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Table of Contents

1) Introduction...... 3 a) About People Enhancing People b) What is PCA Choice c) Hours of Operation (Office Hours) d) Mission, Vision, Goals e) Board of Directors f) Organizational Chart

Client Role & Responsibilities

2) Leading Your Team...... 7 a) Work Environment Expectations b) The Hiring Process c) Staff Management Expectations d) Staff Recognition

3) Billing & Payroll Process...... 12 a) Timesheets b) Pay Periods / Payroll c) Holidays d) Overtime Policy e) Legal Guidelines (275 hours/16 hours)

4) Client Advisory Committee...... 16

PCA Role & Responsibilities

5) People Enhancing People Employment Policies...... 17 a) Equal Opportunity Employer b) Non-Discrimination c) Harassment/Sexual Harassment d) Drug Free Work Place e) Dress Code f) Personal Hygiene g) Employee Misconduct h) Grievance Procedure 6) Professional Conduct Expectations...... 22 a) Code of Ethics b) Client Property c) Confidentiality PCA, Client, & PEP Role & Responsibilities Documentation

7) Contractual Expectations...... 23 a) The Employment Contract b) PCA Responsibilities c) Client Responsibilities d) PEP Responsibilities People Enhancing People Role & Responsibilities

8) What to expect from PEP...... 27 a) Agency Marketing b) Agency Code of Ethics c) Services Provided d) Admission Policy e) Release and Disclosure of Information f) Client Admission Process g) Client Grievance Procedure h) Minnesota Home Care Bill of Rights Safety

9) Client Safety...... 40 a) Emergency Preparedness b) Vulnerable Adults

10) Employee Safety...... 42 a) Maintaining Safe Working Conditions b) Client Responsibilities with Universal Precautions c) What Every PCA Must Know About Their Client d) Lifting & Transfers e) Infection Control & Universal Precautions f) Slips, Trips, Falls, Kitchen Safety g) Driving Safety h) Reporting Injuries i) Incident Reporting

11)Client Manual Documents...... 58 a) Photo Release Form b) MN Workers’ Compensation employee rights and responsibilities c) Minimum Wage Notification d) Age Discrimination e) Family Medical Leave Act 1993 f) Equal Employment Opportunity

People Enhancing People 13 Created 4/2011 Updated 11/2015 Introduction Welcome to People Enhancing People (PEP), a non-profit (501c3) PCA Choice Provider Organization serving the needs of Clients choosing to direct their own PCA services. We are truly pleased that you have made a decision to join our organization as a Client. It is important to us as an organization that you are supplied with the tools you will need for success as a manager. The PCA Client Handbook can increase your ability to create a positive work environment, as well as provide you with guidance on setting your staff up for success. The handbook does not replace the policies in your PCA Written Agreement (signed by yourself, your PCA, and a PEP representative). As you move forward in your role as a staff manager, keep strong communication with your staff to set clear, consistent performance expectations that are achievable for your PCAs. PEP reserves the right to add, delete, or revise the Client handbook at any time for growth and for the excellence of our organization. We will notify you in writing of any changes as it relates to your position.

About People Enhancing People For many people with disabilities, Personal Care Assistants (PCAs) support their ability to remain independent and active members of their communities. As a Client-driven PCA organization, People Enhancing People not only recognizes the important role that PCA services play in the lives of those with disabilities, but it also deems the Client ’s ability to self-direct home health cares is a critical component to facilitating greater independence and service satisfaction. Our organization is a multi-faceted program equipping our Clients with management tools and skills to facilitate their supervisory abilities, creating incentives by which Clients can recognize their quality PCAs, and fostering strong working relationships with their PCAs. People Enhancing People was co-founded by Jim and Claudia Carlisle, who both have disabilities and have used Personal Care Assistant (PCA) services for over 50 combined years, and Susan Beaulieu, a long-time PCA for the Carlisles’. Their extensive experience prompted them to start a unique organization that supports the active, independent lifestyles of people with disabilities, and strengthens the working relationship between Clients and their PCAs. To do this, the organization emphasizes the Client’s ability to manage and direct PCA services in a manner that best fits their needs. People Enhancing People (PEP) is PCA Choice organization, administrating PCA payroll writing services along with supporting individuals with disabilities who want to manage and direct their own in-home PCA services. People Enhancing People promotes not only Client directed PCA care but also community involvement as a powerful factor in the wellness of people with disabilities. Recognizing this, in a unique joint-employer relationship with People Enhancing People, Clients of our services become their own care manager. With the support of People Enhancing People, the Clients are responsible to hire, train, schedule and tailor their services in a way that best fits their individual lifestyles within their own communities. One Client stated: “This has been a real thrilling process,

People Enhancing People 14 Created 4/2011 Updated 11/2015 as far as independence. I am independent physically, but emotionally – making choices, making decisions; it has really felt good. It’s ‘Hey Pat, what are YOU going to do about it?” In January 2002, People Enhancing People was awarded a two-year grant by the Centers for Medicaid and Medicare Services through the State of Minnesota’s Department of Human Services (DHS) to develop a Client-Directed PCA program model to better serve Clients with quality PCAs.

People Enhancing People believes that health care is a basic human right. It must be available, coordinated, and provided in a comprehensive way, combined with other human services when appropriate. People Enhancing People and our staff shall operate and provide services in compliance with all applicable federal, state, and local laws and regulations and disclosure and ownership information. To the best of our knowledge, based on our policy development structure and professional personnel practices, our services comply with professional standards and principles.

What Is PCA Choice? PCA services are available through personal care provider organizations and agencies. Traditional PCA agencies are responsible for recruiting, hiring, training, managing, and scheduling PCA’s for the Client. With a Client-directed PCA Choice Program, the individual with a disability chooses to have more control over their services and takes more responsibility for their daily cares. With a PCA Choice Program the Client is responsible for hiring their primary staff, having backup PCA staff in place, determining pay rate, supervising their staff, evaluating their PCA’s performance, scheduling, and training.

Office Hours of Operation PEP’s office hours are Monday through Thursday, 10:00 am to 4:00 pm and Fridays from 10:00 am to 1:00pm (excluding holidays).

Our Qualified Professional can be reached after hours for urgent matters at (651) 278-3511 or [email protected].

People Enhancing People Phone: 612-789-0049 2817 Anthony Lane S Fax: 651-234-0864 Suite 311 St. Anthony, MN 55418 www.pepeople.org

People Enhancing People 15 Created 4/2011 Updated 11/2015 MISSION: It is the mission of People Enhancing People to nurture a rewarding personal care experience to fortify the independence of persons with disabilities.

VISION:

We envision a time when persons of all ages are able to recognize the contribution and interdependence of every individual.

ORGANIZATIONAL GOALS:

. Increase the availability of quality Personal Care Assistants. . Develop incentives to encourage employment as a Personal Care Assistant. . Increase the satisfaction of both Clients and Personal Care Assistants. . Advocate for Client Choice and Flexibility in Personal Care Assistant services. . Create public awareness of the personal care needs of persons with disabilities and the employment crisis of the personal care assistance industry.

Board of Directors & Staff

People Enhancing People’s Board of Directors has eleven active Directors. The Board of Directors’ Bylaws strives to maintain a member ratio of 25% persons with disabilities (or guardian of person with disabilities) and 25% current or former Personal Care Attendants.

People Enhancing People’s paid staff consists of an Executive Director (part-time), Qualified Professional (part-time), Billing/Payroll Manager (full-time), Administrative Assistant (part-time), and 120+ Personal Care Assistants (mixture of full-time and part-time).

People Enhancing People 16 Created 4/2011 Updated 11/2015 People Enhancing People Organization Chart

Board Chair

Board Treasurer Board Secretary

Marketing Board Member Board Member Board Member Advisory Committee Chair Committee Chair Board Member Board Member Board Member

Executive Director Insurance Partner Billing Partner

Payroll Manager Qualified Administrative Professional Assistant IT Support Accounting Vendor Partner

Personal Care Assistants

People Enhancing People 17 Created 4/2011 Updated 11/2015 CLIENT ROLE & RESPONSIBILITIES

Work Environment Expectations

The Client’s home is each PCA’s workplace environment. Clients are expected to create a workplace environment that is conducive to positive employer-to-employee communication, interactions, and professional relationship development. Please remain focused on setting your staff up for success by communicating clear, reasonable expectations in a positive, supportive, professional manner. Please be consistent and fair in the application and enforcement of all workplace policies pertaining to work-related activities, scheduling, reliability, and overall work performance expectations. In the event that an employee is in need of additional training or support to improve their performance, please partner with your Qualified Professional on the training and corrective action options that can be utilized to assist your staff with their performance improvement needs. All Clients are encouraged to utilize the performance management resources available through People Enhancing People to address concerns with their employees when conflict arises in the work environment. Issues are expected to be addressed early on, before they become too difficult to resolve in a reasonable manner. Clients are expected to complete performance reviews on each of their PCA staff, done in conjunction with the PEP Qualified Professional. Copies of all performance reviews are maintained in each employee’s file. Clients are encouraged to conduct a review in person and in written format with each of their PCAs. The Qualified Professional is available to be present for this meeting as well. THE HIRING PROCESS: RECRUITING, INTERVIEWING & JOB OFFERS

People Enhancing People is a PCA Choice Organization. Clients are responsible for all recruiting, interviewing and hiring of staff. We offer partnership at every step in the process. If you need assistance with recruiting, we have ad templates we can utilize to create an ad for you, we have suggested strategies of recruitment, and we are available to help you get started if you have never recruited staff before or haven’t had to recruit for a while. We have interview templates we can send for conducting phone screens prior to completing face-to-face interviews as well as templates for 1st and 2nd face-to-face interviews. In addition, we offer interview coaching and feedback. Once you have candidates ready for possible hire, they must contact the office to complete the necessary documents, turn in required identification, and have a background study completed. Applicants will then set up orientation to be completed following clearing their background study.

ORIENTATION: WHAT SHOULD YOUR NEW HIRE EXPECT?

People Enhancing People requires every PCA to attend New Hire Orientation (NHO). Re-hires or staff members returning from a leave of absence are required to attend a refresher course. At NHO PCAs review all employment policies (including Harassment free workplace, drug and alcohol policy, dress code, time off requests, leave of absence, Employee Misconduct and other policies), workplace expectations (including Code of Ethics and other expectations), and legal requirements (including HIPPA compliance, billing training on timesheets, Vulnerable Adults law, and other requirements) for providing quality care in the Minnesota healthcare system. In addition, all PCAs complete safety training on lifting & transfers, infection prevention, blood borne pathogens, kitchen safety, preventing slips & falls, safe driving practices, and what to do if they are injured on the job.

People Enhancing People 18 Created 4/2011 Updated 11/2015 New Hire PCAs must complete 3 quizzes following orientation and must receive a score of 80% or better to pass. Failure to pass will require additional training with the Qualified Professional. Clients are expected to support all policies and practices covered in NHO. Clients may contact the PEP Qualified Professional regarding questions on any material covered in NHO. Please note, at this time the Department of Human Services is now requiring PCAs to complete their on-line certification process. PEP does follow all legal guidelines pertaining to employee training, including billing training and steps for success training for administrative and QP staff.

When your new staff starts with you, this is your opportunity to reinforce the expectations set at orientation. Please be sure you understand the expectations that have been set with your new PCA. All expectations put in place by PEP are done to:  ensure the rights of the employee under the law are protected, per Department of Labor regulations.  clarify and reinforce the legal expectations set by DHS for PCAs in the state of Minnesota.  encourage your staff to think through their role in creating a positive, professional working relationship with you. Please be sure the expectations you set for your employees do not violate their legal rights and do not require them to violate their legal obligations as paid health professionals in the state of Minnesota. If conflict arises in your working relationship with your employee, please partner with the Qualified Professional for measures you can take to ensure your well-being is maintained and your home remains a positive space for you to be in.

To reinforce the expectations set during orientation, talk to your staff about what they learned, what they found most interesting, what they will do to be successful in your working relationship, etc and talk to your staff about your role in creating a positive, professional working relationship with them. The sooner you start this dialogue with your staff, the easier it will be to set and follow up on the behaviors each of you can engage in to create a successful, long-term working relationship.

For staff members who have left your team and are returning to your staff, or staff members coming back from a Leave of Absence, we have an abbreviated orientation process.

STAFF MANAGEMENT EXPECTATIONS

Setting your staff up for success is an important aspect of creating a positive work environment. You are expected to treat all staff fairly by implementing and supporting all the employment policies your staff is trained on during orientation. You are expected to drive open, respect-based communication with your PCAs. Please encourage open, appropriate dialogue as you build a successful working relationship. This type of communication should never involve a negative tone, raised voices, or demeaning language by either party. Another expectation is that you will ensure your staff has access to the tools and resources they need to be successful. The final piece to setting your staff up for success is providing timely, relevant, and continuous recognition and feedback on their performance. Please note that at each step of the way, we are available as a partner to you in this process. The following is a good guide to refer back to on a regular basis to evaluate if you are taking all the necessary steps to create a positive, safe working environment for your staff.

People Enhancing People 19 Created 4/2011 Updated 11/2015 SETTING YOUR TEAM UP FOR SUCCESS

Step One: Finding Quality Candidates to Join Your Team Finding quality staff involves more than simply identifying someone that is available to work the hours you need help with. You need to identify as accurately as is possibly the level of integrity, reliability, respect and responsibility the candidate will bring to your team. Questions asked during an interview should help to shed light on how the candidate approaches conflict, manages work/life balance, takes initiative with their performance, and their overall work ethic. Understanding the PCAs work experience and how it pertains to your personal cares is very important for Choice clients. Interview training is just a phone call away! Contact the Client Coordinator for ideas on how to approach the interview process that will help you identify candidates who will be a successful part of your team for a long time. Step Two: Setting Reasonable, Clear Expectations Communication is the biggest driver in workplace conflict. To head off unnecessary workplace conflict, have clear, consist communication as you build a professional working relationship with your new hires. Remember it takes time to get to know one another, for your PCA to learn your routines and understand your needs well. To set your PCA team up for success in working through the learning process at each person’s own pace, be respectful, flexible, consistent, and clear in your communication. It is important that you do not discuss one PCA’s performance level with other PCA staff. If your staff hears you talking negatively about another member of your staff, this leaves them to wonder what concerns you have about their performance and whether or not you are sharing concerns about them with other staff members instead of addressing with them directly! To create a positive work environment, address issues directly and timely by following step three below. Step Three: Providing Quality Feedback Every employee should receive regular performance feedback, whether they are an outstanding part of your team or are having issues meeting expectations. Reinforcing positive performance with timely recognition is the most effective way to build staff morale. In addition, recognition encourages your team to continue doing things that work well for your health and wellness needs. Make it a point to let your PCAs know how they are making a difference in your life with verbal recognition and through Dash of Cash recognition! A common concern for managers is how to handle feedback when performance concerns are present. Oftentimes managers will withhold feedback in these difficult situations in an attempt to avoid conflict. When performance concerns are present, the best way to resolve them is to address them promptly with clear communication. Often times a PCA is not aware they are not meeting performance expectations. This means they do not have any reason to try to improve their performance. Giving your staff accurate feedback is the first step to allowing them the opportunity to improve their performance when concerns are present. In addition to the informal feedback you give to your staff, the Qualified Professional will meet with you several times during the year to complete a formal, written review on each of your PCAs. When working with the QP on the written performance review, be sure to deliver a message that is reflective of the PCA’s level of performance, highlighting what they are doing exceptionally and explaining things that can be improved or done differently. Please set up a meeting with each PCA to go over their performance review with you. Each PCA is notified at orientation that performance reviews are part of the employment experience with PEP and will be expecting to have a formal review with you.

People Enhancing People 20 Created 4/2011 Updated 11/2015 Step Four: Follow Up You have provided feedback. Now what? Once the feedback process has begun, it is important to follow up on the feedback you have given with consistent communication. If your feedback has been positive, recognize the behaviors you would like to see continue. If your feedback has been constructive, create an improvement plan with your PCA. Work together on creating an improvement plan that allows you to set guidelines and a timeframe on the specific changes your PCA needs to implement. When setting the improvement expectations, communicate the importance that the changes be sustained going forward. The most common mistake managers make with communication is only giving feedback or setting an expectation once. This may work for some of your staff, but it will not work for all of your staff. Many people need a message delivered more than once, and in different ways, before both parties are on the same page with expectations. If an expectation has been set, the next step is to follow up and determine if the message is understood and if your staff member knows what to do to meet that expectation. Be open to reinforcing the expectation through quality, positive follow-up communication. Step Five: Knowing When to Partner Sometimes disciplinary action is the best method for improving performance. The corrective process should begin with a verbal warning for performance concerns with issues such as teamwork, reliability, communication, etc. When a corrective action is given, it must be documented in the employee’s file. If you give an employee a verbal warning, you must notify the Care Manager within 24 hours of the date it was delivered, the reason, and the performance improvement needed from your PCA. If the verbal warning has not resulted in a performance improvement, the next step in the corrective action process is a written warning. Please partner with the Care Manager on the writing and delivery of a corrective action. A copy of the written warning will need to be entered into the employee’s file at the office. Step Six: Recognize, Recognize, then Recognize! Recognition reinforces the behaviors that you need your PCAs to engage in to be a successful part of your healthcare team. In addition to the verbal recognition you can provide on a regular basis, PEP works to have incentives in place to motivate your staff to be a quality part of the PEP team. Partner with your Qualified Professional to learn more!

People Enhancing People 21 Created 4/2011 Updated 11/2015 INCENTIVES AVAILABLE TO YOUR STAFF

Dash of Cash Program

PCAs are some of the most important people in the lives of those they work with. Many Clients desire to express their gratitude and affirmation of the work their PCAs do for them. The Client Advisory Committee assisted in the development of this employee recognition program.

The Dash of Cash program allows Clients to recognize outstanding performance from their PCAs. When a PCA does something that is very value-added in the life of the Client, the Client may fill out a recognition letter and send it in to the office. All PCAs who receive recognition from their Client will be entered into a drawing for one of eight $25.00 payroll bonuses each month. Every PCA recognized receives a card from the PEP team thanking them for their outstanding services, indicating why they are being recognized by their Client.

People Enhancing People 22 Created 4/2011 Updated 11/2015 Timesheets

A signed timesheet is a legal medical document and acts as a bill the PCA is submitting, requesting reimbursement for services provided. Timesheets record the hours you have worked. You must sign the timesheets before your Client. Your Client then verifies the hours worked and signs the timesheet. Once the signatures are on the timesheet, these are the hours that will be billed to the state and/or MHCP providers. By signing the timesheet you and the Client acknowledge that it is a federal crime to provide false information on PCA billings for Medical Assistance payment. Your signature verifies the time and services entered on the timesheet are accurate and that the services were performed as specified in the PCA Care Plan. Because a signed timesheet is a LEGAL MEDICAL DOCUMENT, no one other than the individuals that sign the timesheet (Client and PCA) may write on the timesheet. Any incorrect, illegible, or partial timesheets will be held for correction. Any such documents are ineligible for billing and will not be entered into payroll until all necessary corrections have been made. To avoid delays in payroll, both the client and the PCA are expected to review the timesheet for any mistakes and make corrections prior to submission to the office. Timesheets are due in the PEP office every other Tuesday by 5pm – No Exceptions .

You must discuss with your Client who is responsible for faxing, mailing, emailing or delivering the timesheets to the PEP office. If a timesheet misses the Tuesday 5pm deadline, that timesheet will not be processed for that pay period. The timesheet will be on your next payroll and may include a $35 administrative fee.

Paychecks / Payday

Paychecks can be picked up at the PEP office if you notify the Payroll/Billing Manager. Otherwise all paychecks are mailed Thursday afternoon before payday in order for them to be delivered in the mail on Friday paydays. If you are in the outer metro counties, your paycheck delivery may be delivered on Saturday or Monday. Direct Deposit is available to all employees with a checking account or savings account. Please contact the Payroll/Billing Manager to receive the direct deposit form. PEP will not re-issue a paycheck until it receives the original paycheck back in our office. Under special circumstances PEP will do a “stop payment” on a paycheck, however you may be charged the bank processing fee (determined by the Executive Director).

People Enhancing People 23 Created 4/2011 Updated 11/2015

CLIENT BILLABLE HOURS*

The Public Health Nurse (PHN) determines whether or not an individual is eligible to receive Personal Care Assistant Services and how many minutes per day an individual requires. The PHN then sends a request to the state of Minnesota for authorization of services to be put in place. The Minnesota Department of Human Services (DHS) will notify People Enhancing People and the Client if services have been approved and how many units the Client is authorized to bill the state of Minnesota for during their approved Service Agreement. A Client and his/her PCA staff may only bill UP TO THE AMOUNT AUTHORIZED BY DHS FOR BILLING. Per the Employment Contract, the Client is responsible for managing their hours to NOT EXCEED the hours authorized by DHS for billing. Any hours used beyond those authorized by DHS are the financial responsibility of the Client and must be billed directly to the Client by the PCA.

Periods of Ineligibility A client automatically becomes ineligible for Personal Care Assistant Services at the following times:

 Upon admittance into a hospital or medical care facility. o A PCA must stop providing services immediately during hospitalization or treatment in a medical care facility and is not allowed to bill for services until a new Service Agreement has been issued by DHS.  Any time there is a lapse in the Client’s MA services. o A PCA must stop providing services immediately upon notification by DHS that MA services are not in place.  Upon notification to People Enhancing People by the Department of Human services indicating services are no longer in place. o A PCA must stop providing services immediately upon notification by the DHS that services are no longer in place.

PEP will make every effort to provide immediate notification of changes in Client eligibility for services. Therefore, it is critical that you always have a current phone number, address, and email on file. You are also required to keep a current address on file with the Department of Human Services.

* Please note that the level of care a Client is approved for changes per the Public Health Care Assessment any time there is a change in a Client’s level of need for support with activities of daily living. The hours a Client is authorized to bill the state for may increase or decrease throughout the employment period.

Overtime Policy

PCAs may not work more than 40 hours per calendar week. Every timesheet submitted to the office is a bill the PCA is requesting the agency submit on behalf of the PCA and Client. That bill is reimbursed by the state at straight pay for non-holiday hours. Because PCAs are NOT reimbursed time and half pay by the state for the hours they work, they may not exceed 40 hours in a work week. Any overtime worked must be authorized in advance by the Executive Director. Submitting timesheets in violation of the Overtime Policy is considered Serious Misconduct and will result in Corrective Action, up to and including termination.

People Enhancing People 24 Created 4/2011 Updated 11/2015 TIMESHEET GUIDELINES Please note the following mandatory requirements for billing, per DHS requirements. Every timesheet submitted must be an original copy, not photocopied from previous payrolls! The Client must be present for all hours billed for.  Complete date must be entered for every day of the week, Sunday through Saturday, even if no hours were worked on that date. Date must include month, date, and year.  Initials must be placed in the box for each activity performed by the PCA. *The PCA may only perform activities listed in the care plan.*  Time In AND Time Out must include hour and minutes. (7am must be written as 7:00am.)  Either AM or PM must be written in each Time In and each Time Out box.  The total hours for each day and week must be listed, even if the total hours are zero.  Any days not worked must be crossed off on the timesheet.  Any changes made to the timesheet must be initialed by the Client.  Every timesheet must have the PCA number on it.  Timesheets must be filled out daily, on each shift worked.

BECAUSE A SIGNED TIMESHEET IS A LEGAL MEDICAL DOCUMENT, NO ONE OTHER THAN THOSE INDIVIDUALS WHO SIGN THE TIMESHEET (CLIENT AND PCA) MAY WRITE ON THE TIMESHEET.

ANY INCORRECT, ILLEGIBLE, OR INCOMPLETE TIMESHEETS WILL BE HELD FOR CORRECTION. ANY SUCH DOCUMENTS ARE INELIGIBLE FOR BILLING AND WILL NOT BE ENTERED INTO PAYROLL UNTIL ALL NECESSARY CORRECTIONS HAVE BEEN MADE.

ANY HOSPITALIZATION DATES MUST BE NOTED IN THE BOTTOM BOX OF THE TIMESHEET.

FAMILY RELATIONSHIP MUST BE NOTED IN THE BOX IN THE LOWER RIGHT CORNER.

IN THE EVENT THAT A TIMESHEET IS FOUND TO HAVE ERRORS, THE TIMESHEET WILL BE MAILED BACK FOR CORRECTION. THE CLIENT AND PCA ARE RESPONSIBLE FOR RETURNING THE CORRECTED TIMESHEET TO THE OFFICE BEFORE THE PAYROLL DEADLINE OF 5 PM ON TUESDAY.

ALL LATE TIMESHEETS WILL BE PROCESSED ON THE FOLLOWING PAYROLL. IF YOU HAVE ANY QUESTIONS ON FILLING OUT A TIMESHEET CORRECTLY, PLEASE SCHEDULE A TIME TO MEET WITH THE PAYROLL MANAGER. WE ARE HERE TO HELP YOU BE SUCCESSFUL! .

People Enhancing People 25 Created 4/2011 Updated 11/2015 Face to face training is completed at New Hire Orientation with the above guidelines (guidelines are included in Employee Handbook). All timesheets are reviewed by the Payroll Manager. Any timesheets out of compliance with the legal requirements are not accepted for billing. The client and PCA are notified of the necessary resolution to be made. Any PCAs with repetitive mistakes are required to complete additional training at the office with the Payroll Manager. Failure to following the legal guidelines may result in Corrective Action, up to and including termination.

People Enhancing People 26 Created 4/2011 Updated 11/2015 PCA ROLE & RESPONSIBILITIES Employment Policies

Every Client is expected to implement and support the following employment policies. These policies are in place to protect the rights and well-being of all PEP staff members. Failure to support these employment policies may result in notification of termination of services.

Equal Opportunity Employer

PEP complies with federal and state regulations pertaining to affirmative action. Our policy is to employ individuals regardless of race, color, nationality, age, disability, or sexual orientation in compliance with federal and state regulations. The employment requirements are applied to all individuals, and there is no discrimination. Clients must comply with these regulations for all applicants they review in the hiring process. All applicants will have to complete a Criminal Background Study conducted by the Minnesota Department of Human Services Licensing Division, and will check all employment references provided to protect the vulnerable population for which we serve.

Non-Discrimination Policy PEP provides PCA Choice services to individuals with disabilities regardless of their race, color, nationality, age, disability, or sexual orientation.

People Enhancing People 27 Created 4/2011 Updated 11/2015 Time Off Requests At some time, your staff will need time off from their regularly scheduled shift, whether that is due to illness, planned vacation, educational needs, or unexpected changes in their personal circumstances. As an employer, you must understand the legal rights employees have regarding employment protection, such as the legal framework provided through the Family Medical Leave Act. If you have an employee that needs time off under the Family Medical Leave Act, the employee should contact the office immediately. If your employee needs less than two weeks off, they should complete a Time Off Request Form and turn it in to you prior to the needed time off. This form can also be used for permanent schedule changes needed by your PCA. This form is available on our website. If your employee needs more than two weeks, they need to complete and turn in a Leave of Absence Request Form to you. Once you complete a Time Off Request Form or Leave of Absence Form, please provide a copy to your PCA and a copy to the office for the PCA’s employment file. Both forms are available on our website.

FMLA All staff needing time off that falls under the qualifications for the Family Medical Leave Act should be given an FMLA Request Form. Employees who have been employed with People Enhancing People for at least one year are eligible to receive up to 12 weeks of unpaid time off. The FMLA benefit permits employees to take leave on an intermittent basis or to work a reduced schedule under certain circumstances. Potential reasons to be granted time off under the FMLA include self illness, to care for a seriously ill parent, spouse, son or daughter, or the birth or the adoption of a child. This is a legally protected benefit of your staff. Please facilitate their access to this benefit. Staff may obtain needed forms from the office.

Regulatory Compliance

Personal Care Assistants are responsible for complying with all rules and regulations related to the PCA Choice program. This includes, but is not limited to: state Vulnerable Adults Act, Data Privacy, PCA regulations, including medication administration, and Department of Labor laws governing overtime. People Enhancing People (PEP) prides itself on the quality of the Personal Care Assistants who work for our Clients. Within this pride is the appearance and presence of you (the PCA) in the community in which you work with your Client. We receive new clients from you due to your professionalism in the community.

Dress Code As a professional employee, we ask that you wear appropriate clothing while working. Do not wear jean with holes, tight fitting shirts, pants, and other outerwear, t-shirts depicting disturbing language and pictures, or anything that would interfere with safely performing the tasks on the Client’s care plan or cause the Client and their community to question your professionalism.

Personal Hygiene It is important to look your best and take pride in your appearance and personal hygiene when working with your Client. Please be clean and wear clean, appropriate clothing when you work.

People Enhancing People 28 Created 4/2011 Updated 11/2015 Check with your Client for any sensitivity to smells or allergic reaction to perfumes and colognes prior to your first day/night of work. Some Clients do have heightened sensitivity or allergies to certain chemicals in perfumes and colognes. Fingernails must be trimmed and clean before work.

Attitude PCAs are expected to maintain a positive attitude during their workday. Their professional attitude not only reflects upon themselves as well upon the Client. Please support your PCA’s efforts to be courteous and respectful in their communication and interactions with the community and office staff by being respectful and supportive in your communication with them. Schedule Management Expectations for PCAs

RELIABILITY POLICY Tardiness Expectations  Arrive on time for all scheduled shifts.  A phone call is required if you will be more than 15 minutes late.  Multiple occurrences of tardiness in a single month may result in corrective action, up to and including termination. Schedule Change Expectations  You are required to work your scheduled shifts. If you are unable to work your scheduled shifts, you are expected to provide 24 hours notice and complete a time-off request form and turn it in to your client, notifying him/her of the schedule change you are requesting in writing. All schedule change requests must be authorized by the Client in advance.  If you need to make a temporary or permanent change to your regular schedule, you must complete a time-off request form and turn it in to your client. Schedule changes should provide two weeks advance notice.  If your client leaves you a message asking you to cover a shift on short notice, please return your client’s call promptly and let them know whether or not you are able to cover that shift.  Leaving during a shift is considered job abandonment and is grounds for disciplinary action up to and including termination due to the safety risk to the client.

Overall Reliability Expectations  It is your responsibility to know and to follow your schedule accurately.  You are expected to work cooperatively with your co-workers (other PCAs) to help ensure all hours are covered. Please be prompt in letting your client know whether or not you can cover shifts for them.

No Call No Show Policy  No Call No Shows are unacceptable. Due to the safety risk involved, No Call No Shows are grounds for immediate corrective action, up to and including termination.  Two No Call No Shows will result in the termination of your employment contract with People Enhancing People.

Leave Of Absence Policy  Extended leaves of absence can be requested in writing with as much advance notice as possible.  Leave of absence requests will be reviewed on a case-by-case basis.  Leave of absence requests may be made for 30 days, 60 days or 90 days.  All approved Leave of Absences are unpaid time. People Enhancing People 29 Created 4/2011 Updated 11/2015  Upon returning to work, all efforts will be made to find an agreeable schedule, based on your client’s scheduling needs. * Notification of schedule change/tardiness must be direct, not via voicemail, email or text messages. If you are not able to reach your client, call back until you reach him or her.

Harassment/Sexual Harassment

PEP believes that Clients are vulnerable to the threat of verbal, emotional and physical harassment, including sexual harassment. Federal and state law prohibits the use of coercion, intimidation or force when caring for a disabled person. Any verbal, emotional, physical, or sexual misconduct by a PCA towards a Client will result in the immediate termination of the PCA’s employment contract with People Enhancing People. Examples of behavior that will not be tolerated are:  Yelling and/or foul insults at a Client;  Threatening punishment for non-compliance;  Shaking, grabbing kicking or other physical violence  Rape, sexual assault, molestation or attempts to commit these offenses. The above policy also applies to a Client’s treatment of their PCAs. Clients may not engage in any of the above behaviors toward their staff. In addition, any type of harassment or sexual harassment in employee- to-employee relationships will not be tolerated. Any unwelcome sexual advances, offensive language, or physical violence by a PCA employed by People Enhancing People will result in disciplinary action up to and including termination.

Drug Free Workplace PCAs may not show up for work intoxicated and/or under the influence of mood altering drugs. Any infractions of this policy will result in disciplinary action, up to and including termination. Consuming, processing or selling drugs and/or alcohol while working with a Client will result in disciplinary action, up to and including termination. Clients must provide a drug-free workplace for their staff. If a Client encounters a situation in which they believe their staff is working while under the influence, they are to contact their Qualified Professional or the Client Coordinator immediately.

Employee Misconduct

Employment with the Agency is at will and either the Agency or an employee may terminate the relationship at any time, with or without notice. Either party may end the relationship without prior notice, but neither party may breech contracts. The Agency cannot violate state or federal laws, and generally cannot rightfully terminate employees who refuse to do something that is contrary to public policy and sound morality, such as breaking the law.

In the event that an investigation by People Enhancing People, Adult or Child Protective Services or the Department of Human Services finds an employee has engaged in misconduct, defined as any violation of the employment policies present in the Employee Handbook or any requirements by the state regarding PCA services, that misconduct is subject to corrective action, up to and including termination with the agency, People Enhancing People. People Enhancing People 30 Created 4/2011 Updated 11/2015

All corrective actions remain in effect for a period of six months, with the intent that the employee is given the opportunity to improve their performance as needed. If improvement does not occur or there is a decline in performance, other action is taken. Unacceptable behavior is dealt with through positive corrective action. The process includes verbal and/or written warnings that call attention to work performance needing improvement, misconduct or violation of an Agency policy. Nothing in this policy arrogates the employment at will doctrine or creates any contracted relationship, either implied or directed. The critical points in this policy are: due notice, a chance to improve, and a review process.

Corrective action for minor misconduct may follow the following process, as evaluated on a case-by-case basis:

● Verbal warning, written warning, final warning, termination. These guidelines apply to performance and attendance related issues. Each corrective action is in effect for six months. This is not a guarantee that all situations will follow all four steps. The Client and Care Manager will review corrective action cases and may move to termination earlier in the process.

Corrective action for serious misconduct may follow the following guidelines:

● Final Warning, with or without suspension, termination. Employees may be suspended without pay until an investigation of employee misconduct is completed. If cleared of any wrongdoing, the employee may be reinstated into his/her position, depending on the staffing needs of the Client at that time. Each corrective action is in effect for six months.

Corrective action for gross misconduct may follow the following guidelines:

● Termination. Conduct leading to immediate discharge includes, but is not limited to: 1. Falsifying records including time records, mileage, and/or visit documentation 2. Interfering with efficient safe operations and client safety 3. Stealing agency property, co-worker property, or client property 4. Borrowing money from clients and/or their families 5. Carrying firearms or other dangerous weapons while on agency premises or while providing services for the agency 6. Abuse, damage, or destruction of agency or client property 7. Fighting or provoking a fight while on duty or while representing the agency 8. Abusive or threatening language to agency staff, supervisors, or clients 9. Any physical or emotional abuse of clients 10. Possessing/consuming liquor or illegal drugs while at work/on agency premises 11. Sexual harassment 12. “No Call-No Show” for scheduled hours with a client. 13. Insubordination 14. Working as a PCA for more than 275 hours per month or 16 hours per calendar day (for one OR multiple agencies) 15. Client/Job abandonment

People Enhancing People 31 Created 4/2011 Updated 11/2015 16. HIPPA violation(s) 17. Failure to report maltreatment under Vulnerable Adults Act guidelines

PEP Grievance Procedures People Enhancing People believes it is in the best interest of employees and management to have an environment where concerns are openly discussed. For this reason, PCAs are encouraged to bring all work related issues to their manager, the Client. Clients are encouraged to address issues directly with their PCA. If the Client is unable to resolve the issue with their PCA, the Client may bring the issue to the PEP Qualified Professional. If the PEP Qualified Professional cannot resolve the issue, the issue may be brought to the Executive Director. PEP is committed to providing a timely response to concerns brought forward.

People Enhancing People 32 Created 4/2011 Updated 11/2015 Professional Conduct Expectations

People Enhancing People (PEP), is a PCA Choice Organization and thus acts as a fiscal intermediary or employer of record (joint employer) for Clients directing their personal care assistant services. In an effort to enhance the Client and PCA working relationship, PEP has written a Code of Ethics and Professional Conduct Policy for Personal Care Assistants (PCA) and Qualified Professionals (QP). As a PCA or QP working PEP and its Clients: 1. I will conduct myself in a manner that is ethical and appropriate, always keeping professional boundaries when supporting a Client with self-directed cares; 2. My professional interactions at work with the Client reflect the pride I take in doing a great job; 3. I will avoid all negative, discouraging language or degrading comments that may compromise the level of trust the Client expects from me; 4. I will treat the Client with dignity and respect at all times; 5. In addition to creating a pleasing working environment, I will encourage outside activities that fortify the independence of the Client.

Respect for Client’s Property PCAs are expected to focus on building a relationship of trust with their Client. For this reason, the following expectations are set during New Hire Orientation. Please support your PCA in their workplace expectations from PEP by ensuring you create a workplace environment that is conducive to these expectations. The PCA must:  Bring their own meals (unless otherwise planned with your Client);  DO NOT lend, borrow or request things such as cash, keys, clothing, food, or other material objects;  Respect the Client’s furniture, dishes, and cookware;  Report any damaged property immediately to the Client;  Provide a smoke-free environment and check with the Client for designated smoking areas. Confidentiality

All PCAs sign HIPPA paperwork upon employment and must follow this federal policy. Personal Care Assistants are exposed to vital confidential information about a Client’s personal life and medical condition. PEP requires that PCAs refrain from discussing the Client’s personal affairs, condition, diagnosis, or any other specifics about their assignment with any other PCA, outside entity, or person unless the Client has given written or verbal notice to you and the other entity or person authorizing you to discuss certain aspects of their life. Any breach in confidentially may result in the termination of the PCA’s employment contract with PEP.

People Enhancing People 33 Created 4/2011 Updated 11/2015 Federal Fraud Waste and Abuse Prevention Training

1) The client and PCA may only bill for services provided under the Client’s care plan.

2) The PCA must be present with the Client for all hours worked.

3) The client and PCA may only bill for actual hours worked.

4) Staff may NOT work for the Client while the Client is hospitalized.

5) Reporting fraudulent information on legal medical documents, such as timesheets, is a federal

crime.

6) The client and PCA will be contacted at least once every 90 days by People Enhancing People

during working hours to verify the PCA is at work with my client, per legal requirements.

7) In order to work as a PCA, the PCA may not be the legal spouse or legal guardian of the client.

8) Staff have the right to report all known or suspected incidents of fraud to 1-800-Medicare.

9) Staff must complete this training annually.

Staff must complete Medicare Advantage and Part D Fraud, Waste and Abuse

Compliance Training annually. Failure to comply with these federal

requirements may result in corrective action up to and including termination.

People Enhancing People 34 Created 4/2011 Updated 11/2015 The Employment Contract The Employment Contract among the PCA, Client, and People Enhancing People must be entered into PRIOR to any new staff members starting their first working shift with you. Under no circumstances may a PCA begin working without the employment contract signed and in place at the office. Please remember, a background study must be cleared prior to the employment contract being entered into.

Personal Care Assistant Roles and Responsibilities As a personal care assistant in the People Enhancing People PCA Choice program, I agree to the following responsibilities: 1. Obtain training from the Client, with assistance from the Qualified Professional (if applicable), to ensure I can satisfactorily perform all responsibilities in the Client’s plan of care. 2. Enter into a written agreement with the Client and People Enhancing People, as joint employers, before providing services to the Client. 3. Complete all required forms and provide necessary information to People Enhancing People, including criminal background check verification, prior to providing services to the Client. 4. Pass a criminal background check, a requirement of eligibility to be a personal care assistant. 5. Work at scheduled times as determined by the Client, notifying the Client of changes as early as possible to arrange for backup assistance. 6. Provide personal care services to the Client as specified in their plan of care, following written and verbal directions from the Client including the administration of medication, transfers, bathroom needs, maintaining medical equipment and duties which support the well-being of the Client. 7. Assist with activities of daily living (ADLs) as directed. 8. Inform the Client about all visible bodily changes that may need medical attention. 9. Keep Client’s personal life confidential and adhere to data privacy, per HIPPA requirements. 10. Observe and stay alert to ongoing instructions by the Client. 11. Respect the privacy of the Client’s personal property. 12. While working within the Client’s home, maintain respect as a professional and focus on job related activities. Perform duties in an ethical matter, preserving and respecting the rights and dignity of the Client. 13. Be present when working with the Client in their service environment, and leave only when the shift is completed. 14. Communicate respectfully and directly to the Client regarding services. 15. When assisting with the transportation of the Client, request that seat restraints are used properly and consistently. 16. Follow safety procedures and work to identify the safety needs of myself and the Client. Complete all required safety training annually. 17. Support the Client when they participate in community activities, relationships and involvement with others. 18. Comply with policies, procedures and training provided by the Client and/or People Enhancing People.

People Enhancing People 35 Created 4/2011 Updated 11/2015 19. If I am unavoidably going to be late for a scheduled work shift, I will make every attempt to notify the Client. 20. Accurately document time worked for Client by promptly completing and signing timesheets. Manage my schedule to not exceed 48 hours in a calendar week. 21. As a matter of courtesy, give the Client a minimum of two weeks notice if I want to terminate my employment as their PCA.

Client Roles and Responsibilities As a Client in the PCA Choice program, I, or my responsible party, agree(s) to the following responsibilities: 1. Accept responsibility for my health and safety, meaning I will find staff or supports that ensures my health and safety needs are met. 2. In partnership with the People Enhancing People Qualified Professional, develop and revise, as needed, a service care plan that details my health, safety and care needs and schedule based on my physician’s orders and public health nurse assessment. 3. Recruit, interview and hire my own Personal Care Assistant (PCA) staff. Before working, all PCA staff must pass a criminal background check, facilitated by People Enhancing People, to ensure they have no prior criminal record that disqualifies them from being employed as a personal care assistant. 4. Ensure that PCA staff hired can adequately perform the tasks and care that I need. 5. Enter into a written agreement with each of my PCAs before I receive their services. 6. Refer individuals to People Enhancing People to fill out necessary forms to be paid as my PCA. 7. Ensure that I have adequate backup staff and emergency support staff in place in the event that a regularly scheduled PCA is unable to fulfill their duties as scheduled. 8. Refrain from requesting or requiring staff to work off the clock for any training or for any PCA work tasks. Ensure all work performed by the PCA are recorded on the appropriate timesheet for In Time to match the time the PCA began work or training and the Out Time to match the time the PCA completed work or training for every shift. Any questions or issues concerning this provision are to be addressed with the Executive Director immediately. 9. Provide ongoing supervision and evaluation of my PCA staff in partnership with the People Enhancing People Qualified Professional. 10. Schedule my PCA staff. 11. Manage the use of my PCA allocated hours/units to ensure I do not use more than the allocated hours/units in my service plan. 12. Abide by Department of Labor regulations regarding overtime. Overtime consisting of one and one-half times the regular rate must be paid to PCAs working over 48 hours in a calendar week (Sunday through Saturday). I will make every effort to manage my PCA schedule to avoid the payment of overtime. If I will need to schedule any of my PCA staff over 48 hours in a calendar week, I will contact the People Enhancing People Payroll Manager in advance for approval or alternatives. 13. Monitor, ensure accuracy and verify time worked by my PCAs. Verify completion, sign, and submit verified timesheets for my PCA staff to People Enhancing People, by 5 P.M. Tuesday to ensure timely and accurate payroll for the PCA staff. Original timesheets may be submitted by U.S. Mail, Fax or delivered in person to the People Enhancing People office.

People Enhancing People 36 Created 4/2011 Updated 11/2015 14. Notify the county Public Health Nurse, waiver service coordinator or otherwise appropriate individual when it is time for a reassessment of my need for PCA services or if there is a change in condition or change in the level of services that I need. I will inform them of my intent to use a PCA Choice Program. 15. Notify People Enhancing People of my hospitalization dates throughout our service agreement. 16. Terminate my PCA staff if necessary. I will immediately notify People Enhancing People when termination occurs and the effective date of that termination. I will notify People Enhancing People if assistance is needed in terminating an employee. 17. Contact the People Enhancing People Payroll Manager in the event of a billing or payment complaint. People Enhancing People is committed to providing a timely response to all inquiries. 18. Notify People Enhancing People in writing if I want to terminate this agreement at any time.

PCA Care Plans PCA services provided must be directed by a Care Plan which is provided by the Client and/or Qualified Professional and is based on the Client’s Annual PCA Assessment conducted by the County Public Health Nurse. It is your responsibility to set up time with the Qualified Professional to create the PCA Care Plan and to provide training for each PCA for each daily activity listed. The Care Plan must be updated annually, unless you are hospitalized, your medical condition changes, or you require post-hospital care.

People Enhancing People’s Roles and Responsibilities As your PCA Choice provider, People Enhancing People agrees to perform the following responsibilities: 1. Enroll and meet all standards as a PCA Choice Provider with the Minnesota Department of Human Services, including passing a criminal background check. 2. As a joint employer with the Client or responsible party, enter into a written agreement with each PCA the Client chooses to hire before services are provided to the Client. 3. Obtain releases, request and secure background checks according to the State of MN human services licensing act for all PCAs referred. 4. Bill the Department of Human Services or appropriate health care plan for personal care assistant services rendered. 5. Pay the personal care assistant(s) at the rate determined by the Client as provided on the People Enhancing People PCA Pricing Schedule. 6. Withhold for the applicable benefits for personal care assistants and qualified professionals that are arranged for between the Client, PCA and People Enhancing People Program Coordinator. See the PCA Pricing Schedule for specific benefit rates. 7. Withhold and remit all applicable state and federal taxes from personal care assistants' paychecks. 8. Arrange for and pay the employers share of payroll taxes, unemployment insurance, workers compensation insurance and liability insurance for all staff. 9. Verify and keep records of the hours worked by personal care assistants and qualified professional (if applicable).

People Enhancing People 37 Created 4/2011 Updated 11/2015 10. Issue paychecks by 10:00 a.m. on the payroll date. 11. Assist Client in terminating PCAs if requested to do so by the Client. 12. Assess an administrative fee for the provision of PCA Choice Provider services. Refer to the PCA Pricing Schedule for current Administrative Fees. 13. Ensure People Enhancing People is not related to the recipient or personal care assistant. Ensure arms length transactions with the recipient and personal care assistant.

People Enhancing People 38 Created 4/2011 Updated 11/2015 PEOPLE ENHANCING PEOPLE ROLE & RESPONSIBILITIES AGENCY MARKETING POLICY People Enhancing People has an ethical responsibility to the clients and community it serves. PEP supports honest and appropriate interactions with clients and whenever possible, includes them in decisions about their care, treatment and issues including ethical issues. PEP will not provide financial incentives to staff, physicians and Governing Body members for any client care related activities.

SPECIAL INSTRUCTIONS 1. People Enhancing People responsibilities: a. Once a client is admitted for care, the agency has a responsibility to provide services that are within the agency capabilities, mission and applicable laws and regulation. If a conflict arises that might result in denial of care, service or payment, the client’s specific needs will dictate the decision regarding discharge/transfer. 2. Inter-Agency Relationships: a. All referral sources shall honestly and conscientiously cooperate in providing appropriate and timely information about referrals and cooperate to assure comprehensive services. 3. Fiscal Responsibilities: a. The amount of service billed is consistent with the amount and type of service provided. Invoices reflect current published rates. b. Accepted accounting practices are used in determining charges for service, supplies, and equipment. c. The agency will not engage in activities or be in situation or relationships which might indicate “kickback”/”pay-offs” or other inappropriate practice. d. Agency does not compromise client care or allow clinical decisions to influence compensation practices or risk sharing agreements. 4. Marketing and Public Relations a. Oral and written statements will fairly represent available services, benefits, costs, and agency capabilities. b. Services promoted to the public media include information descriptive of home care in general, as well as specific agency information.

People Enhancing People 39 Created 4/2011 Updated 11/2015 AGENCY CODE OF ETHICS POLICY People Enhancing People has an ethical responsibility to the clients and community it serves. To fulfill this responsibility People Enhancing People has an established code of ethics that addresses agency practice guidelines for dealing with internal and external customers.

People Enhancing People supports honest and appropriate interactions with clients and whenever possible, includes them in decisions about their care, treatment and issues including ethical issues

People Enhancing People will not provide financial incentives to staff, physicians, and Governing Body members for any client care related activities

People Enhancing People will not compensate staff, physicians and Governing Body members for client referrals. PURPOSE To articulate the guidelines for ethical conduct of People Enhancing People and its employees in a written code. These guidelines shall include, but are not limited to: . Client rights . Client/family responsibilities . Agency rights . Agency responsibilities . Interagency relationships . Fiscal responsibilities . Agency marketing and public relations . Personnel . Ethical issue review process . Staff rights SPECIAL INSTRUCTIONS Client Rights, as outlined in the Home Care Bill of Rights, are protected and promoted by the agency. A copy of these rights is provided to individuals at time of admission. Clients are informed of how/who to contact at PEP if concerns arise, and are also given the phone number of the Office of Health Facility Complaints and a brief explanation of how to file a complaint. 1. Client/Family Responsibilities: a. At the time of admission, clients are informed of their responsibilities related to the care or service to be provided. 2. People Enhancing People Rights: a. The right to receive payment for services provided. b. The right to refuse admission based on admission criteria, available resources and the ability to meet needs of the client. c. The right to be assured of a safe work environment for its employees. d. The right to expect the client/family to participate in the development of plans for care and subsequent changes. e. The right to discontinue services based on agency policies.

People Enhancing People 40 Created 4/2011 Updated 11/2015 3. People Enhancing People Responsibilities: a. Once a client is admitted for care, People Enhancing People has a responsibility to provide services that are within PEP’s capabilities, mission, and applicable laws and regulation. If a conflict arises that might result in denial of care, service or payment, the client’s specific needs will dictate the decision regarding discharge/transfer. 4. Inter-Agency Relationships: a. All referral sources shall honestly and conscientiously cooperate in providing appropriate and timely information about referrals and cooperate to assure comprehensive services. 5. Fiscal Responsibilities: a. The amount of service billed is consistent with the amount and type of service provided. Invoices reflect current published rates. b. Accepted accounting practices are used in determining charges for service, supplies, and equipment. c. People Enhancing People does not submit claims for services until all necessary documentation to support claim is present. This includes clinical documentation and physician orders. d. People Enhancing People will not engage in activities or be in situations or relationships which might indicate “kickback”/“payoffs” or other inappropriate practice. e. People Enhancing People does not compromise client care or allow clinical decisions to influence compensation practices or risk sharing agreements. 6. Marketing and Public Relations: a. Oral and written statements will fairly represent available services, benefits, costs, and agency capabilities. b. Services promoted to the public media include information descriptive of home care in general, as well as specific agency information. c. People Enhancing People will not directly contact prospective clients or family members to solicit their business 7. Personnel: a. People Enhancing People is an equal opportunity employer and complies with all applicable laws, rules, and regulations. b. Written personnel policies are available and uniformly applied to all employees. c. An adequate number of qualified employees are available and utilized at the level of their competency. d. All employees are supervised. e. All employees receive an ongoing performance review. f. Orientation is provided for all employees. g. Continuing education is promoted and encouraged. h. People Enhancing People has a responsibility to ensure that employees promote ethical and professional values in the delivery of home care. i. Reasonable compensation is awarded to the employee for services rendered. 8. Ethical Concerns Review Process: a. It is the responsibility of the physician, agency management staff, direct-care staff, People Enhancing People 41 Created 4/2011 Updated 11/2015 including those providing services through contract, and the client to report unethical concerns to the agency management staff or designated Source/Group. 9. Staff Rights: a. An employee has the right to refuse to participate in aspects of care or treatment that are in conflict with his/her cultural or religious beliefs. b. Care is not interrupted when an individual employee refuses to participate. Rather, care is reassigned to qualified personnel. In the event employee refuses to participate in care or treatment because of religious or cultural beliefs limits client access to qualified care delivery, the client will be informed and assisted to obtain alternate services. c. Individual performance evaluations will reflect motivation or refusal to provide care.

People Enhancing People 42 Created 4/2011 Updated 11/2015 SERVICES PROVIDED

People Enhancing People will provide PCA services to Clients in their places of residence. Services will be provided using direct employees and contract services as appropriate to meet the needs of the clients.

People Enhancing People shall provide all services required by the Client's Care Plan. The Client is responsible for securing PCA staff to implement the cares outlined in the Care Plan. If a PCA is not able to keep a scheduled shift for providing cares, the Client is responsible for finding a replacement staff member. All Clients are required to maintain available staffing for emergency coverage.

Services will be coordinated by the Qualified Professional in charge of the case, to include implementing, revising and updating care plans as needed and supervision of health team members.

People Enhancing People’s services will be provided to Clients in the following service area and assisted living facilities: Twin Cities and Greater Minnesota Area

People Enhancing People 43 Created 4/2011 Updated 11/2015 ADMISSION POLICY Clients are accepted for treatment in the home on the basis of reasonable criteria and an expectation that the client's medical, nursing and social needs can be met adequately by People Enhancing People in the client's place of residence. PURPOSE To provide guidelines for accepting clients for care to be provided in the client's place of residence that are clear to the home care staff, the medical and lay community and abide by state guidelines, where applicable.

SPECIAL INSTRUCTIONS CRITERIA FOR CLIENT ADMISSION: 1. A direct request for service shall be made to People Enhancing People. The request may be generated by a client, physician, caregiver, family member or a representative of a health facility. 2. The client must reside in the geographic area served by People Enhancing People. 3. There must be a reasonable expectation that the client's medical needs can be adequately met in the client's place of residence. 4. Reasonable expectation shall consider: a. Adequacy and suitability of People Enhancing People personnel and resources to provide the services required by the client. Staff shall be sufficient in qualifications and numbers to adequately provide the services. b. Attitudes of client and his/her caregiver toward his/her care at home. c. Ability to safely meet the physical and safety needs of the client in the home. d. Adequacy of physical facilities in the client's residence for client's proper care. 5. When deemed necessary by the client's condition, it is appropriate for a competent caregiver or significant other to be available at all times who will maintain responsibility for interim care provided to the client. 6. People Enhancing People’s services must be appropriate to meet the specific needs and requests of the client and caregiver.

1. If a non-Medicare-certified provider receives a service plan with a referral for a service that is covered by Medicare, the non-Medicare-certified provider must refer and document the referral of the service to a Medicare-certified provider.

People Enhancing People 44 Created 4/2011 Updated 11/2015 RELEASE AND DISCLOSURE OF INFORMATION POLICY People Enhancing People shall inform the client and or responsible party about the need to request release of information for both client medical record information and financial information that is required to be used in providing services to the client. PURPOSE To ensure that client identifying information and medical record information are properly obtained prior to providing service to the client. To ensure that client financial information is properly obtained by People Enhancing People in preparation of proper client services billing. SPECIAL INSTRUCTIONS Release of information is used to: a. Legally request release of medical record information to authorized representatives of People Enhancing People b. Legally request release of medical record information to authorized representatives of medical insurance carriers for use in determining home health care benefits payable to People Enhancing People. c. Legally request the client to accept responsibility for payment of any or all claims, co-payments or deductibles not paid by insurance carrier. e. Provide People Enhancing People access to necessary client information such as: _____ History & Physical Exam _____ Progress Notes _____ Clinical summary _____ Physician's _____ Operative Reports _____ Nurse's _____ Pathology Reports _____ Other _____ Consultation Reports _____ Outpatient Information _____ X-Ray Reports _____ Other (please specify) _____ Laboratory Reports

These records are required for the purpose(s) of:______f. Provides People Enhancing People access to the documents that may identify the client’s vulnerability status.

People Enhancing People 45 Created 4/2011 Updated 11/2015 CLIENT ADMISSION PROCESS POLICY Clients will be accepted for treatment regardless of race, color, creed, sex, national origin, age, handicap, sexual orientation, or marital status.

PURPOSE To ensure that client-identifying data are obtained and documented and that clients are admitted for care according to the admission criteria.

To determine the appropriateness of the client's health care needs for People Enhancing People services by evaluating the client's physical, psychological, social, spiritual, and cultural status.

SPECIAL INSTRUCTIONS 1. Admission criteria are standards by which a client can be judged for admission. These standards include:  The client/caregiver has an acceptance of home care.  The client/caregiver has the ability and willingness to provide interim care if necessary  The home environment is suitable or adaptable for proper homecare.  People Enhancing People can safely and adequately meet the client’s needs at home, which include the ongoing availability of personnel and equipment.  There is a reasonable expectation that the client’s needs at home, which includes the ongoing  The client/caregiver has an acceptance of home care.

2. When a new referral is received by People Enhancing People, the Intake Form shall be initiated to obtain information about the client. A referral can be received from the physician, social worker, other health team member, third party payer, client, family, friend or another home health care company.

3. The Intake form shall minimally include:

4. Home care referrals may be received by facsimile during normal business hours only. A referral received by facsimile shall minimally include: a. Client identifying data b. Medications and treatment required c. Physician and reimbursement information d. Other pertinent information

5. Upon referral, each client shall be evaluated by a Registered Nurse to determine the appropriateness of home care in accordance with the Admissions Policy.

6. The admission professional will:

a. Verify all information on the Intake Form with the client/caregiver. b. Complete the Physician Statement of Need, Care Plan, and additional documents as required. The data gathered shall form the basis for the client's Care Plan. c. Provide the client/caregiver with a copy and an explanation of the Home Care Bill of Rights and the procedures for filing a complaint. d. Assess and document the client's vulnerability status and identify specific safety measures relating to the vulnerability area; the Care Plan must identify the areas of vulnerability the home care People Enhancing People will address with specific interventions. e. Review the plan for services, treatment and care with the client/caregiver and obtain input when possible. f. Advise the client/caregiver of the charges and billing procedures and, to the extent possible, the anticipated insurance coverage, the client/caregiver financial liability, and other methods of payment. g. Explain the concept of assignment of benefits and the liability for payments received from the insurance company for People Enhancing People’s services, as appropriate. h. Obtain the client's signature on the Home Care Bill of Rights, as applicable. i. Develop an Emergency Plan with the client/caregiver.

7. Upon acceptance and admission of a referral, the admitting Registered Nurse will assign the referral to the appropriately skilled professional.

8. As applicable, past medical information shall be obtained from the transferring organization.

9. If People Enhancing People determines that the client is in need of a service that People Enhancing People is unable to provide, People Enhancing People shall: Inform the client of the possible need, determine the client’s preference with respect to obtaining the service, If the client desires the service, inform the client about available providers or referral services.

A Special Notice to All Clients: If at any time during your relationship with PEP you realize that you are unclear on any of the policies contained in the Client Handbook, please do not hesitate to contact our Qualified Professional.

Client/Family Complaint & Grievance Procedures

The Qualified Professional must be notified of all concerns reported by a Client and/or their family member and develop a resolution action plan, along with the necessary action items to address the concerns and/or grievances brought forward. Action items that require outside partnering, including Vulnerable Adults reporting or concerns relayed to the police, will be communicated to the outside party within 24 hours of the complaint or grievance. Timing on individual action items will depend on their relationship to other action items in the response plan, parties involved and specific circumstances in the case. The resolution goal per action item is within 30 days of the initial complaint or grievance, dependent upon outside People Enhancing People 34 Created 4/2011 Updated 11/2015 partnerships. Communication to the grievant upon resolution or final action in the response plan will occur within seven days of resolution or final action. In the event that a PCA fails to respond to communication requests by People Enhancing People in the investigation, failure to respond within 7 days may result in Corrective Action, up to and including termination. In the event that a Client fails to respond to communication requests by People Enhancing People in the investigation, failure to respond within 7 days will result in the Qualified Professional partnering with the Client’s Health Care Coordinator or Case Manager. In the event that training or a meeting is needed with a PCA, failure to complete the meeting or training within 30 days may result in Corrective Action, up to and including termination. In the event that training or a meeting is needed with a Client, failure to complete the meeting or training within 30 days may result in additional partnering with the Health Care Coordinator or Case Manager.

People Enhancing People 35 Created 4/2011 Updated 11/2015 Minnesota Home Care Bill of Rights

PER MINNESOTA STATUTES, SECTION 144A.44. TO BE USED BY PROVIDERS OF HOME CARE SERVICES EXEMPTED FROM LICENSURE UNDER MINNESOTA STATUTE 144A.46, SUBD.2.

Statement of Rights

A person who receives home care services has these rights:

1. The right to receive written information about rights in advance of receiving care or during the initial evaluation visit before the initiation of treatment, including what to do if rights are violated.

2. The right to receive care and services according to a suitable and up-to-date plan, and subject to accepted medical or nursing standards, to take an active part in creating and changing the plan and evaluating care and services.

3. The right to be told in advance of receiving care about the services that will be provided, the disciplines that will furnish care, the frequency of visits proposed to be furnished, other choices that are available, and the consequences of these choices, including the consequences of refusing these services.

4. The right to be told in advance, of any changes in the plan of care and to take an active part in any changes.

5. The right to refuse services or treatment.

6. The right to know, in advance, any limits to the services available from a provider, and the provider’s grounds for a termination of services.

7. The right to know, in advance of receiving care whether the services are covered by health insurance, medical assistance, or other health programs, the charges for services that will not be covered by Medicare, and the charges that the individual may have to pay.

8. The right to know what the charges are for services, no matter who will be paying the bill.

9. The right to know that there may be other services available in the community, including other home care services and providers, and to know where to go for information about these services.

10. The right to choose freely among available providers and to change providers after services have begun, within limits of health insurance, medical assistance, or other health programs.

People Enhancing People 36 Created 4/2011 Updated 11/2015 11. The right to have personal, financial, and medical information kept private, and to be advised of the provider’s policies and procedures regarding disclosure of such information.

12. The right to be allowed access to records and written information from records in accordance with section 144.335.

13. The right to be served by people who are properly trained and competent to perform their duties.

14. The right to be treated with courtesy and respect, and to have the patient’s property treated with respect.

15. The right to be free from physical and verbal abuse.

16. The right to reasonable, advance notice of changes in services or charges, including at least 10 day’s advance notice of the termination of a service by a provider, except in cases where:

(i) The recipient of services engages in conduct that alters the conditions of employment as specified in the employment contract between the home care provider and the individual providing home care services, or creates an abusive or unsafe work environment for the individual providing home care services; or

(ii) An emergency for the informal caregiver or a significant change in the recipient’s condition has resulted in service needs that exceed the current service provider agreement and that cannot be safely met by the home care provider.

17. The right to a coordinated transfer when there will be a change in the provider of services.

18. The right to voice grievances regarding treatment or care that is, or fails to be, furnished, or regarding the lack of courtesy or respect to the patient or the patient’s property.

19. The right to know how to contact an individual associated with the provider who is responsible for handling problems and to have the provider investigate and attempt to resolve the grievance or complaint.

20. The right to know the name and address of the state or county agency to contact for additional information or assistance.

21. The right to assert these rights personally, or have them asserted by the patient’s family or guardian when the patient has been judged incompetent, without retaliation.

People Enhancing People 37 Created 4/2011 Updated 11/2015 IF YOU HAVE A COMPLAINT ABOUT THE AGENCY OR PERSON PROVIDING YOU HOME CARE SERVICES, YOU MAY CALL, WRITE, OR VISIT THE OFFICE OF HEALTH FACILITY COMPLAINTS, MINNESOTA DEPARTMENT OF HEALTH. YOU MAY ALSO CONTACT THE OMBUDSMAN FOR LONG-TERM CARE.

Office of Health Facility Complaints

(651) 201-4201 1-800- 369-7994 Fax: (651) 281-9796

Mailing Address:

Minnesota Department of Health Office of Health Facility Complaints 85 East Seventh Place, Suite 220 P.O. Box 64970 St. Paul, Minnesota 55164-0970

Ombudsman for Long-Term Care

(651) 431-2555 1-800-657-3591 Fax: (651) 431-7452

Mailing Address:

Home Care Ombudsman Ombudsman for Long-Term Care PO Box 64971 St. Paul, MN 55164-0971

Licensee Name: People Enhancing People

Telephone Number: (612) 789-0049

Address: 2817 Anthony Lane S. Suite 311 St. Anthony, MN 55418

Name/Title of Person to Whom Problems or Complaints May be directed: Qualified Professional assigned to supervise the case.

People Enhancing People 38 Created 4/2011 Updated 11/2015 CLIENT SAFETY Disaster Guidelines Disasters may result in the event of fire, flood, earthquake, hurricane, tornado, severe weather, a local chemical hazardous incident, or acts of terrorism. Measures of preparation should be taken by the client in the event that there are forecasts or predictions of disaster events. In the event of a disaster, follow the guidelines of local and statement government agencies as well as the American Red Cross. Remain calm, utilize the resources gathered during preparation phase, seek appropriate shelter, and listen to a battery- powered radio for instructions from local and state government agencies. Preparation for Disaster  Find out about special assistance that may be available in your community. Register with the office of emergency services or fire department for assistance, so needed help can be provided quickly in an emergency.  Create a network of neighbors, relatives, friends and co-workers to aid you in an emergency. Discuss your needs and make sure they know how to operate necessary equipment.  Discuss your needs with your employer.  If you are mobility impaired and live or work in a high-rise building, have an escape chair.  If you live in an apartment building, ask the management to mark accessible exits clearly and to make arrangements to help you evacuate the building.  Keep bottled water, emergency food supply, batteries, flashlight, and batter-operated radio on hand.  Keep extra wheelchair batteries, oxygen, catheters, medication, food for guide or hearing-ear dogs, or other items you might need. Also, keep a list of the type and serial numbers of medical devices you need. In the event of Disaster  Remain calm.  Seek safe shelter.  Utilize a cell phone or emergency communication devise to alert others of your situation.  Gather resources obtained in preparation phase.  Follow all instructions provided through local government agencies and/or the American Red Cross  Listen to a battery-powered radio for further instructions and information.

People Enhancing People 39 Created 4/2011 Updated 11/2015 Vulnerable Adults

Minnesota’s reporting of Maltreatment of Vulnerable Adults Law is designed to protect adults who, because of a physical or mental disability are vulnerable to maltreatment. In addition, Minnesota law requires the reporting of suspected maltreatment of vulnerable adults and children, investigation of those reports, and requires protection procedures to be in place to prevent maltreatment.

As employed health professionals, all PCAs are mandated reporters. Reports of maltreatment are to be made immediately, as soon as possible, but no longer than 24 hours from the time of initial knowledge that the incident occurred.

All PCAs and QPs hired by People Enhancing People’s Clients are considered by the Department of Human Services to be Mandated Reporters. This means that if a PCA has knowledge that an incident of maltreatment occurred, the PCA is mandated by state statute to make a report.

AS REQUIRED BY MINNESOTA STATUTES, SECTION 626.557, YOU ARE HEREBY NOTI- FIED THAT PEOPLE ENHANCING PEOPLE MAY NOT PROHIBIT A MANDATED RE- PORTER FROM CHOOSING TO REPORT AN INCIDENT TO AN EXTERNAL AGENCY NAME. THIS FACILITY MAY NOT TAKE RETALIATORY ACTION AGAINST ANY MAN- DATED REPORTER WHO REPORTS AN INCIDENT TO THE COMMON ENTRY POINT IN GOOD FAITH. (Minnesota Statutes, section 626.557, subdivision 4a, paragraphs (c) and (d).)

*Adapted from DHS Sample Form 9/95

All reports of maltreatment are handled with the utmost sensitivity and the safety, security and well-being of all Clients are upheld through the requirement that all staff aware of instances or suspected instances make a reporting through the Common Entry point of the applicable county. Failure by any staff member to make a reporting within 24 hours of known or suspected maltreatment may result in Corrective Action, up to and including termination.

People Enhancing People 40 Created 4/2011 Updated 11/2015 PCA SAFETY

Maintaining Safe Working Conditions

The health and safety of the PCA on the job is important to PEP. If a PCA is injured during work, the PCA SHOULD NOT continue working while injured. If the injury is serious or life threatening; the PCA must seek immediate medial attention. If a PCA is injured on the job, the PCA and Client are responsible for notifying PEP’s Care Manager of the incident. Please be sure your information for your emergency staffing is up to date so you are able to find alternate staffing in the event that a member of your PCA staff is injured on the job. You may NOT request that your PCA continue working while injured.

People Enhancing People 41 Created 4/2011 Updated 11/2015 STAFF SAFETY TRAINING

Universal Precautions

Lifting & Lowering

Infection Control

Slips & Falls

Safe Driving Requirements

People Enhancing People 42 Created 4/2011 Updated 11/2015 Universal Precautions

The goal of all infection control procedures is to minimize the transmissions of communicable disease and to prevent infection. The goal is to ensure optimal health for everyone.

Communicable Disease Transmission includes:

 Contact: this is person to person coming in contact with a contaminated surface. This is the most common means of disease transmission;  Airborne: this occurs by “droplet infection” via breathing, talking or coughing;  Blood borne: this occurs through contact with blood, or body fluids that are contaminated with blood. Generally these diseases are transmitted through damaged skin (sore or open skin), eyes, or mucus membranes. Coming in contact with these body fluids is called exposure.

Universal Precautions have been established to reduce the occurrence of communicable disease transmission. Universal precautions require that all human blood and body fluids be treated as if they are known to be infectious.

Universal Precautions require:  Thorough hand washing with antibacterial soap and water;  The use of gloves when in contact with body fluids;  The use of personal preventive equipment as determined necessary (masks, gloves, eye protection, aprons, or other protective clothing);  Bagging contaminated laundry;  Cleaning and disinfecting contaminated surfaces with detergent and warm water;  Disposing of sharp needles etc. without recapping in an approved container (red hazardous);  Annual review of infection control procedures.

Each client and their PCA(s) are responsible to talk about the precautions and what ones are necessary. The Clients provide their own personal preventive equipment for the PCAs.

People Enhancing People 43 Created 4/2011 Updated 11/2015 What Every PCA Must Know About their Client

In order for your PCA to perform their duties safely, they need to know you and your needs as a Client. These are questions you should be prepared for a PCA to ask you:

1. What do you need me, as your PCA, to assist you with? 2. How do you support professional boundaries in working relationships? 3. How do you prefer your PCA to assist with your bath/shower? 4. Do you need my help transferring or only my guidance? 5. How do you do your transfers? Is there a certain way you prefer to be lifted or helped? 6. Can you show me where everything I will need to do my duties is located? 7. How do you prefer your cleaning done and with what supplies? 8. How will I get in if you cannot answer door? 9. Do you have a set daily schedule of PCA duties? 10. Do you have any allergies or sensitivities to food, animals, or smells? 11. Do you need me to take you shopping or do your shopping for you that would require me to use my personal vehicle? 12. Do you need my assistance with cooking or helping you eat (cutting up food, feeding)? 13. Can you review the PCA Care Plan with me today? 14. Can you review your emergency plan with me today in the event there is an emergency while I am working? 15. Where is the fire extinguisher located in your home? Where are the fire-escape routes? 16. In the event of a medical emergency, who would you like me to notify of the situation? 17. In the event of a severe weather hazard, where do we seek shelter? 18. What precautions do you have your PCA staff take to prevent the spread of communicable diseases?

Knowing how you prefer things will help build your relationship and increase your PCA’s knowledge of how to safely perform their duties. Every Client should have a keen interest in ensuring their staff members are performing their duties in a manner that ensures the safest work environment possible.

People Enhancing People 44 Created 4/2011 Updated 11/2015 Lifting & Transferring Back Basics: The spinal column is one of the body's main supports. The spine itself is divided into three sections: the cervical (upper), the thoracic (mid), and the lumbar (lower) spine. These sections are made up of interlocking vertebrae, which allow the backbone some flexibility. Lumbar vertebrae are the strongest; they must support the weight of the upper body. Between the vertebrae are discs made up of cartilage that act as shock absorbers to prevent damage from sudden jolts. Ligaments and muscles that help keep the back aligned in three balanced curves support these structures. You know your back is aligned correctly when your ears, shoulders, and hips are in a straight line.

Lifting: • Always lift and lower persons or objects by bending at the knees and thrusting the hips out. Raise and lower heavy objects by bending and then straightening the knees and hips. • Always keep your body in direct alignment with your spine; feet, head and torso should be facing forward at all times. • Your knees should be bent and your back straight. Otherwise you will be using your back muscles and could injure your back. • Never rotate your spine during a transfer without moving the rest of your body. Moving the entire body at once disperses the weight among many muscles. Twisting can overload your spine and lead to serious injury. Move your feet instead. • Allow yourself enough room in which to move. • Holding things close to you gives you more body strength behind the lift, rather than relying on the strength of your limbs. • Avoid reaching or pulling from a long distance, which gives you less muscle strength. Transfers:

People Enhancing People 45 Created 4/2011 Updated 11/2015 Because each person with a disability transfer differently, ask your Client which method of transferring they prefer. Before you attempt a transfer ask your Client: 1. Can you bear any weight? ______a. How much? ______b. On what area of the body (leg/arm/etc)? ______c. Does this ever change? ______2. How have your PCAs done transfers before? ______3. Where is it safe for me to hold you? ______

Unsafe Transfer Technique: • When you transfer, it’s important to keep your back in balance. • If you bend at your waist and extend your upper body to transfer an individual, you upset your back’s alignment and the center of balance. You force your spine to support the weight of your body and the weight of the person you are lifting. • This example is called overload. You can avoid overloading your back by using good transfer techniques.

Safe Transfer Technique: 1. Begin the transfer when everyone is ready to move. 2. Have everything ready so the person can be moved safely and comfortably. 3. Keep the wheelchair as close as you can to the bed when you are transferring in and out of bed. 4. If you are transferring from the chair to the bed, it’s always best to use a wheelchair where the leg rests swing out; this allows you to get closer to the person. 5. Also, by removing the arm of the wheelchair it keeps you from having to try to transfer over the arm; this can be dangerous to both you and the person you are transferring. 6. Make sure the wheelchair is locked. 7. Assist the person in moving closer to the edge of the bed / chair . 8. Bend at the knees and hug the person close to you as you do your transfers. • By doing this you keep your back in alignment and let the stronger muscles in your thighs do the actual work. • This allows for you not to have to extend your upper body and you are able to maintain your center of balance. 9. Always remember it helps to go down in your transfers; never try to be transferring an individual up. 10. Make the transfer quickly and smoothly – but DO NOT RUSH. 11. When turning the person, move your feet to turn. DO NOT TWIST your body. 12. When lowering the person to a sitting position bend at the knees and lower yourself at the same time. 13. Know your limits and do not try to do more then you are able to do.

If the Client has an electric bed: 1. Raise the bed before doing a bed-to-chair transfer. 2. Lower the bed when doing a chair-to-bed transfer.

People Enhancing People 46 Created 4/2011 Updated 11/2015 Always remember good body mechanics. Some persons may use transfer boards to help with the transfer. Whenever possible always transfer from a higher surface.

Pivot Transfers: There are several ways to assist in transfers, with or without adaptive equipment. The easiest, fastest, and safest method is probably the pivot technique. • Place the wheelchair next to the bed. Make sure the brakes are locked. • Bring your Client to a sitting position on the edge of the bed with the feet flat on the floor. • Stand in front and brace your knees against your Client’s knees. Remember to push your backside out and up. Place your feet on the outside of your Client's feet. • Pull your Client as close to you as possible; stand up, pulling him or her up as you stand. • Once your Client is in a standing position, pivot around to the chair and gently lower to a sitting position. You should bend at the knees and lower yourself also, keeping your back straight. Lifting & Transferring Quiz

1. The spinal column is one of the body’s ______.

2. The spine itself is divided into three sections: a. The cervical section is vertebrae in the ______spine. b. The thoracic section is vertebrae in the ______spine. c. The lumbar section is vertebrae in the ______spine.

3. Always lift and lower persons or objects by bending at the ______.

4. When lifting always keep your body in direct alignment with your ______.

5. During a transfer your knees should be ______.

6. True or False Never rotate your spine during a transfer without moving the rest of your body.

7. True or False Reaching/pulling from a long distance gives you more muscle strength.

8. True or False Twisting can overload your spine and lead to serious injury.

9. True or False When you transfer, it’s important to keep your back in balance.

10. List 3 of the safe transfer techniques. a. ______b. ______c. ______

11. What two things can lead to overload of the spine? ______People Enhancing People 47 Created 4/2011 Updated 11/2015 Universal Precautions: Infection Control Infection Control Blood Borne Pathogens are pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). The following is an outline of the infection control recommendations concerning body substances, isolation, and “occupational exposure to blood-borne pathogens.” Transmission can occur when blood or other potentially infectious body fluids are in contact with mucous membranes (eye, mouth, nose) or broken skin (cuts, rash, dry skin). Body fluids recognized by the Centers for Disease Control to which body substance isolation recommendations apply include: blood, semen, blood products, vaginal secretions, cerebrospinal fluid, synovial fluid (fluid within the joints), pericardial fluid (fluid around the heart), amniotic fluid (fluid within the uterus of a pregnant woman), feces, urine, wound drainage, oral secretions (these are the ones you may deal with the most). The goal of all infection control procedures is to minimize the transmissions of communicable disease and to prevent infection. The goal is to ensure optimal health for everyone. Communicable Disease Transmission includes:

 Contact: this is person to person coming in contact with a contaminated surface. This is the most common means of disease transmission;  Airborne: this occurs by “droplet infection” via breathing, talking or coughing;  Blood borne: this occurs through contact with blood, or body fluids that are contaminated with blood. Generally these diseases are transmitted through damaged skin (sore or open skin), eyes, or mucus membranes. Coming in contact with these body fluids is called exposure.

Universal Precautions have been established to reduce the occurrence of communicable disease transmission. Universal precautions require that all human blood and body fluids be treated as if they are known to be infectious. Universal Precautions require:  Thorough hand washing with soap and water;  The use of gloves when in contact with body fluids;  The use of personal preventive equipment as determined necessary (masks, gloves, eye protection, aprons, or other protective clothing);  Bagging contaminated laundry;  Cleaning and disinfecting contaminated surfaces with detergent and warm water;  Disposing of sharp needles etc. without recapping in an approved container (red hazardous);  Annual review of infection control procedures.

MODES OF TRANSMISSION OF BLOOD-BORNE PATHOGENS: 1. Accidental injury by a sharp object that is contaminated with infectious material – NEEDLES, BROKEN GLASS, ANYTHING THAT CAN PIERCE, PUNCTURE OR CUT YOUR SKIN. People Enhancing People 48 Created 4/2011 Updated 11/2015 2. Direct exposure of open cuts, skin abrasions, or dermatitis to potentially infectious materials, as well as mucous membrane exposure of the mouth, eyes, or nose. 3. Indirect exposure by touching a contaminated object or surface and then transferring the infectious material to your mouth, eyes, nose or open skin.

Infectious Waste What is infectious waste? Infectious waste includes: liquid or semi-liquid blood or other potentially infectious material; items contaminated with blood or other potentially infectious material which would release these substances in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these material during handling; and all pathological and microbiological materials. Examples include tissues, bandages, sanitary napkins and needles.

Protecting Yourself from Infection Protection is only common sense and is suggested in all situations, because people may not know that they have the virus. To protect yourself follow these precautions: • Always wear latex gloves when coming in contact with blood or other body fluids, mucous membranes, or broken skin. Wash your hands immediately after removing the gloves. • If your hands and other skin surfaces come in contact with blood or other body fluids, wash hands vigorously with an antibacterial soap. • Handling of non-waste items: Linens or clothing soiled with blood or body secretions should be washed in hot water with detergent and 1 cup of bleach. • Surfaces contaminated with blood or body fluids should be cleaned with a disinfectant or a mixture of one part bleach and 9 parts water (mix 1 cup bleach with 9 cups water). • Handling of waste items: Tissues, Band-Aids, and dressings should be discarded in a double bagging manner. Place in a leak-proof garbage bag and then place in a second leak-proof garbage bag. • Needles and sharp items should be disposed of in containers which cannot be punctured such as a Sharps container or an empty detergent bottle with a cap.

Hand Washing o Hands should always be washed using an anti-bacterial soap. o Wash your hands under running water for at least 30 seconds, with the hands facing down under the water to wash the bacteria away. o Wash before and after all Client contacts, before eating, drinking, smoking, changing your contact lenses and after using the toilet facilities. o Yes, you still need to wash your hands even though you wear gloves. o Gloves should be worn at all times when conducting bowel programs and changing catheters.

Hepatitis Vaccination • The hepatitis vaccination is a noninfectious, recombinant engineered, yeast-derived vaccine given in three intra-muscular injections in the arm. • The danger of hepatitis is very real, but the danger of being infected with this virus can be prevented or minimized through the utilization of appropriate precautions as suggested above as well as receiving the hepatitis vaccination. People Enhancing People 49 Created 4/2011 Updated 11/2015 • This vaccine is available at your nearest County Public Health Department. Each client and their PCA(s) are responsible to talk about Personal Protective Equipment, precautionary measures, and what to do in the event of possible exposure. The Clients provide their own personal preventive equipment for the PCAs. Speak with your Client regarding expectations of avoiding transferring communicable disease to or from your Client. Please contact the Care Manager at (651) 278-3511 if you have any questions or concerns regarding universal precaution measures that should be taken while working with your client.

Exposure Response

Exposure Response: Skin Contact • Wash the affected area with soap and running water for several minutes. • Do not vigorously disrupt the skin. • Do not use harsh chemicals or bleach on the affected area as the resulting tissue damage may increase the chance of infection. • Contact your primary care physician, nearest urgent care location or county public health department for immediate assistance.

Exposure Response: Eye Contact • Flush the eyes with copious amounts of water. • Do not vigorously disrupt the surface area of the eye. • Do not use harsh chemicals or bleach on the affected area as the resulting tissue damage may increase the chance of infection or damage the eye. • Contact your primary eye care physician, nearest urgent care location or county public health department for immediate assistance.

Exposure Response: Cut/Puncture • Squeeze the area under warm running water until it bleeds. • Do not vigorously disrupt the skin. • Do not use harsh chemicals or bleach on the affected area as the resulting tissue damage may increase the chance of infection. • Contact your primary care physician, nearest urgent care location or county public health department for immediate assistance.

People Enhancing People 50 Created 4/2011 Updated 11/2015 Blood-Borne Pathogens Quiz

1. Blood Borne Pathogens are pathogenic microorganisms that are present in ______and can cause disease in humans. 2. What are the 3 modes of transmission of Blood-Borne Pathogens? a. Accidental ______by a sharp object that is contaminated. b. Direct ______of open cuts, skin abrasions, or dermatitis to potentially infectious materials. c. Indirect ______by touching a contaminated object and then your mouth, eyes, nose or open skin.

3. List two (2) ways to protect yourself from infectious disease while working as a PCA: a. Wear latex ______when performing duties that expose you to bodily substances. b. Wash before and ______all client contacts, with proper hand washing techniques.

4. List the top three (3) “Must Do” steps of hand washing: a. Use anti-bacterial ______. b. Wash for at least______seconds. c. Point hands facing ______.

5. True or False I do not need to wash my hands after providing care if I wear gloves.

6. True or False I should use proper disposal methods when disposing of items that may be contaminated with infectious substances.

7.

8. List two (2) examples of waste items that might be contaminated with infectious material: a. ______b.______

9. List two (2) examples of non-waste items that might be contaminated with infectious material: a. ______b.______

10. Where can you get information regarding the hepatitis vaccination? ______9. If a potential exposure has occurred, I should follow the washing instruction outlined above and then seek immediate ______assistance.

People Enhancing People 51 Created 4/2011 Updated 11/2015 Other Safety Concerns

Falls Falls are the second leading cause of unintentional-injury death, killing more than 22,000 people annually. The Minnesota Safety Council suggests taking the following precautions to avoid falls at home: • Keep traffic areas clear. Be sure people can walk through without walking around or squeezing past obstacles and furniture. • Keep rooms neat. Pick up toys, books, magazines and other clutter from the floor. Wipe up spills immediately. • Equip all stairs, even short ones, with secure handrails. • Repair any frayed or worn edges on rugs and other floor coverings. Choose area rugs that have slip- resistant backings. • Run electrical cords along the walls and away from traffic areas. Make sure any exposed cords are taped down securely. • Skid-proof your bathtub or shower stall with a slip-resistant rubber mat or adhesive safety strips or decals. Install grab bars on walls next to tubs and stalls. • Close cabinets and drawers when you're not using them. • Wear well-fitting shoes and slippers with non-skid bottoms. • Use light switches. You can't avoid what you can't see. • Don't carry loads that block your vision. Instead, make several trips with smaller loads. • Use a sturdy step stool or stepladder to reach items on high shelves. Don't climb on countertops, chairs, tables or other pieces of furniture. • Don't hurry. Move deliberately.

Kitchen Safety The kitchen is one of the most dangerous places in the home - at risk from burns, poisoning, choking and cuts. The majority of burns are from hot foods and liquids. People and children can be poisoned from household cleaners and vitamins and they can choke on certain foods and small objects.

To Prevent Burns • Supervise children (if you are a PCA for a child) when they're in the kitchen. • Place hot foods and liquids away from the edges of counters and tables, and never on tablecloths or placemats. • Keep appliance cords tied up (out of children's reach or where a wheelchair or walker might catch) and unplugged. Place covers over all electrical outlets. • Keep a fire extinguisher handy. Know where it is and how to use it. • Do not wear clothing that hangs while cooking.

To Prevent Poisonings • Lock all detergents, household products, pet supplies, medicines and vitamins out of children's reach (if you are PCA for child or in a home with children). • List poison control center and emergency numbers near telephones. 1-800-222-1222.

To Prevent Choking People Enhancing People 52 Created 4/2011 Updated 11/2015 • Check with your Client about how big they prefer their food to be cut. • Cut food into sizes/amounts which will not cause choking. • Learn CPR and First Aid.

To Prevent Falls • Make sure cords or wires are put away or covered in order to prevent trips. • Wipe up all spills and water off the floors immediately. • If the shower or tub does not have non-slip tiles or mats, ask the Client to purchase mats to ensure their safety and yours.

To Prevent Cuts • Always cut away from your body not towards you. • Store knives and other sharp utensils in drawers or cabinets, do not leave them laying on the counters or tables.

Slips & Falls Quiz

1. True or False Falls are the second leading cause of unintentional-injury death, killing more than 22,000 people annually.

2. List three (3) ways in which you, as a PCA, can prevent falls and slips in your Client’s home: a. ______b. ______c. ______

3. True or False As a PCA you should pick up toys, books, magazines and other clutter from the floor and wipe up spills immediately to prevent falls in your Client’s home.

4. True or False The kitchen is one of the least dangerous places in the home.

5. List two (2) ways to prevent burns: a. Supervise ______b. Know where the ______extinguisher is located 6. How can you, as a PCA, prevent an accidental poisoning? Lock up ______substances. 7. True or False I should store knives and sharp utensils in drawers or cabinets to reduce the risk of accidental injury. 8. To prevent cuts in my Client’s home, I should cut ______my body.

People Enhancing People 53 Created 4/2011 Updated 11/2015 c. Store knives and sharp utensils in ______or ______.

People Enhancing People 54 Created 4/2011 Updated 11/2015 Driving & Transporting your Client People Enhancing People actively promotes the safety of authorized drivers who operate vehicles while on Client business. If an employee has a clean MVR, they may drive for the Client with the understanding of the following responsibilities:  Must possess a valid Minnesota driver’s license.  Must have a clear driving record, free of revocations, suspensions or cancellations for moving violations with no alcohol related offenses for the past 3 (three) years.  Must submit to and pass the MVR check.  Must maintain personal automotive insurance that minimally provides liability insurance in the amount of at least $50,000.00 (fifty thousand dollars) per person, $100,000.00 (one hundred thousand dollars) per occurrence and $10,000 (ten thousand dollars) for property damage.  Must maintain vehicle in good mechanical and operational order with fully functioning seat belts.  Safely transport Client in the vehicle by enforcing seatbelt use by everyone in the vehicle.  Checking vehicle safety before transporting (tires, fuel level, tires, current license tabs).  Comply with all laws and regulations relating to the operation of motor vehicles, including rules relating to the consumption of alcohol and speed regulations.  Following no-smoking and professional conduct policies

The Client and the Employee understand the vehicle being driven on the job is for the benefit of the Client (or Client network), and must comply with statutory insurance requirements and vehicle registration laws.

Drivers shall comply with all laws and regulations relating to the operation of motor vehicles, including rules relating to the consumption of alcohol and speed regulations.

SAFETY BELTS All clients and employees shall wear properly fastened safety belts whenever they drive (personal or client vehicle) on client business.

ACCIDENTS Drivers shall immediately report all accidents (occurring during work hours) involving any vehicles to the Care Manager. Accident reports made out in detail are a necessity, such as a police or highway patrol report. A copy of all accident reports must be filed with the office and the Care Manager will be responsible for proper reporting of all accidents.

Personal injuries, as a result of an accident, are also to be reported immediately to the Care Manager. Appropriate worker's compensation forms should be submitted for any injuries requiring medical attention or resulting in time off work.

Employees are required to inform the Care Manager of all collisions that occur while driving on client business, traffic citations that are issued while driving on client business, or any restriction or limitation that is placed on their driver’s license or their ability to drive. Failure to maintain an acceptable driving record, whether due to on the job or off the job performance, is grounds for review and possible restriction of job driving duties.

People Enhancing People 55 Created 4/2011 Updated 11/2015 Driver Obligations Every driver must review and sign this written checklist of requirements detailing their obligations. A copy will be kept on file. Failure to comply with the driving requirements may result in Corrective Action, up to and including termination. The driver agrees that he or she will:  Possess a valid driver’s license.  Report restrictions or limitations on driving privileges to PEP and my Client.  Not permit any unauthorized person to drive the vehicle on Client business.  Refrain from use of cell phones. Calling or texting while driving is prohibited. Cell phones are expected to be powered off during driving times.  Use seat belts or other available restraints as a driver or passenger and require all occupants to do likewise, in accordance with state laws.  Know and follow all applicable traffic laws, ordinances, regulations, and use safe driving practices at all times.  Assume all responsibilities for fines or traffic violations associated with the use of personal vehicle, rental, or client vehicle on client business. (If you receive a mechanical violation and are in the client’s vehicle, it is the client’s responsibility).  Not drive impaired, under the influence of drugs (prescription or non-prescription) or alcohol, for any reason.  Turn off the ignition, remove the keys, engage parking brake, and lock the vehicle when out of sight of the vehicle, even briefly.  Drive the vehicle at speeds appropriate for road conditions, and in any case no higher than speed limits.  Immediately report all incidents (collisions, vehicle damage, traffic citations) to supervisor or designee and as required by law.

Driver’s Printed Name

Driver’s Signature Date

People Enhancing People 56 Created 4/2011 Updated 11/2015 What should you do if you are injured on the job?

1. Make sure you are okay. You cannot perform your PCA duties if you are injured. 2. Determine if you require medical attention. If so, seek it immediately. 3. Explain what happened to your client and let them know if you are leaving to seek medical treatment. 4. Then call PEP to report your injury to the Care Manager. Please note, you must report ALL injuries, regardless of whether medical treatment is sought or not.

Reporting your injury:

 Don’t wait. Report your injury to your supervisor as soon as possible. You may lose the right to workers' compensation benefits if you do not report the injury within time frames set by law.  PEP must complete the First Report of Injury form.  PEP has 3 days from its knowledge of a lost-time claim to report it to our insurance company.  PEP or our insurer must provide you with a copy of the First Report of Injury.  PEP must give you the Minnesota Workers' Compensation System Employee Information Sheet at the time you are given a copy of the First Report of Injury.  After you have reported the injury, our insurer will investigate your claim, to verify that it was work- related.  You should keep PEP informed of your medical condition and any work restrictions.  You must notify PEP or our insurer of changes in your employment status and keep PEP and our insurer informed of your ability to work.

What you will need when you contact PEP:

1. Date and time of injury.

2. Location of where injury happened.

3. What the injury is.

4. How it happened.

5. Medical attention you sought (Name, address, phone number of doctor or clinic).

People Enhancing People 57 Created 4/2011 Updated 11/2015 Incident Reporting

Policy All incidents will be documented on the Incident Report form and reported to the QP Supervisor and/or Administrator as soon as possible after the incident.

Purpose To provide the client with any appropriate follow-up medical care necessary. To assist People Enhancing People to identify problems or potential problems that may be corrected. To facilitate client safety. To reduce the risk of financial liability.

Special Instructions 1. An Incident Report form shall be completed in its entirety. 2. Incidents to be reported include, but are not limited, to:

● Missing or damaged property

● Treatment error

● Equipment-related incidents

● Client falling at home

● Other medical mishaps The Qualified Professional will follow up on any reported client incidents or injuries, including appropriate physician notification. 3. The Client Coordinator shall perform employee counseling and training, as appropriate. 4. Incident Reports will be filed in an administrative file that contains original report, follow-up report, and specific interventions taken to prevent reoccurrence.

People Enhancing People 58 Created 4/2011 Updated 11/2015 Photo Release Form

I, ______, (print name) being of legal age, authorize People Enhancing People (PEP) the right to use my photographic image by video or still photography in print, audio, video and other electronic communications, including promotional materials, video, Internet-based training, the Web and other media, representing the PEP organization.

Released to whom: People Enhancing People only.

For the purpose of: People Enhancing People publications including the Website, training materials, displays, and promotional materials.

The photograph may be shared with:

I understand that I do not have the right to review and approve the photograph(s) prior to its release. I also understand this authorization will continue to remain in effect unless revoked in writing by the signer and will not apply to images already approved for print or release. I also understand I will not get paid for the use of these images. I give this consent voluntarily.

Print Name ______

Signature ______Date ______

Address ______

City, State, Zip ______

Phone Number (_____) ______

People Enhancing People 59 Created 4/2011 Updated 11/2015 EFFECTIVE DATE

This Client Handbook was developed to define the overall care and employment policies of People Enhancing People. It shall be reviewed and revised as necessary, at least once a year.

This manual for PCA Services shall be available at all times for review by Clients and their designated representatives.

The effective date of this manual shall be April 1 st , 2011.

All policies and procedures in this Client Handbook were reviewed and approved by:

Administrator (print name): Beth Ismil, Executive Director, on April 1 st , 2011.

ANNUAL REVIEW

Scheduled Review: October 1st, 2011 COMPLETE

Scheduled Review: March 1st, 2012 COMPLETE

Scheduled Review: October 1st, 2012 COMPLETE

Scheduled Review: March 1st, 2013 COMPLETE & UPDATED

Scheduled Review: October 1st, 2013 COMPLETE & UPDATED

Scheduled Review October 1st 2014 COMPLETE & UPDATED

Scheduled Review October 1st 2015 COMPLETE & UPDATED

Additional Review November 22, 2015 IN PROGRESS

People Enhancing People 60 Created 4/2011 Updated 11/2015 People Enhancing People 61 Created 4/2011 Updated 11/2015

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