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SE C T I O N E I G H T - PR O V I D I N G PE RSO N A L C A R E T O SE N I O RS

T he M eaning of Personal C are Personal Care Assistants provide practical support to people who have difficulties conducting their activities of daily living. While they also work with children and people with physical or learning disabilities, the majority work with the elderly. They either look after clients in their own homes or they work in institutions, such as nursing homes and adult day care. Personal Care services are required 24 hours per day, 7 days a week and 365 days per year, which contributes to the increasing need for Home Care Assistants. The reasons for this are: Patients are being discharged from hospital earlier and require some short-term assistance. People are living longer with debilitating conditions and diseases. Because of an improvement in medications and treatments, people, who previously would have required facility care, are able to be treated effectively and be maintained at home, with some assistance in carrying out their activities of daily living. People are electing to remain at home instead of going into care facilities. Patients are Being discharged from institutions Because of high costs andGor the client:s preference to be at home. Skills Required By A Personal C are Assistant Personal care assistants should have a working knowledge and be skilled in: communications; oBserving, reporting, and documenting a client:s progressC basic elements of body functions; infection control procedures; reading and recording vital signs; safe transfer techniques; basic nutrition; normal range of motion and positioning; personal hygiene and grooming; patients' physical, emotional, and developmental characteristics; maintenance of a clean, safe and healthy environment; and, recognition of emergencies and procedures for handling them. They also need to be physically fit, be able to lift heavy objects and be committed to the rights of the elderly and disabled.

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Activities Conducted by Personal C are Assistants An overview of some personal care activities is provided to familiarize the Home Care Assistant with the “ins-and-outs” of personal care. It presents the theoretical basics only and should not be perceived as a substitute for practical training.. G rooming Good grooming habits are very important to some people, while others do not give them the same value. To the first group, it is tied into their body image and self esteem. Men in this category will feel better, if they are clean-shaven or if their beards and mustaches are trimmed. Women are concerned how their hair, nails and clothing look and are perceived. The second group “goes with the flow”, so to speak, and are not overly concerned about how they look. They adopt the “take me as I am” attitude. Hhen dealing with clients, the assistant usually adapts to the clients: standards. _ote: Sometimes, if grooming haBits are poor, suggestions might be made to clients about how they might improve their appearance and what the benefits would be; however, they need to be receptive and must not be forced or shamed into changing their habits. H air C are Many elderly clients are not able to care for their own hair due to lack of strength and limited abilities to raise their hands to their head due to painful and restricted movements caused by arthritis and other conditions. To some, it is important that their hair be maintained at a certain standard, as they want it not only to be clean but also styled. Others will just want it clean and cut, while a third group really doesn:t care how clean and or disheveled their hair is. The Home Care Assistant assists as required. When providing hair care, some considerations should Be the client:s culture, personal choice, health history, and ability to perform the maintenance. Hair should be brushed and combed as often as required but at least during the morning and at bedtime. This prevents the hair from tangling or matting. When brushing, start at the scalp and brush down the length of the hair, as this will distribute the scalp oils along the shaft of the hair. Many clients have preferences as to what kind of products they want used and how they want the procedures done. Different types of hair require different tools. e.g. curly hair requires the use of a large toothed comb. Hair washing is usually done in the shower, bathtub or at the sink However, if a client is confined to bed, there are various types of apparatus, which can facilitate giving him/her a wet shampoo or an alternative is to use a dry shampoo. Most hair should use a conditioner after shampooing to maintain the hair:s health and to minimize tangling.

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Common H air Conditions Dandruff Dandruff is flakes of dead skin that form on the scalp. As it is normal for skin cells to die and flake off, a small amount of dandruff is normal and in fact quite common. Some people, however, either chronically or as a result of certain triggers, experience an unusually large amount of flaking, which can be not only a visual nuisance, but is also often accompanied by redness and irritation. Most cases of dandruff can be treated with the proper shampoo or by using common household products such as apple cider vinegar. Pediculosis Pediculosis is a condition wherein lice infest the hair. They attach themselves to hair shafts, where they lay their eggs, which results in severe itching. Lice are easily spread to other people via clothing, furniture, bed linen and sexual contact. Treatment consists of using medicated shampoos, lotions and creams. It is also important to bathe thoroughly and to wash linens and clothing in hot water. A lopecia Alopecia is the temporary or permanent loss of hair. It can occur due to the aging process, heredity, medication (such as chemotherapy for cancer, skin diseases, poor nutrition, pregnancy, stress and hormonal changes). It can also result from improper hair care and prolonged use of certain hair-styling techniques. Cosmetic treatments (e.g., dyes, tints, bleaches, permanents) are generally safe unless the procedures are not done correctly. Hairstyles that pull the hair tightly, and excessive shampooing or brushing can also cause hair loss. Braiding, permanents, excessive heat, and hair straightening cause the hair shaft to weaken. Hair styling techniques such as hair weaving, corn rowing, and straightening procedures can cause permanent hair thinning and scarring. Treatments vary depending on they type of alopecia a person has. It can include wearing a wig or hairpiece, applying cortisone ointments to the scalp or using hair growth products such as Rogaine. Usually alopecia, caused by the aging process. is not reversible. H irsutism Hirsutism in an excessive increase in hair growth. It is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by. However, an inherited tendency, overproduction of male hormones (androgens), medication or disease can cause it to appear at any age. Women who have hirsutism usually have irregular menstrual cycles. They sometimes have small breasts and deep voices, and their muscles and genitals may become larger than women without the condition.

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Treatment is done manually and includes: cutting; bleaching; electrolysis; shaving; tweezing; waxing; and, using hair-removing creams (depilatories).

Shaving Shaving is not usually necessary for medical or sanitation reasons. Many men simply prefer a cleanshaven face while others wouldn:t even consider not having a Beard. Hair is generally removed for comfort, aesthetics, fun, cultural and/or religious reasons. And, it is not shaven for the same reasons -- it is a personal choice. Many women develop coarse, facial hair as they grow older and usually shave their legs and underarms as well. When they are no longer able to perform these functions, they may need assistance or someone to do the shaving for them. Tools required for shaving include: razor (either electric or disposable); gel, foam or shaving lotion; warm water; and, optional items include: o scissors o hair conditioner o tweezers o dry skin lotion or baby oil Shaving tools are a matter of preference or are based on conditions a client might have. E.g. Some prefer that an electric razor be used while others want a razor with a blade. Note: Clients who are on anticoagulants (blood thinners) should not use a razor blade because nicks and cuts are common and can cause bleeding problems. There are some basic techniques, which a personal care assistant should keep in mind when shaving an individual: Pre-Shaving Tips Use a sharp blade as dull blades will pull the hair and increases the chances of ingrown hair. Cut long hair with scissors before shaving it. Let the hair soak in warm water for about 3 minutes before shaving. This softens the hair, opens the hair follicle and relaxes the skin.

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When using gel, apply it at least 4 minutes before shaving, as this will help keep the hair erect, moisturized and will condition the skin. Always use a foamy product for shaving to prevent razor burn (bumps, irritation or red, raw skin). Don:t shave for at least 20 - 30 minutes after lying down because body fluids make the skin puffier. By waiting this amount of time, the skin will tighten up and more of the hair shaft will be exposed. T ips and T echniques for Shaving Wear disposable gloves when shaving a client with a regular razor. With one hand, pull the skin taut and shave with the other. The general direction for shaving is usually in the direction of hair growth. While shaving in the opposite direction will give a closer shave, it also increases the chances of developing ingrown hairs or razor burns. When shaving use: o long, upward strokes on the legs; o short side-to-side strokes on the underarms; and, o upwards on the pubic area. Rinse the blade often, as hair sticking to it will interfere with shaving. Ensure foam is applied any place that is being shaved. Work slowly, especially if using a disposable razor and be careful around bony areas. When shaving more than one part of the body, apply shaving gel to all areas and then start shaving the finest hair first (usually the legs or stomach) A good angle between a disposable razor and the skin is around 30 degrees. Electric razors usually state what angle to use but most are at an angle of at least 45 degrees. A fter Shaving care: Apply a dry skin lotion to the shaved areas, as this will reduce irritation and itching and will soften the skin and hair follicles. It will also reduce the discomfort caused By “stuBble� in Between shaves. Note:

Don:t use the same raPor on two different people (unless it is an electric one and it has been thoroughly disinfected first). Sharing razors could transfer skin infections.

O ral H ygiene The purpose of maintaining good oral hygiene is to: keep the mouth and teeth clean, as this will help prevent bad breath and infections; enhance the well being of the individual; make food taste better; reduce tooth cavities; and, help prevent periodontal disease.

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Most individuals look after their own oral hygiene but, sometimes assistance is needed to either gather up the required tools, which will enable the clients to do their own mouth care or the Personal Care Assistant may have to perform mouth care for them. Tools needed for oral hygiene include: toothbrush; tooth paste (or denture paste for false teeth); dental floss; and, mouth wash. T he Basics for B rushing T eeth Teeth should be brushed 2-3 times a day O usually after breakfast, lunch and supper or at bedtime. The recommended duration is 2-3 minutes. At the least, brush the teeth in the morning and at bedtime. The ideal toothbrush should have rounded bristles, be soft, and not be worn or dirty. It should be shaped and sized to enable it to reach to the back of the teeth. It should be replaced at least every 6 months or even every 3 months, depending on the condition of the toothbrush. A toothbrush is not meant to be shared, as this could spread germs. The toothpaste should contain fluoride. The ideal brushing technique should focus on brushing along the gum line, which is the point where the teeth meet the gums. This is the breeding ground for tartar and bacteria. There are a number of equally effective brushing motions. One is a circular motion, another is a horizontal motion and the third is a vertical motion. Hold the toothbrush at a 45 degree angle and direct the bristles between the neck of the tooth and the gum. Don:t scruB tooth enamel, as Brushing teeth too hard can cause the gums to recede. Clean every surface of the tooth taking care to ensure all chewing surfaces are brushed. Change the method of brushing periodically to ensure that all the tooth surfaces receive a thorough brushing. Electric toothbrushes are very popular, as a motorized head conducts brushing. The user only needs to make sure that it reaches all surfaces of the teeth. They also have automatic timers and shut off after 2 O3 minutes. F lossing Flossing is important because it loosens and removes food particles and plaque between the teeth where a toothBrush can:t reach. An ideal time to floss is right before bedtime at night but the important thing is to develop a routine schedule for flossing and stick to it.

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T he Basics for Denture Care Having dentures is like having real teeth. Regular cleaning and maintenance are as necessary for dentures as they are for regular teeth. Because dentures tend to accumulate bacteria, conditions could surface, which may result in additional tooth loss, swollen and bleeding gums and infections. Use a denture cleaner at least twice per day like your normal brushing routine. A good rule of thumb is to brush, then soak, and then brush them again. Be careful about dropping the dentures while they are being cleaned as they may chip or crack. By placing them over a towel or over a sink full of water, unfortunate accidents may be prevented. By soaking the dentures in a special denture cleaner, the cleaning process can be speeded up. As they are scrubbed and wiped dry, use light circular motions to avoid scratching or grooving the surface. Though all surfaces must be thoroughly cleaned, the key area is where the denture comes in contact with the gums. This is really important especially if the client uses an adhesive. Most denture brushing can be done with a mid-sized toothbrush. The denture cleaner solutions help remove staining and bacteria but should not be used for soaking overnight. For an overnight soak just use regular tap water. Never try to bleach dentures with strong household cleaners. Not only does it weaken the plastic of the denture but it can also be poisonous. For similar reasons, never use extremely hot water to clean them. In the event that serious stain builds up or tartar develops, they can be taken to the dentist for a professional cleaning.

Bathing The purpose of bathing is to remove perspiration, dead skin, excess oils and bacteria from the body. It also increases circulation, is refreshing and is relaxing. The frequency with which an individual bathes is a personal choice. While some bathe daily, others may only bathe once or twice a week. There are different ways to Bathe and, here again, the “where-with-alls� are Based on an individual:s choice andGor on his/her abilities /disabilities. Bathing options include: a tub bath wherein individuals bathe in a bathtub. They may or may not require assistance getting in and out; a shower wherein individuals can stand in a shower, sit on a bath bench in a shower, or have their wheelchair wheeled into the shower (if it is designed for easy access); a sink wash wherein individuals either stand at the sink and wash or they sit on a chair/wheelchair in front of the sink; a complete bed bath wherein individuals have their entire body washed while in bed. It is utilized for people who are not capable of bathing themselves; and,

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a partial bed bath wherein individuals have only portions of their body washed (usually the face, hands, underarms, back, buttocks and perineal areas). G uidelines for Bathing prevent or reduce drafts; ensure privacy; protect individual from falling; use good body mechanics; wash from the cleanest area to the dirtiest area; ensure the temperature of the water is comfortable; keep soap in dish when not lathering; encourage individual to help as much as possible; dry skin well; take safety precautions: o ensure bottom of tuB andGor shower are “gripped� Ie.g. a Bath mat or nonskid stripsNC o use grab bars for support; o avoid bath oils; o place personal care products within individual:s reachC o drain the bathtub before the individual gets out o don:t run water while an individual is bathing (e.g. dishwasher, washing machine, toilet or sink) Skin and Nail C are Good skin and nail care are essential to one:s overall health. The elderly are at great risk for skin breakdown and nail problems.

Skin C are The skin is the largest organ in the body and is responsible for: protecting the body against environmental changes; regulating the Body:s temperatureC and, protecting the body from invading microorganisms, which can cause infection. Therefore, good skin care is most important to prevent skin breakdown, to promote skin healing and to increase circulation.

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Two common skin problems the elderly are prone to develop are: Skin Tears Pressure Sores

Skin Tears Skin tears results when the skin is torn as a result of shearing, pulling or direct pressure on the skin e.g. bumping an arm against a chair. Skin tears can be prevented by overseeing the person carefully and safely. Some measures for preventing skin tears are: keeping the skin well lubricated with lotions and oils; ensuring the individual drinks sufficient fluids; wearing clothing that has long sleeves; putting padding over the elbow; ensuring toenails and hand nails are short and filed; and, placing padding on bed rails and arms of wheelchairs.

Pressure Sores Pressure ulcers are red sores on the skin, which are caused by pressure, friction and skin breakdown. They can occur over any bony part of the body. If severe enough, they can result in damage to the bone, muscle or supporting structure. Pressure ulcers occur when someone has been lying or sitting in one position for too long. Circulation is impeded by pressure and, if it is not relieved, the red area will turn into a pressure ulcer or sore. It is much easier to prevent a pressure sore than it is to heal one. Some preventative measures that can be taken are: maintaining cleanliness; moving/shifting positions regularly (i.e. at least every 2 hours) ; practicing good skin care, which includes inspecting the skin daily and keeping the skin clean and moisture free. (People who are incontinent need to be given extra attention by changing wet clothing frequently and applying ointments, powder or other barriers to prevent skin breakdown.); using devices, which will reduce pressure (e.g. sheepskin, foam padding, powder); and, following a balanced and healthy diet. Nail C are Nails are composed of a protein called keratin and their function is to protect the ends of fingers and toes from trauma. Nail care is also conducted for cosmetic reasons. If the skin is allowed to breakdown, as a 90


result of hangnails or ingrown nails, infections can result. Dirty feet and/or clothing attract microbes, which can create odor. Basic manicuring should be done once a week, taking the following steps:

F ingernails Remove any nail polish by wiping with a cotton ball that has been moistened with nail polish remover, moving from the base of the nail to the tip. Using a file or an emery board, file each nail tip from corner to center. Do not file back and forth since that action may cause nail ridges and nail splitting. Soak the hands in warm, soapy water for a few minutes to remove dirt. Then clean under the free edge of the nail using an orangewood stick. Leave the cuticle (i.e. the skin that grows from the finger onto the base of the nail) intact, as it helps to prevent infection. If nail polish is going to be used, apply it next. Apply a moisturizing cream or lotion to the hands and cuticles to prevent the nails from splitting.

Toenails Generally, the same techniques used for fingernails are used on the toenails. Nevertheless, there are a few things to note: Clip toenails straight across using nail clippers, not scissors. If they are tough, first soak them in warm water or apply a moistening cream. Follow a strict washing regime and dry thoroughly to prevent infection. Change shoes, socks, or hosiery daily to prevent a fungus infection. If ingrown toenails are present, soak the foot in warm water and remove ingrown part. To avoid ingrown toenails, don:t pick at the edges or allow the edges to tear -- just file the ingrown nail and leave it alone. If pain or redness appears and persists, seek a physician's assistance. Make sure toes are clean and dry before applying polish.

T ips for Nail C are An ideal time to manicure is after a bath or shower, since much of the dirt will have been removed from under the nail. Don:t use nail polish remover more frequently than once a week, as it causes the nails to dry out, crack and split. Applying a clear nail polish or a clean coating of nail polish as a top coat will minimize chipping or cracking of the nail.

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Apply cream or lotion after washing hands and keep the cuticles well lubricated. Moisturize nails and hands at bed time. Personal Care Assistants should not cut nails if a client: has a disease that decreases circulation; takes medications that affect blood clotting; has diabetes; has really thick nails; and/or, has ingrown toenails.

D ressing and Undressing A client has the right to choose the clothing he/she wants to buy and/or wants to wear. Clothing has a psychological effect on how a person feels about himself/herself and should not be treated lightly. Some clothing might take a little more time to put on and take off than an item designed for easy access would take. However, for the client:s self esteem, it is worth the eLtra effort to enaBle himGher to war a garment of his/her choice.

D ressing Techniques When putting clothing on a person who has a one-sided weakness (usually the result of a stroke) or an injury, place the garment over that weak side first. E.g. if an arm is broken, put the clothing on the broken arm to start with and then stretch the good arm around to complete the dressing. The reverse is done when removing the clothing. I.e. take the clothing off the good side first and then remove it from the weakened or injured side. When pulling garments over the head, put the head through the neck of the garment first and then slide each arm individually through the opening slot. If there is a weak side or an injured side, follow the procedures listed above. When putting on pants or slacks, slide the pants over the feet and up the legs. If the client is lying down, ask him/her to raise his/her hips and buttocks off the bed. If they are not able to, position the client on his/her strong side and pull the pants over the hips and buttocks on the weaker side. Next, position client on his/her weak side and pull garment over the hips and buttocks on the strong side. Note:

Clients who may have difficulty with zippers, buttons and snaps, as a result of arthritis or other restrictive problems, benefit from clothing, which uses Velcro. By providing Velcro closures, these people often can handle the task of dressing without any assistance.

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Three places a client may be dressed are: on the bed; in the wheelchair; or, partially on the bed and finished on the chair.

T urning Some clients, who are bedridden, are not able to turn themselves. In this case, they must be turned regularly to prevent skin break down. When working alone, a Personal Care Assistant can move the client:s Body By moving it in segments Ifirst the upper Body and second the lower BodyN or By using a lift sheet. Note: Details for these procedures are not being given because home care assistants should receive a practical demonstration before trying it themselves. There are many factors, which must be considered such as the client:s condition Iarthritis, spinal in;ury, spinal surgery etc.N and the importance for the assistant to use good body mechanics.

T ransfer ring Sometimes clients need to be assisted in moving from the bed to a chair/wheelchair/commode and back again. The amount of assistance varies depending on the individual client:s aBilities. Transferring may require one person, two or more people, or it may require a mechanical lift. Safety is of utmost importance to prevent a client from falling and an assistant(s) from being injured. Assistants require training in order to carry out manual turning and to operate mechanical equipment. Note:

Some agencies will not allow their assistants to transfer clients without the use a transfer belt and/or other equipment. (A transfer belt is used for most transfers.)

Some points about transfers: Assistants should discuss procedures with the client before attempting any transfer. A client:s wishes for transfer procedures should Be respected, unless safety is an issue. A stable, firm and level surface is required before attempting any transfer. the transfer surface should be at the same level or height that the client is transferring from.

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When wheelchairs are used, ensure that the foot pedal is out of the way, the brakes are locked, and the armrest is removed from the side the client will be shifting from. The surfaces of equipment, used in the transfer process, should be placed as close as possible to a 90degree angle before transferring. e.g. Have the chair next to and at a 90 degree angle to the bed when preparing to move a client from the bed to the chair.

Pivot T ransfers A pivot transfer is used when moving a client from one surface to another and is done at a right angle closest to the point of transfer. During the transfer the client stands, turns or pivots and then sits down on a new surface. Use a transfer belt when: transferring to the toilet; transferring to the bathtub; transferring to the shower, the client is wearing tight clothing; or, the client is not fully dressed.

How to Do a Pivot T ransfer Place the client:s stronger side closest to the chair (or whatever place he/she is transferring onto). Have the client sit at the edge of the bed with his/her feet flat on the floor. Position the stronger foot slightly behind the weaker one. Place your hands on the backside of the transfer belt, which has Been placed around the client:s waist. Place your feet and knees outside of the client to prevent his/her legs from collapsing. Ask the client to grasp his/her arms around your upper back or elbows (Note: do not allow them to be placed around your neck as that could cause injury to you.) Tell the client you will “rock� himGher Back and forth counting as you go. Zn the count of R, assist the client to stand. Pivot (turn) your feet towards the chair, and rotate the client to a position where he/she can sit on the chair. Ensure the client is standing up straight and is under control before pivoting. Lower the client:s Body slowly to the chair. At the same time, have himGher reach Backwards to grasp onto the armrest or chair. Note:

If the client is unable to do a pivot transfer, there is equipment available which will help e.g. a sliding board, trapeze bar (attached to the bed), or a hoyer lift.

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Tec4niH<es for I@ne-5ersonJ Transfers A one-person transfer is conducted when a client only requires one person to help him/her move. Following are some techniques for one-person transfers of a client moving from a bed to a chair/wheelchair/ commode: Position the chair next to and even with the headboard. Get client into a sitting position with legs and feet dangling over the edge of the bed. Prevent the client from sliding or falling by blocking his/her knees and feet with your own. Have the client put his/arms around your elbows or upper back (if capable); Place your hands under the client:s arms and around the shoulder blades; Support the client as he/she grasps the far arm of the chair; Have the client hold onto the armrests of the chair and lean forward; Have client bend his/her elbows and knees, as he/she is being lowered into the chair. Note: These tips are presented for informational purposes but, again, it is stressed that assistants need to receive proper training and practice before looking after clients who require assistance with transferring. This type of training can often be attained through “on-the-;oB” training, as long as the “instructor” is qualified.

Body M echanics Good body mechanics refers to the way individuals move when carrying out daily activities. It is essential that Personal Care Assistants have a good knowledge of body mechanics to help prevent back injuries when they are lifting, moving heavy objects or transferring clients . T echniques For Practicing Good Body M echanics KstaBlish a solid Base By placing your feet a shoulder:s width apart, with one foot in front of the other. Wear shoes and keep your back straight. Get in close to whatever is being moved, without stretching. Bend from the hips and knees and not from the waist to lift objects. Do not bend or reach unnecessarily. Don:t lift oB;ects higher than chest level or above your shoulders. Lift with your legs and not with your back. When carrying objects, keep them close to your body, use both hands.

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Use the weight of your body to push or pull an object. Do not twist your body. Move your feet slowly around to the new position. When sitting, sit on a hard chair with straight back, and use a back support, such as a pillow.

Range of Motion E xercises â&#x20AC;&#x153;Range of motionâ&#x20AC;? is a term used to descriBe the amount of movement in a ;oint. Kvery ;oint in the Body has a "normal" range of motion, which is maintained through movement. It is therefore very important that all joints be moved every day. Stiff joints can cause pain and can make it hard to carry out the activities of daily living. Range of Motion (ROM) exercises preserve the flexibility and mobility of the joints. The exercises reduce stiffness and will slow down the rate at which joints freeze. There are different kinds of ROM exercises: Active Range of Motion Exercises, which clients can do by themselves, if they have the muscle strength to move the joints through their complete ranges. . Passive Range of Motion Exercises, which are done for the client by the caregiver. Note: Often a combination of both types of ROM exercises will be used. K ey Points A bout Range of Motion E xercises If joints are painful and swollen, move them gently. Do the exercises slowly and steadily. Do not force movements if the exercises cause pain -- stop the movement. If too much force is applied, the joint space can be damaged. Range of motion exercises are done one joint at a time. When going through the motions, place one hand just above the joint and place your other hand below the joint to move the part through its full range of motion. These exercises should be done once per day. Do each exercise 10 times or more to the point of resistance and hold for 30 seconds. (Note: A Physiotherapist will usually determine how many times each exercise should be done.) Begin exercises slowly, doing each exercise a few times only and gradually build up Try to achieve full range of motion by moving until you feel a slight stretch. Support the limbs throughout motion. Move slowly, watching the patient's face for responses to the exercises. Note:

Personal Care Assistants should be shown how to do the various Range of Motion exercises by a qualified person.

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In some situations, Personal Care Assistants are not permitted to do range of motion eLercises on a client:s neck due to the risk of neck injuries. This decision is generally made by the Physiotherapist or Occupational Therapist involved in the case. When assistants are not permitted to do neck exercises, usual practice is that the Physiotherapist or Occupational Therapist will do them.

W alking Even the elderly should be encouraged to walk to maintain their muscle strength, to exercise and to prevent contractures. (Contractures occur when muscle and tendons shorten, which causes a deformity or subnormal range of movement of a joint.) Because some clients are weak and unsteady, they have difficulty walking without assistance from either a device or another person(s). Assistive devices that might be used to help a weak and unsteady client to walk are: Assistive Device Transfer Belts

Crutches Handrails

Canes

Braces

Walkers

Wheelchairs

Electric Scooter

Description A transfer belt is placed around the client:s waist for the caregiver to grasp to support the client while he/she walks or transfers. Crutches are used when a person does not have the use of one leg or when a leg(s) needs to gain strength. They are usually made of wood or metal and extend from the underarm to the ground. It is important that a client be measured properly to decrease the risk of falling. Handrails, installed on walls/stairs, give the client something to grasp onto as he/she walks. A cane is often used when there is weakness on one side of the body. They can be single tipped, three pronged or four pronged. The latter provides the most support. Canes are used on the strong side of the body. E.g. When the client takes a step, he/she places the cane a few inches ahead of his/her body and then moves the weaker leg forward first. Then the stronger leg is brought forward and placed ahead of the cane and weaker leg. A brace is used to support body parts that are weak. They also prevent or correct deformities. They can be made of metal, plastic or leather and are applied over the ankle, knee or back. To prevent skin breakdown, ensure that the skin under the brace is clean and dry. A walker will provide more support than a cane. It has four points. Some walkers have wheels, which enable the client to propel the walker along. The walkers without wheels must be lifted by the client as he/she takes a step forward, Other walkers come equipped with a seat and basket. They allow the client to sit down when feeling tired or unsteady and to transport small items. A wheelchair is a movable chair, which is mounted on large wheels. It is used by invalids or by people who cannot walk. They can be manual or electric. Manual wheelchairs are propelled by the person sitting in them or by a second person pushing the wheelchair. Electric wheelchairs utilize a battery for movement. An electric scooter (also known as an ECV or electric convenience vehicle), is a batterypowered, three or four-wheeled vehicle designed for individuals who have difficulty walking. Scooters are versatile and can be used both indoors and out.

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The type of walking/mobility aid that a client needs is determined by: the client:s physical conditionC the amount of support a client needs; and, the type of condition/disability the client has. Walking aids are usually ordered by a physician, nurse or physical therapist, who then instruct the client how to use them. T he F alling Client An elderly client may start to fall when he/she is standing or walking. They lose their balance because of weakness or dizziness or they may fall as a result of wet floors, slippery mats or shoes without adequate grip. An automatic reaction, when somebody starts to fall, is for a by-stander to try and prevent the fall. This could result in injury to both parties. Things to do, when a client starts to fall: ease him/her to the floor, which will allow you to control the direction of the fall. i.e.: o bring him/her close to your body; o grab the transfer belt (if client is wearing one) or wrap your arms around his/her waist or hold him/her under the arms; o using your leg for support, allow the client:s Buttocks to rest on it, which will enable him/her to slide down your leg to the floor. protect his/her head; do not move him/her once he/she has landed; check for injuries; obtain help as needed; and, document details. U rinary System C are The urinary system removes waste products from the Blood and maintains the Body:s water Balance. About 3 pints of urine are excreted a day, with variations being influenced by age, the amount of fluids ingested, medications taken and the amount of salt consumed. The ability to hold urine depends on the person having anatomically normal and functionally normal urinary tracts and nervous systems. He/she must also be able to recognize the needs for urinating and know what to do. Urinary incontinence is the loss of voiding control, which can range from being an occasional leak of urine to a total inability to hold any urine. They can be short-term or long-term.

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The two main types of urinary incontinence are: Stress incontinence, which occurs during certain activities like coughing, sneezing, laughing, or exercise. Urge incontinence, which involves a strong and sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. Generally, a person doesn:t have sufficient time from the time the urge to urinate is recognized and actual urination takes place.

Common C auses of U rinary Incontinence urinary tract infection/inflammation; prostate infection/inflammation; constipation (puts pressure on the bladder); medications; pregnancy; weight gain; short-term bed rest; dementias; and, physical conditions such as: o spinal injuries; o neurological conditions; o weakness of the muscles which hold urine intact; o abnormal structure of the urinary tract; o enlarged prostate; and, o bladder cancer. T reatment of U rinary Incontinence retrain bladder by voiding at regular times; contract the muscles of the pelvic floor several times a day; keep blood sugars under good control if diabetes is present; avoid constipation; quit smoking to reduce coughing and bladder irritation; avoid alcohol and caffeinated beverages, which stimulate the bladder; and, avoid foods and drinks that may irritate the bladder.

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Bowel C are Bowel elimination is a basic physical process wherein waste products from the gastro-intestinal tract are normally excreted through the rectum. People who have required surgical removal of portions of the intestine are given a colostomy, which enables fecal material to pass through an opening in the abdomen. Common Bowel Problems Constipation is a condition in which too much water is absorbed from the large intestine back into the bloodstream, leaving the feces dry, hard and difficult to expel. It is caused by a lack of fiber in the diet (Fiber holds water, preventing the feces becoming too hard.) Fecal Impaction is an accumulation of hardened feces in the rectum or lower colon, which the person cannot move. Diarrhea is a condition characterized by watery stool or increased frequency (or both) when compared to a normal amount. It may last a few days and disappear on its own. Incontinence is the inability of the body to control urination or bowel movements or both. Flatulence is the presence of excessive gas in the bowel. There are various reasons why bowel movements (defecation) may be affected: F actor Diet Fluid Intake Personal Habits Activity Medications Aging Process Disability Lack of Privacy

Reason High fiber foods and a balanced diet are needed for maintaining regular bowel habits. Often, seniors do not get enough fruits and vegetables. Also, they tend to avoid certain foods if they have problems with their teeth/dentures. The bowels depend on an adequate intake of liquids to work effectively. Otherwise, constipation sets in. Between 6-8 glasses of fluid should be taken daily. Relaxation enhances defecation. Achieving the required state of relaxation may be achieved by eating, walking, reading or having a hot drink. Exercise and movement maintain muscle tone and stimulate the bowels. A frequent side effect of conditions which make a person inactive (e.g. disease, surgery, injury, etc.) can render a person to become inactive. Many medications list constipation or diarrhea as side effects, which make maintaining regular and good bowel habits a challenge. As one ages, illness and slowing down occur . They, in turn, affect bowel control. Also, older people do no always empty their rectum so they may need to go again, shortly after their first bowel movement. People who are quadriplegic or paraplegic do not have voluntary control of their bowel movements. It is beneficial to help them develop regular bowel habits to prevent or lessen impaction, constipation and incontinence. It is not uncommon for people to have difficulty defecating or voiding, if others are around. This is usually easily remedied, by providing privacy.

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T reatments for Common Bowel Problems Bowel Training includes a combination of food selection and encouraging bowel movements at specific times to develop a regular pattern of elimination. Enemas are fluids drained into the rectum to remove feces and relieve constipation. There are various kinds of enemas, each with different purposes. Suppositories are cone-shaped medications which are inserted into the rectum. As they dissolve, they stimulate a bowel movement. Rectal Tubes are tubes inserted 6 inches into the rectum for 20 O 30 minutes to relieve flatulence. Stool Softeners are simple ways to evacuate the bowels. frequencies.

They are taken orally, with varying

Laxatives are products that promote bowel movements. Note: A physician or Registered Nurse usually prescribes one of the above treatments. C aring for the Incontinent C lient Incontinence needs to be managed to prevent discomfort, skin problems and possible infection. measures that will help manage urinary incontinence are:

Some

use personal care supplies to catch urine and stool (e.g. diapers, pads); prevent skin breakdown by changing soiled diapers/pads immediately; clean the perineal and rectal areas after each incontinent episode and dry them well. Apply cream to help guard against skin irritations; ask the client frequently if they need to use the bedpan/urinal/commode; offer to assist the client in getting to the bathroom; discourage the client from drinking fluids near bedtime; and, ensure diuretics, if ordered, are taken early in the day. Devices Used For E limination and Incontinence Bed pans are generally used by people who are bedridden. Urinals are basically used by people in bed. Commodes are chair-like, mobile toilets on wheels or they can be stationary. They are used at the bedside or at a more private location. Devices for eLternal care are used primarily By men. A ruBBer Bag is attached to the client:s calf and is connected via a condom to the penis. A sterile device used for internal care is the catheter, which is inserted into the bladder. The urine then drains into a bag on the outside of the body; and, Disposable garment protectors such as panty liners and padded undergarments will trap urine and feces.

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E ating/F eeding Seniors often have a problem with eating and thus rely on others to assist them. The objectives of a good eating program are to: provide a balanced diet; prevent choking; make the experience pleasurable; improve their quality of life; and, maximize their independence. When a client is eating, ensure that: a non slip placemat is put on the table surface; utensils are clean and in good shape; utensils suited to the individual:s needs are usedC smaller spoons are used to offset spilling; straws and special cups are used if fluid flow is an issue; appropriate feeding utensils are provided. e.g. fork or spoon instead of chopsticks; and, all utensils are within the client:s reach. _ote: An Zccupational Therapist can assess the client:s functional aBility to determine if special adaptive devices would enhance the client:s eating aBility. Zther factors to consider, which are relative to the client:s food consumption are: food preferences; religion; health status; need for special diet; nutritious food; food consistency to enable chewing and swallowing (food may need to be purĂŠed. cut up into small pieces or bones removed). need and/or ability to wear dentures; and, need for the client to be placed in a comfortable and upright eating position for easier swallowing.

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T ips for Safe F eeding Be sure the client is awake and alert during feeding. Make sure he/she is positioned properly. i.e. Have him/her sit with his/her head flexed slightly and the chin pointing downward to reduce the chances of choking. Make sure that food is not too hot or too cold. Allow sufficient time for the client to eat and do not rush himGher. If heGshe doesn:t want to eat, determine the reason why and try to rectify the problem. (e.g. sores in mouth). Be alert for coughing, dribbling or aspiration of food into the nose, as this could indicate swallowing problems. If a client chokes or aspirates , call paramedics, if necessary. Signs and symptoms of aspiration are: o breathing difficulties; o engorged face and neck veins; and, o face turning blue with loss of consciousness in severe cases. Be sure the client is kept well hydrated by encouraging him/her to drink fluids or assist them in drinking. When client has finished eating, check his/her mouth for any food remnants. Wash mouth and clean teeth/dentures.

T ips for E ncouraging Self C are Encourage the client to do as much of his/her personal care as possible. This gives them exercise, promotes independence and develops a feeling of participation. Adapt the environment to enable the client to do things for himself. E.g. install grab bars in the bathroom, put railings on stairs, obtain a bath bench for shower/tub and make the home accessible by wheelchair. Include the client in planning his/her own care. Take his/her feelings and suggestions into consideration and encourage involvement. Adapt the pace to what works for the client. Become knowledgeaBle aBout the client:s disaBilityGcondition to determine what else might Be done to enable him/her to function as independently as possible. Help them function at the top of their capabilities. V ital Signs dital signs are taken to monitor the Body:s performance in respect to temperature, Breathing and heart function. Vital signs are measured by four different methods:

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T emperature The human body normally maintains a constant temperature within a few degrees of 98.6째 Fahrenheit (37째 Celsius). Older people usually have a lower reading. Therefore, a 98.6 measurement for them, could indicate a slight temperature. Temperature is measured by inserting a monitor into the mouth, ear, rectum or underarm. Pulse A pulse is a beat of the heart as blood passes through the artery. It is felt by pressing down on the artery and counting the number of beats in a given length of time (usually 1 minute). If the pulse is regular, it need only be counted for 15 seconds and then multiplied by 4. A watch or clock, with a second hand, is required to measure pulse rate. Respirations Respiration refers to the act of breathing air into and out of the lungs. An adult has between 10 O 20 respirations a minute. They are usually quiet, effortless and regular. The best time to measure respiration rates is when the client is at rest. Count the number of rises and falls of the chest for 30 seconds and then multiply that figure by 2. Note: Try to count respirations right after taking the pulse (i.e. while your finger is still on the pulse so the client thinks you are still taking his/her pulse). Respirations are taken in this manner just in case the client deliberately alters his/her breathing rhythm. Blood Pressure Blood pressure refers to the force blood exerts against artery walls. When the heart is contracting, (called systolic pressure) the amount of blood being forced out of the heart into the Body:s circulation is Being measured. The pressure exerted on the walls of the arteries when the heart is at rest is called diastolic pressure. A normal blood pressure for an adult is 120 (systolic) over 80 (diastolic). Blood pressure is measured by a monitor. Some monitors require the assistance of a stethoscope. Other monitors, such as digital monitors, do not require the use of a stethoscope. Note: Practical training is required to learn how to take vital signs.

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T hings a Personal C are Assistant M ust Never Do

There are some functions that a Personal Care Assistant must never do: 7on0$ give medications in any form. However, the Personal Care Assistant can monitor the client to ensure he/she takes medications as prescribed. Often the Pharmacist will prepare medications in a blister pack, which divides the medications into 4 or more groups to be taken throughout the day. This makes it easier to track what has been taken and what has not. 7on0$ insert tuBes or oB;ects in a client:s Body openings or remove them from the body. 7on0$ take verbal or telephone orders from physicians. 7on0$ perform procedures that require sterile technique. 7on0$ tell a clientGfamily the client:s diagnosis or treatment plans. This responsiBility lies with the Physician. 7on0$ diagnose or prescribe treatments or medications for clients. Only physicians can prescribe and determine treatment. 7on0$ supervise other Personal Care Assistants, as there could be legal implications. 7on0$ do anything that is beyond the duties of a Personal Care Assistant.

E quipment and Supplies Recommended for Personal C are Assistants Personal Care Assistants require only a few pieces of equipment to do their tasks. When working in a facility, these items are usually provided (except for a watch). However, when working as a Selfemployed Home Care Assistant, it would be wise to invest in some equipment and supplies. E quipment: transfer belt to assist clients in and out of chairs and to provide support while client walks. (The belt is placed around the client:s waist.NC temperature gauge IthermometerN to monitor a client:s Body temperatureC watch or clock with a second hand to take client:s pulse and oBserve their respirationsC blood pressure monitor to measure blood pressure; and, solid shoes with good grips to prevent slipping and back strain.

Supplies: Hhile it is usually the client:s responsiBility to have supplies on hand, it is a good idea for the Selfemployed Home Care Assistant to have some as well. This will enable them to meet the needs of clients who unexpectedly require immediate personal care. E.g. A Home Care Assistant gets a call to provide immediate assistance to a client at a time when the stores are closed. If the assistant has a few items at home, then he/she can take them to the client, who either pays for them or replaces them.

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Basic supplies should include: disposable soaker pads; disposable peri-wipes (or other disposable cloths like baby wipes); disposaBle incontinence pads Ie.g. â&#x20AC;&#x153; Dependsâ&#x20AC;?NC and, disposable gloves.

Summary Home Care Assistants often provide personal care to seniors by assisting them with their activities of daily living. These activities include such functions as grooming, bathing, dressing, toileting, transferring and exercising. All require a certain degree of knowledge and skills to perform them efficiently and competently. A crucial part of providing support is to encourage clients to participate in their own care as much as possible. This will maximize their functioning ability, enable them to maintain some independence, keep some control over their lives and enhance their self esteem and self validation. It is especially important that Home Care Assistants know and adhere to the limits of their expertise.

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Providing Personal Care to Seniors  

Collegiate Caregivers University Section 8