Private Duty
Home Services or In-Home Services or In-Home Support Services — assistance with activities of daily living, housekeeping, personal laundry, and companionship provided to an individual in his or her personal residence, which are intended to enable that individual to remain safely and comfortably in his or her own personal residence. “Home services” does not include services that would be required to be performed by an individual licensed under the Nurse Practice Act. (Section 2.09 of the Act)
Home care services are focused on providing assistance that is not medical in nature, but is based upon assisting the client in meeting the demands of living independently and maintaining a personal residence, such as companionship, cleaning, laundry, shopping, meal preparation, dressing, and bathing.
There are 2 types of care for private duty:
Companion care (non-personal care) — services that are non-personal (e.g., no touching of patients). The services we provide are either companionship only or companionship with light housekeeping.
CNA/Home Health Aide Care (personal care) — includes all the services the companion care provides, plus hands-on care of clients with ADLs (bathing, ambulating, dressing, feeding, transfer, positioning, and toileting.
Companionship is a non-personal care. It provides comfort and companionship to clients, with medical and/or safety reason, may not be left alone at home. He/she will engage the client through in-home activities, conversations, taking walks, completing puzzles/games. Services include, but are not limited to:
Attending a senior center, attending religious services, shopping
Assistance with running errands and incidental transportation
COMPANIONSHIP
COMPANIONSHIP WITH HOUSEKEEPING
Home Service Workers can provide additional light housekeeping services. He/she will engage the client through in-home activities and may help to do housekeeping. Services include, but are not limited to:
Assistance with light housekeeping: making the bed, dusting, vacuuming, etc.
Meal preparation for the client
Personal laundry (client’s clothes only)
Certified Nursing Assistant (CNA)/Home Health Aide provides non-personal care, including the companionship and housekeeping services mentioned in the previous levels, and non-medical assistance with daily living activities (ADL) such as ambulation. He/she may also do maintenance of household records, medication reminding, exercise, and skin care.
Non-personal care: Conversations, taking walks, completing puzzles/board games, attending a senior center, attending religious services, shopping, assistance with running errands, and incidental transportation, assistance with shopping and appointments outside the home, assistance with light housekeeping: making the bed, dusting, vacuuming, etc. Meal preparation for the client, and personal laundry
Skin care: Skin care only when skin is intact, using only non-medicated or non-prescription products and preventative general care of unbroken skin. (May perform general skin care assistance. Skin care may only be performed when skin is unbroken, and when any chronic skin problems are not active. The skin care provided by a home services worker must be preventative rather than therapeutic in nature and may include the application of non-medicated lotions and solutions, or of lotions and solutions not requiring a physician’s prescription.
Ambulation: Assist with ambulation using adaptive equipment (walker, cane, and wheelchair) after the patient has been trained by a registered nurse/physical therapist/occupational therapist and released to work on his/her own with the equipment.
Exercise: Assist with exercise, including passive assistance limited to encouraging normal bodily movement and encourage prescribed exercise program. CNA or Home Health Aide may only watch and encourage client as they exercise.
Medication Reminding: Assist a client with medication reminding only when medications have been preselected by the client, a family member, a nurse, or a pharmacist, and are stored in containers other than the prescription bottles, such as medication minders. Medication minders must be clearly marked as to the day and time of dosage. Medication reminding includes:
Inquiries as to whether medications were taken
Verbal prompting to take medications handing the approximately marked medication container to the client
Opening the appropriately marked medication minder container to the client if the client is physically unable to open the container
Immediately report to supervisor any irregularities noted in the pre-selected medications, such as meds taken too often, not often enough.
CNA/HOME HEALTH AIDE LEVEL 1
Cna/home health aide level 2
Level 2 includes all the services of companionship, housekeeping and CNA Level 1, plus additional services and non-medical assistance with daily living activities (ADL) such as ambulation, dressing, and feeding. He/she may also do maintenance of household records, medication reminding, exercise and personal grooming like shaving, mouth, hair nail, and skin care.
Shaving: Assist client with shaving only with an electric or safety razor.
Dressing: Assist client with dressing including clothing and support stockings that can be purchased without a physician prescription. This may include assistance with ordinary clothing and application of support stockings of the type that can be purchased without a physician’s prescription.
Feeding: Assist with feeding when patient can independently swallow and can be positioned upright. They can only assist with feeding when the client can independently swallow and be positioned upright. It does not include syringe, tube feedings, and intravenous nutrition.
Hair care: Assist with the maintenance and appearance of hair (non-medicated shampooing, drying, combing, styling hair). Can apply medicated shampoo and/or shampoo requiring a physician prescription. Assist with the maintenance and appearance of hair (non-medicated shampooing, drying, combing, styling hair)
Mouth care: Assist in and perform mouth care, denture care, and basic oral hygiene, including suctioning for mouth care.
Nail care: Assist with nail care including soaking of nails, pushing back cuticles with utensils, and filing of nails. Does not include nail trimming.
CNA/home health aide Level 3
Level 3 includes all the services of companionship, housekeeping, CNA Level 1, CNA Level 2, plus these additional services such as bathing, toileting, positioning, and transfer.
Bathing: Assist client with bathing, bed bath if worker is trained and competency evaluated, and can direct the bath. Bed Baths are available when clients are unable to be bathed in a tub or shower and only when the following requirements are met:
The home services worker has been trained in the particular methods required to perform a bed bath
The client or client’s representative shall be able to participate in or direct the bathing process and provide ongoing feedback to the home services worker
The agency shall have conducted a competency evaluation of the home services worker’s ability to employ the methods required to perform a bed bath.
Toileting: Assist client to/from the bathroom, provide assistance with bed pans, urinals, and commodes, provide peri-care, change clothing and pads of any kind used for care of incontinence, empty or change external urine collection devices, such as catheter bags or suprapubic catheter bags, empty ostomy bags and provide assistance to client-directed ostomy care only when there is no need for skin care.
Positioning: Positioning may include simple alignment in a bed, wheelchair, or other furniture.
Transfer: Assist with transfers only when the client has sufficient balance and strength to reliably stand, pivot and assist with the transfer to some extent, adaptive and safety equipment may be used in transfers provided the client is fully trained in the use of equipment and can direct the transfer step-by-step, gait belts may be used for safety as long as worker has been trained in their use, assist client in the use of a mechanical or electrical transfer device only when the following conditions are met:
Worker has been trained in the use of the device
The client or client’s representative must be able to direct transfer step-by-step; and the agency has conducted a competency evaluatoin of the worker using the type of device that is in the home.