signs of shock (weak, cold & sweaty), extreme shortness of breath, excruciating pain, etc. Call the office at the first reasonable opportunity. Your first priority is caring for the client.

If the client appears very ill but refuses to let you call 911, call the office immediately, even if the client doesn't want you to. This is the time to remember that we, not the client, are your employer and are responsible for your actions. Exceptions are discussed below.

CPR

Caregivers are not required by law or IHN policies to administer CPR or first aide. If they choose to do so, it is a voluntary action on their part and their actions will come under the provisions of the Good Samaritan Laws.

TERMINALLY ILL CLIENTS AND CLIENT DEATH

We occasionally provide care for terminally ill clients. If the condition of a terminal client worsens, call the office for instructions. Your verbal orientation to the client will tell you what to do in case of client death. Most, but not all, clients with terminal illnesses do not want 911 called. We can respect their wishes provided that:

POLST stands for "Physician's Orders for Life-Sustaining Treatment". It is lime green and should be posted on the refrigerator. It gives detailed instructions for health care professionals about what the patient wants to happen in case of a life-threatening condition. The POLST form is the newest form in use and is gradually replacing the older form, the "EMS-No CPR" form, which is also lime green and should also be posted on the refrigerator.

While there are differences between the two forms, they are the same as far as what you will do in case of client death or life-threatening illness. If the form is present, DO NOT CALL 911 UNLESS THE SITUATION FALLS INTO ONE OF THE EXCEPTIONS LISTED BELOW.

These forms are not the same as a Living Will or an Advance Directive. Neither one of those will prevent basic and advanced life support from being started by EMS on a person who has died from a terminal illness. Only the POLST or EMS-No CPR forms have that effect. Actually, even people without a terminal illness can get such forms, but they seldom bother.

EXCEPTIONS: WHEN YOU MUST CALL 911 FOR TERMINAL CLIENTS

NON-EMERGENCY CHANGES

If the client is having a problem such as vomiting, constipation, or even just a cold, please let us know. Having a nurse evaluate such changes is an important part of the service we offer clients.

CHANGES FOR THE BETTER

Many clients' condition will improve over time. You do not have to let us know of each minor change. However, please report in on a regular basis, perhaps once or twice a month, to let us know of improvements in the client's condition. Sometimes the client will improve to such an extent that they no longer need as much help. We can make adjustments in the number of hours or even their job category to reflect those changes. Remember, office nurses only see the client usually every 3-6 months We depend on you to keep us up to date so we can change their Plans of Care to be accurate.

Let's talk about falls, because they are probably the biggest danger many of our clients face. People who need home help often are at high risk for falls due to poor balance, weakness, confusion, and other problems. Your responsibilities in this area are:

1. To try to prevent falls by making the home as safe as possible

2. To KEEP YOUR CLIENTS as safe as possible while walking or transferring.

3. To let the office know when you feel an unsafe situation exists.

If the client is too heavy, too weak, needs a transfer belt, or if any other problem exists that prevents you from helping the client move around safely, call the office immediately. If you find yourself "stuck", (for example, the client is in the tub and you can't get them out), make the client as comfortable as possible and call the office immediately. Don't hesitate to call us with any problem-- creating a home environment that is safe for you and the client is our biggest priority.

4. To try to prevent injury if the client falls.

You cannot always prevent someone from falling, even if you are right next to him. Dont try to catch someone who is in the middle of falling. You will probably not succeed and may injure yourself. Your goal in such a case is not to stop the fall but to minimize risk of injury by guiding them away from sharp objects or slowing their fall.

5. To act appropriately if a fall occurs

First, check for breathing and pulse- if none call 911. If the client is breathing, but unconscious for more than five seconds, call 911 then call the office. If the client can get up without help, allow them to do so, then call the office. If the client can't get up without help, dont help them up. Make the person comfortable where they are on the floor. Cover them with a blanket and give them a pillow, but move them as little as possible, then call the office. This will minimize the chances that you will cause further injury to someone who has a fractured hip or other serious problem.

OFFICE HOURS

Monday through Friday, from 9:00 a.m. to 5:00 p.m. We have an answering machine, so you can leave a message outside of office hours. If your message can't wait until office hour, page us. Never leave a message canceling work on the answering machine.

PAGING

When the office is closed, someone always carries a cell phone, so you always have support available if you have a problem. To call us:

PAY PHONES

We cannot return pages made from pay phones! Leave a message for us with as much detail as you can.

HOW YOUR AVAILABILITY AFFECTS YOUR HOURS

You probably have a general idea of how many hours you want to work. Most visits happen between 7am and 7pm, so most of your availability should be in this time frame. Night work is much less common. If that is your only availability, we may not be able to offer you consistent work. As a rough guide, for whatever number of hours you want to work, you need to be available during the "prime" hours for roughly 1 1/2 to 2 times that number of hours.

ACCEPTING WORK

Please do not accept work unless you are reasonably certain of being able to do it. You arent obligated to accept any job we offer you. Once you do accept a job, however, we expect you to work it, outside of rare emergencies. It is very difficult or impossible to replace people who cancel at the last minute.

CANCELING WORK

We expect at least 7 days notice if you need time-off for appointments, etc. Let us know of vacation plans as soon as you make them. (We can put information in to the computer years in advance, so you cant let us know too soon!) You must cancel directly with a live human being, using the pager to reach us if necessary. Never leave a cancellation message on the voice mail system.

Last Minute Cancellations (canceling work that is to begin within 48 hours of the time you call)and No Shows, , are especially bad. These cancellations often cause terrible hardships for clients, their families, the schedulers, and other caregivers. The only valid reason for a Last Minute Cancellation is illness or other emergency. We track all cancellations carefully. If there appears to be a pattern of inappropriate or unusually frequent cancellations, the Care Supervisor will use Disciplinary Actions (verbal warning, written reprimand, in-office counseling, and/or termination) as seems appropriate to the individual case. No shows are unacceptable and may be a reason for immediate termination.

WORK REQUIREMENT

Beginning the month after your hire date, you must work at least 35 hours per month to remain employed with Island Home Nursing. You are also required to work two weekend days a month, if needed. This requirement is waived if you are on a formal Leave of Absence.

REPORTING VISIT CHANGES

Please let us know as soon as possible if you worked different hours than you were scheduled for. Many of our jobs are limited to a certain number of hours per month, so we have to track things very closely. If you work more hours from what you were assigned and dont ask us in advance if this is OK, you may not be paid for the extra hours.

We have a 2 hour minimum visit. If a client tries to send you home before 2 hours, call the office from the client's house. We will remind them of the 2 hour minimum. If you leave the house and call from elsewhere, you will not get the 2 hour minimum.

WHEN YOU ARE RUNNING LATE FOR A VISIT

If you know you are going to be late, call us so we can let the client know. Clients get very upset when people are even a little late, because it makes them wonder whether you are going to show up at all. If we can let them know, they are reassured and there is usually no problem.

If you get lost, don't wander around in circles--stop and call us so we can redirect you. If we gave you bad directions, let us know so we can correct them. Keep a map in your car.

SCHEDULING MIX-UPS

Occasionally two people will arrive to work the same shift. If this happens to you, call us immediately from the client's home. If the mix-up was our fault, the person who is sent home will get paid for two hours.

You must call the office or the person on call - she will decide who is to go home. Don't just decide it between yourselves, or you might not get paid. If you are sent home, send in a time card with an explanation.

WHEN THE CLIENT CANCELS

If your work is cancelled within 4 hours of the time it was to start, you will be paid for 2 hours in compensation, provided that there is no substitute work available. If you are offered substitute work and decline, you will not be paid for a last minute client cancellation. If, when you arrive at a client's house, he tells you he doesn't need anyone today or if he/she isn't home, call the office from the house or the nearest phone booth. Don't go all the way home and call from there. Remember to send in a time slip with an explanation so you can get paid.

Island Home Nursing has several contracts with Washington State to provide services. One of these is the COPES Program, which pays for help for low-income persons. The rules of this program specifically forbid providing services when the client isnt in the home. Now if a client is occasionally gone for a brief period of time, it isnt a problem. But if the client is gone for all or most of a shift, please let us know.

CHANGING YOUR SCHEDULE

All scheduling changes must be cleared through the office. Never make different arrangements with the client without letting us know. For scheduling and billing reasons, we must know when and how long you are working.

LEAVES OF ABSENCE

You may take a Leave of Absence once a year for up to 3 months without losing your accumulated hours. If, however, you quit or are taken off our active list because you have not worked in 3 months, you will lose your pay level status and your accumulated hours. If you return to work at a later date, you will be paid as a new employee and you must begin accumulating your hours again. Leaves of Absence must be requested in writing and indicate a start date and end date.

WHAT SHOULD YOU DO IN THE HOME?

We use a Plan of Care to tell you about the client. The Plan of Care tells you:

We think giving you complete and accurate information about the client's needs is critically important to your being able to do a good, safe job, so we try really hard to keep our Plans of Care up-to-date. Please:

GOOD MANNERS

Please remember that it's hard for clients and their families to have strangers in their home, even when they know they need help. Good manners and simple courtesy will make it easier for them to adjust to and live with a difficult situation.

Always knock before entering the home or a room, unless you have been asked to do otherwise. Always call the client and his family by their last names, unless they request that you do otherwise.

CLIENT PRIVACY

Please try to anticipate times when the client might like some privacy, such as when the client is talking on the phone or having visitors, and offer to go elsewhere in the home for a while. Clients might feel it was rude to ask you, and so be reluctant to say anything.

You must respect the clients privacy as much as possible. Therefore, looking in clients drawers and closets should only be done when absolutely necessary and preferably with the clients or familys permission. Desks are an especially sensitive area, so stay out of them at all times unless the client is there asking for your help finding something. NEVER use a clients computer under any circumstances!

TELEPHONE ETIQUETTE

When answering the client's phone, identify the home and who you are. For example: "Smith residence, June Bug speaking." No personal calls, except in emergencies. NEVER charge a long distance personal phone call to the client. If it is an emergency and you can't call collect or use your calling card, call us and we will make the call for you.

Do not give your phone number to your clients. If they ask for it, explain courteously that you are not allowed to do that, and that the best way to contact you is through the office.

PERSONAL PROBLEMS AND PHILOSOPHIES

Clients generally believe that our employees are competent, caring and pleasant. The single most common complaint that we get about our employees is that they discuss their personal problems and views of life. Clients usually have enough problems - they don't need yours. Many employees have lost clients they enjoyed because of inappropriate sharing of personal information. To be professional, you must focus your attention on the client, not on yourself. Try to be cheerful and pleasant. If you aren't, it might cost you the job when the client doesn't want you back.

ABUSIVE CLIENTS

While the safety of our clients is important to us, so is your safety. If a client becomes abusive or threatening, remove yourself from the situation and call us immediately. For more information, see HARASSMENT POLICY.

DRESS CODE

Before leaving for an assignment, ask yourself just how professional you look. Fair or not, clients and their families will judge you not just by your work but by your appearance.

BREAKS

Generally, two fifteen minute breaks and thirty minutes for lunch for an eight-hour shift. A visit that is less than 4 hours long does not get a break. You are paid for your breaks, such as a lunch break, since you are still responsible for the client's safety on your breaks.

SMOKING

Outside, on breaks only, even if the client smokes. Clients can be very sensitive to residual odor of smoke on your clothes and breath. Breath mints and freshly laundered clothes will be appreciated by such clients.

FOOD

Bring your own food and drink. Do not eat the client's food, even if it is offered. If the client is pressing you on this or seems insulted, call the office. We will explain our policy to the client & get you off the hook.

SHOPPING & CLIENT FUNDS

Employees are not allowed to accept or have custody of client valuables or credit cards. If the client gives you money for shopping, you are responsible for giving the client a receipt and any change.

ASSISTING WITH MEDICATIONS

You may not "dispense" medications. This means that you may not read a label, take out a pill, hand it to the client, and say, "Take this now." You may, however, "assist and remind" clients to take their medications. If the person is of sound mind and able to supervise their own med taking, you may help them by taking them the bottle, reading the label for them, telling them the time, and even opening the container for them. Someone who is confused or otherwise unable to supervise their own medication taking will always have their pills set up in Medisets, which were demonstrated at your orientation.

Medisets are set up by time of day and day of week. Following the instructions in the Plan of Care, you may remind and assist the client to take their medications at the appropriate time. Medisets may only be filled by family members, friends, or Home Health Nurses. You cannot fill the boxes.

If you have any questions or concerns about the medications the client is taking or how they are taking them, please call the office immediately. People often get sick or even die, from taking their medicines incorrectly. Help us protect your client from harm.

EMPLOYEE INJURY

We value the safety, health, and well being of all employees. Our policy is to provide safe, healthful working conditions in all operations and to follow the laws and regulations about the safety and health of our employees.

If you are injured on the job (for example, needle sticks or back strain) you must call us immediately, even if you think that the injury is not serious. We will give you instructions on what to do (for example: go home, go to a doctor, continue working, etc.)

We have developed transitional light duty work for employees who are unable to return to their normal duties while recovering from their injuries. Medical studies show that transitional work speeds the healing process. Should you be assigned to transitional duty, you will be expected to follow the advice of your doctor.

No one knows your job better than you do. Please help us by making suggestions about what duties you feel you can safely perform. Also, please let us know how your job might be changed so you work safely.

CLIENT INJURY

WORKING WITH HOME HEALTH NURSES

We frequently share cases with WGH Home Health. Their nurses provide highly skilled treatments and monitoring for the client.

To avoid "too many cooks in the kitchen," we have an agreement with them that, when we share cases, they are the medical managers of the patient's care. This means that you should call changes and problems into them. Even though Home Health nurses will be the medical managers you still need to keep us informed of changes in the client's condition.

GOOD BODY MECHANICS

Protect yourself by using good body mechanics in your work. If it is not possible to do the job without risking injury, ask the family to help you. If no one is available, call us. We can arrange a solution, such as a Hoyer lift.

HOT WATER SAFETY POLICY

Excessively hot tap water represents a serious client-safety hazard that needs to be recognized by those who work in the home care setting. The U.S. Consumer Safety Commission (CPSP) estimates that about 3,800 home tap-water scaldings occur every year; with nearly three dozen deaths resulting. Most of the victims are either very young or old, since these are the most vulnerable populations in terms of physical capabilities, impairments, and skin sensitivity.

How can you protect clients from the perils of too-hot tap water? If you feel the temperature of a particular clients hot water heater is too hot, you can bring that to the attention of the the office. The hot water setting should not be higher than 120 degrees F. It can be tested with a thermometer.

Here are the minimum things we expect you to do when assisting the client to bathe:

HEATING PADS

Heating pads can be dangerous to people with poor circulation and thin skin. Our heating pad policy is as follows:

CLEANING UP AND BEING HELPFUL

Regardless of your job description, it is your responsibility to do light housekeeping and laundry when you have finished your primary tasks. Do not do anything that puts you at risk of injury, such as moving heavy furniture or climbing ladders. ISLAND HOME NURSING is not a janitorial service. If the client needs heavy cleaning done or other specialized tasks (plumbing, etc.), let us know and we will suggest an appropriate professional.

RELIEVING ANOTHER CAREGIVER

If you are relieving another employee, arrive about 5 minutes early to allow time for report. This should be enough time in most cases.

WHEN THERE IS NOTHING TO DO

Try your best to find something to keep busy, for example, playing cards with the client, talking about the client's history, cleaning, etc. If you can't think of anything, ask the client for suggestions. If that doesn't work, call us. Don't watch TV, even with the client's permission. Never take a nap!

CLIENT COMPLAINTS

If a client complains about an employee, you should listen but remain neutral. Tell us as soon as possible. Never badmouth a fellow employee to the client. If you have a problem with another employee, let us know.

If a client complains about other issues with Island Home Nursing, please let us know. We want to keep our clients as happy as possible.

ALCOHOL AND THE CLIENT

If the client wants an alcoholic beverage and the chart doesn't indicate whether this is ok, call the office. Although usually there is no problem with the client having a drink, some clients might be harmed by even one drink. However, the client generally has a right to drink as he chooses, even if it is harmful.

FIRE SAFETY

Once an employee had to deal with a fire at a client's house, so it is an important issue to us. When you first begin work at a new job, familiarize yourself with all exits and the location and type of any fire extinguishers and smoke alarms. Have a plan in mind for getting your patient out of the house in case a fire should start. Remember, if you discover smoke or flames, smother it with a blanket if possible. If it is a trash can fire, stuff a pillow inside the can. If you can't get a fire out, then get your patient out of the house before you call 911.

Beware of potential fire hazards such as frayed or exposed electrical wires, overloaded extension cords, and any flammable material near a heat source. If the client is interested, he can call his local fire department and request a free fire and electrical inspection of his home.

SEPTIC SYSTEMS

Most homes on the island use septic systems to handle wastes from the home, rather than being hooked in public sewage systems. Septic systems are delicate. Everything that goes down the drain needs to be biodegradable. Only toilet paper and human waste should go in toilets. (No tampax, baby wipes, or adult diapers!) Nothing poisonous should go down drains, except in tiny amounts (cleansers, etc.) If you have questions, call.

WHAT KIND OF CHARTING IS REQUIRED?

WHAT TO CHART:

The rule is: if you assisted with an activity in any way, mark it down. This includes reminding someone to do something (even if the client doesnt follow your suggestion). It also includes supervising an activity, even from a distance, such as walking or transferring, to ensure that it is done safely and to be there if something goes wrong. Some examples:

LEGAL FORMAT FOR CHARTING ON TIMECARDS AND CHARTS

Believe it or not, there are actually laws that say exactly how you are supposed to chart. Here are the rules:

We do not pay for mileage to, from, or between jobs. We do pay for errands and transportation done in your car.

DRIVING MINIMUM REQUIREMENTS

Often our clients need errands run or a ride to MD appointments. To do any driving while on IHN time, including driving between assignments, you must meet the following minimum requirements:

REIMBURSEMENT

if you drive your own car, you get paid mileage At our current rate. Use Mileage Reimbursement Sheets to request reimbursement. You must enter the date, client, starting and ending odometer, miles, and list all places your went and for what purpose. The client must sign and initial all entries. Turn in Mileage Reimbursement Sheets with your timecards.

SPECIAL RULES FOR STATE CLIENTS

Clients seen through the state programs get 60 miles per month free. You must write down miles on the Mileage Log in the home, and make the client aware if mileage will go over 60. Failing to log errands on Mileage Log might result in your not getting paid.

CAR INSURANCE REQUIREMENTS

As mentioned above, in order to do any driving on IHN time, you must have at least the state required minimum car insurance. However, to transport clients, you must have at least $300,000/ $300,000 "Bodily Injur per person and per occurrence" limits and you must have provided IHN a copy of your Declarations page that shows that you have the required coverage. You will be paid an extra .27/hour if you carry this coverage, which usually more than covers the cost of the coverage. Higher limits in other areas of your policy (Personal Injury Protection, Property Damage, etc.) are not necessary.

If you would like to invrease your coverage, which we highly recommend for your own sake, and your insurance company doesn't offer the higher limits, we recommend you talk to Bruce Neil at Koetje Insurance in Oak Harbor, 800-873-8606. Only talk to Bruce and mention you work for Island Home Nursing.

If you don't have the higher limits and your client needs transport, call the office and we will help trouble shoot the problem. Only the minimum coverage is required to do errands if the client is not in the car or to drive between assignments.

As an agency, we carry a kind of insurance known as non-owned auto. In the case of an "on the job accident", legally your car insurance must be exhausted first before our non-owned auto insurance takes over. In addition, our insurance legally does not pay for damage to your car. Your insurance does that.

If you are driving for clients, it is our responsibility to inform you to let your insurance company knwo that you are occasionally doing "incidental transportation for work purpose." This means that, in the course of caregiving, you might occasionally do some shopping or take a client to an appointment. Some insurance companies will require a business use rider. You are not required to do this but it is our responsibility to educate you in regards to your liability.

Because your driving increases both your liability and our, we request that you minimize you driving for client by:

YOUR DRIVING RECORD

We check our employees driving record on hire and yearly thereafter. Our insurance company requires the following minimum standards to be met by employees:

If an employee does not meet this standard, the employee may be terminated. You are required to inform IHN if your license is suspended or revoked or if you become uninsured. Failure to do so will result in termination.

OTHER DRIVING POLICIES

It may be OK to drive the client's car if it is in good working order, insured, and both you and the client are comfortable with your driving it. You must call the office first. You are not allowed to be a passenger in a car. We may make occasional exceptions, so call if this arrangement is needed.

Food handling: Food poisoning and food borne illnesses can be life threatening. The best way to prevent food poisoning and spread of contagious disease is by safely handling, preparing and storing food.

PREVENT FOOD POISIONING BY FOLLOWING THESE FOUR SIMPLE RULES: Keep food clean, Keep hot food hot, Keep cold food cold, When in doubt, throw it out.

Food Safety Guidelines: Keep food safety in mind as you buy, prepare, cook, serve, and store food at home or in the home of your clients. When handling food, be sure hands, fingernails, hair, and clothes are clean. Use good hand washing. Keep hands away from mouth, nose, and hair. Use clean utensils, not your hands, to mix food. Use a clean utensil every time you taste food. Thoroughly clean all dishes, utensils, and work surfaces with soap and water after each use. Water should be as hot as you can safely handle. Use dishwasher as much as possible. Keep hot foods HOT and cold foods COLD.

Refrigerate or freeze foods as soon as possible after cooking. Keep foods refrigerated until you are ready to serve or reheat them.

Cooking: Cook eggs until both the yolk and white are firm, not runny, to kill any bacteria. The elderly are in a high-risk group that should avoid eating raw egg in any form because Salmonella bacteria could be present. Use only fresh, clean, unbroken eggs, odor-free eggs.

Meat, Poultry and Fish: Storing: Store in the refrigerator: Thawing: Take out of freezer and leave over night in refrigerator. For faster thawing, put in watertight plastic bag under cold water. You can safely thaw meat and poultry in a microwave oven. It is not a safe practice to thaw meat, poultry or fish on the kitchen counter. Bacteria multiply rapidly at room temperature. Preparing: Thoroughly wash cutting boards with soap and water, and rinse with diluted bleach solution. To heat commercially prepared frozen foods, follow package direction. Cooking: You can cook frozen meat, poultry, or fish without thawing, but you must allow more cooking time to ensure that the center is cooked. Allow at least one and a half times as long to cook as required for unfrozen or thawed foods. Under-cooked foods may not be safe to eat. Do not partially cook meat or poultry one day and complete the cooking the next day. Canned Food; Commercially canned foods are considered safe unless they show and signs of spoilage, bulging can, leakage, spurting liquid, off-odor, or mold. Throw it out.

WHEN YOU ARE SICK

If you have a communicable disease that would likely be passed on to the client or his family, call us.

INFECTION CONTROL

Infection Control is the process by which you protect yourself from the client's germs and protect the client from your germs. Using Universal Precautions to protect yourself from blood-borne pathogens was covered in the videotape during your orientation.

All employees are required to constantly follow the infection control procedures set out below as they relate to their clients.

Employees are given a box of gloves at orientation. Gloves are to be used for personal care, not for cleaning or other purposes. They are to be used only by IHN employees. The employee is responsible for keeping herself supplied with gloves. Client homes will not be supplied with gloves. Gloves are available at the office and at Pony Mailing in Oak Harbor. We have special gloves for those with latex allergies.

If you have contact with bodily secretions and were not using the proper precautions, wash the affected area thoroughly with soap and warm water. Then call as soon as possible for further instructions.

TB POLICY

IHN TB testing requirements vary according to the risk of TB in the community, at the agency and with the work the employee does. This is reevaluated yearly. Currently, Personal Care Aides and Home Health Aides do not have any routine testing requirement, either at hire or ongoing.

Island Home Nursings policy is not to accept clients with known or suspected TB.

As many of you are aware, the incidence of TB is on the rise in the United States again. Twenty thousand cases are reported annually. High risk groups are persons with previously existing medical conditions, alcoholics, IV drug users, residents of long term care facilities, HIV infected persons, those in close contact with infectious cases and persons from high-case countries.

The TB bacillus becomes airborne, and infectious secretions are inhaled. It is spread via the lymph system to the lungs and/or kidneys, bones, etc. Immunity develops and the infection can become contained or "encased", at which time the infected person is asymptomatic and not infectious, but has a reactive PPD (a positive TB test). The treatment is preventative drug therapy at this time, or the dormant TB could reactivate with the infected person becoming symptomatic. Depending on the site of the TB, the infected person could also be infectious. Treatment would then be curative drug therapy.

Symptoms of TB are a prolonged, productive cough (over 3 weeks), fever, chills, night sweats, loss of appetite, fatigue, weight loss, hemoptysis (blood in the sputum). The diagnosis is made based on a history and physical, the PPD, chest X-ray, and sputum cultures. A person is considered non-infectious after 2 weeks of treatment. Call the office if you, a client, or a client family member have any symptoms or any questions.

Handwashing

Personal Protective Equipment

Gloves:

Gloves are required:

Disposable Aprons/Gowns:

Aprons/Gowns are required:

Protective Eyewear

Protective Eyewear is required:

Masks

Masks are required:

Equipment Disposal

Chemotherapy

If the client is undergoing chemotherapy, their body fluids, urine, and feces are extremely toxic. If you are required to provide incontinence care or other care where you are in contact with a client's urine and feces, you must wear gloves to prevent you from coming into contact with the toxic agents.

Hazard Communication

To ensure that information about the dangers of hazardous chemicals are known by all employees, the following hazardous information program has been established.

As part of employee orientation, each new employee will receive information and training on possible hazardous chemicals (cleaning supplies) in the home, physical and health risks of the hazardous chemical, symptoms of over-exposure, prevention and safety techniques. The employee will also be shown the location of the Material Safety Data Sheets manual and how to read labels and to review the MSDS to obtain hazard information.

Copies of Material Safety Data Sheets for hazardous chemicals that may possibly be in use at a client's home are kept in the office. MSDS are available to all employees upon request. The MSDS manual is available in the office for review by any employee.

HAZARDOUS WASTES

The Environmental Protection Agency has classified certain chemicals and chemical groups into categories that have been defined as toxic. This means that in concentrated forms or by accumulating and combining with other chemicals or with the air, these chemicals can be hazardous to human health if exposure occurs.

As a company, we are committed to not creating or disposing of hazardous wastes which will contaminate the environment We will choose materials which have been judged as non-hazardous whenever possible and will property dispose of hazardous materials if used. Also, we will not knowingly dump any wastes into the environment at any time.

We will inform caregivers how to control hazardous wastes and what to do if they are exposed to hazardous wastes. If any caregiver suspects that the wastes he/she may encounter as a caregiver are hazardous, whether or not they are being created or used by the company, or are found present in the home, he/she should inform their Home Care supervisor.

DO NOT TAKE CHANCES - Do not touch, depose of, or use any household cleaners or chemicals that are old, unlabeled, not in original bottles or containers, or that you are not familiar with.

Household Cleaning

Rubber gloves are required when using household chemicals and cleaning products. Each client should provide a pair of cleaning gloves and replacement gloves when they are worn out.

Bleach Disinfecting Solution; (1) Part Bleach to (10) Parts of Water, (use only liquid bleach)

Use care when tasting food. Use a clean spoon to taste food. Wash the spoon after using it once.

Persons with HIV infection should avoid unpasteurized milk, raw eggs or products that contain raw eggs, raw fish, and cracked or non-intact eggs. Cook all meat, eggs and fish thoroughly to kill any organisms that may be present in them. Wash fruits and vegetables thoroughly before eating.

Disinfect countertops, stoves, sinks, refrigerators, door handles and floors regularly. Use window screens to prevent insects from entering the room.

Discard food that has expired or is past a safe storage date, shows signs of mold or smells bad.

Use separate cutting boards for meat and for fruits and vegetables. Disinfect cutting boards frequently. Avoid wood cutting boards if possible.

Kitchen garbage should be contained in a leak-proof, washable receptacle that is lined with a plastic bag. Seal the garbage liner bags and remove the garbage frequently.

Precautions with personal hygiene items

People should not share razors, toothbrushes, personal towels or washcloths, dental hygiene tools, vibrators, enema equipment or other personal care items.

Cleaning blood/OPIM from skin surfaces

Wear appropriate gloves. Use sterile gauze or other bandages, and follow normal first-aid techniques to stop the bleeding. After applying the bandage, remove the gloves slowly, so that fluid particles do not splatter or become aerosolized. Hands should be washed using good technique as soon as possible.

Cleaning body fluid spills on vinyl floors

Any broken glass should be swept up using a broom and dustpan, (never bare hands!) Empty the dustpan in a well-marked plastic bag or heavy-duty container. The body fluid spill may be pre-treated with full-strength liquid disinfectant or detergent. Next, wipe up the body fluid spill with either a mop and hot, soapy water, or appropriate gloves and paper towels. Dispose of the paper towels in the plastic bag. Use a good disinfectant (e.g., household bleach 5.25% mixed fresh with water 1:10) to disinfect the area that the spill occurred. If a mop was used for the cleaning, soak it in a bucket of hot water and disinfectant for the recommended time. Empty the mop bucket water in the toilet, rather than a sink. Sponges and mops used to clean up body fluid spills should not be rinsed out in the kitchen sink, or in a location where food is prepared.

Cleaning body fluid spills on carpeting

Pour dry kitty litter or other absorbent material on the spill to absorb the body fluid. Then pour full-strength liquid detergent on the carpet, which helps to disinfect the area. If there are pieces of broken glass present, the broom and dustpan method can be used next to sweep up the kitty litter and visible broken glass. Use carpet-safe liquid disinfectant instead of diluted bleach on the carpeting. Pour this carefully on the entire contaminated area; let it remain there for the time recommended by the manufacturer. Follow this by absorbing the spill with paper towels and sturdy rubber gloves. Vacuum normally afterwards.

Any debris, paper towels, or soiled kitty litter should be disposed of in a sealed plastic bag that has been placed inside another plastic garbage bag. Twist and seal the top of the second bag as well.

Cleaning clothes or other laundry in home settings

Clothes, washable uniforms, towels or other laundry that have been stained with blood/OPIM should be cleaned and disinfected before further use. If possible, have the person remove the clothing, or use appropriate gloves to assist with removing the clothes. If it is a distance to the washing machine, transport the soiled clothing items in a sturdy plastic bag. Next, place the items in the washing machine, and soak or wash the items in cold, soapy water to remove any blood from the fabric. Hot water permanently sets blood stains. Use hot soapy water for the next washing cycle, and include sufficient detergent, which will act as a disinfectant, in the water. Dry the items using a clothes dryer.

Wool clothing or uniforms may be rinsed with cold soapy water, then dry cleaned to remove and disinfect the stain.

Needles

If the client uses syringes for insulin or other drugs, please use extreme care when cleaning to avoid a needlestick. Used needles must be disposed of in an official sharps container. If client doesnt have one, please call the office. If you do have a needle stick injury, immediately wash the area thoroughly with soap and water then call your supervisor immediately.

Diaper changes

Care providers should use a new pair of appropriate gloves to change diapers. Gloves should be removed carefully and discarded in the appropriate receptacle. Hands should be washed immediately after changing the diaper. Disinfect the diapering surface afterwards. Cloth diapers should be washed in very hot water with detergent and a cup of bleach, and dried in a hot clothes dryer.

Cleaning sponges and mops

Sponges and mops that are used in a kitchen should not be used to clean body fluid spills or bathrooms. All sponges and mops should be disinfected routinely with a fresh bleach solution or another similar disinfectant.

Toilet/bedpan safety

It is safe to share toilets/toilet seats without special cleaning, unless the surface becomes contaminated with blood/OPIM. If this occurs, disinfect the surface by spraying on a solution of 1:10 bleach. Wearing gloves, wipe this away with disposable paper towels. Persons with open sores on their legs, thighs, or genitals should disinfect the toilet seat after each use. Urinals and bedpans should not be shared between family members, unless they are thoroughly disinfected beforehand.

Thermometers

Electronic thermometers with disposable covers do not need to be cleaned between users, unless they are visibly soiled. Wipe the surface with a disinfectant solution if necessary. Glass thermometers should be washed with soap and warm water before and after each use. If it will be shared between family members, the thermometer should be soaked in 70-90% ethyl alcohol for 30 minutes, then rinsed under a stream of warm water between each use.

Pet care precautions

Certain animals may be health hazards for people with compromised immune systems. These animals include turtles, reptiles, birds, puppies and kittens under the age of eight months, wild animals, pets without current immunizations, and pets with illnesses of unknown origin.

Pet cages and cat litter boxes can harbor infectious, sometimes aerosolized organisms. These pet items should be cared for only by someone who is not immunocompromised. If this is not possible, a mask with a sealable nose clip, and disposable latex gloves should be worn each time pet care is done. Follow all pet care with thorough handwashing.

Animals may carry a variety of diseases harmful to people with weakened immune systems. Some of these diseases may be passed by the animal licking their person's face or open wounds. Wash hands after stroking or other contact with pets. Keep cats' and dogs' nails trimmed. Wear latex gloves to clean up a pet's urine, feces, vomit, etc. The soiled area should be cleaned with a fresh solution of 1:10 bleach.

Pet food and water bowls should be regularly washed in warm, soapy water, and then rinsed. Cat litter boxes should be emptied out regularly and washed at least monthly. Fish tanks should be kept clean. It is possible to order disposable latex "calf-birthing" gloves from a veterinarian for immunocompromised individuals. These gloves should offer protection from the organisms that are present in the fish tank.

Do not let pets drink from the toilet, eat other animal's feces, any type of dead animal or garbage. It is best to restrict cats to the indoors only. Dogs should be kept indoors or on a leash.

If you have reasonable cause to believe that a child or dependant or vulnerable adult is suffering from abuse or neglect you are required by law to report such an incident. You must call Island Home Nursing office and we will report the incident to the proper law enforcement agency and to the Department of Social and Health Services. You may also report directly to Adult/Child protection Services if you choose to (800) 487-0416. Listed below are some of the signs of physical, emotional, and sexual abuse and some signs of neglect. If you are unsure that there is abuse or neglect call the office anyway and we can talk it over and decide together if a report needs to be made.

Some signs of physical abuse: unexplained burns, cuts, bruises, or welts in the shape of an object.

Some signs of emotional abuse: apathy, depression, hostility, lack of concentration, eating disorders.

Some signs of sexual abuse: inappropriate interest in or knowledge of sexual acts, seductiveness, avoidance of things related to sexuality, or rejection of own genitals or bodies, nightmares and bed wetting, drastic changes in appetite, over compliance or excessive aggression, fear of a particular person or family member, withdrawal, secretiveness, depression, suicidal behavior, eating disorders, self-injury.

Some signs of neglect: unsuitable clothing for weather, being dirty or unbathed, extreme hunger, apparent lack of supervision

Harassment is violation of both federal and state anti-discrimination laws. In order to keep our ethical and legal obligation to prohibit discrimination in employment, the following is a policy at Island Home Nursing.

It is against the policies of IHN for any employee, vendor, client, or family member to harass an employee of IHN. Harassment is defined as verbal or physical conduct that denigrates or shows hostility toward an individual because of his/her race, color, religion, gender, national origin, age or disability, or that of his/her relatives, friends, or associates, and that; 1. Has a purpose or effect of creating an intimidating, hostile, or offensive working environment; 2. Has the purpose or effect of unreasonably interfering with the individual's work performance; or 3. Otherwise adversely affects the individual's employment opportunities."

Harassing conduct includes, but is not limited to, the following: 1. Epithets, slurs, negative stereotyping, or threatening, intimidating or hostile acts that relate to race, color, religion, gender, national origin, age, or disability, and 2. Written or graphic material that denigrates, or shows hostility or aversion toward an individual or group because of race, color, religion, gender, national origin, age, or disability and that is placed on walls, bulletin boards, or elsewhere on the employer's premises, or circulated in the workplace.

It is a violation of IHN policy to create or allow an intimidating, hostile, or offensive working environment. Such an environment may include such actions as persistent comments showing aversion toward an individual or group because of race, color, religion, gender, national origin, age or disability, or comments of a sexual nature or the display of obscene or sexually oriented photographs, drawings, etc. Any employee found to have harassed another will be subject to discipline, including possible discharge.

It is important that all employees know that such behavior will not be tolerated. Any employee who perceives that they have experienced harassment should understand that IHN administration plans to be supportive and will investigate the situation and take appropriate action.

Any employee directly or indirectly aware of any harassment problems should report the situation to one of the following:

Island Home Nursing will not condone, permit nor tolerate sexual harassment of employees in any manner whatsoever. Sexual harassment is behavior that is unwelcome, personally offensive, and which interferes with our work effectiveness. Unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature, whether by a male or female, constitute sexual harassment when (1) submission to such conduct is made either explicitly or implicitly, (2) such conduct has the purpose or effect of unreasonably interfering with an individuals work performance or creating an intimidating, hostile or offensive working environment.

Employees who believe they have been subject to sexual harassment should immediately bring it to the attention of their supervisor and/or the administrators. Similarly, if you have any question as to whether certain conduct is unlawful discrimination or harassment, you are encouraged to speak with either of the individuals mentioned above. This is particularly true when it comes to sexual harassment, where what is offensive to one person may not be offensive to another. Consequently, it is important that you let your feelings be known.

All complaints will be investigated promptly, and the existence and nature of your complaint will be disclosed only to the extent necessary to make an investigation. There will be no coercion, retaliation, intimidation, or harassment directed against any employee who registers a complaint.

The prohibitions against unlawful discrimination and harassment also may apply to non-employees with whom our employees come into contact in connection with their employment with us. Consequently, if you feel discriminated against or harassed (sexually or otherwise) by a non-employee in connection with your employment, you should use the procedure outlined above.

The purpose of this policy is to establish and maintain a safe, drug-free workplace free from the influence of drugs and alcohol. An employee's voluntary acknowledgment of a drug and/or alcohol problem will not excuse any violation of the Drug-Free Workplace Policy.

Violations listed below are prohibited and subject to disciplinary action, up to including discharge.

1. The use, consumption, possession, transportation, sale, or distribution of unlawful or unauthorized drugs, inhalants, alcohol, or abuse of prescribed drugs or alcohol by anyone while on Company property, on Company time, or in connection with Company business is prohibited. Illegal or controlled substances (other than a valid prescription) will be confiscated and the appropriate law enforcement agency(s) notified. Reporting to work with illegal drugs and/or alcohol in their system is prohibited. Using, possessing, or bringing drug paraphernalia to the work place is prohibited. Employees who sell, distribute, or give away controlled substances or prescription medication are in violation of policy.

2. It is each employee's responsibility to immediately report any violation of the Drug-Free Workplace Policy.

3. Employee(s) may be required to submit to a blood, urine, or other diagnostic test to detect alcohol and/or drugs in his/her system. The Company reserves the right to test without notice at its own discretion.

4. It is the employee's responsibility to provide prescriptions and/or list of all over-the-counter medications taken in the last month before submitting a sample for the drug test. The burden of proof lies upon the employee when testing non-negative for a prescribed or over-the-counter medication.

5. Employees who take over-the-counter or prescribed medication are responsible for being aware of any effects the medication may have on the performance of their duties, and must promptly report usage of such medication to their supervisor.

6. Job Applicants - The Company reserves the right to give blood, urine, or other diagnostic tests to applicants to detect alcohol and/or drugs (or drug metabolites) in their systems. Non-negative test results for drug or alcohol will be considered in making the final employment decision.

7. Employees with a non-negative drug test will be counseled on resources available for drug and alcohol addictions.

8. Employees suspected of or arrested for possession, use or distribution of controlled substances, will be suspended (without pay) pending the resolution of the investigation/charges.

9. The Company reserves the right to carry out reasonable searches of employees.

At the end of your interview, the interviewer assigned you to a particular job type, based on your education and experience. She then gave you a job description for that job type and some guidelines to go with it. Many of our employees work various job categories. Below are brief descriptions of each job category and a chart highlighting the differences.

ALL JOB CATEGORIES

Never do anything you are not trained or legally allowed to do. If you aren't sure whether you are allowed to do a particular task, CALL!

PERSONAL CARE AIDE (PCA)

The PCA provides help with activities of daily living, including minor to moderate assistance with personal hygiene. These tasks can include: protective and/or supportive supervision of a severely confused person; medication reminding; assisting the client to eat, dress, and walk; toileting, bathing, and hair care. In addition, light housekeeping and meal preparation are usually needed.

HOME HEALTH AIDE (HHA)

The HHA provides help for persons with serious medical problems requiring special training to accomplish. These include tasks like taking vital signs, complete bed baths, and lifting and pivot transfers.

SLEEPOVERS

An eight-hour night shift, usually 11-7 or 10-6. Can be a PCA, or HHA. For clients who just need brief, minor assistance at night, such as occasional help to the bathroom. The employee can sleep the rest of the time. (Because a sleepover is paid a flat rate, and you can sleep part of the time, one sleepover counts as 3 hours.)

If you are required to be awake more than two hours total during the eight hour shift or are not able to sleep three hours continuously at some time during the night, due to helping the client, you will be paid at the hourly night rate, provided you call the office the next morning to inform us that it didn't turn out to be a Sleepover.

If you don't call, you won't be paid the hourly rate, even if you were up all night. We have to be able to prove to whoever is paying the bill that the night did not qualify as a Sleepover.

LIVE-IN

Live-ins are 2 hour long visits done from 1-7 days per week. They are quite different from normal visits. These differences are described in detail in the Guidelines for Live-ins which is given to you as part of your orientation materials. Live-ins are considered as 9 hours of work for the purpose of Workman's Compensation calculation. Because of a special federal law, live-in hours are not counted when calculating overtime.

STATE PROGRAMS

Island Home Nursing provides assistance to low income persons through 3 state programs: the COPES program, the Medicaid Personal Care (MPC) program, and the Respite program. We refer to these programs as the state-paid programs. While in most ways, the two types of clients are similar, there are some important differences:

	Private Client	STATE PROGRAM CLIENT
Who decides what's on the Care Plan	Client	Case Manager
Caregiver can be in home without client being there.	Yes	No
911 must be called if client dies, even if the client has declined resuscitation	No	Yes
Restrictions on driving- amount and for what purpose	No	Yes
Hours can be increased if the client wants it.	Yes	NO

Pony Mailing and Business Center is a private mail center in Oak Harbor. If you live in that area, Pony Mailing is a place where you can:

WHAT YOU GET PAID

WHEN YOU GET PAID

We pay twice a month. Actual paydays are listed on your Payroll Dates sheet and also on this website. Pay periods are:

Unless you call and tell us otherwise, your check will be mailed. We take checks to the mailbox at 3:45pm, so if you want to pick up your check, please let us know before then.

If certain critical items are overdue, such as CPR cards, auto insurance verification, etc., we will not mail your check. Instead we will ask that you come by the office to pick it up, so we can get a copy of the document at the same time.

WHEN TO TURN IN TIMECARDS

You will not be paid for work that doesnt have a signed timecard. Late timecards may not be paid until the following payday. Turn all timecards for work done up till that date on paydays and also on the 1st and 16th ( If the 1st or 16th is a Sunday, turn it in on Monday). Timecards may turned in to Pony Mailing, the office, or put in the mail.

Getting timecards in on time is extremely important! Late timecards cause us all kinds of grief in our payroll and billing process.

HOW TO TURN IN TIMECARDS

OVERTIME & HOLIDAYS

MILEAGE REIMBURSEMENT

HEALTH INSURANCE

To be eligible for health insurance, you must work at least 20 regularly scheduled hours per week for state paid clients and have worked for IHN for 3 months. To maintain your health insurance , you must maintain 30 hours per week in regularly scheduled ongoing work. Your health, dental and vision insurance is currently fully paid for by IHN. You must agree to work only for clients on state paid programs. If you have health insurance and your hours drop below the minimum due to no fault of your own (i.e., client goes into the hospital, etc.), you will continue to receive health insurance as long as you accept work that is offered to you in replacement. If you are interested in health insurance, please let us know and we will get you into the state paid hours as soon as the hours are available.

ADMINISTRATIVE TIME

Island Home Nursing pays for Administrative Time. This means any work-related conversation you have with the office that is longer than 5 minutes is paid time. This includes talking on the phone as well as talking in person.

You are paid for 2 hours of time for your orientation, but only after you have worked 20 hours. If you fail to work that amount, the time will not be paid.

You are responsible for tracking Administrative Time. Use a time card, filling in "Island Home Nursing" or "IHN" in the Client Name slot and "Administrative Time" in the Job Type slot. Our office phones have automatic timers, so if you don't have a watch or clock handy you can ask the person you are talking to how long the conversation took.

TRAVEL TIME

We pay Travel Time, which is the minutes it takes to actually drive between 2 clients seen in the same day. Heres what you need to know:

MERIT BONUSES

We want to reward exceptional caregivers with more than words. Every three months we give out merit bonuses for caregivers doing exceptional work. To be eligible for the bonus program:

The better you do in each area, the more points you get. Employees then get a percent of the total bonus money available proportionate to the number of total points scored. The amount we have to give out will vary, but we expect to distribute around $5000 every 3 months.

Here is an example of a time card. Each boxed number refers to one of the numbered explanations below the timecard. Please fill out timecards in black ink, as we frequently have to Xerox them for various reasons.

Dont mix pay periods on one timecard. In other words, a single timecard should have either days between the 1^st and 15^th of the month OR days between the 16^th and the end of the month, but NOT BOTH.

TURN IN THE WHITE AND YELLOW COPIES TO THE OFFICE. The pink copy is for you. Please be sure to keep it until after payday, in case the yellow or white copies are lost by Pony Mailing or the Post Office. In that case, the pink is your only proof that you worked.

Congratulations, you made it to the end! If you think it was tiring to read, just imagine writing it! Please call if you have any questions.


Orientation Manual