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									Orientation Manual


    Welcome!



                     Last Revised 11/2/09
                                                                  Table of Contents
                 Table of Contents................................................................................................................. 3
INTRODUCTION ................................................................................................................................... 3
OUR PHILOSOPHY .............................................................................................................................. 3
YOUR RESPONSIBILITIES .................................................................................................................. 3
          TO TURN YOUR TIMECARDS IN ON TIME ! ............................................................................. 3
          TO KNOW OUR POLICIES AND FOLLOW THEM. .................................................................... 3
          TO KEEP YOURSELF CURRENT ON CAR INSURANCE, EVALUATIONS, ETC. ..................... 4
          TO BE PUNCTUAL AND RELIABLE........................................................................................... 4
          TO BE AWARE OF WHAT YOU DON'T KNOW AND ASK FOR HELP....................................... 4
          NOT TO WORK UNDER THE INFLUENCE OF ALCOHOL OR DRUGS. See drug policy. ......... 4
          TO REMEMBER THAT WE, NOT THE CLIENT, ARE YOUR EMPLOYER................................. 4
          TO BE CONSCIOUS OF SAFETY ISSUES AND USE GOOD BODY MECHANICS IN YOUR
          WORK......................................................................................................................................... 4
          TO BE COURTEOUS AND PROFESSIONAL TO ALL WHILE WORKING. ................................ 4
          TO LET US KNOW WHEN YOU MAKE A MISTAKE. ................................................................. 4
          TO CALL THE OFFICE IF YOU BREAK ANYTHING IN THE HOME. ......................................... 4
EVALUATIONS ..................................................................................................................................... 4
ETHICS ................................................................................................................................................. 4
     CLIENT RIGHTS..................................................................................................................................................4
           FREEDOM FROM ABUSE............................................................................................................................5
           PRIVACY .......................................................................................................................................................5
           CONFIDENTIALITY.......................................................................................................................................5
           GRIEVANCE PROCEDURE .........................................................................................................................5
           PROTECTION FROM FINANCIAL ABUSE ..................................................................................................5
     THERAPEUTIC RELATIONSHIPS ......................................................................................................................5
     THE IMPORTANCE OF COMPANIONSHIP .......................................................................................................6
CHANGES IN THE CLIENT’S CONDITION ...................................................................................... 6
     CHANGES FOR THE WORSE ............................................................................................................................6
           VERBAL AND NONVERBAL COMMUNICATION ........................................................................................6
           EMERGENCY CHANGES.............................................................................................................................6
           CPR ...............................................................................................................................................................7
           TERMINALLY ILL CLIENTS AND CLIENT DEATH ......................................................................................7
           EXCEPTIONS: WHEN YOU MUST CALL 911 FOR TERMINAL CLIENTS .................................................7
           NON-EMERGENCY CHANGES ...................................................................................................................7
     CHANGES FOR THE BETTER ...........................................................................................................................7
FALLS ................................................................................................................................................... 8
          TO TRY TO PREVENT FALLS BY MAKING THE HOME AS SAFE AS POSSIBLE ................... 8
          TO kEEP YOUR CLIENT AS SAFE AS POSSIBLE WHILE WALKING OR TRANSFERRING.... 8
          TO LET THE OFFICE KNOW WHEN YOU FEEL AN UNSAFE SITUATION EXISTS................. 8
         TO TRY TO PREVENT INJURY ................................................................................................. 8
         TO ACT APPROPRIATELY IF A FALL OCCURS ....................................................................... 8
COMMUNICATIONS ............................................................................................................................. 8
          OFFICE HOURS............................................................................................................................................8
          PAGING .........................................................................................................................................................8
          PAY PHONES ...............................................................................................................................................8
SCHEDULING ....................................................................................................................................... 9
          HOW YOUR AVAILABILITY AFFECTS YOUR HOURS...............................................................................9
          YOUR SCHEDULE........................................................................................................................................9
          AVAILABILITY CHANGES ............................................................................................................................9
          LAST MINUTE CANCELLATIONS................................................................................................................9
          WORK REQUIREMENT ................................................................................................................................9
          REPORTING VISIT CHANGES ....................................................................................................................9
          WHEN YOU ARE RUNNING LATE FOR A VISIT ......................................................................................10
          SCHEDULING MIX-UPS .............................................................................................................................10
          WHEN THE CLIENT CANCELS..................................................................................................................10
          CHANGING YOUR SCHEDULE .................................................................................................................10
          LEAVES OF ABSENCE ..............................................................................................................................10
ON THE JOB..................................................................................................................................... 10
          WHAT SHOULD YOU DO IN THE HOME? ................................................................................................10
          GOOD MANNERS.......................................................................................................................................11
          CLIENT PRIVACY .......................................................................................................................................11
          TELEPHONE ETIQUETTE..........................................................................................................................11
          PERSONAL PROBLEMS AND PHILOSOPHIES .......................................................................................11
          ABUSIVE CLIENTS .....................................................................................................................................11
          DRESS CODE .............................................................................................................................................11
          BREAKS ......................................................................................................................................................12
          SMOKING....................................................................................................................................................12
          FOOD ..........................................................................................................................................................12
          SHOPPING & CLIENT FUNDS ...................................................................................................................12
          ASSISTING WITH MEDICATIONS .............................................................................................................12
          EMPLOYEE INJURY ...................................................................................................................................12
          CLIENT INJURY ..........................................................................................................................................12
          WORKING WITH HOME HEALTH NURSES..............................................................................................12
          GOOD BODY MECHANICS........................................................................................................................12
          DRIVING AND MILEAGE REIMBURSEMENT ...........................................................................................12
          CLEANING UP AND BEING HELPFUL ......................................................................................................13
          RELIEVING ANOTHER CAREGIVER.........................................................................................................13
          WHEN THERE IS NOTHING TO DO ..........................................................................................................13
          CLIENT COMPLAINTS ...............................................................................................................................13
          ALCOHOL AND THE CLIENT.....................................................................................................................13
          FIRE SAFETY..............................................................................................................................................13
          SEPTIC SYSTEMS......................................................................................................................................13
CHARTING.......................................................................................................................................... 13
     WHAT KIND OF CHARTING IS REQUIRED?...................................................................................................13
     WHAT TO CHART .............................................................................................................................................14
     LEGAL FORMAT FOR CHARTING ON TIMECARDS AND CHARTS..............................................................14
DRIVING AND MILEAGE REIMBURSEMENT.................................................................................... 14
     DRIVING MINIMUM REQUIREMENTS.............................................................................................................14
     REIMBURSEMENT............................................................................................................................................14
     CAR INSURANCE REQUIREMENTS ...............................................................................................................14
     YOUR DRIVING RECORD ................................................................................................................................15
     OTHER DRIVING POLICIES .............................................................................................................................15
Transportation Info for State Clients................................................................................................ 15
     MEDICAID TRANSPORTATION .......................................................................................................................15
     ISLAND TRANSIT AND PARA-TRANSIT..........................................................................................................16
     CAREGIVER DRIVING ......................................................................................................................................16
     TRACKING MILEAGE........................................................................................................................................16
Introduction to Safety........................................................................................................................ 17
Protect Yourself ................................................................................................................................. 17
     MUSCULOSKELETAL INJURY AMONG CAREGIVERS .................................................................................18
          WHAT CAUSES MUSCULOSKELETAL INJURY?.....................................................................................18
          COMMON BACK MUSCULOSKELETAL DISORDERS: ............................................................................18
          WHAT ARE WORK RELATED MUSCULOSKELETAL DISORDERS?......................................................18
          RULES FOR SAFE LIFTING.......................................................................................................................18
     OTHER THINGS TO THINK ABOUT.................................................................................................................19
     DEFINING TRANSFERS, LIFTS, AND REPOSITIONING:...............................................................................19
     INFORMATION ABOUT TRANSFERS, LIFTS AND REPOSITIONING ...........................................................20
     SHOPPING AND HOUSEKEEPING TIPS TO PROTECT YOUR BACK ..........................................................22
GENERAL EMERGENCY PLANNING ................................................................................................ 22
          IF AN INJURY OCCURS .............................................................................................................................22
          IF A FIRE OCCURS ....................................................................................................................................23
          IN CASE OF EARTHQUAKE ......................................................................................................................23
BAD WEATHER AND DISASTERS .................................................................................................... 23
     YOUR CLIENTS.................................................................................................................................................23
     YOU AND YOUR FAMILY .................................................................................................................................23
     YOUR RESPONSIBILITIES...............................................................................................................................23
CLIENT SAFETY PROCEDURES....................................................................................................... 24
     HOT WATER SAFETY POLICY ........................................................................................................................24
     HEATING PADS ................................................................................................................................................25
FOOD HANDLING POLICY ................................................................................................................ 25
INFECTIOUS DISEASES ................................................................................................................... 26
     WHEN YOU ARE SICK......................................................................................................................................26
     INFECTION CONTROL .....................................................................................................................................26
     TB POLICY.........................................................................................................................................................26
     HANDWASHING ................................................................................................................................................26
          GLOVES ................................................................................................................................... 27
          GLOVES ARE REQUIRED ....................................................................................................... 27
          DISPOSABLE APRONS/GOWNS............................................................................................. 27
          APRONS/GOWNS ARE REQUIRED ........................................................................................ 27
          PROTECTIVE EYEWEAR......................................................................................................... 27
          PROTECTIVE EYEWARE IS REQUIRED................................................................................. 27
          MASKS ..................................................................................................................................... 28
          MASKS ARE REQUIRED ......................................................................................................... 28
     DISPOSAL OF CONTAMINATED SUPPLIES:..................................................................................................28
     CHEMOTHERAPY.............................................................................................................................................28
     HAZARD COMMUNICATION ............................................................................................................................28
     HAZARDOUS WASTES ....................................................................................................................................28
     HOUSEHOLD CLEANING .................................................................................................................................29
          PRECAUTIONS WITH PERSONAL HYGIENE ITEMS ............................................................. 29
          CLEANING BLOOD FROM SKIN SURFACES.......................................................................... 29
          CLEANING BODY FLUID SPILLS ON VINYL FLOORS............................................................ 29
          CLEANING BODY FLUID SPILLS ON CARPETING................................................................. 30
          CLEANING CLOTHS OR OTHER LAYNDRY IN HOME SETTING........................................... 30
          NEEDLES ................................................................................................................................. 30
          DIAPER CHANGES .................................................................................................................. 30
          CLEANING SPONGES AND MOPS ......................................................................................... 30
          TOILET/BEDPAN SAFETY ....................................................................................................... 30
          THERMOMETERS.................................................................................................................... 30
          PET CARE PRECAUTIONS...................................................................................................... 31
AIDS INFORMATION .......................................................................................................................... 31
MANDATORY REPORTING OF ABUSE/NEGLECT .......................................................................... 31
HARASSMENT POLICY .................................................................................................................... 32
ANTI-SEXUAL HARRASSMENT POLICY .......................................................................................... 32
DRUG-FREE WORKPLACE POLICY ................................................................................................. 33
JOB TYPES & DESCRIPTIONS ......................................................................................................... 34
           ALL JOB CATEGORIES..............................................................................................................................34
           PERSONAL CARE AIDE (PCA)..................................................................................................................34
           HOME HEALTH AIDE (HHA) ......................................................................................................................34
           SLEEPOVERS.............................................................................................................................................34
           STATE PROGRAMS ...................................................................................................................................34
PONY MAILING ................................................................................................................................. 35
MONEY MATTERS ............................................................................................................................ 35
          WHAT YOU GET PAID ...............................................................................................................................35
          WHEN YOU GET PAID ...............................................................................................................................35
          WHEN TO TURN IN TIMECARDS..............................................................................................................35
          HOW TO TURN IN TIMECARDS ................................................................................................................35
          OVERTIME & HOLIDAYS ...........................................................................................................................35
          MILEAGE REIMBURSEMENT ....................................................................................................................36
          HEALTH INSURANCE ................................................................................................................................36
          NORTH-SOUTH BONUS ............................................................................................................................36
          ADMINISTRATIVE TIME .............................................................................................................................36
          TRAVEL TIME .............................................................................................................................................36
          MERIT BONUSES .......................................................................................................................................37
FILLING OUT TIMECARDS ................................................................................................................ 37
         1. Employee Name.................................................................................................................... 38
         2. Employee Sign Here: ............................................................................................................ 38
         3. Job Type: .............................................................................................................................. 38
         4. Client's Name: ....................................................................................................................... 38
         5. Authorized Client signature: .................................................................................................. 38
         6. Month/Year:........................................................................................................................... 38
         7. Date: ..................................................................................................................................... 38
         8. Day: ...................................................................................................................................... 38
         9. Time In: ................................................................................................................................. 38
         10. Time Out: ............................................................................................................................ 38
         11. HOURS: Regular:................................................................................................................ 39
         12. HOURS: S/O: ..................................................................................................................... 39
         14. Client Initials:....................................................................................................................... 39
         15. Charting Area: ..................................................................................................................... 39
         16. Driving Minutes: ................................................................................................................. 39
         17. Previous client:................................................................................................................... 39
         18. Special Tasks/ Notes:......................................................................................................... 39
         19. North-South Bonus:............................................................................................................ 39
THE END............................................................................................................................................. 39
ORIENTATION MANUAL POST TEST ............................................................................................ 40
Island Home Nursing Orientation Manual                                                               -3–


                                     Island Home Nursing
                                      Orientation Manual
                                         INTRODUCTION
Dear Employee:
Welcome to ISLAND HOME NURSING.
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 until you learn our way of doing things.

                                         OUR PHILOSOPHY
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.
Island Home Nursing, our state clients, and our private clients all 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.

                                  YOUR RESPONSIBILITIES
TO TURN YOUR TIMECARDS IN ON TIME !
   Timecards are to be turned in on the 1st and the 16th of every month, and on paydays. Ways of turning
   in timecards are: taking them to the office (we have a drop box outside the door for after hours drop-off),
   mailing them, or dropping them off inside at Pony Mailing in Oak Harbor (See Pony Mailing Section for
   details.)
TO KNOW OUR POLICIES AND FOLLOW THEM.
   This manual has all our policies relevant to doing your work. Read this manual carefully. The main way
   we have of communicating policy changes is in the newsletter, so reading the newsletter is required.
   Our Policy and Procedure manuals are found in the main room at the office.
   Not following our policies, whether deliberately or through not knowing what they are, can be grounds
   for termination.
Island Home Nursing Orientation Manual                                                               -4–

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. SEE DRUG POLICY.
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 it may be a dangerous choice, you must call the office. We try to respect the
   client’s wishes whenever possible, but sometimes we just can’t.
TO BE CONSCIOUS OF SAFETY ISSUES AND 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.


                                          EVALUATIONS
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 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.
After your probationary period, you will be evaluated yearly.

                                                ETHICS
                                          CLIENT RIGHTS
The client has the right to be treated with dignity and respect. The client has the right to participate in
decisions and to refuse care. 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:
Island Home Nursing Orientation Manual                                                                   -5–

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. See Mandatory Reporting of Abuse/ Neglect for further details.
PRIVACY
Respect the client's right to privacy in regards to their records in the office, which includes the Plan of Care,
and in their home 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?
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: If they are a state client: (800) 585-6749
Northwest Regional Council and ask for Kim Dooley and if they are a private client the state hotline (800)
633-6828.
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.

                                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.

                                                                   ORDINARY              THERAPEUTIC
                    WHAT’S DIFFERENT?
                                                                  FRIENDSHIP             RELATIONSHIP
    Care about the client.                                            Yes                     Yes
    Expect to be treated with respect                                 Yes                     Yes
    Listen to client’s religious and political ideas.                 Yes                     Yes
    Expect to get your emotional needs met                            Yes                     NO
    Talk about your personal problems                                 Yes                     NO
    Borrow, buy, or sell money or other 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
Island Home Nursing Orientation Manual                                                                      -6–


    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 client’s 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.

                    CHANGES IN THE CLIENT’S CONDITION
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
VERBAL AND NONVERBAL COMMUNICATION
Some clients may tell you they feel ill or different. Others may not, either because they can’t or because
complaining is not something they “do.” Be alert for non-verbal communication such as moaning, wincing,
favoring one leg or arm, changes in posture or energy level, worsening balance, etc.
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,
Island Home Nursing Orientation Manual                                                                    -7–

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 to this rule 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 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:
• They have either a POLST form OR an EMS-No CPR form in the home.
• They do not fall into one of the exceptions listed below.
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 form has that effect. Actually, even people without a terminal illness can get such a
form, but they seldom bother.
EXCEPTIONS: WHEN YOU MUST CALL 911 FOR TERMINAL CLIENTS
• If a client in one of the state programs (COPES, MPC, Respite, DDD) dies, you must always call 911,
     even if they have an POLST form/bracelet and even if the death is expected. The reason for the
     difference is that the folks who run these programs require that 911 be called for all deaths, even
     expected ones.
• If the client or family want you to, regardless of the reason.
• If the client has an emergency unrelated to their terminal illness, for example, a broken leg.
• If the client is having problems that you are unable to cope with and you don't have time to wait until a
     page to the office gets through. An example might be: a client with throat cancer who is vomiting blood.
• If you aren't sure whether to call 911 or not, and the situation can't wait for you to call the office.
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 supervisor consult regarding changes in medical conditions 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 supervisors 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.
Island Home Nursing Orientation Manual                                                                 -8–


                                                  FALLS
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:
TO TRY TO PREVENT FALLS BY MAKING THE HOME AS SAFE AS POSSIBLE
   Keep your eye out for dangers in the home that might lead to falls, for example, scatter rugs, lack of
   grab bars in the bathroom, and cords across pathways.
TO KEEP YOUR CLIENT AS SAFE AS POSSIBLE WHILE WALKING OR TRANSFERRING
   Until you know your client well, stay close to them during those times.
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.
TO TRY TO PREVENT INJURY
   You cannot always prevent someone from falling, even if you are right next to him. Don’t 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.
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, don’t 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.


                                         COMMUNICATIONS
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 hours, 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 page us:
• Dial 360-929-2946, which is a cell-phone.
• Leave your voice message if the call isn’t picked up by the on-call person..
• We will call you back within 15 minutes. If you don't hear from us, it means we didn't get the message. In
   any case, call again
• We suggest that you carry our business card, which has our After Hours number on it, in your wallet.
PAY PHONES
We cannot return calls made from pay phones! Leave a message for us with as much detail as you can.
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                                           SCHEDULING
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.
YOUR SCHEDULE
We try to get your schedule to you a week in advance. Because of last minute admissions and other
changes not under our control, don’t consider your schedule set in stone- it can and will change. You are
expected to accept any work offered to you that falls within the availability you have given us. You will
probably develop preferences for clients, etc. Please let us know and we will work with you to develop a
schedule that works for you.
AVAILABILITY CHANGES
You need to let us know:
• About vacations, appointments, etc. immediately when you make the plan. We can put information in to
   the computer years in advance, so you can’t let us know too soon! We must have 7 days notice, except
   for emergencies, if your plans will cause you to cancel work you are already scheduled for. Also, if you
   are canceling work that is already scheduled, you must cancel directly with a live human being. Never
   leave a cancellation message on the voice mail system.
• About last minute changes in your availability, even if it doesn’t affect your work schedule. For example,
   you are normally available for work on Thursdays, but have no work scheduled for this Thursday. You
   decide on Tuesday night to go see your daughter in Tacoma on Thursday. You need to let us know that
   you are no longer available to work on Thursday. Because you are not canceling scheduled work, this
   information can be left as a voice message.
• By keeping us informed you are helping us not waste our time calling people who are not available. You
   are helping yourself by cutting down on the number of phone calls from us!

LAST MINUTE CANCELLATIONS
If you need to cancel work at the last minute due to illness or other emergency, call the office as soon as
possible, except not between the hours of 10pm and 6am, unless your work starts during or close to those
hours. If it is outside office hours, you will be directed to call the on-call person. Remember, you must
cancel directly with a live human being. 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, 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 don’t ask us in advance if this is OK, you may not be
paid for the extra hours.
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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 isn’t in the home. Now if a client is occasionally gone for a brief period of
time, it isn’t 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.

                                            ON THE JOB
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:
• Basic client information such as address, directions, living situation, etc.
• The client's problems and needs
• What you are supposed to do when
• 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:
• NEVER do anything that isn't on the Plan of Care without checking with the office first
• If the Plan of Care doesn't match what you find in the home, CALL US.
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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 client’s privacy as much as possible. Therefore, looking in client’s drawers and closets
should only be done when absolutely necessary and preferably with the client’s or family’s 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 client’s 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. Also do not give your family a
clients telephone number if they need to talk to you have them call IHN and we will contact you so that you
may call if there is an emergency.
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
Always wear your nametag—this is actually a state requirement for the safety of vulnerable adults. Also,
many of our clients have poor memories but would be embarrassed to keep asking you your name. If lost,
we will replace it.
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. Our client’s are older and in general
fairly conservative.
Wearing clothing that looks professional will make it more likely that they will respect and listen to you. Nice,
clean street clothes are fine. Below are listed some dos and don’ts. Just because something isn’t listed as a
don’t doesn’t mean that it’s OK to wear it. We expect you to use your common sense. For example, a full
length evening gown wouldn’t be appropriate for work.
         • No facial jewelry. Other jewelry should be small and not too flashy
         • No sleeveless tops
         • No visible tattoos
         • Tee shirts should be plain or with a small pattern—NO slogans or large pictures.
         • No sweatpants or tattered jeans. In summer, cropped pants or shorts that come down to the
            knee are OK.
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       •   No open toed shoes; Sneakers OK as long as they are clean and in good condition.
       •   Never wear perfumes- many of our clients are nauseated by perfumes.
       •   In general, skirts are not practical for this type of work and are discouraged. If worn, they must
           be below knee length.

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, this means that you must not leave the client’s home
setting.
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
Food safety is covered in a later section. 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 for what you have bought.
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
See Safety Section.
CLIENT INJURY
See section on Changes in the Client’s Condition.
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
Important! See section on Protect Yourself.
DRIVING AND MILEAGE REIMBURSEMENT
See Driving and Mileage Reimbursement section later in this manual.
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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 Island Home Nursing, please encourage the client to call us or let us know
yourself. We want to keep our clients as happy as possible. A copy of the Grievance procedure we give to
clients in included in you Orientation Packet. If the client is unhappy with our resolution of their complaint,
the procedure contains additional numbers they can call.
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 up
to the 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.

                                                CHARTING
                         WHAT KIND OF CHARTING IS REQUIRED?
•   Permanent charting is done on the timecard. See the Filling Out Timecards section for details.
•   In addition, we keep a blue folder in the home for the Plan Of Care. It may also have Flow Sheets or
    other instructions, depending on the needs of the client, the family, and other caregivers. It is discarded
    when the client is discharged.
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                                          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 doesn’t 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:
• If you remind them to go to toilet or bathe, you’ve assisted with toileting or bathing.
• If you escort them to the bathroom, you’ve assisted with toileting and ambulation.
• If you maintain toileting supplies such as pads or toilet paper, you’ve assisted with toileting.
• if you are in the home when the client bathes, mark bathing, even if you aren’t in the bathroom, because
    you are providing supervision by being there to help if he/she has a problem. If the client bathes while
    you aren’t in the home, you can’t mark bathing. PS, If there’s no sign client is ever bathing (towels
    untouched, soap bone dry, etc.), call!
• If you hand someone a sweater, tie a shoe, suggest clothing to wear, or remind the client to change
    clothes, you have assisted with dressing and should mark it on your timecard.
• If you ask someone if they’ve taken their medications, hand them a mediset, remind them to reorder
    from the pharmacy, or watch for medication reactions, you’ve assisted with medications.
• In helping persons with memory problems or dementia, please mark Protective Supervision.
• If you have any questions, please call.
         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:
• Use black ink and write clearly.
• If you make a mistake, cross through it once and initial it. You must be able to read the writing
    underneath. No correction fluid or correction tape is allowed.

                   DRIVING AND MILEAGE REIMBURSEMENT
We do not pay for mileage to, from, or between jobs. We do pay for errands for clients done in your car.

                            DRIVING MINIMUM REQUIREMENTS
Often our clients need errands run. To do any driving while on IHN time, including driving between
assignments, you must meet the following minimum requirements:
• Must have a current driver’s license
• Must have state required minimum car insurance. To transport clients, must have at least $100,000/
   $100,000 limits (See below)
• Driving record must meet minimum requirements (see below)
                                          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, and list specifically list all places you went and for
what purpose:
        • Right: “Payless, Island Drug”
        • Wrong: “Errands”, “Oak Harbor”, “shopping”
The client must sign and initial all entries. Turn in Mileage Reimbursement Sheets with your timecards.
Improperly filled out mileage sheets will have to be corrected before we can pay the mileage.

                              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 $100,000/ $100,000 “Bodily
Injury per person and per occurrence” limits and you must have provided IHN a copy of your Declarations
Island Home Nursing Orientation Manual                                                                - 15 –

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 increase 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 know 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 driving increases both your liability and ours, we request that you minimize your driving for clients
by grouping errands, using transit systems, and having others drive the client.

                                     YOUR DRIVING RECORD
We check our employee’s driving record on hire and yearly thereafter. Our insurance company requires the
following minimum standards to be met by employees:
• No physical restrictions other than wearing corrective lenses.
• No more than 3 moving violations or more than 1 chargeable accident in the last 36 months.
• No major convictions such as DUI or reckless driving violations within the last 7 years.
If an employee does not meet this standard, the employee may be terminated, asked to make other
transportation arrangements, or be required to complete a remedial program.
You are required to inform IHN if your license is suspended or revoked or if you become uninsured. You
may be terminated if you fail to do so.

                                    OTHER DRIVING POLICIES
No passengers other than the client are permitted in the client’s or the caregiver’s car. In other words, the
only people in the car will be the caregiver and the client.
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, if the Plan of Care doesn’t state that it’s OK
to drive the client’s car, because we’re required to verify the amount of liability coverage the client carries.
Everyone knows they have to stop for a school bus. But have you ever noticed how many kids ride the
regular transit? They do NOT pay attention and will often dart out from behind the bus straight into traffic.
Please be careful!!

                 TRANSPORTATION INFO FOR STATE CLIENTS
                                 MEDICAID TRANSPORTATION
Medicaid Transportation was created to help clients meet their transportation needs to medical
appointments. Medicaid Transportation uses a variety of transportation types, including Para-Transit (see
below). Please encourage your clients to use Medicaid Transportation as much as possible.
       o Medical appointments include not just visit to doctors but also therapy appointments such as
                 physical therapy and even massage therapy that is prescribed by your physician. If
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                  Medicaid will pay for the therapy appointment, then the Medicaid Brokerage will help you
                  get there.
       o   The Brokerage must be called or emailed at least 2 business days in advance, but should be
                  notified as soon as the appointment is made, because that gives them more time to get a
                  good plan together. They prefer emailing, if the client has email, because then they have
                  a hard copy of the request and mistakes are less likely.
       o   Currently we don’t permit our caregivers to participate in the gas voucher plan because the only
                  gas station participating is north of Oak Harbor and the whole procedure is very time-
                  consuming.
       o   Caregivers can go with the client.
               Medicaid Brokerage: 1-800-860-6812 or nwrcmedicaidaccess@dshs.wa.gov

                           ISLAND TRANSIT AND PARA-TRANSIT
The regular transit busses are all 100% wheelchair accessible, have numerous routes and provide frequent
and convenient stops. For many people, the regular transit is more convenient than Para-transit.
        o The regular transit buses can even go off their routes to pick up and drop off the client at their
                    door, becoming part of the Para-transit system..
        o If you are a “driver” (someone authorized to transport clients), you can drive to a Park and Ride
                    lot to get the transit. This can avoid transfers and make better use of client’s miles.
        o Caregivers can go with client, of course.
        o The phone numbers are the same as for Para-Transit
Clients are likely eligible for Island Para-Transit services, which can help supplement the transportation we
provide.
        o The screening process can take up to 3 weeks.
        o If client is a client of Compass Health, they can help client fill out the application form.
        o Reservations must be confirmed by phone between 3:30pm and 5pm the day before the
                    appointment. If client, family, or caregiver won’t be able to call, let office know.
        o Caregivers can ride with clients on Para-Transit as well.
                                       Island Para-Transit: 321-6688 or 678-7771

                                         CAREGIVER DRIVING
Caregivers can help with Essential Shopping and other needs listed on the Plan of Care. If they are driving:
       o All caregivers can run errands, but not all caregivers can transport clients. Let office know a
                 week in advance when a client needs transportation so they get a “driver”.
       o Driving is limited to 2 trips per week.
       o Clients need to use grocery stores and pharmacies in their town, unless their town doesn’t have
                 one. In that case, they need to use the nearest one.
       o Errands may not be combined with going to a medical appointment.
       o None of this applies if the caregiver takes the transit.
                                         TRACKING MILEAGE
Clients seen through state programs get up to a maximum of 60 miles. In no case may the number of miles
go over 60 per month.
        o The Mileage Log should be posted on client’s refrigerator or other prominent place.
        o Write down miles immediately after a trip and to keep an accurate running total, even if you are
                  the only caregiver in there. Not writing down mileage immediately is subject to
                  disciplinary actions.
        o Put up a new Mileage Log when needed. Keep the old one in the folder for 3 months in case of
                  questions.
        o When clients run out of Mileage Logs, ask us to send a new one.
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You must write down miles on the Mileage Sheet in the home and make client aware if mileage will go over
60. Failing to log errands on Mileage Log might result in your not getting paid. Driving is limited to “essential
errands”, which are shopping, getting medications, etc. Any trip that will be more than 10 miles round trip,
must be cleared with the office in advance.

                                INTRODUCTION TO SAFETY
If you are injured on the job (for example, needle sticks or back strain) you must call us immediately,
even if you think the injury is not serious. We will work with you to decide what to do (for example: go
home, go to a doctor, continue working, etc.)
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.
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.
Please report all hazardous situations to Island Home Nursing immediately.
Island Home Nursing, Inc. is committed to the safety of its caregivers, property, and equipment. To this
end, we use a safety program in our daily activities. The basic safety policy of this company is that no task
is so important that an employee must violate a safety rule or put herself/himself at risk of injury or illness in
order to get a job done. Any caregiver that disregards any company safety rule and/or regulation is subject
to disciplinary action including termination of employment.
Island Home Nursing has established safety rules and regulations to be observed by all caregivers at all
times. With regard to these rules, the following will be considered standard procedures for all caregivers:
• If you believe that a safety regulation should be modified or improved to insure a caregiver’s or a client’s
     safety, you are required to inform the Island Home Nursing office or the on call person as soon as
     possible.
• You may ask questions or express concern related to any tasks that you are asked to do at any time.
     Please do not hesitate to call the office if you have a safety concern.
• An Island Home Nursing Safety Committee Representative is available to answer questions or listen to
     your safety concerns. Contact the Care Supervisor.
It is our responsibility to see that every caregiver at Island Home Nursing is provided with safe working
conditions. You need to observe all safety regulations and use common sense to protect yourself and
others. The Home Care Supervisor will periodically inspect working conditions in the home environment
and may suspend all work activity until an unsafe condition is corrected.
The most important part of safety is YOU. It is your responsibility to abide by the safety rules. These rules
are made for your protection. Report any personal injury IMMEDIATELY to the office or on call person.
Report any unsafe condition or practice to the Care Supervisor.

                                      PROTECT YOURSELF
Safety is a team effort that involves everyone at Island Home Nursing. As caregivers you will participate in
the Safety Program by identifying client transfers that present potential risk for injury. You will discuss with
office staff ways to eliminate manual lifting thus minimizing potential risk. This is an ongoing process. The
client is assessed at time of admit regarding transfers. The office staff communicates the information to you
and coordinates any necessary training. Schedulers are responsible for sending the client the appropriate
caregiver to provide safe care. This means you must have the skills and training to safely care for the client
and be able to continuously assess the situation keeping safety in mind in an effort to prevent injury. You
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are our eyes and ears. Any change in client condition or unsafe situation must be immediately reported to
the office. Do not attempt a transfer that you feel is unsafe. Employees who disregard these safety rules are
subject to disciplinary action and possible termination.

                  MUSCULOSKELETAL INJURY AMONG CAREGIVERS
Caregivers have the highest number of lost workdays and the highest percentage of lost work time
attributable to illness and injury among many other major occupational groups. Occupational back injuries
are a serious problem. In a study that monitored the health of caregivers 90 % of participants cited
musculoskeletal conditions/injuries as a major health concern. Direct client care, especially client transfers
were found to be the most common cause of reported back injury.
WHAT CAUSES MUSCULOSKELETAL INJURY?
A single high load incident.
Awkward postures for sustained periods of time.
Lifting continuously without significant rest of the tissues.
Chronic strain to muscles and joints.
Imbalance of activities; repetitive and sustained activities in one direction.
Stressful living: smoking and poor nutrition.
Repetitive wear and tear; reduction of spine’s flexibility.
Psychosocial factors: time pressures, monotonous work, heavy responsibility, too many tasks, too few
breaks, low control, not enough social support from peers and supervisors.
COMMON BACK MUSCULOSKELETAL DISORDERS:
STRAINED LIGAMENTS: High, fast forces such as slipping and falling can tear or strain ligaments. Slower
forces can tear ligaments from the bone. It has been shown that prolonged stretch of ligaments (such as
from prolonged slouching) can cause muscle spasms. Remember to sit and stand properly and to change
positions often.
STRAINED MUSCLES: Muscle strains usually occur during activities that require the muscle to tighten
forcefully. The muscle is strained either because it is not properly stretched, or warmed up before the
activity; it is too weak; or because the muscle is already injured and not allowed time to recover. Muscle
strains can occur during exercise, sports activities or when lifting heavy objects.
WHAT ARE WORK RELATED MUSCULOSKELETAL DISORDERS?
Work Related Musculoskeletal Disorders is a term that defines injuries to muscles, tendons or nerves that
are caused or aggravated by work. Some of the risk factors could include workplace organization such as
intensified workload, stressful work environments with stressful deadlines, working in awkward postures for
extended periods of time and repetitive loading or lifting.
RULES FOR SAFE LIFTING
Use the following acronym as a guide when engaging in client transfers:
       Back Straight
       Avoid Twisting
       Close to Body
       Keep Smooth
    1. BACK STRAIGHT
       Your spine can tolerate larger loads when the back is straight.
       Your spine is weaker when lifting in a flexed position.
Island Home Nursing Orientation Manual                                                                    - 19 –

        Maintain your back’s natural curves, which keeps the spine aligned and moving smoothly and
        minimizes stress.
    2. AVOID TWISTING
        Discs are weaker when lifting is combined with twisting.
        Joints are designed to prevent rotation.
        If you twist when you lift, the joints become inflamed and sore.
    3. CLOSE TO YOUR BODY
        If an object is at a greater distance from your body for lifting, your back muscles and joints have to
        work harder to lift the weight creating greater stress on your back.
        If you keep the exact same load close to your body, the lesser distance creates a lighter load and
        less stress on your back.
    4. KEEP SMOOTH
        Jerking increases the load on your spine.

                               OTHER THINGS TO THINK ABOUT
Always consider the use of a mechanical aid.
During client handling, use your leg and hip muscles and knee joints to lift.
When assisting a client to transfer or lifting an object, tighten your abdominal and pelvic muscles and keep
the client or object close to your body to prevent injury.
Avoid reaching over your head to lift to prevent strain on joints located along your spine.
Lift in stages if you need to. If the person or object slips, lower them gently to the floor while tightening your
abdominal muscles and avoid rotation.
Follow the general lifting guidelines specified by Island Home Nursing, which state, the most a person can
lift with minimal risk of injury under ideal conditions 40 pounds. We do not want you to lift anything over 15
pounds.
A No Lift Program is a program that will help to reduce the unnecessary risk of injury for clients and
caregivers. Our policy states that there is no lifting of clients.
The goal of a no lift program is to provide employees with a policy that will promote an environment where
the usage of assistive equipment is encouraged and expected.
These goals can be achieved by providing staff with access to guidelines, training and the appropriate
number of assistive devices for client handling. These could include: gait belts, total lifts, sit stand lifts,
shower chairs, transfer boards and slide sheets.
Training may involve hands on training and practice sessions.

                 DEFINING TRANSFERS, LIFTS, AND REPOSITIONING:
Transfers are guiding and/or assisting the client from one surface to another. The client is able to bear most
of their own weight in the legs and/or arms, and/or a part of the weight is borne by an assistive device or a
transfer board, walker or cane.
Lifts are any procedure where the client’s entire body weight is borne by something other than the client
(i.e.: a mechanical lifting device) for purposes of repositioning or moving to another surface. Island Home
Nursing has a no-lift policy. So if the client is unable to bear weight then a mechanical device must be used.
Repositioning is shifting, adjusting or changing the client’s position in bed, wheelchair, chair, or other
supportive surface.
ASSESSMENT: Completing an assessment before a transfer or lift is important because it:
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Helps to determine risk for injury.
Promotes continuity of care.
Helps you to be prepared for possible risks.
Helps to minimize the risk of injury for the caregiver and the client.
ASSESSMENT OF THE WORK AREA:
The work area should allow easy access to clients.
A room should not be cluttered with furniture or equipment.
A cluttered room increases the potential for trips and falls.
A small room, such as a bathroom, may not allow natural body movements.
Avoid transfers in crowded spaces.
In small rooms, there may not be enough room for a portable lifting device. There are fixed lifting aids on
tracks, which do not require a lot of space.
There should be enough clearance around beds and toilets to allow access on either side.
A highly polished or wet floor does not provide good traction or a safe base for lifting (i.e. shower). Slips are
more likely to occur on a highly polished or wet floor. Cover floors that get wet with a non-slip material.
PURCHASING OF EQUIPMENT:
Client may be instructed to purchase equipment with safe transfers in mind and must be purchased if a safe
transfer is to be provided by Island Home Nursing caregivers.
Removable arm and foot rests on wheelchairs and shower chairs make transfers easier.
Beds that can be raised or lowered also make transfers easier.
Adaptive clothes are needed for clients who are toileted using a mechanical lift.
The shower and toilets should be designed so pushing and pulling shower chairs into position is as easy as
possible (i.e. reduce height changes in the floor).
STAFFING: Ensure there are enough caregivers, family members, or friends available to perform client
handling tasks safely especially during high activity periods. There may need to be overlapping shifts to
accomplish difficult transfers.
CLIENT COGNITION: Assess the client’s senses, state of mind, memory, communication medical status
and physical condition before engaging in client transfers.

       INFORMATION ABOUT TRANSFERS, LIFTS AND REPOSITIONING
1. INDEPENDENT TRANSFERS: This should be used when a client is able to mobilize without risk of
injury and the client is comfortable with the use of mobility aids such as a cane and has the strength to
move on their own. This is designated on the Care Plan as a stand by assist.
2. SUPERVISED TRANSFERS: This should be used when the client is able to mobilize, but may require
verbal or minimal physical cueing. Transfer belts may be required. This is designated on the Care Plan as a
stand by/hands on assist as needed, with cueing and may include use of transfer belt.
3. ONE-PERSON TRANSFER BELT/ PIVOT TRANSFER: This should be used when a client can stand
unsupported or weight bear with assistance of one person. You must be able to do this with ease and with
the least risk of injury to yourself and the client. For safe handling a transfer belt must be used. Instructions
will be on the Care Plan and in the home chart. Keep transfers to a minimum. If client too weak, don’t do
transfer.
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4. TWO-PERSON STANDING PIVOT TRANSFER: This transfer should be used when a client can bear
weight on at least one leg but is heavy and/or unreliable. This technique requires two caregivers, with the
tall person behind the client. A transfer belt must be used. This will be designated on the Care Plan as a 2-
person transfer. Instructions to be provided in chart.
5. WALKER TRANSFER: Walker transfer should be used when a client can bear weight on at least one
leg, and whose upper extremity strength and mobility are adequate. This will be designated on the Care
Plan as a walker transfer with stand by or hands on assist as needed and may include use of transfer belt.
6. SIT-STAND MECHANICAL LIFT: This lifting technique should be used when client can sit with minimal
support at the edge of bed and is able to bear some weight. The client needs to be cognitively predictable
and reliable and able to tolerate harness under arms. This should not be used with clients who have a
hemiplegic arm. This will be designated on the Care Plan as a mechanical sit-stand transfer. Instructions
provided in home chart.
7. TOTAL MECHANICAL LIFT: A total mechanical lift should be used when a client can only minimally
transfer or is not able to assist with weight bearing. This should also be used if the client is cognitively
unreliable or uncooperative, has poor head control or sitting balance or is extremely large or heavy and
requires assistance. This will be designated on the Care Plan as a total mechanical lift. Instructions
provided in home chart.
8. TRANSFER BELT: Transfer belts should be used when a client needs assistance with any transfer or
for mobilization.
9. SLIDE BOARD/TRANSFER BOARD: Slide boards/Transfer boards should be used when transferring
between equal height surfaces. Slide boards should also be used to facilitate transfer to wheelchair and for
a client with excessive weakness in their lower limbs and may need a 2-person assist. Specific instructions
will be in home chart and Care Plan.
10. SLIDE SHEETS: Slide sheets should be used to reposition a client in bed that is unable to move
independently. Two caregivers are required for this move. This should only be done at change of shift.
Specific instructions will be in home chart and Care Plan.
INJURY PREVENTION PREVENTION:
Examine your work environment.
Avoid awkward or sustained postures or repetitive movements by varying your work activities throughout
your day.
Avoid forceful movements with a high load to avoid back injury.
Maintain a neutral relaxed posture.
Ensure adequate caregiver to client ratios when considering client handling procedures.
Ensure that caregivers have proper training, access to appropriate equipment, and all devices are in good
working order.
Ensure that your work area provides easy access to clients. (i.e. transfer clients onto a shower chair outside
the bathroom to reduce transfers in crowded spaces).
Plan ahead to ensure that you have considered all factors before beginning a specific activity.
Adjust the working height of equipment to avoid bending stretching or twisting.
Consider the use of a mechanical aid for client transfers.
Exercise such as strength and conditioning helps maintain functional ability and helps prevent muscle
sprains, low back pain, osteoarthritis, osteoporosis, shoulder instability and knee stability and pain.
Stretching should be incorporated into an exercise program to help improve flexibility.
Do not lift anything immediately after sitting for an extended period of time. Walk around and loosen up first.
BOTTOM LINE:
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Reducing the chance of injury when handling clients requires a combination of equipment, training, and
policy.
If caregivers are not properly trained on how and when to use ergonomic equipment, they will not use it
properly and may injure themselves or others.

        SHOPPING AND HOUSEKEEPING TIPS TO PROTECT YOUR BACK
Everybody knows that you shouldn’t lift anything too heavy. But what is too heavy? Do you know what a
gallon of milk weighs? Well, a gallon of milk weighs 9 pounds. All liquids that are mostly water will always
weigh about 9 pounds a gallon. A gallon of cooking oil, on the other hand, only weighs 8 pounds. A liter of
soft drink weighs about 4.5 pounds. A half-case of Coke (12, 12oz.) in cans is 10 pounds. In glass bottles,
the same amount weighs 30 pounds! So what does this boil down to? Here are our shopping tips:
       Start paying attention to what things weigh.

       Everyone’s a little different, some people a little stronger, some a little weaker, but in general, use
       caution when lifting anything heavier than a gallon of milk (9 pounds).

       Weight isn’t the only important factor. Sometimes an object has an awkward shape that makes it hard
       to carry even though it isn’t very heavy. Be cautious with those things too.

       Never buy anything heavier than 15 pounds when working for Island Home Nursing if you will have
       to carry it as a unit. This includes such things as large bags of dog food, large bags of cat litter, and
       bulk detergent in 2-gallon plastic bins. You still might be able to buy it if you have store personnel
       load it into the car, then break up the container and carry it inside a little at a time. If the client
       objects, please explain that you are obligated to follow our rules and have them call the office if they
       are still upset.

       You might consider limiting what you carry outside of work hours too. Take care of yourself!

       Vacuum cleaners are heavy, usually weighing about 35 pounds. Be cautious when vacuuming and
       always pull or push. Never carry one up stairs. Call the office to problem solve if necessary.


                          GENERAL EMERGENCY PLANNING
In each client’s home the caregiver must know the following:
• Location of all exits.
• Location of telephone or nearest available telephone.
• Emergency phone numbers (911)
• Location of fire extinguishers and other safety equipment.
IF AN INJURY OCCURS
• Call 911 and start CPR, if necessary. Contact the IHN office or the person on call ASAP.
• In case of serious injury, do not move the injured person. Only provide assistance to the level of your
    training.
• If the injury involves bleeding, Universal Precautions must be followed. All blood should be assumed to
    be infectious. AIDS/HIV and Hepatitis B are the primary infectious diseases of concern. If you must
    apply pressure to a wound, gloves are required. If you are exposed to blood, wash immediately with
    soap and water and report the incident to the office or on call person. The appropriate follow-up
    procedures will be initiated (see Exposure Procedures above).
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IF A FIRE OCCURS
• Leave the premises with the client (keep low to avoid smoke inhalation, feel doors for extreme heat
    before proceeding).
• If unable to get the client out safely, exit immediately.
• Call 911 from the nearest phone.
• DO NOT go back inside the house for any reason.
• Call the office or the person on call to report the incident ASAP
IN CASE OF EARTHQUAKE
• Get yourself and the client outside if possible, under a table, in a doorjamb or other strong structural
    area of the home. Stay away from windows and heavy bookcases or areas where unsecured objects
    may become airborne and hurt you.
• When the shaking stops, check yourself and the client for injuries. Call 911 if necessary, assess the
    damage, call the office or the person on call with report.
• If a gas odor is present, get out of the home and call 911 for instructions.
• If possible turn on a radio and listen for public safety instructions.

                             BAD WEATHER AND DISASTERS
                                             YOUR CLIENTS
Do what you can to get your clients prepared to do without help or electricity and other utilities. Some things
to consider, depending on the particular client’s situation:
    • Flashlights and battery powered lights
    • Water in containers small enough for the client to manage
    • Food in a form that the client can eat without heating. This may mean power bars.
    • Try not to let critical medications or oxygen get too low.
    • A phone that will work without electricity
    • A battery powered radio
    • An emergency evacuation plan—who will the client call if they find they can’t manage at home

                                       YOU AND YOUR FAMILY
Of course, all of the above apply to you as well as your clients. In addition:
    • Check your tires and replace if needed—good traction is essential for winter driving.
    • Keep an emergency kit in your car: Flashlight, power bars, water, blanket, walking shoes, and a
           radio.

                                      YOUR RESPONSIBILITIES
If you can’t get to work without risk, don’t go, even if you think your clients are in danger without help. Call
us if you can’t go to work. If needed, we will activate the client’s Disaster Plan. If you think your client might
be without power, call us before going. Some clients want/need help when without power, some don’t.
On the other hand, if you have a great car and good bad weather driving skills and want to work, call us,
whether or not you are scheduled to work. We usually need to change our schedule drastically to try to get
help where it is needed most.
If you are working during bad weather, we have some additional rules:
•           When the roads are even a little icy, you may not run errands for your clients unless you get
            permission from the office first. Unless the situation is truly desperate, we will not give
            permission.
•           Try to take the transit for errands whenever possible.
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•          You may never under any circumstances have the client in your car when the roads
           are even a tiny bit icy—don’t even ask.


                              CLIENT SAFETY PROCEDURES
If unsafe or potentially unsafe conditions exist or are recognized, call the office.
1. IHN staff will be alert to conditions, such as the following that may be unsafe:
        • Loose rugs
        • Stairways without rails or with inadequate lighting
        • Portable heaters near bedclothes or curtains
        • Slippery floors or stairways
        • Electrical or phone cords in Client’s pathway
        • Use of oxygen in rooms where Client or family members smoke
        • Need for and proper use of adaptive equipment or need for adaptive equipment
2. Please be familiar with the following safety precautions:
        • Add non-slip treads to carpet on stairs
        • Light stairways - use a night light in bedrooms
        • Extend staircase handrails beyond the last step on both sides of the stairs
        • Put in non-slip rubber mats and horizontal grab bars in bath tubs/ showers
        • DO NOT WAX FLOORS
        • Do not use scatter rugs; tack down edges on rugs or use non-slip rugs
        • Mark all large glass surfaces such as patio doors and mirrors with masking tape
        • Keep furnishings clutter free
        • Mop up all spills immediately
        • Store flammable liquids safely or out of the home or dispose of them after use
        • Do not overload electrical outlets
        • Use electrical appliances endorsed by Underwriters Laboratory
        • Have heating and air conditioning equipment inspected regularly
        • Restrict smoking to areas where oxygen is not in use
        • Use household materials that are non-flammable for curtains and bedding
        • Buy non-flammable clothing whenever possible
        • Maintain an easily accessible fire extinguisher and instruct household members
        • Install smoke detectors & maintain
        • Place bedridden individuals on the whichever floor is most convenient for emergency exit
        • Obtain necessary adaptive equipment to make job safer for the caregiver
                                   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:
• Assess the physical and mental capacities of your client.
• Recognize that baths may be preferable to showers, since baths pose less risk of scalding from sudden
     changes in water temperature.
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•   Draw bath water before the client enters the tub, and do not run the water with the client in the tub.
•   Always check water temperature before helping the client into the tub. Test for comfort by using your
    elbow, not your hand, or by using a thermometer.
•   Be sure that the water temperature is appropriate for the skin condition and medical status of your
    individual patient.
•   Always supervise the client in the tub or shower. Encourage all clients to let you stay with them when
    they shower or bathe. If a client refuses and you are worried about their ability to bathe or shower alone,
    call the office.
                                            HEATING PADS
Heating pads can be dangerous to people with poor circulation and thin skin. Our heating pad policy is as
follows:
• Get permission from office first to use a heating pad.
• Pad should be only slightly warm. Electric pads should be on "low". Gel pads should be checked by
     leaving them against your inner forearm for two full minutes.
• Do not sandwich pad between patient's skin and bed, pillow, chair, etc. This allows skin to perhaps burn.
• Do not leave the room once pad is applied. Check placement and skin every five minutes. If skin is red,
     remove pad and call office immediately.
• Don't leave pad on patient more than 30 minutes.



                                 FOOD HANDLING POLICY
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.
Special Precautions: The following foods should be handled with special care:
Egg and egg-rich foods: Storing and handling: Keep raw eggs clean and cold.
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.
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                                   INFECTIOUS DISEASES
                                         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
introduced 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.

                                               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 Nursing’s 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
• Handwashing is the single most important way to prevent the spread of infectious organisms.
• Requires a vigorous lather for at least 10 seconds with soap and thorough rinse
• Clean healthy hands with smooth skin, short fingernails, and no rings minimize the risk of contamination
• Use lotion on clean hands to replace the natural oils removed by handwashing
• Dry, chapped hands lead to open areas through which disease causing organisms may enter
• Mild infections may develop which could be spread to the client
• Paper or a clean towel should be used for drying hands
• Waterless hand sanitizer may be used in place of soap and water
•
Hand washing is required:
• Before and after client contact.
• Before and after coming in contact with wounds.
• After contact with a source that is likely to be contaminated with virulent organisms
• Following removal of gloves.
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•   Prior to making meals; before & after eating; After using the bathroom or contact with one's own body
    fluids (i.e. blood, semen or mucous);
•   After handling a client's personal articles, dressings, or any equipment used in his/her care;
•   Before handling sterile supplies;
•   After using your own handkerchief or tissue.
GLOVES
•   Gloves act as a barrier to prevent the spread of infection agents to the client or caregiver,
•   Hands do not need to be gloved to touch the client's intact skin (i.e. back-rubs, baths, transfers, or
    talking to the client,)
•   Gloves are non-sterile, as caregivers are not to do sterile procedures
•   Heavy-duty gloves may be necessary if work performed normally tears exam gloves.
•   Change gloves when they become obviously soiled to avoid contaminating equipment or other work
    areas.
•   Wash hands after removing gloves,
•   Gloves are available from Island Home Nursing on request.
GLOVES ARE REQUIRED
•   Where there is a break in the skin of the caregiver;
•   When there is a chance for contact with body secretions, blood/ urine, feces, wound drainage, vomitus,
    skin lesions, breast milk, etc.:
•   When giving oral care in which contact with mucous membranes/ oral lesions, or blood are likely.
•   When giving peri-care to a client who is incontinent or to a woman who may be menstruating,
•   When handwashing facilities are not available.
•   When there is a potential for contact with blood and body fluids (i.e. handling soiled linen, clothes,
    diaper, incontinence pads, bedpans, urinals, urine bags, drains and such containers.
•   When cleaning bathrooms (heavy-duty gloves may be used and kept in the client's home and reused
    only at that time).
•   When gloves are used to work in a contaminated area, wear once and then discard before leaving the
    client area.
•   Remove and discard gloves when contact with contaminated material is completed
DISPOSABLE APRONS/GOWNS
•   If unexpected soiling occurs while not wearing an apron, clothing should be changed.
•   Hot water washing in detergent will destroy the AIDS virus. The addition of household bleach to the
    laundry may provide added protection.
•   Use disposable aprons/gowns once and discard in a receptacle within the client area.
•   Gowns are available from Island Home Nursing upon request.
APRONS/GOWNS ARE REQUIRED
•   Where there is a known risk of blood or body fluids soiling clothing.
PROTECTIVE EYEWEAR
•   Protective eyewear is to protect the mucous membranes of the eye.
•   Contact lenses are not protective eyewear.
•   Reusable protective eyewear is available from your supervisor.
•   Disposable glasses should be washed with soap and water to keep clean and reused until visibility is
    affected.
PROTECTIVE EYEWARE IS REQUIRED
•   Where there is a known high risk of body fluids splattering on the face.
•   Protective eyewear is a personal choice for use with any contact where there may be, but is not always,
    splattering,
•   If you need protective eyewear, please call Island Home Nursing.
Island Home Nursing Orientation Manual                                                               - 28 –

MASKS
•   Do not double mask.
•   Change mask when it becomes wet.
•   AIDS is not an airborne disease. Masks are to protect from cases where splattering may occur.
•   Wear only once, do not handle while worn, and dispose of in a receptacle in the client area.
•   Masks must cover both nose and mouth,
•   Masks are available through supply (see your supervisor if you need help obtaining one).
•   Ask the client to cough or sneeze into tissue or handkerchief not directly into the air.
•   Keep living quarters well aired, Airborne diseases are less likely to be a problem when diluted by lots of
    air,
•   Masks are available from your supervisor.
MASKS ARE REQUIRED
•   For contact with clients known to have AIDS who are coughing productively.
•   For contact with clients with suspected or proven pulmonary mycobacterium tuberculosis. However,
    Island Home Nursing does not accept clients with TB.
•   When there is known high risk of blood or body fluids splattering on the face.
•   When employee has a cough.
                        DISPOSAL OF CONTAMINATED SUPPLIES:
•   Flush body waste down the toilet.
•   Soiled, disposable supplies used in the care of client (gloves, diapers, incontinence pads, toilet paper,
    dressing supplies, therapy tubing, or nebulizers) may be disposed of by double bagging,
•   Double bagging is accomplished by placing the soiled supplies in a plastic bag, placing it into a second
    bag, and also sealing it securely and marking it "contaminated".
•   The bag should be replaced and disposed of when 3/4 full
•   Dispose of the double bag in an outside receptacle with a lid or reliable disposal system where
    incineration is accomplished if possible. Do not burn in burn barrels or wood stoves,
•   Hand washing completes the process of disposal of contaminated materials
                                          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.
Island Home Nursing Orientation Manual                                                               - 29 –


•   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 properly 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, despose 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.
•   BE ALERT TO HAZARDOUS WASTES - Household cleaners and chemicals.
•   DIRECT ANY QUESTIONS TO YOUR HOME CARE SUPERVISOR.
                                     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)
•   Kitchen Instructions-.
•   Wash hands thoroughly before preparing food.
•   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 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.
Island Home Nursing Orientation Manual                                                                - 30 –

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 CLOTHS OR OTHER LAYNDRY IN HOME SETTING
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 doesn’t 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.
Island Home Nursing Orientation Manual                                                                    - 31 –

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 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.

                                         AIDS INFORMATION
Much progress has been made in the treatment of AIDS in the last ten years. New drugs and new
combinations of drugs have been very successful in extending the lives of persons with AIDS. Treatment is
so effective, in fact, that not only do people with AIDS live longer, they are able to lead normal lives in terms
of quality, not just quantity. Still, it is an ultimately terminal disease, so clearly prevention is the best policy.
HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted
through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected
from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get
HIV from mosquitoes. HIV is primarily found in the blood, semen, or vaginal fluid of an infected person. HIV
is transmitted in 3 main ways:
    •   Having sex (anal, vaginal, or oral) with someone infected with HIV; always use condoms.
    •   Sharing needles and syringes with someone infected with HIV
    •   Being exposed (fetus or infant) to HIV before or during birth or through breast feeding
    •   Men who are uncircumcised have a higher risk of getting AIDS if they are exposed to the virus. If
        you are having a child, you should discuss this with your obstetrician.



                MANDATORY REPORTING OF ABUSE/NEGLECT
Mandatory Reporting of Abuse or Neglect - 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 must also report directly to
Adult/Child Protection Services (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.
Island Home Nursing Orientation Manual                                                                  - 32 –

   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 POLICY
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:
• Care Supervisors (unless the Supervisor is the source of alleged harassment.)
• Administrators. No employee will be subject to any form of retaliation or discipline for pursuing a
     harassment complaint.
Additional information is in our anti-sexual harassment policy, which follows.

                        ANTI-SEXUAL HARRASSMENT POLICY
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 individual’s 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
Island Home Nursing Orientation Manual                                                                    - 33 –

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.



                             DRUG-FREE WORKPLACE POLICY
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. Employee must submit to testing at the time the Company requests. 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. Should be outcome of testing be non-
negative, the employee will be terminated and will reimburse the company for the cost of the test. This will come out
of the last paycheck.
9. The Company reserves the right to carry out reasonable searches of employees and their personal
belongings when at work, including cars, purses, lunchboxes and other personal items.
Island Home Nursing Orientation Manual                                                                - 34 –


                                JOB TYPES & DESCRIPTIONS
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
When is a Sleepover a “Sleepover” - An eight-hour night shift, usually 11-7 or 10-6, PCA or HHA, will be
paid as a “sleepover or as a straight 8 hour shift.
    If a clients needs only brief, minor assistance at night, not totaling more than 2 of the 8 hours, then you
will be paid at the flat rate of a “sleepover”.
   If you are up with the client for more than 2 hours total during the night and you don’t get at least 3
consecutive hours of uninterrupted time to yourself, then you will be paid on an hourly basis PROVIDING
YOU CALL THE OFFICE THE NEXT MORNING TO REPORT THAT IT WAS NOT A SLEEPOVER.
   Sleepover or not, all of the client’s ups and downs during the night must be documented on the time
card. Without this documentation, the shift will be paid as a “sleepover” regardless of how much time you
were awake with the client. IHN needs this documentation for billing purposes.
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:
                                                                                STATE PROGRAM
                                                   PRIVATE CLIENT
                                                                                      CLIENT
    Who decides what’s on the Care Plan               Client/family               Case Manager
    Caregiver can be in home without
                                                           Yes                           No
    client being there.
    911 must be called if client dies, even
                                                            No                          Yes
    if the client has declined resuscitation
    Restrictions on driving- amount and for
                                                            No                          Yes
    what purpose
                                                                                         No
    Hours can be increased if the client                                     Requests for different
                                                           Yes
    wants it.                                                               hours must be cleared
                                                                              by office in advance.
Island Home Nursing Orientation Manual                                                              - 35 –

Island Home Nursing caregivers are prohibited by state contract from caring for a family member through
Island Home Nursing. It is your obligation to inform us if a client we are scheduling you for is a family
member.

                                         PONY MAILING
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:
• Drop off your timecards.
   Timecards must be taken INSIDE-- the outside box is for stamped and addressed regular mail only. Put
   your timecards in an envelope that says “Island Home Nursing, Box 326” on the outside.
• Pick up blank Timecards, Mileage Reimbursement Forms, and gloves. Call the office at least a week in
   advance to have a box of gloves sent to Pony for you.
Hours:
   Mon- Friday     8:30am – 5:30pm
   Saturday       10am - 2pm
   Sunday         closed
Address: 316 SE Pioneer Way, Oak Harbor


                                         MONEY MATTERS
WHAT YOU GET PAID
For current pay scales, see the sheet that was given to you at the interview.
WHEN YOU GET PAID
We pay twice a month. Actual paydays are listed on your Payroll Dates sheet and also on our web site. Pay
periods are:
• The 1st through the 15th
• The 16th through the 31st
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 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 doesn’t 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 be 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
• Put them in the mail on the 1st and the 16th of the month, as well as on paydays.
• Take them INSIDE at Pony Mailing in Oak Harbor. (Outside box is for postal mail.) We pick them up
   early in the morning after the deadline day, unless that was a Sunday, in which case we pick them up a
   day later.
• Bring them to the office. We have a box outside next to the front door for after-hours drop off.
OVERTIME & HOLIDAYS
The overtime rate is 1½ times the hourly rate. Overtime is paid for:
Island Home Nursing Orientation Manual                                                               - 36 –


•   Work over 40 hours per week (One week is the hours between 7am Sunday and the following Sunday at
    7am. Don’t forget, Sleepovers count as 3 hours.)
•   Work on the following holidays:
    Easter Sunday         11pm Sat to 11pm Sun
    Memorial Day          11pm Sun to 11pm Mon
    July 4                7am 7/4 to 7am 7/5
    Labor Day            11pm Sun to 11pm Mon
    Thanksgiving          11pm Wed to 11pm Th
    Christmas            3pm Christmas Eve to 11pm Christmas Day
    New Year's Day        3pm NY Eve to 11 p.m. NY Day
MILEAGE REIMBURSEMENT
See Driving and Mileage Reimbursement section.
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
130 hours per month in regularly scheduled ongoing work. Your health, dental and vision insurance is 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.
NORTH-SOUTH BONUS
Our dividing line for North/ South is a line drawn east to west through the Greenbank store. If you do a job
on the opposite side of the island from where you live, you are paid an extra 50 cents per hour—but only if
you document it on your timecard. If you forget, we will not back pay you for past work beyond 1 pay period
ago. For instructions on how to document this bonus on your timecard, see the “Filling out Timecards”
section.
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.
Here’s what you need to know:
• The scheduled time between the end of the last client and the start of the next client must be less than
   45 minutes. If the time between shifts is 45 minutes or more, Travel Time is not paid. Exception: if it
   takes more than 45 minutes to drive the distance, the time is paid, even if there is more than 45 minutes
   between the visits.
• The time entered must be the minutes you took to drive directly from one client to the next, not including
   any personal errands.
• Enter your time in minutes. Do not round.
Island Home Nursing Orientation Manual                                                                 - 37 –


•  If you have a scheduled appointment at the office and also see a client the same day, Travel Time
   between will be paid as long as it meets the criteria outlined in number 1, as described above.
• If you run an errand on the way to the client's house, the Travel Time ends and your visit time begins
   when you get to the place where you are doing the errand.
• You must fill in both the minutes and the name of the previous client. If either is absent, you won't be
   paid.
• We reserve the right to alter Travel Time that is outside reasonable boundaries for how long it should
   have taken you.
See the next section for instructions on how to chart travel time.
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:
• You have to have worked throughout the 3 month bonus period.
• You must still be working at the time the bonus is paid.
• You must have worked at least 300 hours during the bonus period.
• You must have at least average attendance and quality of work and have no more than 2 “0”’s in other
    areas.
We rate all eligible employees in these areas:
• Quality of work
• Number of hours worked per month
• Attendance
• Weekend work
• Willingness to accept last minute requests
• Team player
• Turning in timecards
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 $3000 every 3 months.

                                  FILLING OUT TIMECARDS
Timecards must be filled out at the time of the visit. The client must sign the timecard at the end of
the visit. Filling out timecards in advance or after the fact can be grounds for disciplinary action or even
termination. If your client is unable to sign or you didn’t comply with this policy, please call the office right
away for instructions.
Don’t mix pay periods on one timecard. In other words, a single timecard should have either days between
the 1st and 15th of the month OR days between the 16th and the end of the month, but NOT BOTH.
TURN IN THE WHITE COPY TO THE OFFICE. The yellow copy is for you. Please be sure to keep it until
after payday, in case the white copies are lost by Pony Mailing or the Post Office. In that case, the yellow
copy is your only proof that you worked.
Below 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 often have to copy them for various reasons.
Island Home Nursing Orientation Manual                                                           - 38 –




1. EMPLOYEE NAME
   Print your name.
2. EMPLOYEE SIGN HERE:
   Sign your name here.
3. JOB TYPE:
   Fill in with the type of visit you did: PVT (Private), CPS (Copes), DDD (Department of Developmental
   Disabilities, or MPC (Medicaid Personal Care).
4. CLIENT'S NAME:
   Print the client's name.
5. AUTHORIZED CLIENT SIGNATURE:
   The client or authorized representative must sign here.
6. MONTH/YEAR:
   Fill in the Month and Year, for example, "Oct 2004".
7. DATE:
   Write the day of the month when the shift started. Don't overlap time periods- numbers in this column on
   a given timecard should be from 1-15 or from 16 to 31.
8. DAY:
   Write the first letters of the day of the week you worked.
9. TIME IN:
   Write the time you arrived, including a.m. or p.m.
10. TIME OUT:
   Enter the time you left. We have a two-hour minimum. If the client wants to send you home before
   two hours are up, call the office BEFORE leaving. We will remind the client of the two-hour minimum.
Island Home Nursing Orientation Manual                                                               - 39 –

11. HOURS: REGULAR:
   Use this column for everything but sleepovers. Enter the total number of hours you worked to the
   nearest 1/4 hour.
12. HOURS: S/O:
   If the shift was a Sleepover, put a check here.
14. CLIENT INITIALS:
   Have client, family, or another caregiver initial each shift at the end of the shift.
15. CHARTING AREA:
   This is the charting area. Leaving it blank is unacceptable, as this would mean that you did nothing.
   Using the abbreviations at the bottom of the card, write down what you did for the client. The tasks you
   list here should match the tasks on the client’s Plan of Care. Six of the listed are considered critical: A
   (Ambulation), X (Transfers), T (Toileting), B (Bathing), D (Dressing), and PH (Personal Hygiene).
   Your job is to encourage each client to do as much as they can in these six areas of Personal Care to
   help maintain their independence. You must observe they can do these activities safely and step in to
   assist if they need help.
   If there is anything written in the areas on the Plan Of Care that pertains to these activities, you need to
   chart it. The only exception is bathing since most elderly clients do not usually bathe daily. (Bathing
   means everything gets bathed from head to foot: a full bed bath; a shower or tub bath; a sponge bath
   where everything from neck to feet gets washed.) Even if the client goes into the bathroom to shower
   alone, you are “assisting” by being close by to help if needed and should mark a “B” in the charting area
   of the timecard.
   List other tasks from the list you did as they occur.
16. DRIVING MINUTES:
   Put Travel Time here. It is the number of minutes it takes you to drive between clients. If you are running
   an errand for the client before going to her house, Travel Time stops when you arrive at the place of the
   errand.
17. PREVIOUS CLIENT:
   Write the last name of the previous client. YOU WILL NOT GET PAID THE TRAVEL TIME UNLESS
   YOU FILL IN THE PREVIOUS CLIENT'S NAME.
18. SPECIAL TASKS/ NOTES:
   Use this space to chart important occurrences, such as falls or illnesses, or therapies that can’t be
   otherwise charted. Use this space to chart Sleepovers that convert to 8 hour night shifts.
19. NORTH-SOUTH BONUS:
   Check the box if the visits are eligible for the North-South Bonus (see the North-South Bonus section
   under Money Matters).


                                                THE END
Congratulations, you made it to the end! Well, almost. You still need to do the Post Test. If you think it was
tiring to read, just imagine writing it! Please call if you have any questions.
YOUR NAME: ____________________________________________DATE: __________________

                         ORIENTATION MANUAL POST TEST
INSTRUCTIONS:              Circle whether each statement is true or false.


                                                                                           T         F
You will be held responsible for knowing IHN policies
Your clients like you so well that it doesn't matter if you are a little late.             T    F
After only one hour of a two hour job, you have done everything you can think of. It is    T    F
OK for you to leave without calling IHN.
It's OK to tell your husband, without mentioning names or other identifiers, that the      T    F
client you cared for today has AIDS.
It's OK to watch TV quietly while the client is asleep.                                    T    F
Mrs. Smith is wealthy and likes you. It's OK to accept a necklace she offers you in        T    F
gratitude.
Ms. Garfield tells you that June Bug, an IHN CNA, chats with her friends on the phone      T    F
while she is working. You should report this to the office.
Your client becomes severely short of breath and complains of severe chest pain, but       T    F
doesn’t want you to call anyone. You should do what the client wants.
Your daughter is ill. It is OK for you to call the client and schedule another time with   T    F
him or her without calling the office.
It’s illegal for you to decide what, when, or how much of a medication a client should     T    F
have.
Your time cards must be mailed in on the 1st, and 16th.                                    T    F


INSTRUCTIONS: Circle the letter next to the best answer.


12.     You are supposed to wash a catheter bag, but don’t know how. You should:
a. Just do the best you can.
b. Call office for instructions.
13. You are asked to transfer a 250 pound non weight-bearing client into a wheelchair by yourself.
You would:
a.      Give it a try.
b.      Call the office immediately.
14. Your client has refused to take her morning medicines. What would you do?
a.      Try to find out why she doesn't want to take them.
b.      Call the office.
c.      Both of the above are essential.
15. Your client, who has Alzheimer’s, behaves inappropriately when you try to help him get dressed.
    You would:
a.      Remove yourself from the room and call the office immediately.
b.      Smile and say, "Naughty, naughty, Mr. Smith."
16. After you get home from work, your husband asks you how your day went. You tell him:
a.     "A little harder than usual, but OK.”
b.     “Mrs. Smith was upset today."
17. It's 5:30 p.m. You are supposed to work tomorrow morning. Your son breaks his leg and you won't
    be able to work tomorrow. You would:
a.     Leave a message on the answering machine.
b.     Page us immediately.
18. You walk into Mr. Potter’s house and find him lying on the floor, appearing to be unconscious.
    Which of these actions would you perform first?
a.     Call the office.
b.     Call 911.
19. You've had a bad week: Your water heater broke, your husband didn't get a raise, and your son
    flunked out of the 8th grade. Your client asks you are doing. The most appropriate response would
    be to:
a.     Say, "I 'm doing OK. How are you?"
b.     Treat him like a friend and start telling him all your problems.
20. At the clients' home, you should wash your hands:
a.     At the beginning of the shift.
b.     After using the toilet or helping the patient use the toilet.
c.     Before preparing food.
d.     All of the above.
21. While transferring Mrs. Smith from a wheelchair to the bed, she falls to the floor. She is conscious
    and says she doesn't hurt anywhere, but can’t get herself up. Which of the following would be most
    appropriate:
a.     Helping her back to bed and calling the office later.
b.    Making her comfortable on the floor with pillows and a blanket and calling the office
immediately.
22. Your regular client, Mrs. Doe, calls you at home and wants you to give her a ride to the doctor
    because her ride fell through. You should:
a.     Tell her you will call the office and explain the problem.
b.     Tell her you will be right over.
23. Your client wants you to put a heating pad on her back. The Employee Instructions do not mention
    doing this. You should:
a.     Go ahead and do it- after all, what's the harm?
Call the office and ask if it's OK to use a heating pad.
24. Why do we want you to do a good job caring for IHN clients?
a.     Because clients need and deserve good care.
b.     Because it will bring you personal satisfaction.
c.     Both

								
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