Your Job
Understand Your Role
Understanding your role within the organization, or in the client's home, and knowing what is expected of you
is important in order to have a satisfactory relationship with your employer. Ten specific steps you can take to
improve the relationship with your employer and help make sure you are content in your job are:
• Have a positive attitude about your job.
• Do everything you can to be good at your job, including learning the best way to complete the job.
• Know and follow policies, procedures and client preferences affecting your job.
• Complete your charting and record keeping accurately and on time, every time.
• Always ask your supervisor about problems with assignments or with clients. If you are working out of a placement
agency, discuss issues with your client.
• Let your supervisor or client know if there is anything preventing you from doing your very best at work.
• Ask questions when you do not understand something or need clarification.
• Try to take directions and evaluation comments without getting upset.
• Always be on time for assignments.
• Take responsibility for getting education hours completed on time.
Knowing the Job Description
One responsibility you have to the employer (and to yourself) is to be aware of the details of the job. A job
description provides a detailed listing of the tasks and responsibilities expected of the home services worker.
Be sure to thoroughly review the job description before agreeing to accept the position. Some employers require you to sign the job description as proof that you have read it and understand what is required of you in
the role of a home services worker.
Job descriptions may not state all of the tasks you are expected to complete as part of your employment. Job descriptions are intended to include a basic outline of expectation of the job, but typically do not include special circumstances that may be encountered as part of the job. Additionally, job descriptions do not typically list what you are not allowed to do.
Home services workers that work for Home Services Placement Agencies should be familiar with the written notice given to them by the placement agency. You should be familiar with the notice before being placed with
a client. This notice, and the additional agreement you reach with the client, serve the same purpose as the job description that a home services worker receives when working in a Home Services Agency
Work Assignment
A supervisor or other agency official will develop a Service Plan with the client and his or her family members or other contact. Based on the Service Plan, the supervisor will determine the skills the worker should have to meet the client's needs. He or she will also create a care p lan/assignment for you to follow and will discuss this
sheet with you as part of your orientation to the individual client. You will be assigned clients to care for, and you will be told the various skills, tasks and activities that the client needs to have completed. The supervisor
determines if you are competent to perform the skills and will provide additional training as needed. It is important to recognize that you must maintain client safety at all times. If you are unfamiliar or not
comfortable performing a task that is assigned to you, make sure you let the supervisor know that you need more training.
For example, it may have been several years since you were asked to provide care for the client's hearing aid. You will need to notify the supervisor of the circumstances and request additional training prior to performing the task. You should begin a task only after you have had training and have received a training certificate or have been approved by your supervisor. If you are working on your own as a result of a placement agency
placement, you should let the client or family member know when you do not understand a task. You should
ask for more training and support in order to learn the skills required for the task.
Communication
Have you ever said, or heard someone else say, “No one told me that” when some message did not get passed on to the appropriate persons? In order to have consistent, good communication, everyone involved in the
client's care has to regularly communicate with other members of the team. Mistakes happen when communication fails.
As a member of the client's care team, you are responsible for communicating your needs and the needs of your client to the most appropriate person. For example, if the client’s condition changes, you need to communicate that to your supervisor. If you are ill and cannot work as scheduled, you need to communicate that as well.
Most often, you will report to the person who is responsible for supervising you, the worker. In a home services agency, this individual will be your supervisor or the care manager for the client. If you are working from a
placement agency, the supervisor will probably be the client, family member, other individual who is paying your wages, or another person who is named as your contact.
Know Where to Find Policies and Procedures
When you work for a home services agency you should either be given or told where to locate a list of policies and procedures that you are expected to follow. Part of your orientation to the job should include being informed about basic policies and procedures that affect you. Many times there are too many policies and procedures for you to know all of them. However, you should know where to locate a manual if you need to know something about the policy or procedure. Additionally, you may ask for a copy of any policy or procedure.
Policies and procedures are written for the safety and well-being of clients and employees. They hold workers to a certain standard of practice that has been adopted by the agency.
Definition of Ethics
Ethics are standards of behavior and moral decision-making to evaluate right and wrong and guide the behavior of home care workers. An ethical person has a sense of duty and responsibility toward others, and
tries to do what is right. Ethics tells us what we should do; laws tell us what we must do. Laws are usually based on ethics. The purpose
of having laws is to ensure order and safety. Ethics and laws are very important in home care because they
protect people receiving care and guide workers giving the care.
An Ethical Worker
An ethical worker is one who:
• Is honest about all aspects of their work
• Promotes health, independence, safety and quality of life for each client
• Reports all client observations and incidents to the supervisor
• Documents (charts) accurately and on time
• Follows infection control practices known as Standard Precautions
• Respects the client’s area as his/her home. Demonstrates this respect by taking care of the client’s belongings.
• Never becomes personally or sexually involved with clients or family members
• Does not discuss own personal problems with the client and family.
• Does not discuss facility or agency issues with client and family
• Does not share or discuss own personal opinions regarding religious, political, or cultural beliefs, or customs, or living or financial
conditions.
• Works within job description; knows limits of job and self, seeks help, advice and clarification when needed.
• Never performs tasks outside his or her scope of practice
• Accepts no “tips” for service to the client
• Accepts responsibility for job and own behavior and is willing to accept constructive criticism and suggestions graciously.
Ethics in Practice
No Harm or Injury
You need to act in a manner that will not cause harm or injury to the client.
• Keep all client information confidential. For example, do not talk about one client to another client and do
not talk about clients to friends and family except to the extent allowed by your supervisor.
• Know your limitations when providing care and never perform a task for which you have not been trained. If
you are assigned a task before you have had appropriate training, talk to your supervisor and respectfully
decline to perform the task until training is completed.
• Perform client care according to policy and procedures. Agencies have policy and procedure manuals. If you
are unfamiliar with a specific agency policy, ask your supervisor to review it with you. You may also request a
copy of the procedure.
• Practice good health habits. For example, get an appropriate amount of sleep before coming to work. More
mistakes tend to be made when the worker is tired and not thinking clearly. Remember also not to come to
work when you are ill. Many clients are at a high risk of getting an illness when exposed to someone with the
illness. Be sure to report your illness to the supervisor so a replacement can be found.
Safe and Quality Care
To provide safe, quality care for clients you will need to:
• Follow assignments as written on the care plan/assignment sheet. Contact your supervisor if you have
questions about an assignment.
• Be a responsible, cooperative member of the client care team. Communicate client concerns to the other
members of the team.
• Show respect for the client’s belongings.
• Consider all aspects of the client’s needs, including physical, social, emotional, and spiritual needs.
You can help ensure ethics in practice by providing care that is fair and appropriate for clients. Give the same
quality care to all clients, showing equal courtesy and respect, regardless of race, religion, personality or other
differences.
Ethics in Practice
Etiquette
Etiquette is good manners and maintaining a polite, courteous, and kind attitude to clients, visitors and other
staff, such as your co-workers. The following practices are considered good manners/etiquette:
1. Practice the “Golden Rule” – do for others as you would want done for you.
2. Address/call others respectfully by preferred name; clients, nurses, doctors, family, visitors, co-workers. For example, some clients
preferred to be called by Mr. or Mrs.
3. Knock on door before entering.
4. Pull privacy curtains and ask family and visitors to leave when giving personal care.
5. Use respectful language – do not use “baby talk” or dehumanizing words such as “dear,” “honey,” “sweetie.”
6. Never whisper outside a client’s room.
7. Always speak in a caring tone of voice, not a raised voice or a harsh tone.
It is important always to practice “good etiquette” when caring for clients. This may be difficult with “hard-to-
care-for” clients. If you are struggling to act in this professional manner with any client, contact your supervisor
for advice on dealing with the client.
Allowing Clients to Make Choices
One way in which to adhere to ethical practice is to allow the client to make his or her own choices. You can
help do this if you:
• Know the client's rights, and follow them.
• Allow the client to participate in making decisions about his or her care whenever possible. For example,
allow the client to help decide the time of day for his bath and the clothes he will wear for the day. If
preparing a meal, such as is commonly done in home care, allow the client to choose food for the meal.
Client Rights
Clients have certain rights as consumers of home care, regardless of the type of services provided. All members
of the client care team need to respect the client's rights and make sure they help maintain those rights for all
clients. Providing these rights to the client helps maintain and protect the client’s dignity and basic human
rights.
Generally, the client and family have the right to participate in considerations of ethical issues regarding client
care concerns. For example, the client has the right to refuse treatment or services, even when such treatment
or service will help the client.
The client also has the right to have all problems/complaints dealt with in a timely manner and the right to
privacy and confidentiality. Clients have the right to be respected and protected from harm, both physically and
verbally and to receive quality care.
(410 ILCS 50/) Medical Patient Rights Act
Client Complaints
Under the Client Service Contract, each home services agency client has the right to voice his or her complaints
or concerns about the services. Additionally the client has the right to assistance to resolve the complaint,
without fear of revenge or punishment for complaining.
The home services worker is not typically asked to resolve a formal complaint from the client. Instead, he or
she should report the information regarding any conflicts or complaints accurately and immediately to his or
her supervisor. In most circumstances the problem can be easily resolved.
Home Services Placement Agencies also have complaint procedures that clients can use to make complaints.
These are listed in the Client Service Contract. The client signed the Client Service Contract when you were
placed in their home to provide services.
Scope of Practice: What is NOT Included?
There are many skills and activities a home services worker should not do. The following examples of tasks and actions outside the scope of
practice for a home services worker are not intended to list every circumstance, but instead they will give you an idea of what you may not do:
• Never give medications
• Never insert or remove tubes or objects from a client’s body such as IV tubing.
• Never perform procedures that require sterile technique, such as a dressing change on a wound.
• Never diagnose or prescribe treatment or medications
• Never administer prescribed treatments, such as medication lotions or Ace bandages, or apply any lotion when skin is broken or a
chronic skin condition is active.
• Never perform Passive Range of Motion exercises. Passive Range of Motion means moving a client's limbs because he she cannot
move them.
• Never cut client toenails or fingernails with scissors or clippers. Client's nails may be filed to shorten them.
• Never insert or remove a catheter or perform digital stimulation, insert suppositories or give an enema.
• Never operate a mechanical lifting device without proper training.
• Never become involved in managing a client's oxygen equipment beyond removal and replacement of oxygen cannula during
grooming.
• Never be involved in any financial transactions of the client that are not specified in the Client Service Contract. Follow agency
policies for receipts and reimbursements, and ask your supervisor if you have any questions.
• Never become or act as a Power of Attorney. A "power of attorney (POA)" gives one person (an agent or attorney) the authority to
legally act on behalf of another individual. Individuals may sign a legal document granting the "power of attorney" to their agent for
general reasons or very specific reasons related to financial, health and business decisions.
Information about Legal Liability
It is valuable to be aware of various aspects of your job that could be legally problematic. The best way to avoid
legal problems is to be aware of what could become a problem. You can help avoid potential legal issues if you
make sure you become aware of your legal responsibility and your employer’s policies about the following:
• Using your own car.
• Transporting a client.
• Having insurance on your vehicle.
• Carrying out any financial transactions for your client and/or handling the client’s money.
• Lending money to a client or family member.
• Witnessing documents such as living wills and becoming a durable power of attorney.
• Accepting gifts from a client or family member.
Staff Safety
A liability concern of home care agencies is the safety of their staff. As a staff member of an agency you need to ensure that the environment
you are working in is a safe location. If you find yourself in an uncomfortable or unsafe situation, report this to your supervisor immediately.
There are a number of things you can do to ensure your safety in the client's home and in your travel to and from work.
When caring for a client in the home, you are sometimes in this work situation with only you and your client. Sometimes, family members are
also present. As with any work situation, it is important to keep your personal safety in mind at all times. If you are ever working in a home and
feel your safety is uncertain either because of the client's behavior or a situation with the client's family, call your supervisor. If you feel you are
in immediate danger, leave the home immediately and call your supervisor from another location. Trust your own instincts. Always be alert to
your surroundings. Know where the doors are in the home so that if you need to leave quickly, you are aware of all exits from the home.
Other measures to take to help ensure your personal safety include:
• Keep your money and identification items (for example, driver's license) with you or nearby at all times.
• Make sure your car is in good working order so that it does not break down on the way to or from the client's home.
• Keep your gas tank at least half full at all times.
• Always keep your car locked while driving and when you park the vehicle. Park only in well-lighted areas.
• Plan your route to clients' homes and make someone else aware of your plans (for example, let your supervisor know your usual route).
• When walking, make sure your route is the safest route even if it may be a longer route. Walk only in well-lighted areas, avoiding vacant lots and buildings.
• When taking the bus, make sure you have money or tokens ready, sit near the front of the bus and know the bus schedule and a safe route to the client's
home.
• Know when you should call 911.
Knowing Your Limitations
As a home services worker, you are responsible for the actions you take when caring for your client. It is
important to recognize the limitations of your role as a home services worker. The most important document
to guide you in regard to what you are allowed to do and what you are not allowed to do is the client’s care
plan, which is also sometimes called the home services worker assignment sheet. It is important to review the
assignment sheet with your supervisor and the client to make sure you clearly understand the tasks assigned.
The care plan/assignment sheet is often kept in a folder. This folder may be left in the home or is given directly
to the home services worker. On the bottom of the page is an example of a home services worker assignment
sheet.
Tasks that you are to complete will vary from one client to another and may change over time with each client.
That makes it very important for you to review the sheet each time before you start to care for the client. In an
agency setting the assignment sheet is often the method the supervisor uses to communicate to you any
changes in care or any changes in specific instructions (for example, when you should call the supervisor). If
you have been placed by a placement agency, changes may be communicated more directly by the client or
your supervisor.
If you have any questions about the tasks on the service plan/assignment sheet, you should immediately
contact your supervisor for clarification. Additionally, if the client or the client’s family asks you to do
something that is not on the assignment sheet, contact your supervisor before you attempt to do what the
client/family is asking you to do. If you work for a placement agency, discuss changes with the client or
supervisor carefully so that you fully understand what your are expected to do. Then, you can decide whether
it is something you should be doing.
It is also important to know your personal limitations. Know what you are able to do and when you need
additional training. If you are assigned to complete a task and you are uncomfortable accepting the
assignment either because you have not completed the task before or because it has been awhile since you
last completed the task, recognize your limitation and ask for additional training before you accept the
assignment. Notify your supervisor that you need additional training.
Knowing Your Limitations
Responding to Gift Offers
If a client offers you gifts or offers to lend money to you, explain to the client that your employer does not
allow you to accept gifts and money. Also notify your supervisor about the offer so that he or she can explain
the policy to the client and answer any questions he or she may have. As a result, home services workers
should not accept gifts from the client or their families. Home services workers should only accept the wages
or benefits stated in the Client Services Contract.
Developing a caring, effective relationship with your client helps you provide excellent care. While you should
not try to become close friends with your clients, you should try to develop a caring relationship with them,
built on mutual trust. Staying within professional boundaries helps to build that trust.
Legal Problems with Gifts from Clients
In return for thoughtful care or to show appreciation, occasionally a client or a client’s family may offer an
employee money, personal property or other gifts. An employee’s acceptance of such an offer, however, can
create problems that could lead to criminal accusations or law suits. Sometimes the client’s family may object
to the client giving a gift, or if the client has a mental impairment, he or she may not recall giving the gift and
may accuse the employee of stealing the item at a later time.
For example, you may work with one client for an extended period of time. One day she offers to give you a
piece of jewelry. You accept it. The daughter assumed this piece of jewelry would be left to her when the client
died. The daughter notices the missing jewelry and asks the client about it. The client does not remember
giving the jewelry to anyone. One day the daughter notices you wearing the jewelry and she calls the police to
report that you have stolen the jewelry.
Civil Fraud
In addition to the risk of being accused of stealing, by accepting gifts you may also put yourself at risk of being
sued for what is known as “civil fraud.” This basically means you used “undue influence” to get the gift from
the client. That is, it might be assumed that you used your personal relationship and the client’s dependence
on your care to influence the client so that she would give you the gift. Even when this is untrue, it places you
in an awkward, embarrassing and uncertain situation that can be avoided by not accepting gifts. If you are
working for a client though a placement agency, let the client know that the wages he or she is paying you are
all that the law allows you to accept. As a result, home services workers should not accept gifts from clients or
their families. Home services workers should only accept the wages or benefits in the Client Services Contract.
Similar to gifts, loans from clients (money, items, equipment etc.) create the same problems and risks. Never
accept loans of any kind from a client. Never lend money, even small amounts, to a client and never borrow
money from a client.
Confidentiality
It is important to remember confidentiality as part of communication. All information specific to a client is
considered confidential or private information. Information about a client should only be given to appropriate
members of the client care team. For example, you may communicate all information about a client to the
supervisors or care manager that is responsible for that client's services. However, you may not communicate
any information about a client to another client or to another worker who is not caring for that client.
Confidentiality is a right the client has that is established by law. Violating confidentiality is a serious offense
that may result in immediate termination from your job or assignment.
Health Care Privacy
Purpose of Documentation
As we examine issues related to confidentiality, it is important to briefly reflect on why it is essential to
maintain a written record of the services provided to a client. Why not just eliminate it and save all the
concern about where and to whom the information travels? Documentation is necessary for several reasons
including:
• As an historical record to be used for subsequent care
• As a source for direction and treatment activities
• As a record of the care provided
• As a resource for analyzing the quality of care provided
• For consultation, support, supervision, and monitoring progress
• For regulatory compliance
Basic Principles of Confidentiality
Boundaries
An individual's personal information should be used for the client's purpose and only those purposes, except
for a few carefully defined exceptions. It should be easy to use information for those defined purposes (for
example, to communicate from one caregiver to another about the current status of the client), and very
difficult to use it for other purposes (such as for marketing purposes like obtaining client informa tion so that
drug companies can market directly to clients). In general, and in all walks of life, any personal information
given or received in confidence for one purpose may not be used for a different purpose or passed to anyone
else without the consent of the provider of the information.
Basic Principles of Confidentiality
Security
Organizations to which personal information is entrusted ought to protect it against deliberate or inadvertent
misuse or disclosure. Careless practices should not be an excuse for failing to protect private information.
Basic Principles of Confidentiality
Consumer Control
Clients should be able to see what is in their records, get a copy, correct errors, and find out who else has seen
their records. It is important to significantly strengthen the ability of consumers to understand and control
what happens to their personal and health care information.
Basic Principles of Confidentiality
Accountability
Those who misuse personal and health care information should be held accountable, and those who are
harmed by its misuse should have legal options.
Basic Principles of Confidentiality
Public Responsibility
Individuals' claims to privacy must be balanced by their public responsibility to contribute to the common good, through use of their information for important, socially useful purposes, with the understanding that their information will be used with respect and care and will be legally protected. Limited areas should be identified in which public responsibilities call for authorization of access to medical information, yet sharply limits the uses and disclosure of information within those circumstances. The duty of confidence should be established, but at the same time not be interpreted so rigidly that there is a risk of its operating to a client's disadvantage or that of the public generally.
