Lesson 2- Providing Personal Care
Understanding and using a Plan of Care (PoC)
A Plan of Care outlines your caregiving responsibilities. it is made up of two sections: the Service Summary and the Assessment Details.
The Service Summary of the plan of care gives you an overview of your caregiver responsibilities and what you and other members of the care team will be providing to support the client. The Service Summary also has contact information for other care team members, a list of any advance directives a client may have, and any other people involved in making decisions for a client.
In the Assessment Details, a case manager will document the client’s needs, strengths, limitations, preferences, any special equipment necessary, and specific caregiver instructions for each needed task. Many tasks also include a section with specific instructions containing “Do’s and Don’ts” for the caregiver.
The types of services you may see in a Plan of Care
The type of personal care services a client receives will vary depending on where the client lives, the services he/she needs, and what the client is financially eligible to receive.
Activities of Daily Living (ADLs) a client may need help with include:
Bathing: taking a full-body bath/shower, sponge bath, or transferring in/out of
tub/shower.
Bed mobility: moving to and from a lying position, turning side to side, and
positioning his/her body while in bed.
Body care: passive range of motion, applications of dressings and ointments
or lotions to the body, pedicure to trim toenails and apply lotion to feet. Body
care excludes foot care for clients who are diabetic or have poor circulation
and changing bandages or dressings when sterile procedures are required.
Dressing: putting on, fastening, and taking off all items of clothing, including a
prosthesis.
Eating: eating and drinking, regardless of skill. Eating includes any method of receiving nutrition, e.g., by mouth, tube, or through a vein.
Locomotion in room and immediate living environment:: moving between locations in a room and immediate living environment.
Locomotion outside of immediate living environment, including outdoors: moving to, and returning from, more distant areas. Locomotion outside immediate living environment includes moving to and returning from a patio or porch, backyard, the mailbox, or the next-door neighbor, etc.
Medication management: the amount of assistance, if any, required to receive medications, over the counter preparations or herbal supplements.
Toilet use: using the toilet room, commode, bedpan, or urinal, transferring on/ off toilet, cleansing, changing pad, managing an ostomy or catheter, and adjusting clothes.
Transfer: moving between surfaces (e.g. to/from bed, chair, wheelchair, standing position).
Personal hygiene: maintaining personal hygiene, including combing hair, brushing teeth, applying makeup, washing/drying face, hands, menses care,
and perineum.
Instrumental activities of daily living (IADLs)
Your client may need help with include:
Meal preparation: preparing meals (e.g. planning meals, cooking, assembling ingredients, setting out food, utensils, and cleaning up after meals).
Ordinary housework: performing ordinary work around the house (e.g. doing dishes, dusting, making bed, tidying up, laundry).
Essential shopping: shopping to meet a client’s health and nutritional needs (e.g. selecting items). Shopping is limited to brief, occasional trips in the local area to shop for food, medical necessities, and household items required specifically for his/her health, maintenance, or well-being. This includes shopping with or for a client.
Wood supply: supplying wood (e.g., splitting, stacking, or carrying wood) when the client uses wood as the sole source of fuel for heating and/or cooking.
Travel to medical services: traveling by vehicle to a physician’s office or clinic in the local area to obtain medical diagnosis or treatment. This includes a client driving a vehicle or traveling as a passenger in a car, bus, or taxi.
Telephone use: receiving or making telephone calls, including the use of assistive devices such as large numbers on telephone, amplification as needed.
The following scale is used by a case manager to communicate the client’s ability to complete each personal care task.
Independent: no help or supervision required.
Supervision: oversight of client required (monitoring, encouragement or cueing).
Limited Assistance: client is highly involved in the task, but needs some physical help in guided maneuvering of limbs or other non-weight bearing assistance.
Extensive Assistance: client requires weight bearing or full assistance from caregiver during part of task.
Total Dependence: client requires caregiver to do all of the task.
Care settings and care plans
If you work for a home care agency, the full Plan of Care is normally kept at the home office. Many home care agency caregivers receive part of the care plan or a list of their assigned personal care tasks.
Adult family home and boarding homes with DSHS clients use the DSHS care plan as a starting point for developing their own negotiated service agreement or negotiated care plan.
This negotiated care plan has more details about the client’s care preferences.
This negotiated care plan is what caregivers normally see and may be kept in a notebook or as part of the client’s records.
Understanding client preferences
No care plan has all the details you will need to do your job. You still need to talk with the client about EACH task you are assigned to do.
Follow up
Periodically, go back and make sure care tasks are still being done the way the client wants them to be. By asking again, you make sure you understand the client’s current wishes and keep doing the tasks the way that works for him/her.
Clients who have trouble speaking, can’t speak at all, or have other ways of communicating (e.g. sign language, assistive devices, gestures) still have preferences that are important to understand.
Depending on where you work, the case manager or supervisor is a good resource to talk with about how best to communicate directly with the client. If a client is unable to communicate at all, a family member or friend will be authorized as the client’s contact and can give you more detailed information. His/her name and telephone number is listed in the Service Summary. There will also be information in the Assessment Details regarding communication with that client.
Knowing what your caregiver job isn’t
The client or a family member may ask you to do things that are not on the care plan (e.g. lawn care or cleaning up after others in the house). Say “no” to these requests. Do so nicely. If the client continues to expect you to do something not on the care plan, encourage him/her to talk with the Agency case manager or your supervisor. Tasks need to be listed in the care plan before you can do them.
How you provide personal care requires great sensitivity and understanding.
The term “personal” is a reminder that you are helping with tasks that are normally done in private.
View your caregiving role from a client’s perspective. Most people would prefer to wash, groom, and care for themselves. Needing help with personal care can make a client feel a variety of very vulnerable emotions. A client may:
Adult family home and boarding homes with DSHS clients use the DSHS care plan as a starting point for developing their own negotiated service agreement or negotiated care plan.
This negotiated care plan has more details about the client’s care preferences.
This negotiated care plan is what caregivers normally see and may be kept in a notebook or as part of the client’s records.
Understanding client preferences
No care plan has all the details you will need to do your job. You still need to talk with the client about EACH task you are assigned to do.
Follow up
Periodically, go back and make sure care tasks are still being done the way the client wants them to be. By asking again, you make sure you understand the client’s current wishes and keep doing the tasks the way that works for him/her.
Clients who have trouble speaking, can’t speak at all, or have other ways of communicating (e.g. sign language, assistive devices, gestures) still have preferences that are important to understand.
Depending on where you work, the case manager or supervisor is a good resource to talk with about how best to communicate directly with the client. If a client is unable to communicate at all, a family member or friend will be authorized as the client’s contact and can give you more detailed information. His/her name and telephone number is listed in the Service Summary. There will also be information in the Assessment Details regarding communication with that client.
Knowing what your caregiver job isn’t
The client or a family member may ask you to do things that are not on the care plan (e.g. lawn care or cleaning up after others in the house). Say “no” to these requests. Do so nicely. If the client continues to expect you to do something not on the care plan, encourage him/her to talk with the Agency case manager or your supervisor. Tasks need to be listed in the care plan before you can do them.
How you provide personal care requires great sensitivity and understanding.
The term “personal” is a reminder that you are helping with tasks that are normally done in private.
View your caregiving role from a client’s perspective. Most people would prefer to wash, groom, and care for themselves. Needing help with personal care can make a client feel a variety of very vulnerable emotions. A client may:
- Feel uncomfortable having anyone, especially a stranger, help with these tasks;
- Not want to talk about “private” things;
- Feel his/her independence and sense of self-worth is threatened.