In 2011, the state of Georgia passed House Bill 1040 which allows unlicensed caregivers to perform "health maintenance activities" after receiving competency based training. This presentation is an overview of this new level of caregiver, the proxy caregiver. For more information: http://fivestarresourcegroup.com/proxy-caregiver-training.php

1. PROXY CAREGIVER WORKSHOP
OWNERS, ADMINISTRATORS AND EXECUTIVE DIRECTORS

2. DEFINE THE ROLE OF THE PROXY CAREGIVER
DEFINE LICENSED HEALTHCARE FACILITIES
VS. LICENSED RESIDENTIAL FACILITIES
STATE THE DIFFERENCES BETWEEN
PERSONAL CARE AND HEALTH
MAINTENANCE SERVICES/ACTIVITIES

3. DISCUSS THE KEY COMPONENTS OF AN
INFORMED CONSENT FOR PROXY
CARGIVERS
BE ABLE TO INTEGRATE PROXY CAREGIVERS
INTO FACILITY OPERATIONS
DISCUSS THE COMPONENTS OF A BACK-UP
PROXY CAREGIVER SERVICE PLAN

4. DISCUSS WITH POTENTIAL OR CURENT
RESIDENTS HOW PROXY CAREGIVERS ARE
USED IN THE FACILITY
IDENTIFY THE TRAINING REQUIREMENTS
FOR PROXY CAREGIVERS
DISCUSS THE TRAINING REQUIREMENTS
FOR PROXY CAREGIVERS THAT ADMINISTER
MEDICATIONS TO SPECIFIC RESIDENTS

5. EXAMINE AN EXAMPLE OF A MEDICATION
ADMINISTRATION CURRICULA THAT CAN BE
USED TO TRAIN PROXY CAREGIVERS
IDENTIFY MEDICATIONS THAT ARE
PROHIBITED FROM BEING GIVEN BY A
PROXY CAREGIVER
DISCUSS THE DIFFERENCES BETWEEN
PROXY CAREGIVER AND MEDICATION AIDE

6. SERVICES THAT ARE REQUIRED BY RESIDENTS
PERSONAL CARE
SERVICES
ACTIVITIES OF DAILY
LIVING
EATING, BATHING, G
ROOMING, DRESSIN
G
TRANSFERS, TOILET
USE, EATING, BATHI
NG, BED MOBILITY
HEALTH
MAINTENANCE
ACTIVITIES
HB 1040

7. UNLICENSED PERSON
TRAINED BY A
LICENSED
HEALTHCARE
PROFESSIONAL
QUALIFIED THROUGH
TRAINING;
KNOWLEDGE AND
SKILLS; COMPETENCY
BASED
HEALTH
MAINTENANCE
ACTIVIITES
WRITTEN INFORMED
CONSENT BASED ON
PHYSICIAN ORDERS
PLAN OF CARE

8. A PROXY CAREGIVER IS AN UNLICENSED
PERSON WHO HAS BEEN DETERMINED
QUALIFIED TO HAVE THE NECESSARY
KNOWLEDGE AND SKILLS ACQUIRED
THROUGH TRAINING BY A LICENSED
HEATHCARE PROFESSIONAL TO PERFORM
DOCUMENTED HEALTH MAINTENANCE
ACTIVITIES INCLUDING SPECIALIZED
PROCEDURES, FOR AN INDIVIDUAL WITH A
DISABILITY WHO HAS DELEGATED TO THE
DESIGNATED PROXY CAREGIVER THE
PERFORMANCE OF SUCH HEALTH
MAINTENANCE ACTIVITIES THROUGH
EXECUTION OF A WRITTEN INFORMED
CONSENT BASED ON WRITTEN PHYSICIAN
ORDERS BY THE INDIVIDUAL WITH A
DISABILITY OR LEGAL GUARDIAN

9. HEALTH MAINTENANCE ACTIVITIES ARE THOSE LIMITED ACTIVITIES
THAT, BUT FOR A DISABILITY, A PERSON COULD REASONABLY BE EXPECTED
TO DO FOR HIMSELF OR HERSELF.
SUCH ACTIVITIES ARE TYPICALLY TAUGHT BY A LICENSED HEALTHCARE
PROFESSIONAL OR CAN BE TAUGHT DIRECTLY TO THE RESIDENT.
DOES NOT INCLUDE ACTIVITIES THAT REQUIRE COMPLEX OBSERVATIONS
OR CRITICAL THINKING.
CAN BE SAFELY PERFORMED AND HAVE REASONABLY
PRECISE, UNCHANGING DIRECTIONS; AND HAVE OUTCOMES OR RESULTS
THAT ARE REASONABLY PREDICTABLE.

10. WHAT IS MEANT BY
“COMPETENCY-BASED
TRAINING”?
 TRAINING THAT IS TIED TO
AN INDENTIFIED SET OF
SKILLS AND KNOWLEDGE
 REQUIRES INDEPENDENT
DEMONSTRATION AND
DOCUMENTATION
 ACCEPTABLE LEVEL OF
PERFORMACE OF A TASK OR
ACHIEVEMENT OF AN
OUTCOME

11. COMPETENCY BASED SKILLS
CHECK-OFFS
 WRITTEN EVIDENCE OF
SATISFACTORY PERFORMANCE ON
INITIAL AND ANNUAL SKILLS
COMPETENCY DETERMINATIONS
 UTILIZE CHECKLIST DEVELOPED BY
DCH OR LICENSED HEALTHCARE
PROFESSIONAL
 TEST THE KNOWLEDGE AND
OBSERVATION OF THE SKILLS
NECESSARY TO DO THE SPECIFIC
HEALTH MAINTENCE ACTIVITY IN
ACCORDANCE WITH STANDARDS OF
CARE

12. HEALTH MAINTENANCE
ACTIVITIES ARE TAUGHT BY AN
ATTENDING
PHYSICIAN, REGISTERED
NURSE, PHYSICIAN
ASSISTANT, ADVANCED
PRACTICE NURSE, PHARMACIST
LICENSED HEALTHCARE
PROFESSIONALS
OR DIRECTLY TO THE
RESIDENT HIMSELF/HERSELF
THESE HEALTH MAINTENANCE ACTIVITIES ALLOW
RESIDENTS TO REMAIN IN THEIR LIVING ENVIRONMENT OF
CHOICE ONCE THEIR CARE REQUIREMENTS GO BEYOND
PERSONAL CARE SERVICES

13. NOT ALLOWED UNDER PROXY CAREGIVER REGULATIONS
INITIAL DOSES OF IM
OR SQ MEDICATIONS
COMPLICATED WOUND
CARE
CENTRAL LINES
IV MEDICATION ADMIN

14. WHERE CAN PROXY CAREGIVERS BE EMPLOYED?
RESIDENTIAL FACILITES--YES
•
•
•
PCHs AND ALFs
COMMUNITY LIVING ARRANGEMENTS
RESIDENTIAL DRUG ABUSE TREATMENT
EDUCATION PROGRAMS
•
TRAUMATIC BRAIN INJURY FACILITES
HEALTHCARE FACILITIES--NO
•
•
•
•
HOSPITALS
RESIDENTIAL MENTAL HEALTH FACILITIES
NURSING HOMES
MEDICARE-CERTIFIED HOME HEALTH
AGENCIES
PRIVATE HOME CARE PROVIDERS

15. EXAMPLES OF HEALTH MAINTENANCE ACTIVITIES
BLOOD GLUCOSE
MONITORING
RANGE OF MOTION
CATHETER CARE
MEDICATION
ADMINISTRATION

16. EXAMPLES OF HEALTH MAINTENANCE ACTIVITIES
SPLINT APPLICATION
SIMPLE DRESSING
CHANGE
OSTOMY CARE

17. HOW ARE PROXY CAREGIVERS HIRED?
FACILITY
FOLLOW FACILITY HIRING PROCEDURE
APPLICATION, CRC, TB SCREENING
DRIVING RECORD, IF APPROPRIATE
ORIENTATION
COMPETENCY BASED TRAINING
DOCUMENTATION IN FILE
RESIDENT
CRC, TB SCREENING, DRIVING RECORD
EVACUATION PROCEDURES
ENSURE THERE IS A PROCEDURE IN PLACE
TO PROTECT OTHER RESIDENTS FROM
HARM BY PROXY CAREGIVERS NOT
UNDER THE CONTROL OF THE FACILITY
DOCUMENTATION IN FILE

18. WHAT HAPPENS WHEN THE PROXY CAREGIVER CANNOT PROVIDE
SERVICES?
ILLNESS
INCLEMENT WEATHER
FAMILY
EMERGENCY
CAR TROUBLE
CHILL ILL

19. PROXY CAREGIVERS VS CERTIFIED MEDICATION AIDES
ASSISTED LIVING FACILITIES
•
•
•
ASSIST WITH OR SUPERVISE SELFADMINISTRATION OF MEDICATIONS TO
RESIDENTS THAT ARE CAPABLE OF SELFADMINISTRATION. CANNOT ADMINISTER
MEDICATIONS
CAN PERFORM OTHER HEALTH
MAINTENANCE ACTIVITIES
MEDICATION AIDES
PERSONAL CARE HOMES
•
•
•
CAN ADMINISTER MEDICATIONS IF
PROPERLY TRAINED
CAN PERFORM ADDITIONAL HEALTH
MAINTENANCE ACTIVITIES
CAN ASSIST/SUPERVISE MEDICATIONS
TO RESIDENTS THAT CAN SELFMEDICATE

20. WHAT SYSTEMS MUST BE IN PLACE TO IMPLEMENT A PROXY CAREGIVER
PROGRAM
 POLICY/PROCEDURE
 PHYSICIAN ORDERS
 INFORMED CONSENT
 PLAN OF CARE
 TRAINING CURRICULA
 SKILLS CHECK-OFFS

21. POLICIES AND PROCEDURES
 SCOPE OF THE HEALTH MAINTENANCE ACTIVITIES THAT ARE
PERFORMED BY THE PROXY CAREGIVERS
 NOTIFICATION PROCEDURES THAT WILL BE UTILIZED WHEN
THE PROXY CAREGIVER OBSERVES A CHANGE IN THE
RESIDENT’S CONDITION THAT MAY NEED FURTHER
EVALUATION/TREATMENT
 THERE IS A CHANGE IN THE PLAN OF CARE
 SAFETY AND SECURITY PRECAUTIONS (CRC, TRAINING)
 THE MANNER IN WHICH PROXY CAREGIVERS ARE SUPERVISED;
FREQUENCY OF RE-EVALUATIONS
 BACK-UP PROXY CAREGIVERS; QUALIFICATIONS OF THE
LICENSED HEALTHCARE PROFESSIONALS
 MANNER IN WHICH RESIDENTS CAN CHANGE PROXY
CAREGIVERS

22. ADMISSION AGREEMENT
 AFTER JANUARY 8, 2013, MUST STATE
WHETHER FACILITY ALLOWS PROXY
CAREGIVERS
 IF PROXY CAREGIVERS ARE ALLOWED, THEN
MUST STATE WHETHER OR NOT THERE WILL BE
ANY ADDITIONAL CHARGES

23. MEDICATION POLICIES/PROCEDURES
REQUIREMENTS
 ADDRESS PROCEDURES FOR RECEIVING MEDICATIONS
 RECONCILING MEDICATIONS RECEIVED AGAINST
THOSE ORDERED
 MEDICATION STORAGE
 PROCEDURES FOR MANAGING MEDICATIONS
 PROCEDURES FOR DISCONTINUED MEDICATIONS
 PROCEDURES FOR DISPOSAL OF MEDICATIONS

24. TRAINING REQUIREMENTS
 TRAINING CURRICULA
DEVELOPED BY A LICENSED HEALTHCARE PROFESSIONAL
THAT ENSURES THAT THE PROXY CAREGIVER DEMONSTRATES THE HEALTH MAINTENACE
ACTIVITY CORRECTLY AND SAFELY
 LEARNING OBJECTIVES THAT RELATE SPECIFICALLY TO THE HEALTH MAINTENANCE
ACTIVITY TO BE PERFORMED
 CONTENT KNOWLEDGE AND SKILLS THAT ARE REQUIRED TO ACCOMPLISH THE LEARNING
OBJECTIVES
 LEARNING OBJECTIVES THAT WILL BE UTILIZED TO PROVIDE INSTRUCTION ON
KNOWLEDGE AND SKILLS REQUIRED
 SATISFACTORY AND INDEPENDENT COMPLETION OF THE REQUIRED SKILLS
COMPETENCY CHECKLIST RELATED TO THE SPECIFIC ACTIVITY TO BE PERFORMED
BEFORE AN APPROPRIAELY TRAINED LICENSED HEALTHCARE PROFESSIONAL

25. TRAINING REQUIREMENTS
 SKILLS COMPETENCY CHECKLIST FORMS MUST INCLUDE ALL THE REQUIRED
INFORMATION SET FORTH IN THE REGULATIONS AND REQUIRED BY THE SPECIFIC
RESIDENT
 SATISFACTORY EVIDENCE OF ROUTINE EVALUATIONS OF CONTINUED SKILLS
COMPETENCIES BY AN APPROPRIATELY LICENSED HEALTHCARE PROFESSIONAL AT LEAST
ANNUALLY IF NOT ASSESSED MORE FREQUENTLY AS SPECIFIED ON THE WRITTEN PLAN OF
CARE
 A SCORE OF 75% OR GREATER ON THE TEST OF FUNCTIONAL HEALTH LITERACY (TOFHLA)
USED AS AN ASSESSMENT TOOL TO INDIVIDUALIZE NECESSARY TRAINING FOR THE
SPECIFIC SKILLS

26. MEDICATION ASSISTANCE RECORD
 NAME OF THE RESIDENT
 ANY KNOWN ALLERGIES
 NAME, TELEPHONE NUMBER OF
THE HEALTHCARE PROVIDER
 THE NAME, STRENGTH AND
SPECIFIC DIRECTIONS OF EACH
MEDICATION
 TIME/DATE MEDICATIONS ARE
TAKEN OR REFUSED

27. MEDICATION RESOURCES
FOR PROXY CAREGIVERS

28. CHANGES IN RESIDENT
CONDITION
CHANGES IN RESIDENT’S MEDICATIONS
CHANGES IN RESIDENT’S PLAN OF CARE
CHANGES IN HEALTH MAINTENANCE
ACTIVITIES

29. INTRODUCE CONCEPT
TO MEDICAL
DIRECTOR, PHYSICIA
NS AT QA MEETING
DISCUSS THE
CONCEPT OF “AGING
IN PLACE”
DEVELOP POLICIES
TO ADDRESS
SAFETY, TIMELY
NOTIFICATION AND
DOCUMENTATION, AA
INTRODUCE PROXY
CAREGIVERS
CONCEPT TO
RESIDENTS/FAMILIES
AND STAFF
DISCUSS HOW PROXY
CAREGIVERS WILL BE
UTILIZED IN THE
FACILITY

31. FEES FOR HEALTH
MAINTENANCE ACTIVITIES

32. QUESTIONS

33. Alfreda Bivins
RN Consultant
678-576-8790
alfreda@fivestarresourcegroup.com