Module 17. Safety for the Client and the Worker

Home Health Aide Training Module 17. Safety for the Client and the Worker Goal The goals of this module are to prepare participants to: Support a safe living environment for the client. Recognize and address risk factors for falling by the client and the worker. Respond to emergency situations in the home including medical emergencies, fire, and other situations that would require evacuation. Provide basic first aid to the client and respond appropriately if the client is choking. Keep themselves safe in the community where they work. Time 2 hours and 45 minutes Trainer s Manual Page 17.1

Activities Teaching Methods Time 1. Safety in the Home Pairs exercise, brainstorming, and interactive presentation 2. Falls Prevention Interactive presentation, brainstorming, large-group discussion, and pairs work 3. First Aid and Choking Interactive presentation, demonstration, large-group discussion, and pairs practice 4. Fire Safety and Emergency Brainstorming and interactive Procedures presentation 5. Safety for the Worker in the Large-group discussion Community 30 minutes 50 minutes 40 minutes 30 minutes 15 minutes Supplies Flip chart, markers, and tape Paper and pencils Teaching Tools, Activity 2. Safety Outside the Home Learner s Book 1. Keeping the Client s Home Safe 2. Facts about Falls in the U.S. 3. Home Fall Prevention Checklist for Older Adults 4. Physical Mobility and Falling 5. Medications and Falls 6. Preventing Falls after Hospital Discharge 7. Fear of Falling 8. Safety Outside the Home 9. What Older Adults Can Do to Prevent Falls 10. Types of First Aid that Can Be Provided to Clients 11. Did You Know? Important Facts about Choking 12. Choking: First Aid 13. Fire Safety Checklist 14. Medical Emergency Procedures 15. Two Responses to an Emergency: Stay or Go 16. Personal Safety in the Community Trainer s Manual Page 17.2

Worksheets Worksheet 1. What Is Not Safe Here? Handouts Handout 1. Summary of Key Information Advance Preparation Review all the training instructions and learner s materials for this module. Note that icons are used to remind the trainer of the following: When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in the Learner s Book and the handouts, but we use the key icon only when it is covered elsewhere in the learning process.) When it is important to ask a particular question to get participants input. When it is time to refer to the Learner s Book. When it is time to distribute a worksheet. When it is time to distribute and discuss a handout. Copy all worksheets and handouts for participants. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS. Trainer s Manual Page 17.3

Activity 1. Safety in the Home Prepare the following flip chart pages: Learning Agenda (Step 1) Types of Accidents (Step 6) Worksheet 1. What Is Not Safe Here? is two pages. Participants will work on the worksheet in pairs, with each pair getting one copy of the two-page worksheet. So you only need to make as many copies as the number of pairs in your group (i.e. half the number of participants). Activity 2. Falls Prevention Prepare the following flip chart pages: Risk Factors for Falling (Step 3) The risk of falling increases (Step 6) Being afraid of falling (Step 8) Make copies of the six scenes from Teaching Tools, Activity 2. Safety Outside the Home. Make enough copies for each group to have at least one scene. Activity 3. First Aid and Choking Prepare a flip chart page for Heimlich Maneuver (Step 6). Activity 4. Fire Safety and Emergency Procedures Prepare a flip chart page for Fire Safety in the Home (Step 1). Activity 5. Safety for the Worker in the Community No advance preparation needed. Trainer s Manual Page 17.4

Activity 1. Safety in the Home 30 minutes Learning Outcomes By the end of this activity, participants will be able to: Observe and document key information about safety in the home environment. Describe steps the home health aide can take to help the client make the home safer. Key Content The question Is it safe? should constantly be in the minds of workers assisting the client. Safety extends to the client, family members, and the worker. Using a safety checklist can help create a safer work and living environment. It is essential that workers discuss any risks they observe with clients before making any changes. Home health aides may wish to share the safety checklist with clients early on. Activity Steps Pairs Exercise 10 minutes 1. Introduce the module. As adults, participants already know a lot about safety in their own homes. Working in the client s home means that they have to be concerned about safety there, too. Home health aides also have to be prepared to deal with emergency situations fire, medical emergency, or natural disaster. And their own safety concerns start from the moment they leave their own home until they get to the client s home, and back again. In this module, participants will review what they already know and will learn some new information and tips about safety issues for both the client and the worker, and being prepared for emergencies. Post and read the flip chart page with the Learning Agenda. Trainer s Manual Page 17.5

Flip Chart LEARNING AGENDA: Safety for the Client and the Worker Safety in the client s home Preventing falls identifying risk factors Basic first aid and response to choking Fire safety and emergency procedures Safety for the home health aide in the community 2. Set up exercise. Explain that you ll begin with a quick exercise. Ask participants to quickly pair up with the person sitting next to them. Distribute one copy of Worksheet 1. What Is Not Safe Here? to each pair. Ask one member of each pair to work on the living room photo, and the other member to work on the kitchen photo. 3. Give instructions. Ask each participant to look closely at their picture and circle anything in the picture that they think could be a safety hazard for example, something that could cause a person to get hurt, or could cause a fire. Tell them they will have two minutes to do this. 4. Ask each pair to work together now. After two minutes, ask participants to stop working on their photo. Ask them to share their photo with their partner and together see if they can find any more safety hazards in their photos. They will have another two minutes to do this. 5. Ask for volunteers to share their answers. Ask one pair to give you one safety risk in the living room photo. List it on the flip chart page. Go to another pair for a different risk. Keep going to different pairs and listing their safety risks until there are no more. Add any from the Teaching Tip that they did not mention. (Note that these may be hard to see in the photo.) Then do the same for the kitchen photo. Trainer s Manual Page 17.6

Flip Chart WHAT IS NOT SAFE HERE? Living Room Kitchen Teaching Tip Living room safety hazards: Uncapped syringe on end table Cup and saucer at edge of end table Partly open end table drawer Oxygen tank on unstable surface (couch) Rumpled throw rug on floor Appliance cords on floor (2) Iron on floor (it may be on) Plastic wastebasket near iron (melting/burning hazard) Something hanging out of wastebasket (may contain bodily fluids) Iron and wastebasket in front of blue chair (someone could trip over them while trying to sit on chair) Throw rug on back of couch (could be dirty, with germs from the floor) Kitchen safety hazards: Knife on toaster Pitcher tipped over with contents spilling out Extension cord with multiple cords on counter and draped over the front Cord on top of burner Knife pointing out on counter Two metal utensils on burner (can get hot) Potholder on top of burner (can catch fire) Container of food left open (food can spoil) Cabinets left open could hit your head on the doors Trainer s Manual Page 17.7

Brainstorming 5 minutes 6. Facilitate brainstorming. Thank participants for their good work at identifying safety hazards. Explain that you want to follow that up by listing all the various types of accidents that can occur in the home. Write their responses on flip chart paper. [Some examples include: falls, choking, cuts, burns, electrocution, poisoning.] Flip Chart TYPES OF ACCIDENTS Interactive Presentation 15 minutes 7. Discuss safety checklist. Explain that you will now look at the role of the home health aide to help prevent these kinds of accidents in the home. Refer to 1. Keeping the Client s Home Safe in the Learner s Book. For each item on the checklist, ask a participant what type of accident (from the flip chart list) it could prevent. 8. Discuss how to use the checklist. Explain that this checklist will help create a safer work and living environment. It is essential that the worker discuss with the client any risks she or he observes before making any changes. Home health aides may wish to share this checklist with clients, too. Note that this list is only a guide and all things on it may not be applicable to a particular client s home. 9. Discuss the balance between safety and client needs/preferences. Reinforce with the participants that the question Is it safe? should constantly be in the minds of workers assisting the client. Safety extends to the client, family members, and the worker. However, the client will arrange various household items or furniture according to his or her needs, and it is important for the home health aide to honor the client s decision about where things go, and to discuss safety concerns if they arise. Trainer s Manual Page 17.8

Activity 2. Falls Prevention 50 minutes Learning Outcomes By the end of this activity, participants will be able to: Describe the impact of falling on the safety and well-being of elders in the U.S. Explain that falls are not an inevitable part of aging, and that simple concrete actions can decrease the risk of falling for elders. List six categories of common risk factors for falling. For each risk factor, give one example of how the home health aide can help the client reduce the risk of falling. Key Content One out of every three older adults in the U.S. falls each year. Twenty to 30 percent of the elders who fall have moderate to severe injuries, limiting their mobility and independence. And every 35 seconds, an elder dies as a result of injuries from falling. Still, falls are not an inevitable part of aging. There are simple strategies that can help to prevent falls for elders. By being aware of and addressing common risk factors, the home health aide can play a big role in supporting the older client to carry out those strategies. Six categories of common risk factors for falling are: o Home safety o Physical mobility o Medications o Coming home from the hospital o Fear of falling o Safety factors outside the home Trainer s Manual Page 17.9

Most serious falls occur in the home. Aides, clients, and family members should regularly review home safety guidelines to consider risk factors in the following areas: floors, stairs and steps, kitchen, bathrooms, bedrooms, and lighting. Risk factors related to physical mobility include muscle weakness, balance and gait, vision problems, dizziness, and foot problems. Side effects from medications can cause clients to lose their balance or feel unsteady on their feet. Interactions between medications can result in unexpected side effects. Clients and aides should keep a list of all medications including vitamins, food supplements, and over-the-counter medications, as well as prescription drugs and carry the list to all doctor s appointments and pharmacy visits. Aides should follow their guidelines for assisting with medications e.g., The Five Rights to help prevent falls. When someone returns home from the hospital, their risk of falling increases in all three areas mentioned above home safety, physical mobility, and medications. The aide needs to pay special attention to these factors to prevent falls after hospitalization. Being afraid of falling causes many elders to limit their activities. Unfortunately, this often results in loss of strength and a downward cycle of decreasing activity and decreasing strength which can, in itself, lead to increased risk of falling. The home health aide can help a client to overcome fear of falling by encouraging the client to stay active and helping him or her to take specific actions to reduce the risk of falling. Risk factors for falling outside the home include vision factors such as changes in the light from indoors to outdoors and sun glare; steps, curbs, and irregular pavement on sidewalks and in streets; elevators and escalators; floors that become slippery when wet. The aide needs to be aware of all these risk factors and prepare the client for these challenges, in order to keep them both safe when going outdoors. Four strategies for a home health aide to help the client prevent falls are: o Assist the client to begin or maintain a regular exercise program o Keep a list of all medications and check them with the pharmacist, doctor, or the nurse/supervisor o Encourage the client to get his/her vision checked regularly o Do a home safety check and talk with the client and/or family members about the problems identified Trainer s Manual Page 17.10

Activity Steps Interactive Presentation 15 minutes 1. Assess participants experience. Ask: How many of you know someone who has fallen in their home? What caused the fall? How did that person s life change after the fall? 2. Review facts about falls. Refer to 2. Facts about Falls in the U.S. in the Learner s Book 3. List risk factors for falling. Post and review the prepared flip chart that lists the key categories of common risk factors for falling: Flip Chart RISK FACTORS FOR FALLING Home safety Physical mobility Medications Coming home from the hospital Fear of falling Safety outside the home 4. Explain the approach. Tell participants that, in this activity, they will have the opportunity to review and explore each of these risk factors more fully for themselves and their clients. It is important to remember that THEY can fall, too it s not just elders who are at risk. The goal is to help prevent falls for their clients and themselves, whether at home or at work. Trainer s Manual Page 17.11

5. Review the three risk factors that have been covered already. Note that three of the risk factors have been addressed already in this training home safety (in the previous activity), physical mobility (in Working with Elders ), and medications (in Assisting with Self-Administered Medications ). Review 3. Home Fall Prevention Checklist for Older Adults, 4. Physical Mobility and Falling, and 5. Medications and Falls. Focus on the specific issues related to preventing falls. A. Coming Home from the Hospital 10 minutes Large-Group Discussion 10 minutes 6. Facilitate discussion. Note that the next key risk factor for falling is returning home after being in the hospital. Post the prepared flip chart page. Read the statement and ask participants: Why do you think this happens? Encourage a variety of responses and explore briefly. Flip Chart The risk of falling increases after clients come home from the hospital. Teaching Tip To help participants come up with the answers themselves during the discussion, note that they can consider the risk factors already discussed and how these factors might change for an individual returning home from the hospital. Trainer s Manual Page 17.12

7. Refer to 6. Preventing Falls after Hospital Discharge in the Learner s Book. Emphasize the tips in this section that summarize what an aide can do to prevent falls during this time of transition. B. Fear of Falling 10 minutes Large-Group Discussion 5 minutes 8. Post the prepared flip chart page. Note that fear of falling is the next risk factor to discuss. Read the statement and ask: Why do you think this is true? Flip Chart Being afraid of falling can increase a client s risk of falling. Teaching Tip In facilitating this large-group discussion, note that participants can draw from their own experiences about how their behavior changed when they were concerned about falling. Interactive Presentation 5 minutes 9. Refer to 7. Fear of Falling in the Learner s Book. Note the points that participants raised in their discussion. Emphasize the tips in this section of the Learner s Book that describe what an aide can do to reduce and/or alleviate the fear of falling. Trainer s Manual Page 17.13

C. Safety Outside the Home 15 minutes Pairs Work 5 minutes 10. Explain the purpose of this exercise. Explain to participants that in this exercise, they will learn more about the risk factors for falling outside the home. 11. Give instructions. Put participants in pairs. Explain that they will look at photos of places outside the home and identify the potential risk factors for falling that are in the photo. Ask one person in the pair (or small group) to take notes. 12. Distribute one photo to each pair. Repeat the instruction for them to list (on a sheet of note paper) all the possible risk factors for falling that they see in the photo, or that they can imagine from the scene. Distribute paper if needed. Tell them they will have 5 minutes for this task. Teaching Tip See Advance Preparation and Teaching Tools, Activity 2. Safety Outside the Home. Encourage participants to move through this part of the activity quickly, and include on their list anything that comes to mind. Remind participants that risk factors for falling do not only include obvious obstacles in the outside environment, but also fear. Remind them that, in addition to vision-related risk factors, there may also be hearing-related risks of falling. Large-Group Discussion 5 minutes 13. Facilitate group reporting. Ask each group to show their photo and share their list of possible risk factors for falling. After each group has reported, ask if other participants have ideas of other risk factors that might be in this situation. Trainer s Manual Page 17.14

Interactive Presentation 5 minutes 14. Summarize. Refer to 8. Safety Outside the Home in the Learner s Book and briefly review. Note the key points that were already named in the group reports, as well as ones that were not mentioned. 15. Wrap up the activity. Refer to 9. What Older Adults Can Do to Prevent Falls. Note that this is another way of summarizing most of what they have learned, and may be a useful way to share the information with their own friends and families. Trainer s Manual Page 17.15

Activity 3. First Aid and Choking 40 minutes Learning Outcomes By the end of this activity, participants will be able to: Define first aid. Explain what first aid procedures home health aides are allowed to do in their agency. Explain what choking is and why choking occurs. Recognize the universal sign for choking. Explain the five-and-five procedure for assisting a choking person. Explain when and how to perform the five-and-five procedure. Key Content First aid is care that is given for a medical emergency, until trained medical workers arrive. Participants need to know their agency s policy about what type of first aid they can provide to their clients. In general, a home health aide should provide only the most basic first aid unless they have had certified first aid training. Medical emergencies for which a home health aide can provide basic first aid generally include: Burns, including from chemicals Choking Poisoning Sprains or broken bones Bleeding Trainer s Manual Page 17.16

Choking is a common breathing emergency that accounts for more than 3,000 deaths each year. Choking is life threatening because it cuts off oxygen to the brain within minutes. Choking occurs when food or a foreign object gets lodged in a person s windpipe or throat. This blocks the flow of air. (The clinical term is airway obstruction.) Choking prevents breathing and can be partial or complete. Partial choking allows some, although inadequate, flow of air into the lungs. If someone is able to cough or speak they are not choking. Adults who are elderly, have had a stroke, or have chronic diseases that may cause problems with the swallowing reflex for example, Parkinson s, dementia, and multiple sclerosis are at an increased risk for choking. The universal sign for choking is clutching the throat with both hands. Other choking signs include: Inability to cough Inability to talk Wheezing sound when trying to breathe Skin, lips, or nailbeds getting dusky or blue Loss of consciousness The Mayo Clinic and the American Red Cross recommend a procedure in choking situations nicknamed the five and five. 1 This combines five firm back blows and five abdominal thrusts (formerly called the Heimlich Maneuver). If you are the only person present when someone is choking, perform five and five before calling 911. If there is another person, ask them to call 911 while you perform five and five. 1 http://www.mayoclinic.com/health/first-aid-choking/fa00025. Trainer s Manual Page 17.17

Activity Steps Interactive Presentation 20 minutes 1. Introduce the topic. Ask participants: What does the term first aid mean to you? 2. Describe basic first aid techniques and what is allowed by home health aides. Refer to 10. Types of First Aid that Can Be Provided to Clients in the Learner s Book. Teaching Tip Different agencies have different policies about what home health aides can and cannot do regarding first aid for clients. Be sure to check the policies of your agency and adapt this section of the Learner s Book as needed. 3. Assess participants experience with choking. Ask participants if they have ever observed someone choking or have choked on something themselves. Ask what they observed, or what they felt. 4. Review facts about choking. Refer to 11. Did You Know? Important Facts about Choking in the Learner s Book. Make connections to what participants reported when possible. 5. Introduce recommended technique for assisting an adult who is choking. Explain that participants will learn how to assist an adult who is conscious and choking. Note that recommended techniques are different with small children who are choking and when they need to assist themselves. 6. Review terminology. Post the prepared flip chart page with terms: Heimlich Maneuver, Abdominal Thrust, Five and Five. Ask participants if they have ever heard these terms before, and if so, what they have heard. After a few responses, tell participants they will know all these terms by the end of this activity. Trainer s Manual Page 17.18

Flip Chart HEIMLICH MANEUVER ABDOMINAL THRUST FIVE AND FIVE Demonstration and Large-Group Discussion 15 minutes 7. Introduce the demonstration. Note that you are now going to conduct a demonstration of five and five. This is the method now recommended (by the American Red Cross and the Mayo Clinic) to assist a choking person. 8. Give instructions. Ask for one participant to volunteer to play the role of a client who s choking on a piece of food. Instruct participants to notice the technique that you use to assist the person to dislodge the obstruction. Teaching Tip You may want to emphasize that this is an opportunity for participants to apply their skills of observing and reporting because they need to watch closely in order to discuss their observations with each other immediately following the demonstration. 9. Demonstrate the five-and-five method. Teaching Tip When conducting the demonstration, it s important to follow closely the steps described in 12. Choking: First Aid in the Learner s Book. This will help participants recognize the steps more easily when they review the Learner s Book. 10. Discuss what participants observed. Ask participants what specific action they saw you do in the demonstration. If needed, guide them with leading questions so that they recall all the key steps that you performed. Trainer s Manual Page 17.19

11. Refer to 12. Choking: First Aid in the Learner s Book. Ask participants if they have any remaining questions about how to do five and five. Pairs Practice 5 minutes 12. Give instructions for pairs practice. Ask participants to form pairs. Explain that they will practice the five-and-five technique with each other, taking turns being the one who is choking and the one who is doing the technique. 13. Monitor the practice and give feedback as needed. Give a time-check after five minutes so the pairs can switch roles. 14. Wrap up the activity. Ask participants how they felt doing the technique, AND having it done to them. Ask if there are any additional questions. Trainer s Manual Page 17.20

Activity 4. Fire Safety and Emergency Procedures 30 minutes Learning Outcomes By the end of this activity, participants will be able to: Describe safety procedures to prevent a fire. Describe procedures for fire and medical emergencies. List some emergencies that will require either evacuation or staying inside for an extended period of time. Describe at least two steps to prepare for evacuation or staying inside in an emergency situation. Key Content Some basic strategies can help prevent a fire in the client s home. Home health aides may find themselves in situations that will require them to be knowledgeable and responsible during an emergency. It is important to know how to help the client exit the home safely and how to respond to medical emergencies. Different disasters require different safety and survival strategies. In natural disasters, the home health aide needs to know when the agency s policy is to evacuate with the client or when they should stay inside. In either case, having a plan and being prepared ahead of time are the keys to staying safe during the disaster for both the client and the home health aide. Trainer s Manual Page 17.21

Activity Steps Brainstorming 5 minutes 1. Invite participants to share fire safety tips. Ask participants to think about their own homes and what kinds of precautions they take against fire and preparations in case of fire. Write their responses on a flip chart page. Flip Chart FIRE SAFETY IN THE HOME Teaching Tip Some responses may include: Fire extinguisher easy to find Fire ladder for upstairs windows Smoke detector with working batteries Carbon monoxide detector with working batteries Fire Department number by telephone Cigarette smoking outside only Interactive Presentation 25 minutes 2. Review fire safety precautions for client homes. Emphasize that the same precautions should be employed in a client s home as in their own homes. Refer to 13. Fire Safety Checklist in the Learner s Book. Note what is similar and what is different from their list. Explain to participants that they should make sure that a client s home has a smoke detector and a carbon monoxide detector with working batteries, fire extinguisher, and easily identifiable exits. Participants should talk to a client who does not follow these precautions about the importance of doing so. Trainer s Manual Page 17.22

3. Ask participants: If a client does not want to follow these basic safety measures, what should you do? After a few responses, explain that the home health aide should report this as part of ORR, unless there is an immediate risk involved in which case, they should report to their supervisor right away. 4. Lead discussion on emergency fire response. Ask participants what they would do first if they smelled smoke or saw fire in the client s home. After discussing a few responses, review the guidelines in 13. Fire Safety Checklist for helping a client to exit the home if there s a fire. 5. Continue discussion of emergency protocols. Ask participants: What would be called a medical emergency? After a few responses, explain that medical emergencies can result from sudden illness or accidents. Heart attacks, stroke, diabetic emergencies, choking, automobile accidents, and gunshot wounds are all medical emergencies. Falls, burns, and cuts can also be emergencies when they are severe. Refer to the guidelines regarding medical emergencies in 14. Medical Emergency Procedures in the Learner s Book. If time permits, ask participants what experience they have had with emergencies like these. 6. List other types of emergencies. Note that there have been a lot of emergencies in the news lately, some of which have involved home health aides and clients. Ask participants: What kind of situation, besides fire and a medical emergency, could be considered an emergency? Trainer s Manual Page 17.23

After a few responses, note that natural disasters such as hurricanes, tornadoes, floods, and earthquakes all require an emergency response, but some require staying in the home and others require evacuation. Storms can result in a client and an aide being stuck in the house without electrical power for days. Ask participants: How would you prepare yourself and your client for this situation? 7. Review Learner s Book and agency policy on natural disasters. After a brief discussion about how participants would prepare for a disaster, refer to 15. Two Responses to an Emergency: Stay or Go in the Learner s Book. Clarify the agency s policy on evacuation or staying in an emergency. Trainer s Manual Page 17.24

Activity 5. Safety for the Worker in the Community 15 minutes Learning Outcomes By the end of this activity, participants will be able to: List at least three strategies for keeping themselves safe while traveling to and from the client s home. Key Content A home health aide s responsibility for safety includes being responsible for her or his own safety on the way to and from the client s home. There are several things the aide can do to help ensure her or his own safety if traveling by car or by public transportation, and when going to neighborhoods or areas that they are not yet familiar with. Activity Steps Large-Group Discussion 15 minutes 1. Emphasize the importance of the home health aide s safety. Most of this module has focused on the role of the home health aide to keep the client safe. However, the aide has an equally important responsibility for his or her own safety while traveling to and from the client s home. 2. Facilitate a discussion about safety strategies participants already use. Ask participants: Trainer s Manual Page 17.25

What are some of the things you do to stay safe when you re driving a car? What are some of the things you do to stay safe when you re using public transportation? What are some of the ways you try to be safe when you re going into an area that you re not familiar with? 3. Summarize by reviewing the Learner s Book. Thank participants for their sharing. Then refer to 16. Personal Safety in the Community in the Learner s Book. Note the ideas that they already mentioned and any new ones that weren t mentioned. Ask if there are any questions or further comments. 4. Summarize the module. Distribute and review Handout 1. Summary of Key Information. Ask participants if they have any questions. Trainer s Manual Page 17.26

Teaching Tools, Activity 2. Safety Outside the Home Trainer s Manual Page 17.27

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Learner s Book Module 17. Safety for the Client and the Worker Activity 1. Safety in the Home 1. Keeping the Client s Home Safe Activity 2. Falls Prevention 2. Facts about Falls in the U.S. 3. Home Fall Prevention Checklist for Older Adults 4. Physical Mobility and Falling 5. Medications and Falls 6. Preventing Falls after Hospital Discharge 7. Fear of Falling 8. Safety Outside the Home 9. What Older Adults Can Do to Prevent Falls Learner s Book Page 17.1

Activity 3. First Aid and Choking 10. Types of First Aid that Can Be Provided to Clients 11. Did You Know? Important Facts about Choking 12. Choking: First Aid Activity 4. Fire Safety and Emergency Procedures 13. Fire Safety Checklist 14. Medical Emergency Procedures 15. Two Responses to an Emergency: Stay or Go Activity 5. Safety for the Worker in the Community 16. Personal Safety in the Community Learner s Book Page 17.2

1. Keeping the Client s Home Safe Page 1 of 2 Keeping the client s home safe is a big job. There are many things that a home health aide can do to help make the home safer. To keep the home safe: Keep a first aid kit on hand. Label cleaning products. Keep them in a safe place. Make sure the client can reach the things she needs. Place night lights in bedrooms, bathrooms, and halls. Wipe up spills right away. Encourage the client to replace appliances with frayed or cracked power cords. Kitchens and bathrooms are the rooms where accidents happen most often! To keep the kitchen safe: Turn handles of pots and pans toward the back of the stove. Clean up spills of food or liquids on the floor, so people don t slip and fall. Do not leave food uncovered. It can attract mice and other pests. Pour hot drinks away from where the client is sitting. Learner s Book Page 17.3

1. Keeping the Client s Home Safe Page 2 of 2 To keep the bathroom safe: Label medicines clearly. Throw out old medicines. Place rubber mats in the bathtub and shower. Put in hand grips by the bathtub, shower, and toilet. Clean up water on the floor, so people don t slip and fall. To keep the floors safe: Clean up clutter, especially on stairs and in doorways. Get rid of throw rugs. Or nail them down. Place furniture so that it s easy for the client to move around. Clean up spills. To keep the bedroom safe: Place a light by the bed. To keep the stairs safe: Put in strong railings. Don t leave clutter on the stairs. Nail down rugs or treads that are loose. Learner s Book Page 17.4

2. Facts about Falls in the U.S. 1 One out of three older adults falls each year in the U.S. Every 18 seconds, an elder is treated in the emergency room for a fall. 2 In 2009, that was 2.2 million older adults. Among older adults, falls are the leading cause of injury death. Every 35 seconds, an elder dies as a result of injuries from falling. 3 In 2008, that was 19,700 olders adults. Nearly 60 percent of all fatal falls happen at home. 4 More serious injuries increase with age adults 85 or older who fall are four to five times more likely to be injured than people who are 65 to 74 years old. 5 1 Unless indicated, information on this page comes from the Centers for Disease Control and Prevention (CDC). Falls among Older Adults: An Overview. http://www.czaxwedc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed 3/5/2012. 2 National Council on Aging, unpublished document, 2009. 3 Ibid. 4 Home Safety Council (2004). State of home safety report. 5 CDC, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System. http://www.cdc.gov/injury/wisqars/ Accessed 11/30/2010. Learner s Book Page 17.5

3. Home Fall Prevention Checklist for Older Adults 6 Page 1 of 4 This checklist is meant to be used by the client and his/her family. (The words you and your refer to the client.) The purpose is to find falling hazards in the home that are easy to fix. The home health aide can also read the list with the client (or use it to check for hazards in the HHA s home). The checklist asks about hazards that may be found in each room of the client s home. For each hazard, the checklist also tells how to fix the problem. At the end of the checklist, you ll find other tips for preventing falls. (Some of these hazards have already been covered in Section 1. They are repeated here to focus on fall hazards.) FLOORS: Look at the floor in each room. Q: When you walk through a room, do you have to walk around furniture? Ask someone to move the furniture so your path is clear. Q: Do you have throw rugs on the floor? Remove the rugs or use double-sided tape or a non-slip backing so the rugs won t slip. Q: Are there papers, books, towels, shoes, magazines, boxes, blankets, or other objects on the floor? Pick up things that are on the floor. Always keep objects off the floor. Q: Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)? Coil or tape cords and wires next to the wall so you can t trip over them. If needed, have an electrician put in another outlet. 6 Adapted from Centers for Disease Control and Prevention, Check for Safety: A Home Fall Prevention Checklist for Older Adults, 2005. The complete brochure is available at http://cdc.gov/homeandrecreationalsafety/pubs/english/booklet_eng_desktop-a.pdf Learner s Book Page 17.6

3. Home Fall Prevention Checklist for Older Adults Page 2 of 4 STAIRS AND STEPS: Look at the stairs you use both inside and outside your home. Q: Are there papers, shoes, books, or other objects on the stairs? Pick up things on the stairs. Always keep objects off stairs. Q: Are some steps broken or uneven? Fix loose or uneven steps. Q: Are you missing a light over the stairway? Have an electrician put in an over-head light at the top and bottom of the stairs. Q: Do you have only one light switch for your stairs (only at the top or at the bottom of the stairs)? Have an electrician put in a light switch at the top and bottom of the stairs. You can get light switches that glow. Q: Has the stairway light bulb burned out? Have a friend or family member change the light bulb. Q: Is the carpet on the steps loose or torn? Make sure the carpet is firmly attached to every step, or remove the carpet and attach non-slip rubber treads to the stairs. Q: Are the handrails loose or broken? Is there a handrail on only one side of the stairs? Fix loose handrails or put in new ones. Make sure handrails are on bothsides of the stairs and are as long as the stairs. Learner s Book Page 17.7

3. Home Fall Prevention Checklist for Older Adults Page 3 of 4 KITCHEN: Look at your kitchen and eating area. Q: Are the things you use often on high shelves? Move items in your cabinets. Keep things you use often on the lower shelves (about waist level). Q: Is your step stool unsteady? If you must use a step stool, get one with a bar to hold on to. Never use a chair as a step stool. BATHROOMS: Look at all your bathrooms. Q: Is the tub or shower floor slippery? Put a non-slip rubber mat or self-stick strips on the floor of the tub or shower. Q: Do you need some support when you get in and out of the tub or up from the toilet? Have a carpenter put grab bars inside the tub and next to the toilet. BEDROOMS: Look at all your bedrooms. Q: Is the light near the bed hard to reach? Place a lamp close to the bed where it s easy to reach. Q: Is the path from your bed to the bathroom dark? Put in a night-light so you can see where you re walking. Some nightlights go on by themselves after dark. Learner s Book Page 17.8

3. Home Fall Prevention Checklist for Older Adults Page 4 of 4 Other Things You Can Do to Prevent Falls Exercise regularly. Exercise makes you stronger and improves your balance and coordination. Have your doctor or pharmacist look at all the medicines you take, even over-the-counter medicines. Some medicines can make you sleepy or dizzy. Have your vision checked at least once a year by an eye doctor. Poor vision can increase your risk of falling. Get up slowly after you sit or lie down. Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers. Improve the lighting in your home. Put in brighter light bulbs. Florescent bulbs are bright and cost less to use. It s safest to have uniform lighting in a room. Add lighting to dark areas. Hang lightweight curtains or shades to reduce glare. Paint a contrasting color on the top edge of all steps so you can see the stairs better. For example, use a light color paint on dark wood. Other Safety Tips Keep emergency numbers in large print near each phone. Put a phone near the floor in case you fall and can t get up. Think about wearing an alarm device that will bring help in case you fall and can t get up. Learner s Book Page 17.9

4. Physical Mobility and Falling Page 1 of 2 Risk Factors Muscle weakness especially in the legs. What the Home Health Aide Can Do to Reduce Risk Assist client with prescribed exercises Encourage and assist client to stay physically active Assist with transferring, standing, etc. ORR signs of increasing weakness Ensure client uses assistive devices, such as walkers and canes, as prescribed Balance and gait Assist with transferring, standing, etc. Remind client to use cane or walker Ensure safe use of devices (if needed) Encourage client to wear flat, rubbersoled shoes that fit well ORR signs of balance or gait problems Vision problems Increase lighting in rooms; use night lights If client wears glasses, remind him or her to use them and to keep them clean Encourage client to wear sunglasses outside Allow time for the client s eyes (or glasses) to adjust to the change in brightness when going outside or when going back inside ORR problems with seeing or hearing Learner s Book Page 17.10

4. Physical Mobility and Falling Page 2 of 2 Risk Factors Dizziness drop in blood pressure after standing up What the Direct Care Worker Can Do Encourage client to get up slowly after sitting or lying down Go slowly during transfers; wait to ensure client is not dizzy Encourage client to drink plenty of water Check client s blood pressure ORR signs of dizziness Foot problems pain, numbness, or wearing unsafe footwear Assist client to keep feet clean and dry Ensure that client wears flat shoes with nonslip soles Encourage client to wear shoes inside as well as outside the house ORR corns, calluses, numbness, or pain in client s feet Other important factors to observe include: sores, discoloration and length of toenails Learner s Book Page 17.11

5. Medications and Falls 7 Page 1 of 2 Medications include prescription medicines, vitamins, herbal supplements, and over-the-counter remedies from the store. Some medications have side effects that make a person feel drowsy, dizzy, or light-headed. They may cause a person to lose their balance or feel unsteady on their feet. Sometimes this happens when you combine two or more medications. These guidelines are for your client to use, or for you to use with your client. (The words you and your refer to your client.) These steps will help your client to lower their risk of falling due to medications. Take Action: Talk with your pharmacist and doctor about all of your medications and side effects and share with them your goal of preventing a fall. Four or More Medications When you take four or more medications, the chance of side effects increases. Four medications is not a lot when you include prescriptions, over-thecounter remedies, vitamins, and herbal supplements. Take Action: Make a list of all the medications you are taking and update it every time one is started or stopped or the dose is changed. Carry the list of medications in your wallet or purse. Share your list of medications with your pharmacist and doctor. 7 Adapted from Minnesota Falls Prevention, Know Your Medications, 2008. The complete fact sheet is available at http://www.mnfallsprevention.org/pdf/mnfp-medications.pdf. Learner s Book Page 17.12

5. Medications and Falls Page 2 of 2 Over-the-Counter Medication Over-the-counter medicines can include aspirin, antacids, cold medicines, pain relievers, vitamins, and herbal supplements. These may interact with your prescription medications. Take Action: Include over-the-counter medicines on your list of medications. Ask your pharmacist and doctor about possible medication interactions. High Blood Pressure Medication These medicines may cause side effects such as feeling dizzy or lightheaded. If you feel dizzy or light-headed: o Slowly stand up from a seated position. o When getting out of bed, dangle your legs over the side of the bed for a few moments before standing. Take Action: Make a list of the side effects you are experiencing and share the list with your pharmacist and doctor. Alcohol and Medication Alcohol can make you feel dizzy or light-headed. Alcohol can interact with your medicines. Alcohol may make medicines less effective or cause side effects. Take Action: If you drink alcohol, ask your pharmacist and doctor to explain how alcohol interacts with your medicines and if alcohol should be avoided. Learner s Book Page 17.13

6. Preventing Falls after Hospital Discharge The risk of falling increases after a client is discharged from the hospital. Think about the other risk factors and see how being hospitalized adds to the risk: Physical Mobility Muscle weakness, balance, and gait are likely to be worse after a stay in the hospital. Client may have new assistive devices to get used to. Client may be experiencing new pain that may limit mobility. Medication Client is likely to have new medications, with new side effects to manage. Safety of Living Environment Moving around the living environment may be more difficult than before if the client is weaker, or has new assistive devices, and/or new medications. At the same time, the client may feel safer in their usual living environment and eager to get back to their old routine. Tips to help prevent falls after hospital discharge: Observe, record, and report (ORR) problems with physical mobility Make sure client uses glasses and hearing aids (if needed) Make sure client uses cane or walker safely (if needed) Encourage client to drink lots of water/fluids Use the living environment safety checklist (with new clients) or review it again (with clients you ve already worked with) Learner s Book Page 17.14

7. Fear of Falling Page 1 of 2 Being afraid of falling is understandable, especially after a person has had a fall. It s good for clients to be concerned about safety and to be more careful about moving around. However, fear of falling sometimes makes elders stop doing things that they are still capable of doing. When elders stop doing their usual physical or social activities, they become physically weaker and then even more fearful of falling. This downward cycle results in an increase in their risk of falling: The client is afraid of falling. The client wants to do fewer activities. The client becomes weaker from less exercise. Feeling weaker makes the client want to do even fewer activities. The client becomes even weaker. The client has higher risk of falling. Learner s Book Page 17.15

7. Fear of Falling Page 2 of 2 What can the home health aide do to break the downward cycle? Encourage the client to stay active. Help the client identify activities they would like to do and make a plan to help them feel confident enough to do those activities. Help the client take concrete steps to reduce risk of falling. For example, do a safety survey together of their living environment. ORR signs of increasing weakness or lack of balance. Learner s Book Page 17.16

8. Safety Outside the Home Page 1 of 2 When LEAVING the client s house or building, be aware of: Items the client should have when leaving: o Glasses o Hearing aids o Walkers, canes, or crutches o Appropriate footwear (rubber soles, low/flat heels, well fitting) o Appropriate clothing (pants/skirts/coats do not hang below shoes and create a tripping hazard) Elevators: o Ensure that the doors stay open until the client is safely in or out o Control the open button until the client is safely in or out Escalators Assist or remind client to: o Tie shoelaces o Step onto the middle of the stair o Hold the handrail o Encourage use of elevator if available as alternate Changes in light Assist or remind client to: o Wear sunglasses or a hat o Go slowly from dark to brightly lit areas, and vice versa let the eyes (or glasses) adjust The floors! o Tile or marble floors are slippery when wet o Deep-pile carpet, throw rugs, and changes in the floor between rooms can be a tripping hazard Learner s Book Page 17.17

8. Safety Outside the Home Page 2 of 2 When you re OUTSIDE, watch out for these things and assist the client. Sidewalks and Parking Lots: o Uneven surfaces and cracks o Curbs and ramps o Wet or icy surface Learner s Book Page 17.18

9. Summary: What Older Adults Can Do To Prevent Falls 8 Many falls can be prevented. By making some changes, older adults can lower their chances of falling. This is good information for you to remember and to share with older clients. (The words you and your refer to your client.) Four things YOU can do to prevent falls: 1. Begin a regular exercise program Exercise is one of the most important ways to lower your chances of falling. It makes you stronger and helps you feel better. Exercises that improve balance and coordination (like Tai Chi) are the most helpful. Lack of exercise leads to weakness and increases your chances of falling. Ask your doctor or health care pro-vider about the best type of exercise program for you. 2. Have your health care provider review your medicines Have your doctor or pharmacist review all the medicines you take, even overthe-counter medicines. As you get older, the way medicines work in your body can change. Some medicines, or combinations of medicines, can make you sleepy or dizzy and can cause you to fall. 3. Have your vision checked Have your eyes checked by an eye doctor at least once a year. You may be wearing the wrong glasses or have a condition like glaucoma or cataracts that limits your vision. Poor vision can increase your chances of falling. 4. Make your home safer About half of all falls happen at home. Use the checklist in Section 3 of this Learner s Book to notice things in the home that need to be moved or repaired to prevent falls. 8 Adapted from Centers for Disease Control and Prevention, What YOU Can Do to Prevent Falls, n.d. The complete brochure is available at http://cdc.gov/homeandrecreationalsafety/pubs/english/brochure_eng_desktop-a.pdf. Learner s Book Page 17.19

10. Types of First Aid that Can Be Provided to Clients First aid is care that is given for a medical emergency, until trained medical workers arrive. Make sure you know your agency s policy about what type of first aid you can provide to your client. In general, a home health aide should provide only the most basic first aid unless they have had certified first aid training. A home health aide can provide basic first aid for a variety of medical emergencies, including: Minor burns dampen a clean cloth with cool water (not ice) and place it over the burn. Ice will cause more damage to the skin. Serious burns cover the burned area with a clean sheet. Choking use the five-and-five approach with abdominal thrusts (see 12). Poisoning call the Poison Control Center. Sprains or broken bones keep the injured area still; do not move the client. Bleeding apply direct pressure. Chemical burns flush the burned area with lots of water. Learner s Book Page 17.20

11. Did You Know? Important Facts about Choking Choking is a common breathing emergency that accounts for more than 3,000 deaths each year. Choking occurs when food or a foreign object gets lodged in a person s windpipe or throat. This blocks the flow of air to the lungs (clinical term is airway obstruction). Choking prevents breathing, and can be partial or complete. Partial choking allows some, although inadequate, flow of air into the lungs. If someone is able to cough or speak, they are not choking. Choking is life threatening. It cuts off oxygen to the brain within minutes. Adults who are elderly or who have had a stroke are at an increased risk for choking. So are adults who have chronic diseases that may cause problems with the swallowing reflex (Parkinson s, dementia, MS). The universal sign for choking is clutching the throat with both hands. Other signs of choking include: o Inability to cough o Inability to talk o Wheezing sound when trying to breathe o Skin, lips, or nailbeds turning dusky or blue o Loss of consciousness Learner s Book Page 17.21

12. Choking: First Aid If a client is choking, use the five-and-five approach to deliver first aid. 9 First, deliver five back blows between the person s shoulder blades with the heel of your hand. Next, perform five abdominal thrusts (also known as the Heimlich maneuver). Alternate between five back blows and five abdominal thrusts until the blockage is dislodged. To perform abdominal thrusts on another person: Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly. Make a fist with one hand. Position it slightly above the person s navel. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust as if trying to lift the person up. Perform a total of five abdominal thrusts, if needed. If the blockage still isn t dislodged, repeat the five-and-five cycle. If you re the only rescuer, perform back blows and abdominal thrusts before calling 911 or your local emergency number for help. If another person is available, have that person call for help while you perform first aid. 9 http://www.mayoclinic.com/health/first-aid-choking/fa00025. Learner s Book Page 17.22

13. Fire Safety Checklist Page 1 of 2 There are many things you can do to help prevent a fire in the client s home, or to be prepared in case a fire starts. Check to see if the client s home has the following: Fire extinguisher is it easy to find? Fire ladder is it easy to get to? Smoke detector are the batteries working? Carbon monoxide detector are the batteries working? Is the Fire Department number by the telephone? Here are some things you can do to prevent a fire: Make sure people smoke cigarettes outside only. Keep heaters away from things that could burn. Keep candles away from things that could burn. Never leave a candle burning if you are not in the room. Make sure power cords are in good shape. Don t run them under rugs. Learner s Book Page 17.23

13. Fire Safety Checklist Page 2 of 2 Talk with the client about making a fire escape plan: Find out where all the exits are. Keep exits clear (no furniture or boxes blocking them). Learn how to assist the client to get out in a hurry. Make an exit plan with the client and anyone else who lives in the house. Talk about how they would get out if there is a fire. Make a plan to meet outside so they will know if everyone got out safely. Rehearse calling 911. What would you say? If there is a fire: 1. Stay calm. 2. Assist the client to get out of the house. If your clothes catch on fire, stop, drop to the ground, and roll to put out the flames. Do not run. Feel a door before touching the handle. If the door is hot, use a different exit. Close doors to stop smoke from spreading. 3. Call 911. Learner s Book Page 17.24

14. Medical Emergency Procedures If the client needs medical care right away: 1. Stay calm. But act fast. 2. Find out if the client is conscious. Tap her and say, Are you all right? 3. If the client does not answer, call 911 right away. 4. If the client does answer, check her condition. Call 911 immediately if your client: Is bleeding badly Has chest pain that doesn t go away immediately after she takes appropriate medication Has trouble breathing Has fallen and cannot get up (DO NOT lift the client) Has slurred speech 5. Talk with the client. Try to find out what happened. 6. Don t move the client. Get a blanket to keep her warm. 7. Don t give the client any foods or liquids. 8. Make sure you are not exposed to body fluids. Use gloves. 9. Write down key facts, such as the time. Learner s Book Page 17.25

15. Two Responses to an Emergency: Stay or Go Emergency Situations Find out what your agency s guidelines are for emergency response to: Floods Hurricanes Tornadoes Blizzards Power outages There are two responses to natural disasters stay inside or get out of the house. Both require you to plan ahead of time and be prepared. Emergency Response: Stay Inside in a tornado, hurricane, power outage, blizzard, ice storm, or earthquake. Stock up on water, food, medicines, and essential supplies enough to last for several days. Plan for surviving without electricity or heat save up food that doesn t need to be cooked or refrigerated. Make sure there are enough blankets. Get flashlights and extra batteries. If a cell phone is available, keep it charged. Emergency Response: Get Out (Evacuate) in a fire, flood, or smell of gas. Plan how to get out identify more than one exit. Plan for getting out when there is no power no lights, no elevators, no phones. Plan a safe place to go when you get out. Plan how to get there. Plan how to get out if your client is disabled. See http://www.fema.gov/pdf/library/pfd_all.pdf. For other emergency planning resources, go to: http://www.ready.gov/basicdisaster-supplies-kit Learner s Book Page 17.26

16. Personal Safety in the Community Page 1 of 2 It is part of your job to keep yourself safe when you are in the community. Here are some guidelines that will help you stay safe. In Your Car: In Traffic: Keep your car in good condition. Make sure you have enough fuel. Think about joining an auto club (for emergencies). Always keep your car doors locked. Always wear a seat belt. Don t allow children under 12 in the front seat. Make sure children age 8 and under have a car safety seat. Obey speed limits. Know how to drive when the weather is bad. Don t use drugs or alcohol. If You Use Public Transportation: If you are not familiar with the route, take public transportation to your client s address during daylight hours BEFORE your first day of work. See how far it is from public transportation to your client s home. See if it feels safe to you. Report to your supervisor if it does not. Learner s Book Page 17.27

16. Personal Safety in the Community Page 2 of 2 In Neighborhoods that You Don t Know: Keep your cell phone charged. Consider getting a cell phone (if you don t have one). Have the correct address and clear directions before you go. Be aware of your surroundings. Don t take shortcuts that might be unsafe. Become familiar with local residents. Don t change your schedule without telling the office. Don t carry a purse. Don t wear expensive jewelry or carry a lot of money. Have your keys ready when you approach your car. Learner s Book Page 17.28

Handout 1. Summary of Key Information Page 1 of 7 Helping to keep the client s home safe is an important job. There are many things that a home health aide can do to help make the home safer. There are checklists for general home safety and for special tasks for the kitchen, bathroom, bedroom, floors, and stairs. Remember kitchens and bathrooms are the rooms where accidents happen most often! One out of three older adults falls each year in the U.S. Among older adults, falls are the leading cause of injury death. 1 That s why preventing falls is an important part of home safety. Falls are often due to hazards that are easy to overlook but easy to fix. The Centers for Disease Control has a checklist to help you find and fix those hazards in every room of your client s home. 2 There are physical factors that make older adults more likely to fall. These include muscle weakness (especially in the legs), problems with balance, vision problems, dizziness, and foot problems. There are specific things that the HHA can do to help the client in each of these areas. Medications can also add to the risk of falling. Some medicines have side effects that make the client feel drowsy, dizzy, or light-headed. (For example, high blood pressure medications may cause dizziness.) These may cause clients to lose their balance or feel unsteady on their feet. 3 When clients take four or more different medications, they have an even greater risk of falling. 1 Centers for Disease Control and Prevention (CDC). Falls among Older Adults: An Overview. http://www.czaxwedc.gov/homeandrecreationalsafety/falls/adultfalls.html. Accessed 3/5/2012. 2 Centers for Disease Control and Prevention, Check for Safety: A Home Fall Prevention Checklist for Older Adults, 2005. http://cdc.gov/homeandrecreationalsafety/pubs/english/booklet_eng_desktopa.pdf 3 Minnesota Falls Prevention, Know Your Medications, 2008. http://www.mnfallsprevention.org/pdf/mnfp-medications.pdf. Handouts

Handout 1. Summary of Key Information Page 2 of 7 The HHA can help clients by making a list of all the medications they are taking. Include prescriptions, over-the-counter drugs, vitamins, and herbal supplements. Then remind the client to show the list to their doctor or pharmacist, to see if there are any problems with the combination of medications. The risk of falling increases after a client is discharged from the hospital. This is because the client is generally weaker and is taking medications. Also the client may be eager to get back to their regular activities and moving around their living space before they are fully recovered. If they have assistive devices, the client may feel that it s not necessary to use them in their own home. Being afraid of falling is understandable, especially after a person has had a fall. However, fear of falling sometimes makes elders stop doing things that they are still capable of doing. When elders stop doing their usual physical or social activities, they become physically weaker and then even more fearful of falling. This means that fear of falling can increase clients risk of falling. To help the client get over the fear of falling, the HHA can: Encourage the client to stay active. Help the client identify activities they would like to do and make a plan to help them feel confident enough to do those activities. Help the client take specific steps to reduce risk of falling. For example, do a safety survey together of their living environment. Observe, record, and report signs of increasing weakness or lack of balance. Handouts

Handout 1. Summary of Key Information Page 3 of 7 There are special risks of falling outside the home. When going outside with the client, the HHA can help by reminding the client of things they will need outside, such as safe shoes, appropriate clothing to avoid tripping, glasses, maybe sunglasses, hearing aids, and assistive devices for walking. Changes in the light from indoors to outdoors can make it hard to see tripping hazards. There are tips for helping clients to be safe on different floor surfaces, in elevators and escalators, and on sidewalks and parking lots. To summarize, many falls can be prevented. By doing these four steps, older adults can lower their chances of falling. This is good information for you to remember and to share with older clients. 4 o Begin a regular exercise program o Have their health care provider review their medicines o Have their vision checked o Make their homes safer First aid is care that you give in a medical emergency, until the trained medical workers arrive, or until you can report the injury to your supervisor. Make sure you know your agency s policy about what type of first aid you can provide to your client. In general, a home health aide should provide only the most basic first aid unless they have had certified first aid training. 4 Adapted from Centers for Disease Control and Prevention, What YOU Can Do to Prevent Falls, n.d. http://cdc.gov/homeandrecreationalsafety/pubs/english/brochure_eng_desktop-a.pdf. Handouts

Handout 1. Summary of Key Information Page 4 of 7 A home health aide can provide basic first aid for a variety of medical emergencies, including: Minor burns dampen a clean cloth with cool water (not ice) and place it over the burn. Ice will cause more damage to the skin. Serious burns cover the burned area with a clean sheet. Choking use the five-and-five approach with abdominal thrusts (see 12). Poisoning call the Poison Control Center. Sprains or broken bones keep the injured area still; do not move the client. Bleeding apply direct pressure. Chemical burns flush the burned area with lots of water. Choking is when food, or a foreign object, gets stuck in a person s throat. This blocks the flow of air to the lungs (clinical term is airway obstruction). Choking is a common breathing emergency that kills more than 3,000 people each year. The universal sign for choking is clutching the throat with both hands. (If someone is able to cough or speak, they are not choking.) Other signs of choking include: o Wheezing sound when trying to breathe o Skin, lips, or nailbeds turning dusky or blue o Loss of consciousness If someone is choking and you re the only rescuer, do back blows and abdominal thrusts before calling 911. If another person is available, have that person call for help while you do first aid. Handouts

Handout 1. Summary of Key Information Page 5 of 7 Fire safety is another important task for the home health aide. There are many things you can do to help prevent a fire in the client s home, or to be prepared in case a fire starts. To prevent a fire: Make sure people smoke cigarettes outside only. Keep heaters away from things that could burn. Keep candles away from things that could burn. Never leave a candle burning if you are not in the room. Make sure power cords are in good shape. Don t run them under rugs. Be prepared for a fire. Check to see if the client s home has the following: Fire extinguisher Fire ladder Smoke detector Carbon monoxide detector Fire Department number by the telephone Have a fire escape plan. Talk with the client about: Where all the exits are. Keep exits clear (no furniture or boxes blocking them). Learn how to assist the client to get out in a hurry. Make an exit plan with the client and anyone else who lives in the house. Talk about how they would get out if there is a fire. Make a plan to meet outside so they will know if everyone got out safely. Rehearse calling 911. What would you say? Handouts

Handout 1. Summary of Key Information Page 6 of 7 If there is a fire: 1. Stay calm. 2. Assist the client to get out of the house. If your clothes catch on fire, stop, drop to the ground, and roll to put out the flames. Do not run. Feel a door before touching the handle. If the door is hot, use a different exit. Close doors to stop smoke from spreading. 3. Call 911. If the client has a medical emergency and needs medical care right away: 1. Stay calm. But act fast. 2. Find out if the client is conscious. Tap her and say, Are you all right? 3. If the client does not answer, call 911 right away. 4. If the client does answer, check her condition. Call 911 immediately if your client: Is bleeding badly Has chest pain that doesn t go away after taking medication Has trouble breathing Has fallen and cannot get up (DO NOT lift the client) Has slurred speech 5. Talk with the client. Try to find out what happened. 6. Don t move the client. Get a blanket to keep her warm. 7. Don t give the client any foods or liquids. 8. Make sure you are not exposed to body fluids. Use gloves. 9. Write down key facts, such as the time. Handouts

Handout 1. Summary of Key Information Page 7 of 7 There are two responses to natural disasters stay inside or get out of the house. Both require you to plan ahead of time and be prepared. Stay Inside in a tornado, hurricane, power outage, blizzard, ice storm, or earthquake. Get Out (Evacuate) in a fire, flood, or smell of gas. For emergency planning resources, go to: http://www.ready.gov/basicdisaster-supplies-kit It is part of your job to keep yourself safe when you are in the community. There are guidelines that will help you stay safe in your car, in traffic, in public transportation, and in neighborhoods that are unsafe or are new to you. Handouts

Module 17. Safety for the Client and the Worker Worksheet 1. What Is Not Safe Here? Page 1 of 2 How many unsafe things can you find in this room? Circle each item on your paper. Worksheets

Module 17. Safety for the Client and the Worker Worksheet 1. What Is Not Safe Here? Page 2 of 2 How many unsafe things can you find in this kitchen? Circle each item on your paper. Worksheets