ENSURING QUALITY CARE THE AFH JOURNEY BEGINS September 2019 - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

THE AFH JOURNEY BEGINS

September 2019 Safety, Oversight and Quality Unit 1

WELCOME

Welcome

• Your journey towards opening or managing an Adult Foster Home (AFH)

begins today.

The purpose of the Ensuring Quality Care (EQC) Training is to provide you with the information you need to provide:

• Appropriate care; AND
• Ready your house to support individual resident choice

September 2019 Safety, Oversight and Quality Unit 2

EQC TRAINING

The EQC Training covers a broad range of topics necessary to:

• Understand the scope of what is expected form an AFH licensee and their

caregivers

• Prepare your home for residents
• Understand your home is now also the home of each resident

September 2019 Safety, Oversight and Quality Unit 3

EQC TOPICS

• Business basics
• Care planning
• Common chronic conditions
• Communication
• Dementia and challenging

behaviors

• Documentation requirements
• Emergency preparedness
• Fire safety
• Food safety and handling
• Infection control
• Managing your time
• Medication administration

September 2019 Safety, Oversight and Quality Unit 4

EQC TOPICS CONTINUED

• Normal aging
• Nutrition
• Personal hygiene
• Privacy, HIPAA and security
• Problem solving and conflict

resolution

• Resident rights
• Safety in the home environment
• Screening and admission
• Taking care of yourself

September 2019 Safety, Oversight and Quality Unit 5

ADDITIONAL TRAINING

Your participation in the EQC training is only the beginning. The EQC training does not cover all aspects of resident care. It is your responsibility to seek additional training such as:

• Topics covered that you do not feel adequately prepared to handle
• Knowledge needed prior to admitting a resident with a condition you are

unfamiliar with

• On-going training as required by Oregon Administrative Rule (OAR)
• Additional information on successful operation of a business

September 2019 Safety, Oversight and Quality Unit 6

ADDITIONAL TRAINING CONTINUED

Resources and tools are available to help you find the right information and training.

EQC additional tools and resources:

https://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/Pages/eqc-manual.aspx

Safe medication administration:

https://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/Pages/safe-med- administration.aspx

Adult Foster Home training website:

https://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/APD- AFH/Pages/Training.aspx

September 2019 Safety, Oversight and Quality Unit 7

PURPOSE AND KEY TERMS

The purpose is to assist the learner in understanding what information must be gathered during the screening process, how to evaluate the information before admitting a resident, and your responsibilities in educating potential residents, their family and medical professionals about AFH care.

• Activities of Daily Living (ADLs)
• Behavior management
• License classification
• Screening
• Transfer

September 2019 Safety, Oversight and Quality Unit 8

OBJECTIVES

The learner will be able to:

List four major questions to ask during the screening process to determine if a prospective resident is appropriate for your AFH Describe the type of information that needs to be gathered during the screening process and where to find the information Define the three ADL levels and describe the importance of determining the ADL requirements of a prospective resident before admitting them to your foster home Evaluate the information gathered to assist in determining if the AFH can meet the needs of a prospective resident

September 2019 Safety, Oversight and Quality Unit 9

INTRODUCTION

Preparing for on-going needs:

All residents have conditions that will change over time:

• Normal aging process
• Changes in medication needs
• Changes in chronic health care needs
• Progression of degenerative conditions.
• Be prepared to provide care according to the individual needs and

preferences of each resident.

September 2019 Safety, Oversight and Quality Unit 10

WHOSE HOME IS IT?

Once your home is licensed, your house is also each resident’s home:

Within reason, accommodations need to be made reflecting their expectations. Residents have a say in:

• Activities
• When and where they choose to eat
• When the resident goes to bed and gets up each morning
• Who their visitors are and when they can visit

September 2019 Safety, Oversight and Quality Unit 11

WHOSE HOME IS IT? CONTINUED

Imagine how you would feel if you could not:

• Arrange your furniture and decorate your room as you like
• Lock your bedroom door for privacy
• Access snacks when you want
• Provide input into mealtimes or the food you are offered
• Decide who visits you and when they can visit

September 2019 Safety, Oversight and Quality Unit 12

WHAT IS AN AFH?

Adult foster homes are highly regulated businesses and must be run in accordance with:

• All applicable state and federal Medicaid and Medicare laws and regulations
• Applicable federal and state business regulations
• OARs for adult foster homes
• Fair housing rules and guidelines

September 2019 Safety, Oversight and Quality Unit 13

WHAT IS AN AFH? CONTINUED

An adult foster home is also a place of employment, and you must follow all applicable employment laws, BOLI (Bureau of Labor and Industry), including wage and hour laws.

September 2019 Safety, Oversight and Quality Unit 14

WHAT IS AN AFH? CONTINUED

There are additional responsibilities of an AFH provider, such as:

Routine maintenance of the interior and exterior of the home:

• Painting
• Yard maintenance and debris removal
• Keeping exits and walkways clear and accessible

Ensuring adequate supplies Keeping electrical and plumbing in good working order

September 2019 Safety, Oversight and Quality Unit 15

WHAT IS AN AFH? CONTINUED

Owning and operating an adult foster home is not an 8am to 5pm job. For example, it requires a significant time commitment and typically requires more than one person to be managed successfully. Proper management includes:

• Maintenance of home and property
• Resident care and service needs
• Nighttime care needs
• Laundry
• Nutritional needs
• Financial records
• Resident and facility records

September 2019 Safety, Oversight and Quality Unit 16

SCREENING

September 2019 Safety, Oversight and Quality Unit 17

PURPOSE AND KEY TERMS

Assist the learner in understanding:

• What information needs to be shared with the prospective resident
• What information must be gathered during the screening process
• Behavior management
• License classification
• Screening

September 2019 Safety, Oversight and Quality Unit 18

INTRODUCTION

Referrals come from a variety of sources:

• Prospective residents, their family or friends
• Healthcare practitioners
• Nursing facilities and hospital discharge

planners

• Local Aging and People with Disabilities or

Area Agency on Aging staff, such as:

• Case manager; or
• Transition coordinator

September 2019 Safety, Oversight and Quality Unit 19

FINDING THE RIGHT MATCH

Before accepting a prospective resident:

• Visit the person in their current setting; and
• Gather enough information to make an informed decision

The decision to admit a person to an AFH often results from a crisis. Many times hospital social workers, physicians, families, case managers

• r the potential residents may try to push for an immediate decision.

It is vital that you take the time to gather information from as many sources as possible before deciding to admit a resident.

September 2019 Safety, Oversight and Quality Unit 20

FINDING THE RIGHT MATCH CONTINUED

You are the only one who can determine if you are qualified, willing and able to care for a new resident. Taking in a resident without adequate information:

• Leads to turmoil for the resident, his or her family, the other residents in the

AFH and you as the licensee

• May result in corrective action from APD for admitting a resident without

being able to meet their needs

September 2019 Safety, Oversight and Quality Unit 21

ALERT

Once admitted, a resident can

• nly be asked to leave for specific

reasons as allowed by Oregon Administrative Rules.

September 2019 Safety, Oversight and Quality Unit 22

FINDING THE RIGHT MATCH CONTINUED

Avoid unnecessary challenges by ensuring:

• You can support the prospective resident’s needs an expectations
• Prospective residents, families, or the resident’s representative understand

your home’s policies, residency agreement and resident’s rights

• You have completed a thorough screening of each resident prior to admission
• You are aware of the limitations of the AFH and your staff

September 2019 Safety, Oversight and Quality Unit 23

SDS 0902

Use the mandatory SDS 0902 form to identify required information including, but not limited to:

• Medical diagnosis, medications and nursing care
• Personal care needs, including night care needs
• Cognitive and communication care needs
• Nutritional needs
• Activities and lifestyle preferences; and
• Other data to assure you can meet the resident’s care needs

September 2019 Safety, Oversight and Quality Unit 24

SDS 0902 CONTINUED

September 2019 Safety, Oversight and Quality Unit 25

SDS 0340

Use the AFH Care Plan (SDS 0340) during the screening

• process. This guideline will

provide you with a better understanding of the resident’s needs.

September 2019 Safety, Oversight and Quality Unit

26

SCREENING PROCESS

Ask as many questions as possible over the phone. The answers will help you to determine your next action:

• Have a list of questions or a copy of the Screening and General Information

form (SDS 0902) near the phone

• Determine if the caller needs a placement for a man and you only have a

shared room with an existing female resident; or

• You could be operating a non-smoking home and the potential resident is a

smoker

Screening people out is as important as screening residents into your home.

September 2019 Safety, Oversight and Quality Unit 27

SCREENING CONTINUED

The information gathered will focus on the potential resident’s ability to participate in activities of daily living (ADLs). These are in the activities we do to function in our daily lives:

• Bathing/personal hygiene
• Eating/nutrition
• Dressing
• Transfer/mobility
• Toileting
• Behavior management

September 2019 Safety, Oversight and Quality Unit 28

SCREENING CONTINUED

You can determine how much help the potential resident requires through:

• Your own observations
• Written information about the potential resident, from the family, other

caregivers and medical professionals involved; and

• Interviews with the potential resident, the family, caregivers and medical

professional involved

September 2019 Safety, Oversight and Quality Unit 29

SCREENING CONTINUED

You will note the person’s abilities, and based on their specific needs, determine if the potential resident can do the ADLs without help. The terms are used:

• Independent “I”: Can manage the ADL without assistance or reminding.
• Assistance “A”: Is able to do the task but cannot do it alone.
• Dependent “D”: Cannot do any part of the task and it must be done entirely

by another person.

September 2019 Safety, Oversight and Quality Unit 30

SCREENING CONTINUED

You need to determine the ability of the person to exit in an

• emergency. You must consider the person’s ability to:
• Transfer (get up from a chair, off the bed or toilet, etc.)
• Understand directions; and
• Cope in a stressful situation

September 2019 Safety, Oversight and Quality Unit 31

SCREENING CONTINUED

The layout of the home must be considered in evaluating the person’s ability to evacuate in less than three minutes:

• If the potential resident can only walk 12 feet without resting and the exit to

use in an emergency is 20 feet from the bedroom, they would not be able to exit independently

• Assess whether they can walk quickly enough to exit independently within

three minutes – if assistance is required, you must balance their abilities with the needs of the other occupants in the home

September 2019 Safety, Oversight and Quality Unit 32

SCREENING CONTINUED

You need to determine if their care needs will affect your ability to provide care for the other residents:

• Medical diagnosis – will the person require more care time
• Medications
• Nurse consultation or RN delegation
• How well does the individual communicate needs
• Special diets; and
• Lifestyle choices and activities

September 2019 Safety, Oversight and Quality Unit 33

COLLECTING DATA

Keep track of where information was gathered, especially if you need clarity on the issues. Common sources of information for nearly all potential residents:

• The potential resident
• Family/friends
• Physician or nurse practitioner or the office nurse
• Pharmacist

September 2019 Safety, Oversight and Quality Unit 34

COLLECTING DATA CONTINUED

When collecting data from other sources you must have the resident’s written permission to request their records or to talk with others about their care:

• A special release provided by the mental health agency may be required if

requesting data for mental health concerns

• Veterans’ Administration (VA) hospitals may be treating veterans living in an

AFH – the VA has its own release form required to have access to information in VA hospitals or from the VA staff

September 2019 Safety, Oversight and Quality Unit 35

COLLECTING DATA CONTINUED

Other sources of information include:

Hospital or nursing facility:

• Discharge planner/social service worker
• Patient/resident chart:
• Admission information
• Current medication administration record
• Nurses’ notes are written around the clock and describe progress, care

needs, sleeping habits and behavioral issues

• Social service notes on pervious living arrangements, contact people,
• ther personal information, etc.
• Dietitian notes
• Physical, occupational or speech therapy notes

September 2019 Safety, Oversight and Quality Unit 36

COLLECTING DATA CONTINUED

Assisted or residential living facility:

• Care manager or facility administrator
• Persons actually providing care
• Resident record:
• Service plan describing what services are provided for the resident

based on the resident’s individual capabilities and preferences

• Narratives/notes regarding care provided and response to care
• Current physicians’ or nurse practitioners’ orders for medications,

treatments and therapies

September 2019 Safety, Oversight and Quality Unit 37

COLLECTING DATA CONTINUED

Previous Adult Foster Home:

• Owner provider/resident manager
• Resident records:
• General information form
• Most recent physicians’ or nurse practitioners’ orders for medications,

treatments and therapies

• Narratives/incident reports indicating resident’s current condition
• Instructions from other members of the health care team such as RN,

physical, occupational, speech or mental health therapist, social worker, etc.

September 2019 Safety, Oversight and Quality Unit 38

COLLECTING DATA CONTINUED

Living in the community:

• Neighbors
• Churches
• Support groups
• Service groups the person has been involved with: e.g., Lions Club,

Daughters of the American Revolution (DAR), Shriner’s, Elks, Moose, American Legion, Eagles, Odd Fellows

• Other community organizations specific to the location of the person

September 2019 Safety, Oversight and Quality Unit 39

GENERAL SCREENING GUIDELINES

Each piece of information fills in the puzzle to enable you to make an informed decision:

• You do not need nor should you have access to all information
• Out of respect for privacy, confine your research to information that is

reasonably related to your ability to provide care

Effective screening and assessment requires sensitivity, good communication skills and a professional attitude.

September 2019 Safety, Oversight and Quality Unit 40

GENERAL SCREENING GUIDELINES CONTINUED

Listen and show you care:

• Potential residents and their family members are often under tremendous

stress

• Be understanding as it may be difficult to talk about problems without crying
• r sounding angry
• Be reassuring
• Prepare the resident and the family for a period of adjustment that may take

up to six months

• Encourage questions

Have standard screening procedures.

September 2019 Safety, Oversight and Quality Unit 41

ADMISSION PACKET

Develop an admission packet:

Provide information about yourself and the AFH to clarify expectations for residents and families:

• Qualifications of you, your staff, and consulting RN
• Your license classification
• The types of residents you serve
• Criteria for admission and residence in your home
• Daily routine, including children, visitors and pets
• Convenient services such as shopping, church, and transportation
• AFH rules determining if the resident must move

September 2019 Safety, Oversight and Quality Unit 42

ADMISSION PACKET CONTINUED

Services to be provided:

• Services you can and cannot provide
• Services the family can and cannot provide
• Transportation
• Meals and snacks
• Personal items

Rates and related schedules:

• Rate schedule and notice for rate increases
• Billing procedure for when payment is due
• Refund policy
• Whether you have a Medicaid contract

September 2019 Safety, Oversight and Quality Unit 43

ADMISSION PACKET CONTINUED

Policy and procedures:

• Policy of confidentiality
• Safety and emergency procedures
• Notification procedures in emergencies or other issues
• Notification procedures regarding the move of a resident
• Social activities within and outside of the home
• How roommates are selected and the number of persons per room
• Policy regarding personal possessions
• Policy regarding food brought in by friends and family

September 2019 Safety, Oversight and Quality Unit 44

ADMISSION PACKET CONTINUED

House rules (discussed in Chapter 9); Resident’s medical needs:

• Arrangements for medical and personal appointments
• Replacement of or payment for medications
• Procedures for care needs beyond your skills or license level
• Procedures for medical emergencies and when a death occurs

September 2019 Safety, Oversight and Quality Unit 45

SCREENING PROCEDURES

These procedures will facilitate the screening process:

• Be familiar with the Screening Information and General Assessment

worksheets and complete the forms as you talk with the potential resident, initial caller or other contact people.

• Discuss your criteria for admitting new residents and providing care. Briefly
• utline your qualifications, your license classification, and the type of

residents you serve.

• Arrange to meet with the prospective resident and their family. If the person

making the inquiry is interested in placement, stress how important it is for all parties to meet and talk together.

September 2019 Safety, Oversight and Quality Unit 46

SCREENING PROCEDURES CONTINUED

• A face-to-face interview with the potential resident is vital. You must

gather your own information and consider information give to you by

• ther people.
• If possible, the potential resident should come to your house to see the

room, meet you and the other residents, and see your house rules.

• Talk with the prospective resident. It is essential to involve the person as

much as possible in the decision-making process, even if they seem confused or disoriented.

• Discuss the materials in the admission packet. As part of your screening

process, it is important for you to explain the admission process and what they can expect when living in your home.

September 2019 Safety, Oversight and Quality Unit 47

SCREENING PROCEDURES CONTINUED

• Review the house rules and contract as well as the services provided and

all fees if the person is paying privately for care.

• If the person may be admitted, ask if she or he has any significant

documents such as an Advanced Health Care Directive, Power of Attorney,

• r Letters of Guardianship or Conservatorship.
• Advise the potential resident or the legal representative that you must

have signed written orders from the physician or nurse practitioner before giving medications and doing treatments.

• Discuss expectations of the prospective resident and family. What kind of

care and services do they expect you to provide? Thoroughly discuss differences between what they expect and what you can provide.

September 2019 Safety, Oversight and Quality Unit 48

SCREENING PROCEDURES CONTINUED

• Determine who will be responsible for caregiving decisions. Be sure

everyone involved has a clear understanding before admitting to your home.

• Determine who will make payments and when. You must have an APD-

approved contract with people who pay privately for their care.

• Discuss sensitive caregiving issues and decisions including:
• Policy and procedures for the discharge of a resident
• The resident’s wishes in the event of a life-threatening medical

emergency or instructions if they have not been written in an Advanced Directive or in another manner; and

• Procedures to follow if the resident dies in your home

September 2019 Safety, Oversight and Quality Unit 49

SCREENING PROCEDURES CONTINUED

Set a time for the prospective resident to visit: Inviting a potential resident for a meal gives you both valuable information about one

• another. The resident gets to see what, how and where you serve meals as well as the
• pportunity to socialize with other residents.

You can observe and note several things:

• Was the resident able to travel in a standard car? If not, how did she or he

arrive?

• Did the person require help getting in or out of the car?
• Did the individual use mobility aids (cane, walker, wheelchair, etc.) to walk into

your house?

• If you have stairs, was the resident able to walk up them comfortably?
• While in the house, did the individual get up and down from chairs without

assistance? If help was needed, what type of help was required?

September 2019 Safety, Oversight and Quality Unit 50

SCREENING PROCEDURES CONTINUED

• Did the individual need help with toileting or mobility while there? If yes,

what help was needed?

• Could the person eat independently or did he or she have problems

chewing or swallowing? Could he or she cut his own food?

• Did the individual seem alert and oriented?
• Did he or she seem to tire easily?

Respect privacy

Be sure not to ask personal questions in front of the other residents during this

• time. Interviewing for personal information needs to be done in a private

setting.

September 2019 Safety, Oversight and Quality Unit 51

SCREENING PROCEDURES CONTINUED

If a potential resident is in the hospital or is unable to visit you, it would be best to do a face-to-face screening where they reside. Things to note:

• Was the person able to come to the door?
• Were they alone or was a caregiver with them?
• Do they have a caregiver? How many hours a day do they need help? What

tasks do they perform?

• Did the person use mobility aids? How was she or he able to get to a standing

position?

• Does the home smell of urine or feces?
• Can the prospective resident show you their medications? Can they tell you

about them?

September 2019 Safety, Oversight and Quality Unit 52

SCREENING PROCEDURES CONTINUED

Observe family interactions during the visit:

• Does a family member answer the questions for the person?
• How well does the family get along?
• Do family members respect one another? Do they argue or show other

signs of communication problems?

• Does one person speak for the whole family?
• How does the prospective resident react to family members?
• Your observations may provide clues about how the resident may be

affected by family visits and how easy or difficult it may be to work with the family.

September 2019 Safety, Oversight and Quality Unit 53

SCREENING PROCEDURES CONTINUED

Encourage future contact:

• Conducting a thorough screening takes time
• Often prospective residents and family feel overwhelmed
• Let them know you are available for additional meetings or further

discussion by telephone

Talk to members of the prospective resident’s care team.

September 2019 Safety, Oversight and Quality Unit 54

SCREENING PROCEDURES CONTINUED

Gather information from appropriate sources. Family members may not be able to give you a realistic picture of the person’s current condition, personality or behavior.

• They may not have spent time with the person on a regular basis or, they

have dealt with the relative’s behavior for many years and it no longer seems unusual.

• They may look for the best and ignore the problem, find it difficult talking

about the problems, or fear you will refuse to admit their relative.

September 2019 Safety, Oversight and Quality Unit 55

ALERT

Be honest with yourself and

• thers. If at any point in the

screening you determine that you will not be able to provide the care, let the potential resident or their representative know so they can look elsewhere for a placement.

September 2019 Safety, Oversight and Quality Unit 56

ANALYZING THE INFORMATION

Once you have gathered all the information, you will need time to assess all of the data you have collected:

• Take your time and really consider all aspects of what you have learned about

the potential resident

• Some of the gathered information should cue you to:
• Seek additional information
• Carefully consider if you can meet the potential resident’s needs

September 2019 Safety, Oversight and Quality Unit 57

ANALYZING THE INFORMATION CONTINUED

Additional information may be needed when there is a history of:

Frequent moves from one home to another:

• Could mean there are hidden care issues you need to be aware of before

making a decision

• Note the potential resident’s and the family’s reasons for the move but

also check with other caregivers when possible

September 2019 Safety, Oversight and Quality Unit 58

ANALYZING THE INFORMATION CONTINUED

Non-compliance with recommended care:

• You cannot change a lifetime of

habits

• Bathing and hygiene issues become

very important when the person refuses to clean up or change clothes and their appearance or

• dor is offensive to you and others
• Refusing to follow a diet or take

medications ordered by their doctor is not a valid reason to request that a resident leave your home

September 2019 Safety, Oversight and Quality Unit 59

ALERT

Not following a bathing routine, sleep schedule or non- participation in other activities is not a valid reason for an involuntary move-out notice.

September 2019 Safety, Oversight and Quality Unit 60

ANALYZING THE INFORMATION CONTINUED

Be aware of the dynamics between the resident and their family:

• You cannot change a lifetime of family dynamics
• You must help the resident exercise his or her rights according to rule

September 2019 Safety, Oversight and Quality Unit 61

ANALYZING THE INFORMATION CONTINUED

Nighttime care needs:

• AFH licensees must meet the night needs
• f residents. Consider how the resident

will notify the caregiver when assistance is needed at night

• All residents may have some nighttime

care needs

• Some residents may have regular

nighttime needs

September 2019 Safety, Oversight and Quality Unit 62

ANALYZING THE INFORMATION CONTINUED

One caregiver cannot provide care during both the day and night on a regular basis:

• If you identify the potential resident has regular nighttime care needs, and

you are unable or unwilling to hire additional nighttime staff, you cannot admit the potential resident.

• Residents requiring regular nighttime assistance cannot be asked or

required to use (for the convenience of the licensee):

• Incontinence supplies
• A bedside commode

September 2019 Safety, Oversight and Quality Unit 63

ANALYZING THE INFORMATION CONTINUED

Residents with dementia or challenging behaviors may require more routine cueing or redirection and may require additional staff:

• Use of psychotropic medications or physical restrains for the

convenience of the licensee is not allowed

• Residents with nighttime behaviors need to have caregiving staff

available for cueing or redirection

September 2019 Safety, Oversight and Quality Unit 64

ANALYZING THE INFORMATION CONTINUED

Before accepting a new resident consider:

• The needs of the potential resident as well as the needs of the current

residents in your home

• The current roommate has the right to choose their roommate, if shared

rooms are necessary.

You must consider:

• All caregiver’s qualifications and their willingness and ability to provide care

for the residents; and

• All information and data gathered in your preadmission packet

September 2019 Safety, Oversight and Quality Unit 65

ANALYZING THE INFORMATION CONTINUED

Discuss sensitive caregiving issues and decisions including:

• Procedures to follow if the resident dies in your home
• Obtain the name and number of the resident’s funeral home, or any

information regarding funeral plans

• Each county may have different rules regarding what to do in case of a death.

Prior to admitting any residents contact your local sheriff’s office, EMS, or county medical examiner to obtain the requirements in your area.

September 2019 Safety, Oversight and Quality Unit 66

ALERT

If a resident does not want medical intervention in the event

• f cardiac or respiratory arrest

they must have a written and signed Physician Orders for Life- Sustaining Treatment (POLST) or

• ther legal medical

documentation. You cannot require a POLST.

September 2019 Safety, Oversight and Quality Unit 67

ANALYZING THE INFORMATION CONTINUED

Arrange for caregiver training:

• How to properly use all resident equipment
• How to properly provide transfer assistance
• Appropriate RN delegation for tasks of nursing that can be delegated
• Administration of non-oral medications, such as eye drops (if

caregivers are unfamiliar with proper eye drop administration)

September 2019 Safety, Oversight and Quality Unit 68

ALERT

The resident cannot be admitted before caregivers have received proper training.

September 2019 Safety, Oversight and Quality Unit 69

ANALYZING THE INFORMATION CONTINUED

Can you provide care based on the level of your license?

• What is the resident’s current

health condition?

• What are the resident’s

healthcare needs?

• What is your license level?

September 2019 Safety, Oversight and Quality Unit 70

ANALYZING THE INFORMATION CONTINUED

Equipment needs:

• Make arrangements to access medical equipment prior to admissions

(wheelchair, walker or other assistive devices):

• If your home is not wheelchair accessible, you cannot take resident’s who

are wheelchair-mobile

• Residents who are not independent in mobility can only be placed in a

room on the ground floor

• If equipment or training is not available, the resident should not be

admitted

September 2019 Safety, Oversight and Quality Unit 71

ANALYZING THE INFORMATION CONTINUED

Classification license level expectations:

• Class I License:
• Provider may only admit residents who need assistance in no more than

four ADLs

• Residents must be in stable medical condition
• Residents cannot have:
• Complex medical conditions like Parkinson’s disease
• Newly acute medical conditions like newly diagnosed insulin dependent

diabetes or recovery from a hospital stay requiring significant wound care

September 2019 Safety, Oversight and Quality Unit 72

ANALYZING THE INFORMATION CONTINUED

Classification license level expectations:

• Class II License:
• Provider may provide care to

residents who require assistance in all activities of daily living but who require full assistance in no more than three ADLs

September 2019 Safety, Oversight and Quality Unit 73

ANALYZING THE INFORMATION CONTINUED

Classification license level expectations:

• Class III License
• A health care professional or have at least three years of full-time

experience providing direct care and at least two medical professional references

• Residents require full assistance in more than four ADLs but only one

resident who requires bed care or full assistance with all ADLs

September 2019 Safety, Oversight and Quality Unit 74

ANALYZING THE INFORMATION CONTINUED

The licensee must be able to answer “yes” to each of the following questions before admitting a prospective resident.

• Can the residents needs be met within the license classification?
• Can the licensee and all caregivers meets the resident’s needs?
• Can all of the AFH staff meet the needs of the prospective and current

residents?

• Can the prospective resident and all occupants of the AFH, including family

members, be evacuated as required?

September 2019 Safety, Oversight and Quality Unit 75

ANALYZING THE INFORMATION CONTINUED

• Do you have written physician orders for the resident’s medications,

treatments and therapies?

• Is the RN consultant available to assist with evaluating the medical needs of

the resident?

• Is the RN available to delegate tasks of nursing prior to the task being

needed?

September 2019 Safety, Oversight and Quality Unit 76

ANALYZING THE INFORMATION CONTINUED

You are required to offer the resident or their legal representative a copy of the completed screening and assessment documentation, regardless of your decision to admit:

• If the resident is admitted into your AFH, a copy must be placed in the

individual resident’s record

Completed screening forms must be maintained for a minimum of 3 years if the prospective resident is not admitted to your AFH.

September 2019 Safety, Oversight and Quality Unit 77

ADMISSION

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PURPOSE AND KEY TERMS

The purpose of this section is to assist the learner in understanding what must occur after the resident moved into the AFH.

• Assessment
• Medical orders
• Medical visit report

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OBJECTIVES

The learner will be able to:

Describe the steps prior to admission, upon admission and after admission of a resident Understand confidentiality and how to maintain the confidentiality of the resident Describe how to help a resident adjust to the move into your AFH Document your observations after admission of a new resident

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ADMISSION

Admitting a new resident indicates you:

• Have determined that the new resident has care needs within the

classification of your license

• Are able to meet the new resident’s needs and the needs of the current

residents

• Can evacuate all occupants of the AFH, including occupants, as required
• Have written order for the new resident’s medications, treatments and

therapies

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ADMISSION CONTINUED

Set a day and time for the move-in:

• Schedule a time that ensures you, the resident and any family members or

representatives do not feel rushed

Encourage the resident to personalize their room with:

• Favorite pictures and other decorative items
• Furniture that suits their personal taste
• Resident furniture must comply with fire and safety rules
• If the resident does not have furniture, the licensee must furnish the

room before the resident is admitted

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ADMISSION CONTINUED

Document personal possessions:

• Discuss labeling personal items

Suggest clothing the resident should bring:

• Ideally clothing and other personal items should be washable
• If the resident has non-washable clothes, discuss the cost of dry cleaning

in advance

• Clothing should be comfortable and easy to put on or take off

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ADMISSION CONTINUED

Encourage relatives or friends to help the new resident move-in:

• On move-in day, make the new resident your priority:
• You may need additional staff on the day when a new resident moves into

your AFH

• Show the new resident around your home and make sure he/she knows

how to find the bathroom, where meals are served, and where the common areas are located

• Introduce the new resident and their family or representative to the other

residents in the AFH

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ADMISSION CONTINUED

• Respect the privacy of all resident during the move-in activities
• Review emergency evacuation procedures within 24 hours of admission
• You must show all new residents how to respond to a smoke and carbon

monoxide alarm, how to participate in a fire drill, and how to exit the AFH in the even of an emergency

• Expect to spend extra time with the new resident for a few days as they

become accustomed to their new home

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ADMISSION CONTINUED

During the first 14 days after the resident has been admitted the licensee will begin to write the written assessment of the resident.

• This requires continuing to observe the resident’s abilities to perform

activities of daily living (ADL’s)

• Document the resident’s preferences directly onto the care plan

The care plan must be completed within 14 days of admission.

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ADMISSION CONTINUED

Recognize the resident’s feelings:

• Anger, loneliness, resentment and depression

are common

• Do not dismiss the resident’s feelings by saying

“you shouldn’t feel that way” The adjustment process involves three stages:

• Shock
• Anger or depression; and
• Acceptance

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ADMISSION CONTINUED

You can assist resident and their families through the adjustment process by:

• Keeping them informed and involved
• If you notice the resident’s anger or depression persists for more than two

months, it may be appropriate to request a medical evaluation

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ADMISSION CONTINUED

Be a model for the new resident

• Visit with residents and encourage socializing
• Make mealtime pleasant
• Respect privacy
• Knock before entering the resident’s room
• r the bathroom

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ADMISSION CONTINUED

Be patient with the new resident and their family:

• Reassure the family that someone is always in the AFH to meet the resident’s

needs

• If family members or others find it hard to reach you by phone, problems may

arise

• Explain that when you are busy with a resident you may not be able to

answer the phone

• Reassure you’ll call them back as soon as possible

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DISCUSSION/QUESTIONS

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