EmailMe Form - CG IN FACILITY ALF/ SNF Protocols / Reminder EMF

Today's Date *

MM / DD / YYYY

Your Name *

Your Email

Name of Facility I am being sent to is *

Name of Client I am being assigned to is *

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.

Nurses Aide Uniform *

I understand that I am responsible to have my uniform on at all times unless the client asks me not to in which case I will wear appropriate clothing approved by the agency

Jewelry, perfume/ cologne *

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

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 in encouragin

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

Walking *

Especially if the client is in a hospital or nursing home, I am responsible to ask the staff EXACTLY how often (every hour? 2 hours? 3 hours) the client should walk the halls and I am responsible to maintain such schedule with support of the staff

PERSONAL CARE/ MEDICATIONS

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Facility rules regarding (i) Personal Care and (ii) Medication Reminders *

Since I am in a facility, I will ask the nurses on staff how they want me to assist with regard to personal care and medication reminding since each facility is different and have strict rules

Personal Care *

I am responsible to make sure my client is clean in toiling, oral care, grooming and well dressed at beginning and end of shift and throughout the shift. Since I am in a facility, I will ask the nurses on staff how they want me to assist since each f

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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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

OTHER ITEMS

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Cell phone *

I acknowledge that use of my cell phone for personal use, especially 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

Discharge Plans *

I acknowledge that if I hear the doctor or client talk about being discharged back home or somewhere else that I will call my agency so they can prepare for this

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 *