EmailMe Form - WORK AT ASSISTED LIVING FACILITIES / Reminder EMF

Today's Date *

MM / DD / YYYY

Your Name *

Your Email *

Name of your client *

Name of the assisted living facility they are in *

UPON ARRIVAL*************************

Masks & Covid-19 testing *

When inside the facility, it is mandatory to use your mask at all times.

The mask must be the Home Instead mask provided to you

The mask must be worn over BOTh (i) nose and (ii) mouth at ALL times (not just when social distancing is not possible)

Please note that any complaint received due to lack of use of mask may result in immediate termination.

If working inside the facility, compliance with covid 19 testing is mandatory.

Sign into the sign in sheet *

Upon arrival, I understand that I am responsible to Sign into the sign in sheet at front desk

Identification badge *

I Understand that I am responsible to have my identification badge around my neck at all times. If I do not have one, I will call the agency

No Nurses Aide Uniforms allowed *

I understand that I am NOT allowed to wear a nurses aide uniform at the Atria, only Atria staff is allowed to do that

Business casual *

I understand that I am responsible to dress business casual (black jeans allowed, NO blue jeans) no open toe shoes; nothing flashy.

Jewelry, perfume/ cologne *

I understand that I am not to wear jewelry or fragrances that are flashy or may draw attention

No tattoos showing *

I understand that I am responsible to cover any tattoos I may have with appropriate clothing

HAND WASHING*************************

Hand washing *

I acknowledge I am responsible to wash my hands (i) upon arrival & departure, (ii) before & after personal care, (iii) before & after meals & (iv) if the client is to be isolated for any reason, let us know so we teach you certain procedures

ACTIVITIES*************************

Activities Calendar *

I am responsible to ask for the list of activities every day and to try and work with the staff to encourage my client to participate in activities. If client refuses, I will ask the facility staff and also to Home Instead to assist me encourage

Activities (Caregiver rules) *

Caregivers must bring the client to the activities room and help them settle in. However, caregivers can only sit off to side of room for activities, they cannot participate unless there is special permission. The caregiver must stay nearby

Exercises, Therapy *

I am responsible to ask the staff what exercises I am permitted to get my client to do. I will try and get a routine of things that are permitted. This can be either in the client’s bed, in the room, in the hallway, etc

MEALS

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Dining Room *

Caregivers cannot eat in Dining Room or Cafe. Home Instead caregivers can bring client there, but must leave while residents are eating.

Walkers in the dining room *

When bringing client to dining room, if they have a walker, it is to be placed off to side of room. Walker cannot be right next to client while dining.

ATRIA MANHATTAN ONLY (not Hallmark) - "The Grille" (special dining room where caregivers can go with their clients) *

ATRIA ONLY (not Hallmark) - Although no Caregivers are allowed in main dining room, there is a small cafe called the Grille that Caregivers are allowed to eat in with clients. You can purchase lunch tickets for $6 from front desk.

PERSONAL CARE/ MEDICATIONS

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Personal Care *

I acknowledge I am responsible to wash my hands (i) upon arrival & departure, (ii) before & after personal care, (iii) before & after meals & (iv) if the client is to be isolated for any reason, let us know so we teach you certain procedures

Medications *

Medications must be given as per a care plan designed by the facility. Home Instead knows exactly what I need to do. I am responsible to make sure I am clear as to what my role is in medication reminders. If I am not sure, I will cal 212-614-8057

PEOPLE

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Lobby *

I am responsible to make sure I am not hanging out in the lobby, with or without my client, they want this for transit only

Staff at the facility (including outside private aides) *

I am responsible to be professional with everyone at all times but to not discuss my client with anyone who is not directly involved in the client’s care

Other patients or residents at the facility *

I am responsible to be professional with everyone at all times but to not discuss my client with anyone who is not directly involved in the client’s care

Nurses responsible for the client *

I am responsible to give updates regarding the client’s health and to never leave a shift without updating the nurse

Socializing in the facility *

I understand my responsibility during my shift is to my client. Socializing is not permitted and going to the facility outside of scheduled shifts is also prohibited

OBSERVING AND REPORTING

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Observing and Reporting *

I acknowledge that I am the eyes and ears for the agency regarding this client and that if my client is not well for any reason, I will let the facility know as well as Home Instead (212-614-8057)

Leaving my shift *

I acknowledge that I can never leave my shift if my client is not feeling well unless I report this to Home Instead or to the facility nurse immediately

MISCELLANEOUS

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Video cameras *

I understand that all areas are under video and that I am under observation and any inappropriate conduct will lead to suspension, termination and/or police report

Cell phone (talking , chatting or texting) *

I acknowledge that use of my cell phone for personal use in public areas where others can see me will result in immediate termination

Punctuality and leaving early *

I understand my responsibility is to arrive on time or early and stay the entire shift. Asking another aide to watch your client until your shift or during a break is prohibited and subject to termination

Break time *

I understand that unless I am told specifically by the agency (which is never the case) that there is no break time and I cannot leave my patient during my shift unless the facility or Home Instead authorizes

Ambassador *

I acknowledge that I am at the facility to represent Home Instead and to do a good job. If I cannot do this for any reason, I will call the agency and ask for a day off or to be removed from the case

Signature *

Clear

Sign your name with mouse or with your finger

Any questions? Call us at 212-614-8057 or email us at *