Safety Tour

1. Safety Tour Well Care Home Health The Safety Tour is required upon hire and annually in January. Please contact HR or PI/Ed with any questions. Review the slides, at the end of each section answer the questions associated with that section and mark your answers on the answer sheet. Turn your completed answer sheet into Cam at the Ashton Dr. front desk.

2. Inclement Weather • During inclement weather, pre-recorded instructions will be left for staff. This line is intended for all inclement weather and emergency messages. • Dial 910-202-1313, press 9 to hear the recorded message. • During inclement weather, such as hurricanes or snow storms, etc., staff will need to call into the emergency line frequently for updated information.

3. Safety Tour • Mandatory for all staff annually. • Consists of: • Advanced Medical Directives & Patient Rights & Responsibilities • Violence in Home Healthcare • Domestic Violence • Abuse & Neglect • Blood Borne Pathogens • TB & Infection Control • Safety & Age Specific Competency • Emergency Preparedness (disaster planning, bio terrorism, etc.)

4. Advanced Medical Directives • What are advanced medical directives? • Legal documents that allow you to give directions for your future medical care • There are two types of advanced directives: • Living wills • Durable power of attorney for health care • Patients have the right to: • Privacy • Information about their condition • Information about advanced directives • Informed consent

5. Advanced Medical Directives (cont.) • You have the right to say yes or no to treatments recommended by your doctor or mental health provider. You will need an “advanced directive” in order to control your health or mental health care even if you become unable to make decisions for yourself.

6. Advanced Medical Directives (cont.) • What is an “advanced directive”? • An advance directive is a form you sign now to direct your future health care if you cannot speak for yourself in the future. Advance means you tell you wishes ahead of time, before you are too sick to talk. Directive means you direct your future health care. The advance directive will allow you the opportunity to state your wishes about what happens to you when you are dying or in a coma and unable to speak. You decide if you want artificial treatments that may keep you alive for a very long time.

7. Advanced Medical Directives (cont.) • What is “Artificial Treatment”? • Some examples are: • Starting you heart after it has stopped (called cardiopulmonary resuscitation or CPR) • A breathing machine (a ventilator) • A kidney machine (dialysis) • Food through tubes in your stomach • Sugar water through tubes in your veins • Blood transfusions • Chemotherapy and / or X-ray therapy

8. Advanced Medical Directives (cont.) • Are there different kinds of “Advance Directives”? • Yes. There are two kinds. You can have either one, or both. • The “living will” is about your health, not your property. It states, “If I am near death or in a coma, do not keep me alive by tubes or machines”. • The durable power of attorney for health care is about another person speaking for your health care wishes. It states, “I want ____________(someone you name) to make decisions for me if I am unable to do so.

9. Advanced Medical Directives (cont.) • What does “Do Not Resuscitate” (DNR) mean? • If you are very sick, your doctor may ask if you want CPR in case you stop breathing or your heart stops. This means someone will press on your chest to make your heart pump and blow air into your lungs. Most efforts to restart your heart and breathing do not work when you are near death. But CPR attempts will be made unless you or your family says not to perform CPR. If CPR works, you may be hooked up to a breathing machine to stay alive. It is helpful for you to decide about CPR before you are sick enough to need it.

10. Advanced Medical Directives (cont.) • May I get medicine for pain even if I do not wish to be kept alive by machines? • Yes. You should always get pain medicine if you need it. • Why should I have advance directives? • To let the health care team and your family know what you want, or don’t want, when you are unable to speak for yourself. • To lighten the burden on your family to make decisions for you. • To protect your right to die a natural death. • To allow nature to take its course when you do not want machines and tubes to keep you alive. • Why should I complete an advance directive form now? • Because no one ever expects to be in an accident and become badly injured. • Because no one ever knows exactly when he or she will die. • Because no one ever expects to end up unable to speak or think for oneself.

11. Advanced Medical Directives (cont.) • What happens if I do not have an advance directive and I become unable to talk for myself? • Your doctor and family will decide what happens to you. • These decisions may or may not be what you would want if you could speak for yourself. • How do I decide if I want an advance directive? • Think about what makes life worth living for you. • Think about what would make life not worth living for you. • Talk with your family, close friends, and your doctor. • Do I have to use a lawyer to complete advance directive forms? • No.

12. Advanced Medical Directives (cont.) • May I change my mind about my advance directives? • You may always change your mind. Just tell your family and doctor, and tear up the forms. Also, if you want to change the forms, you may make new ones. • What if I have an advance directive from another state? • An advance directive from another state may not meet all of North Carolina’s rules. To be sure about this, you may want to make an advance directive in North Carolina too. • For more information, please contact us at: Well Care Home Health 910-362-9405 or 888-815-5310 toll free.

13. Advanced Medical Directives (cont.) • Where do I get forms and who can help me fill them out? • Ask a nurse, social worker, a chaplain, the Patient’s Relations representative, or your doctor to help you fill out the forms. You will need two witnesses who are not relatives and not hospital staff. You will need a notary to sign the forms. Banks and hospitals have notaries available. • What do I do after my form is notarized? • Make a copy for: • Your doctor • Your family members • Your medical record • Keep your original with your other important papers, like your will.

14. Did You Know? • All home care clients must be notified in writing of their rights before treatment begins. • Anyone 18 years or older has the right to make decisions about their medical treatment. • All home health staff & contractors are required to sign a statement attesting to their knowledge of patient confidentiality. • All documentation on health care records must be kept confidential. Patient documents should be secured and out of view at all times. • All patients and their families have a right to lodge a “compliant” by: • Completing the client concern form • Calling into the agency • Calling the Home Care Hotline number

15. Answer the following questions on AMD • Which statement about advanced medical directives is true: • Patients only have the right to privacy while in the hospital • Patients have the right to have information about their condition • There are four types of advance directives • Advance directives give the surgeon permission • Clients and families can lodge complaints by: • Completing a client concern form • Calling the agency • Calling the North Carolina Home Care Hotline • All of the above • Patient rights and responsibilities include all but the following: • Selling illegal drugs • Refusing services • Notifying the agency if the visit scheduled needs to be changed • Informing provider of any change in their advance directive

16. AMD Questions • All home care clients have the right to refuse to answer questions: • True • False • Anyone 12 and older has the right to make decisions about their treatment: • True • False • A Health Care Power of Attorney is: • Your family doctor • Not legal in the state of North Carolina • The person you name to make medical/mental health care decisions for you if you later become unable to decide for yourself • Your next door neighbor

17. Code of Ethical Behavior • Policy Well Care will maintain a high standard of professionalism for all employees. • Purpose To provide a code of ethics by which Well Care operates and to provide a code of conduct for employees to perform their respective duties.

18. Code of Ethical Behavior (cont.) • Policy Detail Well Care Home Health will strive to: • Maintain the highest levels of professional standards for the agency. • Demonstrate an active concern for the well being of patients. • Maintain clinical knowledge of its employees and enhance that knowledge through continuous education. • Cooperate with all levels of government regarding the provision of home health care. • Promote and maintain professional relationships within the medical community and the community at-large. • Verify certifications and licensure of clinical employees to ensure that home health services are provided by qualified personnel. • Utilize technology to enhance the levels of care provided. • Educate the patients, caregivers and community about home health care. • Demonstrate professional judgment and accept responsibility for professional practice. • Maintain confidentiality of patients, clients and co-workers. • Respect the rights of patients. • Demonstrate honesty and integrity to avoid situations of conflict of interest. • Enforce the Well Care Code of Conduct.

19. Code of Ethical Behavior (cont.) • Any professional or paraprofessional employee providing direct patient care that is assigned to a patient, with which there is a relationship with the patient, or a member of the patients family, must disclose the existence of a relationship with their supervisor. • The Clinical Manager, in conjunction with the Director of Clinical Operations, will determine if it is necessary to reassign the care provider in order to meet reimbursement requirements, and/or conflict with interest standards.

20. Well Care Code of Conduct • All employees are expected to treat patients/clients and co-workers with dignity and respect. • Care is to be provided in a professional manner. • Professional conduct is expected at all times. • Attire is to be neat, clean and professional in appearance. • All documents and patient information is to be treated confidentially. • No employee shall harass, abuse, either physically or verbally, another employee or disrupt his/her performance in any way. • Staff members shall report to work in a timely manner. • Employees will notify their supervisor immediately if unable to report to work or arrive at the scheduled time. • Staff members will not accept gifts of money, loans or other compensation from patients/clients.

21. Well Care Code of Conduct (cont.) • NO employee shall request money from patients/clients. • All employees must report any misconduct, suspicious, illegal or unethical activity immediately to their supervisor, Clinical Manager, Assistant Director and Clinical Director or the PI/Ed Manager. • Profanity or abusive language will not be tolerated. • Employees will not sleep while on duty. • No employee shall report to work while under the influence of alcohol or any drug which impairs their ability to function whether legal or illegal drug. Nor shall any employee have alcohol or illegal drugs in their possession. • Assigned tasks are to be completed in an efficient manner in accordance with quality standards. • Meals are to be taken in properly designated areas and at times compatible with clients schedule.

22. Patients Rights & Responsibilities • Clients and Providers Have a Right to Dignity and Respect • Home Care clients and their formal caregivers have a right to not be discriminated against based on race, color, religion, national origin, age, sex, or handicap. Furthermore, clients and caregiver’s have a right to mutual respect and dignity, including respect for property. Caregivers are prohibited from accepting personal gifts or borrowing from clients.

23. Patients Rights & Responsibilities • Clients have the right to: • To have relationships with home care providers based on honesty and ethical standards of conduct • To be informed of the procedure they can follow to lodge complaints with the home care provider about lack of respect for property and for care that is, or fails to be, furnished • To know about the disposition of such complaints • To voice their grievances without fear of discrimination or reprisal for having done so • To be advised of the telephone number and hours of operation of the State’s home health hotline, which receives complaints or questions about local home care agencies. You may call 24 hours a day at 1-800-624-3004 • To be advised of the telephone number to report a complaint about quality of care, you may call the Joint Commission Office of Quality Monitoring at 1-800-994-6610 or online at www.jcaho.org • For additional agency information, you may contact Well Care’s Director of Performance Improvement at 910-362-9405. For TTY users, please call1-800-735-2962

24. Patients Rights & Responsibilities Decision Making • Clients have the right: • To be notified about the care that is to be furnished, the types (disciplines) of caregivers who will furnish the care, and the frequency of the visits that are proposed to be furnished • To be advised of any change in the plan of care before the change is made • To participate in the planning of care and in planning changes in the care, and to be advised that they have the right to do so • To be informed in writing of rights under State law and to make decisions concerning medical care including the right to accept or refuse treatment and the right to formulate advance directives • To be informed in writing of policies and procedures for implementing advance directives including an limitations if the provider cannot implement an advance directive on the basis of conscience • To have health care providers comply with advance directives in accordance with State law requirements • To receive care without condition on, or discrimination based on, the execution of advanced directives and to refuse services without fear of reprisal or discrimination

25. Patients Rights & Responsibilities • The home care provider or the Client’s physician may be forced to refer the client to another source of care if the Client’s refusal to comply with the plan of care threatens to compromise the provider’s commitment to quality care.

26. Patients Rights & Responsibilities Privacy • Clients have the right: • To confidentiality of information about their health, social, and financial circumstances and about what takes place in the home; and • To expect the home care provider to release information only as required by law or authorized by the Client Financial Information • Clients have the right: • To be informed of the extent to which payment may be expected from Medicare, Medicaid, or any other payor known to the home care provider • To be informed of the charges that will not be covered by Medicare • To be informed of the charges for which the Client may be liable • To receive this information orally and in writing before care is initiated within 30 working days of the date the home care provider becomes aware of any changes in charges • To have access, upon request, to all bills for services the client has received regardless of whether the bills are paid out-of-pocket or by another party

27. Patients Rights & Responsibilities Quality of Care • Clients have the right: • To receive care of the highest quality • In general, to be admitted, by a home care provider only if it has the resources needed to provide the care safely and at the required level of intensity, as determined by a professional assessment; a provider with less than optimal resources may nevertheless admit the client if a more appropriate provider is not available, but only after fully informing the client of the provider’s limitations and the lack of suitable alternative arrangements • To be told what to do in case of emergency • To professional pain assessment and management

28. Patients Rights & Responsibilities • The home care provider shall assure that: • All medically related home care is provided in accordance with physician’s orders and that a plan of care specifies the services, their frequency and duration • All medically related personal care is provided by an appropriately trained home care aide who is supervised by a nurse or other qualified home care professional.

29. Patients Rights & Responsibilities • Client responsibility • To notify the agency of changes in condition • To follow the plan of care • To notify the agency if the visit schedule needs to be changed • To inform the agency of the existence of any changes made to advance directives • To advise the agency of any problems of dissatisfaction with the services provided • To provide a safe environment for care to be provided, (e.g. leash vicious dogs, refrain from illegal activities, etc.) • To carry out mutually agreed upon responsibilities • To be present at the agreed upon visit time and call the home health care office if you are not going to be home for a scheduled visit • To remain under the care of a physician and inform the nurse or therapist of any changes in orders which you receive from your physician • To participate in decision making regarding your care and assist in the development and revision of your plan of care • To provide the agency staff with all known health insurance information • To inform and provide agency care providers with copies of any advance care documents (e.g. Living Will, Health Care Power of Attorney) you may have • To inform the agency supervisory staff of and to secure all valuables and money • To carry out mutually agreed upon responsibilities • To behave in a manner that is reasonable, considering the nature of Client illness.

30. Patients Rights & Responsibilities Ethics • An ethical dilemma occurs when a choice must be made among two or more actions and there are good reasons for each of the choices. Our Ethics Group includes people from the community as well as home health staff members. After consultation, they can offer recommendations to you. If you or your caregivers have an ethical dilemma about your health care, you may request an ethics consultation by asking your health care worker or calling the office and speaking to a supervisor.

31. Patients Rights & Responsibilities Patient Concerns • Home health staff members make every effort to provide quality services to all patients. If you are unhappy with any of our services, please call our office at 910-362-9405 or 1-888-815-5310 (TTY users should call 1-800-735-2962) and ask to speak with the Director of Performance to help resolve your concern.

32. Patients Rights & Responsibilities Planning for Discharge • Planning for discharge is an important part of your care. Discharge planning begins as soon as you are admitted. Your nurse or therapist will help you and your caregiver plan for the time when Home Care may no longer be provided. • Patient care staff, in consultation with your physician, will continually monitor your health condition and evaluate progress being made toward your goals. • Certain requirements must be met in order for your home care to continue. Patient care staff will continue to determine if patients are following doctor’s orders and the teaching of your nurse or therapist.

33. Patients Rights & Responsibilities Planning for Discharge (cont.) • The agency will discontinue care in the event that you • No longer qualify for Home Care • Refuse Home Care • Have planned to make different arrangements for your care • Will not sign for financial responsibilities not covered by a third party payer • Are not home on three consecutively scheduled home visits • Agency provider cannot meet the patient’s needs safely at home • Do not fulfill your responsibilities in the plan of care • Risk the safety of the agency care provider due to vicious animals, violence, sexual advances, verbal or physical abuse, or illegal activities in the home • Have a physician who refuses to sign home health treatment orders and/or you fail to get a new physician

34. Patients Rights & Responsibilities Performance Improvement • It is the mission of Well Care to provide quality home care to those in need of our services. Our interdisciplinary team is committed to delivering skilled, professional home health care services to individuals and their families as an alternative to inpatient care. • Well Care Home Health monitors and evaluates the quality of its services through an ongoing comprehensive performance improvement program that results in improved outcomes in client care and improved internal and external customer satisfaction. This program is designed to facilitate continuous improvement of client services and to ensure a comprehensive well coordinated program for collecting, analyzing, trending, and disseminating information about Well Care and the quality of its delivery of care and services provided. • Client satisfaction surveys are performed randomly on a monthly basis. We encourage our client to participate if called upon, in order to better assist us in our continuous efforts to improve every aspect of our services.

35. Patients Rights & Responsibilities Benefits • Home care provides a high quality, cost efficient way of receiving your health care at home. With support, you can recover at home with security of family and in the comfort of familiar surroundings.

36. Home Health Agency Outcome & Assessment Information Set (OASIS) STATEMENT OF PATIENT PRIVACY RIGHTS As a home health patient, you have the privacy rights listed below. • You have the right to know why we need to ask you questions. We are required by law to collect health information to make sure: • you get quality health care, and • payment for Medicare and Medicaid patients is correct. • You have the right to have your personal health care information kept confidential. • You may be asked to tell us information about yourself so that • we will know which home health services will be best for you. • We keep anything we learn about you confidential. • This means, only those who are legally authorized to know, or who have a medical need to know, will see your personal health information. • You have the right to refuse to answer questions. • We may need your help in collecting your health information. • If you choose not to answer, we will fill in the information as best we can. • You do not have to answer every question to get services. • You have the right to look at your personal health information. • We know how important it is that the information we collect about you is correct. If you think we made a mistake, ask us to correct it. • If you are not satisfied with our response, you can ask the Centers for Medicare & Medicaid Services, the federal Medicare and Medicaid agency, to correct your information.

37. You can ask the Centers for Medicare & Medicaid Services to see, review, copy, or correct your personal health information which that Federal agency maintains in its HHA OASIS System of Records. See the back of this Notice for CONTACT INFORMATION. If you want a more detailed description of your privacy rights, see the back of this Notice: PRIVACY ACT STATEMENT - HEALTH CARE RECORDS. This is a Medicare & Medicaid Approved Notice.

38. Privacy Act Statement PRIVACY ACT STATEMENT - HEALTH CARE RECORDS. THIS STATEMENT GIVES YOU ADVICE REQUIRED BY LAW (the Privacy Act of 1974). THIS STATEMENT IS NOT A CONSENT FORM. IT WILL NOT BE USED TO RELEASE OR TO USE YOUR HEALTH CARE INFORMATION. • AUTHORITY FOR COLLECTION OF YOUR INFORMATION, INCLUDING YOUR SOCIAL SECURITY NUMBER, AND WHETHER OR NOT YOU ARE REQUIRED TO PROVIDE INFORMATION FOR THIS ASSESSMENT. Sections 1102(a), 1154, 1861(o), 1861(z), 1863, 1864, 1865, 1866, 1871, 1891(b) of the Social Security Act. Medicare and Medicaid participating home health agencies must do a complete assessment that accurately reflects your current health and includes information that can be used to show your progress toward your health goals. The home health agency must use the ^Outcome and Assessment Information Set] (OASIS) assessment, it is protected under the federal Privacy Act of 1974 and the [Home Health Agency Outcome and Assessment Information Set] (HHA OASIS) System of Records. You have the right to see, copy, review, and request correction of your information in the HHA OASIS System of Records.

39. Privacy Act Statement (cont.) • PRINCIPAL PURPOSES FOR WHICH YOUR INFORMATION IS INTENDED TO BE USED The information collected will be entered into the Home Health Agency Outcome and Assessment Information Set (HHA OASIS) System No. 09-70-9002. Your health care information in the HHA OASIS System of Records will be used for the following purposes: • A support litigation involving the Centers for Medicare & Medicaid Services; • A support regulatory, reimbursement, and policy functions performed within the Centers for Medicare & Medicaid Services or by a contractor or consultant; • A study the effectiveness and quality of care provided by those home health agencies; • A survey and certification of Medicare and Medicaid home health agencies; • A provide for development, validation, and refinement of a Medicare prospective payment system; • A enable regulators to provide home health agencies with data for their internal quality improvement activities; • A support research, evaluation, or epidemiological projects related to the prevention of disease or disability, or the restoration or maintenance of health, and for health care payment related projects; and • A support constituent requests made to a Congressional representative.

40. Privacy Act Statement (cont.) • Routine Uses These [routine uses] specify the circumstances when the Centers for Medicare & Medical Services may release your information from the HHA OASIS System of Records without your consent. Each prospective recipient must agree in writing to ensure the continuing confidentiality and security of your information. Disclosures of the information may be to: • the federal Department of Justice for litigation involving the Centers for Medicare & Medicaid Services; • contractors or consultants working for the Centers for Medicare & Medicaid Services to assist in the performance of a service related to this system of records and who need to access these records to perform the activity; • an agency of a State government for purposes of determining, evaluating, and/or assessing cost, effectiveness, and/or quality of health care services provided in the State; for developing and operating Medicaid reimbursement systems; or for the administration of Federal/State home health agency programs within the State; • another Federal or State agency to contribute to the accuracy of the Centers for Medicare & Medicaid Services' health insurance operations (payment, treatment and coverage) and/or to support State agencies in the evaluations and monitoring of care provided by HHAs; • Quality Improvement Organizations, to perform Title XI or Title XVIII functions relating to assessing and improving home health agency quality of care; • an individual or organization for a research, evaluation, or epidemiological project related to the prevention of disease or disability, the restoration or maintenance of health, or payment related projects; • a congressional office in response to a constituent inquiry made at the written request of the constituent about whom the record is maintained.

41. Privacy Act Statement (cont.) • EFFECT ON YOU, IF YOU DO NOT PROVIDE INFORMATION The home health agency needs the information contained in the Outcome and Assessment Information Set in order to give you quality care. It is important that the information be correct. Incorrect information could result in payment errors. Incorrect information also could make it hard to be sure that the agency is giving you quality services. If you choose not to provide information, there is no federal requirement for the home health agency to refuse you services. NOTE: This statement may be included in the admission packet for all new home health agency admissions. Home health agencies may request you or your representative to sign this statement to document that this statement was given to you. Your signature is NOT required. If you or your representative sign the statement, the signature merely indicates that you received this statement. You or your representative must be supplied with a copy of this statement. CONTACT INFORMATION If you want to ask the Centers for Medicare & Medicaid Services to see, review, copy, or correct your personal health information that the Federal agency maintains in its HHA OASIS System of Records: Call 1-800-MEDICARE, toll free, for assistance in contacting the HHA OASIS System Manager. TTY for the hearing and speech impaired: 1-877-486-2048.

42. Well Care Incident/Concern Form

43. Do Not Resuscitate • An Advanced Care Directive such as a living will or health care power of attorney alone can not substitute for a DNR order. Clients and/or family members who request a “Do Not Resuscitate” order are instructed to speak with their primary physician. Registered nurses and therapist may obtain the DNR in the following manner: • Obtain a signed order from the physician • Obtain a verbal order from the physician (two RNs or Therapists must listen and sign verbal order) • Client/family may obtain Out of Facility DNR (Goldenrod Form) from physician. Note: By law, EMS must resuscitate when called to the home if there is no Out of Facility Form • Home health staff who view a current Out of Facility DNR form may include that order on the 485 after confirming with the client and family that this is their wish.

44. DNR Order

45. Questions on DNR • Who may obtain a verbal order for a DNR? • Two qualified persons (registered nurse or therapist) must listen to the order and sign it • The nursing assistant • The family member and nurse who listened over the phone • One registered nurse may obtain the order • The goldenrod “Do Not Resuscitate” form: • Is a portable DNR form that can legally be honored by EMS • Cannot be copied or altered • Must be signed by the physician • All of the above

46. Violence In The Home • Be Smart. • Be Safe.

47. Assault Cycle • In your job it is essential to recognize warning signs that an individual is prone to violence. When a situation escalates into violence it is called an assault cycle. • Sometimes an upsetting incident can trigger the cycle. Other times, a situation builds slowly. • The assault cycle is made up of a series of events or phases: • The escalation phase • The attack phase • The recovery phase • The post-crisis phase

48. The Escalation Phase • During the escalation phase of an assault cycle, a potentially violent individual will exhibit behaviors that should serve as clear warning signs. Examples include: • Staring • Rapid breathing • Flushed appearance • Tense and anxious body posture • Pacing • Constantly shifting body position • Shouting • Swearing

49. The Escalation Phase (cont.) • Regardless of whether a situation is triggered by a particular event or builds slowly, you should recognize the signs and take immediate action to prevent the situation from escalating. • Remain calm • Let the person express his or her feelings • Listen carefully • Show empathy

50. Attack Phase • The attack phase occurs when the situation continues to escalate into some form of physical confrontation. When confronted by an actively violent person, you should: • Maintain an assertive position with your body; feet should be held hip-width apart with one foot in front of the other • Always keep the perpetrator at arms length • Have someone call the police or get help from the closest possible source • Position yourself near an exit for easy escape • Make a scene if you must – yell and scream • Don’t let them isolate you • Look confident, do not look like an easy target