HHA Handbook

["| HHA HANDBOOK 51","\u2022\t Starting January 1, 2021: 12 weeks York State during the previous calendar of leave. year and is determined and published by the New York State Department of NYPFL may be taken for the following Labor each year. reasons: Pay under NYPFL is available from the \u2022\t To care for a spouse, domestic first day of the leave (no waiting period). partner, child, parent (including in- The insurance carrier, not the Agency, laws), grandparent, or grandchild with is responsible for approving and serious health condition (as defined paying benefits under the NYPFL Law. under the NYPFL Law); To receive such benefits, you will be required to file a claim with the carrier \u2022\t To bond with a child after the child\u2019s and to follow the carrier\u2019s requirements birth or placement for adoption or with respect to claim filing, certification, foster care or to meet adoption or and supporting documentation (see foster care obligations (leave to be Procedures for Applying for FMLA Leave completed within one year of the and\/or NYPFL Leave section below). child\u2019s birth or placement); or If you are eligible for leave under both \u2022\t To meet qualifying exigencies (as the FMLA and the NYPFL, your leaves defined under the NYPFL Law and the under both of these laws will run FMLA) arising from the fact that an concurrently to the maximum extent employee\u2019s spouse, domestic partner, permitted by law. child, or parent is on active duty or has been notified of an impending call to Family Members Working for active duty in the U.S. Armed Forces. the Agency Note that NYPFL is not available for FMLA. Where eligible spouses both work the employee\u2019s own serious health for the Agency, they will be limited to condition. Also note that disability a combined total of 12 weeks of FMLA benefits and NYPFL leave may not be leave in a 12-month period for the used at the same time. An employee birth\/placement of and bonding with will not be entitled to paid family leave if a child and the care of a parent with a he or she received more than 26 weeks serious health condition. The spouses of NYPFL leave and disability benefits will also be limited to a combined during any 52 consecutive calendar total of 26 weeks of FMLA leave in a week period. 12-month period to care for a Covered Servicemember with a serious injury or During NYPFL leave, paid benefits will illness (see Definitions section, Military be provided by the Agency\u2019s NYPFL Caregiver Leave subsection below). insurance carrier, at the following levels in accordance with law: NYPFL. The Agency will not permit more than one employee to take \u2022\t Starting January 1, 2021: 67% of the NYPFL at the same time to care for the employee\u2019s AWW, up to 67% of the same family member (e.g., where both then-current NYS AWW. spouses or other qualifying relatives work for the Agency). The NYS Average Weekly Wage is the average weekly wage paid across New 52 HHA HANDBOOK |","3.\t Intermittent Leave to an employee is calculated based on the average number of days FMLA. If medically necessary, FMLA the employee works per week. For leave occasioned by a serious health example, an employee with a schedule condition may be taken intermittently of 5+ days per week can take up to (in separate blocks of time due to the then-applicable maximum weeks a serious health condition) or on a of leave multiplied by 5 days (in 2018, reduced leave schedule (reducing the maximum is 8 weeks, so the the usual number of hours you work employee would be eligible for up to per workweek or workday). Medically 40 days of leave in a 52-week period). necessary means that there must For an employee who works 3 days be a medical need for the leave and per week (60% of the work week) can the leave can best be accomplished receive only 60% of the then-applicable through an intermittent schedule. FMLA maximum leave (in 2018, this would leave may also be taken intermittently be 60% of 40 days, so the employee or on a reduced leave schedule for a would be eligible for up to 24 days of qualifying exigency relating to covered leave in a 52-week period). military service. Concurrent Leave. Where FMLA and If FMLA leave taken intermittently is NYPFL run concurrently, intermittent unpaid, the Agency will reduce the leave will be immediately deducted employee\u2019s salary based on the amount from the employee\u2019s FMLA entitlement. of time actually worked. In addition, Because intermittent NYPFL is while an employee is on an intermittent measured in daily increments, or reduced schedule leave, the Agency intermittent leave will be deducted may temporarily transfer him or her from the employee\u2019s NYPFL entitlement to a position, with equivalent pay and each time the hours taken under FMLA benefits, for which the employee is add up to the number of hours in an qualified and that better accommodates employee\u2019s usual work day. recurring periods of leave. 4.\t Definitions When leave is needed to care for an immediate family member or Serious Health Condition \u2013 FMLA. the employee\u2019s own illness, and is For FMLA purposes, \u201cserious health for planned medical treatment, the condition\u201d means an illness, injury, employee must attempt to schedule impairment, or physical or mental treatment so as to minimize disruption condition that involves: (a) inpatient to the Agency\u2019s operations. Employees care; or (b) continuing treatment by a should consult with the Agency prior health care provider.\u201d to scheduling the treatment in order to arrange a schedule that best suits the \u2022\t Inpatient care means an overnight stay needs of the employee and the Agency. in a hospital, hospice, or residential medical care facility, including any NYPFL. Eligible employees may take period of incapacity, as defined by the NYPFL intermittently in no less than law, or any subsequent treatment in daily increments. The maximum connection with such inpatient care. number of days of NYPFL available | HHA HANDBOOK 53","54 HHA HANDBOOK |","\u2022\t A serious health condition involving recovery therefrom) by a continuing treatment by a health care health care provider or provider requires any one or more of a provider of health care the following: services under orders of, or on referral by, a health care 1.\t A period of incapacity of provider. more than three consecutive, full calendar days, and any Serious Health Condition \u2013 NYPFL. subsequent treatment or For NYPFL purposes, \u201cserious health period of incapacity relating condition\u201d means illness, injury, to the same condition, that impairment, or physical or mental also involves: (a) treatment condition that involves: (a) inpatient two or more times, within care in a hospital, hospice, or residential 30 days of the first day of health care facility; or (b) continuing incapacity, unless extenuating treatment or continuing supervision by circumstances exist, by a a health care provider. health care provider, a nurse under direct supervision \u2022\t A serious health condition involving of a health care provider, continuing treatment or continuing or a provider of health supervision by a health care provider care services (e.g., physical requires any one or more of the therapist) under orders of, or following: on referral by, a health care provider; or (b) treatment 1.\t More than 3 consecutive full by a health care provider days of inability to work, on at least one occasion attend school, perform regular which results in a regimen of activities, or other incapacity continuing treatment under due to a condition, plus any the supervision of the health subsequent treatment or care provider; period of incapacity that involves treatment two or 2.\t Any period of incapacity due to more times, or treatment pregnancy or for prenatal care; at least once that results in a regimen of continuing 3.\t Any period of incapacity or treatment under the treatment for such incapacity supervision of a health care due to a chronic serious health provider. condition; 2.\t Any period of inability to work, 4.\t A period of incapacity which attend school, perform regular is permanent or long-term activities, or other incapacity due to a condition for which due to a chronic serious treatment may not be health condition that requires effective; and periodic visits for treatment by a health care provider, 5.\t Any period of absence to continues over an extended receive multiple treatments period of time (including (including any period of | HHA HANDBOOK 55","recurring episodes of an underlying condition), and may cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy). 3.\t A long-term or permanent period of inability to work, attend school, perform regular activities, or other incapacity due to a condition for which treatment may not be effective (e.g., Alzheimer\u2019s, severe stroke, or terminal disease). The family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. 4.\t A period of inability to work, attend school, perform regular activities, or other incapacity due to treatment (including any period of recovery therefrom) by a health care provider for restorative surgery, or for a condition that would likely result in more than 3 consecutive full days of incapacity without treatment (e.g., cancer, severe arthritis, kidney disease). Qualifying Exigency. For purposes of both FMLA and NYPFL, \u201cqualifying exigency\u201d means a situation arising out of the fact that the employee\u2019s spouse, child, or parent is a military member in the United States Armed Forces, Reserves or National Guard on covered active duty or who has been notified of an impending call or order to covered active duty status (\u201cMilitary Member\u201d). \u201cCovered active duty,\u201d for members 56 HHA HANDBOOK |","of the Regular Armed Forces, means immediate need basis (but not duty during deployment of the Military on a routine, regular, or everyday Member with the Armed Forces to basis); (iii) enrolling in or transferring a foreign country. \u201cCovered active to a new school or daycare facility; duty,\u201d for members of National Guard and (iv) attending meetings or Reserves, means duty during the with employees at a school or deployment of the Military Member with daycare facility; the Armed Forces to a foreign country under a call or order to active duty in 4.\t Financial and legal arrangements. support of a \u201ccontingency operation,\u201d as To make or update financial and defined by law. legal arrangements to address the Military Member\u2019s absence while A \u201cqualifying exigency\u201d exists where one of on covered active duty or call to the following events occurs: covered active duty status; 1.\t Short-notice deployment. To address 5.\t Counseling. To attend counseling any issue that arises from the fact provided by someone other than that the Military Member is notified a health care provider, for oneself, of an impending call or order to for the Military Member, or for covered active duty, for a period of the biological, adopted, or foster seven (7) or less calendar days from child, a stepchild, or a legal ward the date of notification; of the Military Member, or a child for whom the Military Member 2.\t Military events and related activities. stands in loco parentis, who is To attend any official ceremony, either under age 18, or age 18 or program, or event sponsored older and incapable of self-care by the military that is related to because of a mental or physical the covered active duty or call to disability at the time that FMLA leave covered active duty status of the is to commence, provided that the Military Member, or family support need for counseling arises from or assistance programs and the covered active duty or call to informational briefings sponsored covered active duty status of the or promoted by the military, military Military Member; service organizations, or the American Red Cross that are related 6.\t Rest and recuperation. To spend to the covered active duty or call time with a Military Member who to covered active duty status of the is on short-term, temporary, rest Military Member; and recuperation leave during deployment for up to fifteen (15) 3.\t Childcare and school activities. calendar days; To attend to certain childcare and school activities that are 7.\t Post-deployment activities. To attend necessitated by the Military arrival ceremonies, reintegration Member\u2019s active duty or call to briefings and events, and any active duty status, such as: (i) other official ceremony or program arranging for alternative childcare; sponsored by the military for a (ii) providing childcare on an urgent, period of 90 days following the | HHA HANDBOOK 57","termination of the Military Member\u2019s aggravated by service in the line of covered active duty status; and to duty on active duty that may render address issues that arise from the the servicemember medically unfit to death of a Military Member while on perform his or her duties, for which the covered active duty status; servicemember is undergoing medical treatment, recuperation, or therapy; 8.\t Parental care. To provide certain or is in outpatient status; or is on the care to a Military Member\u2019s parent temporary disability retired list; or who is incapable of self-care, and where each instance of the care \u2022\t A veteran who: (1) is undergoing provided is necessitated by the medical treatment, recuperation, or Military Member\u2019s covered active therapy for a serious injury or illness; duty. Covered activities provided (2) was a member of the Armed Forces to the parent of a Military Member (including a member of the National under this provision include: (1) Guard or Reserves); (3) was discharged arranging for alternative care for or released within the five-year period a parent of the Military Member; before the eligible employee first takes (2) providing care for a parent of FMLA leave to care for him or her; and the Military Member on an urgent, (4) was discharged or released from immediate need basis; (3) admitting the Armed Forces under conditions or transferring the parent of a other than dishonorable (\u201cCovered Military Member to a care facility; Veteran\u201d). An eligible employee must and (4) attending meetings with commence leave to care for a Covered employees at a care facility where Veteran within five years of the the parent of a Military Member Covered Veteran\u2019s active duty service. resides or stays; or For purposes of Military Caregiver 9.\t Additional activities. To address Leave under the FMLA \u201cserious injury or other events which arise out of the illness\u201d means: Military Member\u2019s covered active duty or call to covered active duty \u2022\t In the case of a Current status, provided that the Agency Servicemember, an injury or illness and employee agree that such that was incurred by him or her in leave shall qualify as an exigency, the line of duty on active duty in the and both agree to the timing and Armed Forces (or that existed before duration of such leave. the beginning of his or her active duty and was aggravated by service in FMLA Military Caregiver Leave. For the line of duty on active duty in the purposes of Military Caregiver Armed Forces) and that may render Leave under the FMLA, \u201cCovered the Covered Servicemember medically Servicemember\u201d means: unfit to perform the duties of his or her office, grade, rank, or rating; and \u2022\t A current member of the Armed Forces, including a member of the \u2022\t In the case of a Covered Veteran, an National Guard or Reserves, who injury or illness that was incurred or has a serious health condition (as aggravated by him or her in the line defined under the FMLA) incurred or of duty, while on active duty in the 58 HHA HANDBOOK |","Armed Forces, and which manifested basis such that an employee may itself before or after he or she be entitled to take more than one became a veteran, and is: period of 26 workweeks of leave if the leave is to care for different 1.\t A continuation of a serious injury Covered Servicemembers or to care or illness that was incurred or for the same Covered Servicemember aggravated when the Covered with a subsequent serious injury or Veteran was a member of the illness, except that no more than 26 Armed Forces and rendered him workweeks of leave my be taken within or her unable to perform the duties any single 12-month period. of his or her office, grade, rank, or rating; \u201cNext of kin\u201d: An employee is \u201cnext of kin\u201d of a Covered Servicemember if he 2.\t A physical or mental condition or she is the nearest blood relative of for which the Covered Veteran the Covered Servicemember (other has received a VA Service Related than the Covered Servicemember\u2019s Disability Rating (\u201cVASRD\u201d) of 50 spouse, parent, or child). Unless the percent or greater and such VASRD Covered Servicemember has specifically rating is based, in whole or in part, designated in writing a particular blood on the condition precipitating the relative as his or her nearest blood need for leave; relative for the purposes of the Military Caregiver Leave, the following is the 3.\t A physical or mental condition that order of priority used to identify the substantially impairs the Covered nearest blood relatives of the Covered Veteran\u2019s ability to secure or follow Servicemember: (a) blood relatives a substantially gainful occupation by who have been granted legal custody reason of a disability or disabilities of the Covered Servicemember; (b) related to military service or would siblings; (c) grandparents; (d) aunts do so absent treatment; or and uncles; and (e) first cousins. When no such designation is made, and 4.\t An injury, including a psychological there are multiple family members injury, on the basis of which the with the same level of relationship to Covered Veteran has been enrolled the Covered Servicemember, all such in the Department of Veterans family members shall be considered Affairs Program of Comprehensive the Covered Servicemember\u2019s next of Assistance for Family Caregivers. kin and may take FMLA leave to provide care to the Covered Servicemember, Important limitation: If an employee either consecutively or simultaneously. does not take all of his or her 26 When such designation has been workweeks of leave entitlement to care made, the designated individual for a Covered Servicemember during shall be deemed to be the Covered the 12-month period, the remaining Servicemember\u2019s only next of kin. part of his or her 26 workweeks of leave is forfeited. | HHA HANDBOOK 59 Maximum duration of leave in any 12-month period: The Military Caregiver Leave is applied on a per- Covered-Servicemember, per-injury,","5.\t NYPFL Contributions and Waivers injury or illness of a family member, etc.), an employee must provide Consistent with the NYPFL Law, the the Agency with at least 30 days Agency will fund the NYPFL insurance advance notice of the need for policy through deductions from the leave. If 30 days advance notice is pay of those employees who have not not possible (e.g., because of lack of filed valid waivers in accordance with knowledge of approximately when this policy. The Agency will make the the leave will be required to begin, a maximum deductions permitted by law. change in circumstances, or a medical emergency), the employee must Employees whose regular schedule at least provide notice as soon as is 20 or more hours per week but practicable under the circumstances. who will not work 26 consecutive Normally, it should be practicable for weeks, and employees whose regular the employee to provide notice of the schedule is less than 20 hours per week need for leave either the same day he but who will not work 175 days in a or she becomes aware of a qualifying 52-consecutive-week period, may file event or the next business day. a waiver of NYPFL benefits. Upon filing a waiver, the employee will be exempt \u2022\t Unforeseeable Leave. When the from making contributions to NYPFL approximate timing of the qualifying and thus will not be subject to payroll event and the need for leave is not deductions. However, the employee will foreseeable, the employee must be ineligible for NYPFL benefits. provide notice as soon as practicable under the facts and circumstances of If the work schedule of an employee who the qualifying event. Absent unusual has filed a waiver changes so that he circumstances, it generally should or she will work 26 consecutive weeks be practicable for the employee to or 175 days in a 52-consecutive-week provide notice at least four hours period (as applicable), the waiver will be before your scheduled shift as automatically revoked within 8 weeks required by the Agency\u2019s normal call- of the change. The employee will then in policies. be obligated to make contributions, including any retroactive contributions These rules apply to each use of due from date of the waiver. intermittent leave, except that when leave is to be taken on a reduced 6.\t Application for FMLA Leave and\/ schedule basis, notice need only be or NYPFL Leave given one time, but the employee shall advise the Agency as soon as To take FMLA leave or NYPFL, an employee practicable if dates of scheduled leave must provide the Agency with advance change or are extended, or were initially notice of the need for leave as follows: unknown and become known. \u2022\t Foreseeable Leave. Where the need If an employee is planning a medical for leave is foreseeable (e.g., planned treatment or a series of treatments medical treatment, expected birth under FMLA or NYPFL or is taking or placement of a child, planned Military Caregiver Leave under the medical treatment for a serious 60 HHA HANDBOOK |","FMLA, he or she must consult with will notify him or her of the requirement the Agency first regarding the dates of for medical certification and when it such treatment to work out a schedule is due (at least 15 days after leave is that best suits the needs of both the requested). If the employee provides employee or the Covered Military at least 30 days\u2019 notice of medical Member, if applicable, and the Agency. leave, he or she should also provide the medical certification before leave Requests for leave under FMLA leave begins. Failure to provide requested and\/or NYPFL should be submitted medical certification in a timely manner in writing to the Human Resources may result in denial, delay, or revocation office. Employees seeking FMLA leave of leave. may be required to submit a medical certification (see FMLA Certification The Agency, at its expense, may require Procedure, below). In addition, an examination by a second health care employees seeking NYPFL will be provider designated by the Agency. required to file a claim with the Agency\u2019s If the second health care provider\u2019s NYPFL insurance carrier (see NYPFL opinion conflicts with the original Claim and Certification Procedure medical certification, the Agency, at its section, below). expense, may require a third, mutually agreeable, health care provider to Failure to provide proper notice of your conduct an examination and provide a need for FMLA leave and\/or NYPFL may final and binding opinion. The Agency result in the denial or delay of protected may require subsequent medical leave, depending on the particular facts and recertification. Failure to provide circumstances. requested certification within the required time frame may result in delay 7.\t FMLA Certification Procedure of further leave until it is provided. If an employee\u2019s need for leave may The Agency also reserves the right to qualify under the FMLA, the Agency require certification from a covered will notify the employee if he or military member\u2019s health care provider she is eligible for FMLA leave and, if if an employee is requesting military eligible, provide a notice of rights and caregiver leave and certification in responsibilities under the FMLA. If the connection with military exigency leave. employee is not eligible, the Agency will provide a reason for ineligibility. 8.\t NYPFL Claim and Certification Procedure If an employee is requesting FMLA leave because of his or her own or a covered To obtain NYPFL benefits, you must relation\u2019s serious health condition, file a claim with the Agency\u2019s NYPFL the employee and the relevant health insurance carrier on the carrier\u2019s care provider must supply appropriate prescribed form(s). The employee medical certification. Employees may will also be required to provide the obtain Medical Certification forms from NYPFL insurance carrier with sufficient the Human Resources office. When an certification of the need for leave employee requests leave, the Agency and supporting documentation as | HHA HANDBOOK 61","provided by the NYPFL Law, the relevant 9.\t Reporting While on Leave insurance policy, and the carrier\u2019s own requirements. For example, the While an employee is on NYPFL, he employee may be required to provide: or she must notify the Agency (and, if applicable, the NYPFL insurance carrier) \u2022\t Certification from a health care as soon as practicable (within two provider regarding the serious health business days, if feasible) if there is any condition for which the employee change in his or her circumstances or if needs leave; his or her dates of leave change or were initially unknown and become known \u2022\t Documentation such as a birth or estimated. Where appropriate, certificate establishing the birth the Agency may require periodic of a child; recertification supporting the need for FMLA leave. \u2022\t Documentation such as court documents or placement letters 10.\tEmployee Compensation and establishing that the employee is in the Benefits during FMLA Leave and\/ process of adopting or has adopted a or NYPFL Leave child or is fostering a child; or Compensation during FMLA. As noted \u2022\t Certification of military exigencies and above, FMLA leave is unpaid. However: supporting military orders. \u2022\t Nothing in this policy prevents an If an employee\u2019s need for leave may employee from applying for worker\u2019s qualify under the NYPFL Law, the compensation or NYS Disability Agency will provide the employee with benefits. Leave which is covered by a copy of the relevant NYPFL claim workers\u2019 compensation or disability form(s) and complete any employer benefits will be designated as portion(s). An employee can also FMLA leave to the maximum extent obtain and file the claim form(s) permitted by law. directly through our NYPFL insurance carrier, Shelter Plan. Employees must \u2022\t When FMLA leave is not concurrent complete the claim form(s), including with NYPFL leave, (a) employees not any required certification or supporting receiving workers\u2019 compensation or documents, and submit them to disability benefits will be required to the carrier in order to obtain NYPFL contemporaneously use any available benefits. The claim form and any paid time off, and (b) employees will required certification and supporting also be required to use any available documents must be submitted in paid time off during any waiting accordance with the NYPFL Law and periods for disability benefits or the carrier\u2019s requirements. Employees workers\u2019 compensation benefits. should contact the carrier if they have any questions about the forms and An employee taking FMLA or NYPFL documents that must be submitted in leave may not engage in other work or support of their claim for benefits. employment during time the employee would have been working if not for the leave of absence or where such 62 HHA HANDBOOK |","work or employment is otherwise plan premiums which had been paid inconsistent with the underlying by the employee prior to leave must reason(s) for their leave of absence. continue to be paid by the employee If an employee engages in such other during the leave period. Where the work or employment during the leave employee is receiving pay directly from of absence, the employee will be the Agency (i.e., using available paid considered to have violated the terms time off), deductions for group health of the leave of absence. insurance will continue to be made on the same basis as if the employee Compensation during NYPFL. As noted was actively working. Where the above, NYPFL is paid by the Agency\u2019s employee is not receiving pay from the NYPFL insurance carrier in accordance Agency, arrangements will be made with the insurance policy, the maximum for employees to pay their share of benefits set forth in the law, and the the group health insurance premiums carrier\u2019s own rules and procedures. while on leave. If the Agency pays the employee\u2019s share of any premium During NYPFL leave (whether payments, the Agency reserves the concurrent with FMLA leave or not), right to recover the full value of employees may, but is not required those payments made in any manner to, use any available paid time off permitted by law. in order to receive full pay. Use of available paid time off will allow the An employee whose health insurance employee to receive full pay during coverage is maintained pursuant to the leave until available paid time off this policy during an approved FMLA is exhausted. Where an employee is and\/or NYPFL leave will be subject to paid for available paid time off during any changes in the Agency\u2019s group NYPFL (whether concurrent with FMLA health plan that occur while he or she or not), the Agency will be entitled to is on leave (e.g., changes in coverage, receive the NYPFL payment from the premiums, deductibles). NYPFL carrier as reimbursement for the NYPFL portion of the amount paid If an employee\u2019s premium payment is to the employee. In no event shall more than thirty (30) days late while an employee\u2019s use of available paid the employee is on FMLA leave and\/ time off during NYPFL result in the or NYPFL, his or her group health employee\u2019s receipt of more than 100% insurance benefits may be terminated his or her average weekly wage. and the employee will be extended continuing coverage opportunities in Health Insurance during FMLA and\/or accordance with COBRA. However, if NYPFL. To the extent required by law, coverage is terminated for this reason the Agency will maintain group health and the employee returns to work insurance benefits for employees from FMLA leave, the employee\u2019s on FMLA and\/or NYPFL leave on the group health insurance benefits will same basis as coverage would have be reinstated, to the same extent the been provided if the employee had employee would have been entitled been actively working during the leave to those benefits had he or she not period. Any share of group health taken leave. | HHA HANDBOOK 63","If an employee gives unequivocal son, daughter, or parent, or next of notice of his or her intent not to kin, who is a Covered Servicemember; return to work, the Agency\u2019s obligation or (c) other circumstances beyond the to continue group health insurance employee\u2019s control. benefits will cease, subject to COBRA, and the employee will have no right Other Benefits. An approved FMLA leave to job restoration. In addition, an and\/or NYPFL pursuant to this policy will employee on approved FMLA leave not result in the loss of any employment who fails to return to work at the end benefit that accrued before the date the of his or her leave will be required to leave of absence started. For all periods reimburse the Agency for all premium when an employee uses available paid payments expended by the Agency on time off concurrently with FMLA or the employee\u2019s behalf during the period NYPFL, benefits that are accumulated on of unpaid FMLA leave, unless the reason an accrual basis will continue to accrue the employee does not return to work is to the extent they would have otherwise. due to: (a) the continuation, recurrence, Employees will not accrue or receive or onset of a serious health condition any benefits (other than group health of the employee or the employee\u2019s insurance benefits as noted above) for spouse, son, daughter, or parent; (b) periods where FMLA and\/or NYPFL is the serious injury or illness of a spouse, not run concurrently with use of the employee\u2019s available paid time off. 64 HHA HANDBOOK |","11.\tReturning From FMLA Leave and\/ 12.\tFurther Information or NYPFL Leave Employees wanting further information Unless the employee\u2019s employment regarding this policy should consult with was or would have been terminated the Human Resources Department. for reasons unrelated to the leave (e.g., reorganization, lay off, reduction in The Agency will not interfere with, force, etc.), the Agency will restore an restrain, or deny an employee the employee who returns from approved exercise of any right provided under FMLA and\/or NYPFL leave to the same the FMLA, retaliate against an employee position that the employee held prior for using or trying to use FMLA leave, to the leave or to an equivalent position or discriminate against any person for with substantially similar duties, opposing any practice made unlawful conditions, responsibilities, privileges, by the FMLA or for being involved in any and status as the original position, proceeding under or relating to the FMLA. subject to the terms, limitations, and exceptions provided by law. Employees may file a complaint with the United States department of labor, Employees returning to work from a wage and hour division, or may bring leave of absence for their own serious a private civil action. The FMLA does health condition are required to provide not affect any federal or state law a fitness-for-duty certification from their prohibiting discrimination or otherwise health care provider. An employee\u2019s supersede any such law or collective failure to provide such certification at bargaining agreement that provides the time the employee attempts to greater family or medical leave rights. return to work may result in a delay or denial of job restoration. The Agency will not discriminate or retaliate against an employee because Employees are expected to return he or she claimed NYPFL benefits, to work when the FMLA leave and\/ attempted to claim NYPFL benefits, or NYPFL ends, unless an employee or testified or is about to testify in a requests and is granted an extension proceeding under the NYPFL Law. of leave as an accommodation or pursuant to another Agency policy. If an This policy is intended to implement employee does not return to work on the FMLA and the NYPFL and their the agreed upon date after expiration accompanying regulations. To the of FMLA leave and\/or NYPFL, and an extent this policy is inconsistent extension of leave was not granted to therewith, the law and regulations will the employee, the employee will be govern. Further, to the extent any state considered to have voluntarily resigned. or local law provides for additional leave benefits, the Agency will comply with With respect to certain \u201chighly paid\u201d or any such requirements. \u201ckey\u201d employees, there may be specified and limited circumstances under which the Agency may refuse to reinstate such individuals following FMLA leave. This determination will be made in accordance with applicable law. | HHA HANDBOOK 65","V.\t EMPLOYEE BENEFITS 66 HHA HANDBOOK |","A.\tJury Duty Leave True Care will pay a non-exempt employee forty dollars ($40.00) per day for the first three (3) days of jury duty. Exempt employees will be paid their regular rate of pay while on jury duty leave so long as they perform some work for the Agency during the week of jury duty. All employees may be required to utilize accumulated PTO during jury duty leave. Employee on a jury duty leave must also comply with the following rules: \u2022\t Immediately upon receipt of the notice or summons for jury duty, the employee must deliver a copy of such jury duty notice or summons to the supervisor and the Director of Payroll. \u2022\t If the employee is excused from jury duty for any day or half day during the required period of service, the employee shall report for work. \u2022\t An eligible employee who is called for jury duty shall give the supervisor and the Director of Payroll proof of the days of such service. B.\tHealth Insurance Certain True Care employees who are regularly scheduled to work thirty (30) hours or more per week and who have satisfactorily completed their Introductory Periods may be eligible for health insurance coverage. C.\t Worker\u2019s Compensation Any injuries suffered as a result of employment activity at or on behalf of | HHA HANDBOOK 67","True Care must be reported orally to your D.\tShort-Term supervisor immediately, and then in writing Disability Insurance within three (3) days of any accident. Failure to report an injury promptly may impact Short-term disability benefits may be your receipt of benefits. Your Coordinator available for employees who have met can assist you with processing the required employment term requirements under paperwork\/claim properly. the law, and in cases of a non-work related injury. If you believe you might qualify, Unemployment Insurance is a benefit please contact Human Resources to paid by New York State from employer inquire. The Company cannot know about contributions who lose their employment off-work injuries and need for assistance involuntarily (such as by a layoff) and or accommodations unless you inform the when no other work is available to them. Company, so please be sure to speak with True Care is fortunate to regularly have Human Resources if you have any questions. available work hours for our caregivers. If your patient assignment ends, for whatever Short-term disability benefits do not pay for reason, you are expected to coordinate any medical expenses but rather provide a your availability and schedule with your nominal income replacement benefit while coordinator to ensure a new patient you are considered disabled under the law. assignment. The Company reserves the right to Unemployment Insurance is not available request and obtain medical information to employees who lose their employment from you in relation to any request for for misconduct. True Care will dispute accommodations due to any injury or all unemployment claims of employees illness, including those that may be who seek benefits even though work was covered by short-term disability laws. offered to them by True Care. True Care will also dispute and vigorously challenge any fraudulent claims of employees, such as claims for benefits when the employee is regularly working at True Care or otherwise ineligible for benefits under the Unemployment Insurance Law. For more information about unemployment insurance, please contact Human Resources. 68 HHA HANDBOOK |","| HHA HANDBOOK 69","VI.\tSAFETY 70 HHA HANDBOOK |","A.\tClient Safety \u2013 General The home health aide should be aware of the Client\u2019s surroundings and any safety problems in the Client\u2019s home. If a new safety issue is identified, the supervisor should be notified immediately so that an appropriate intervention can be initiated. 1.\t Abuse a.\t Overview It is a role of True Care\u2019s professional nursing staff to safeguard Clients and the public when their health and safety are affected by the incompetent, unethical, or illegal action(s) of any person. The nurse will advocate for the Clients and the public, and will work to identify, intervene, treat, and refer any person victimized by domestic mistreatment or neglect. In accordance with the Social Service Law, an act of abuse or maltreatment observed or suspected by a True Care professional staff member must be reported to the appropriate government agency. Below are the applicable definitions, as well as procedures which must be followed by True Care\u2019s professional staff to identify and report to proper authorities instances of abuse of our Clients or their suspected abuse. b.\t Definitions Neglect: The intentional (active), or unintentional (passive) failure to fulfill a caretaking obligation and related services. Abuse (physical): The infliction of physical pain or injury or physical | HHA HANDBOOK 71","coercion (confinement against \u2022\t By using a drug or drugs. one\u2019s will). \u2022\t By using alcoholic beverages to Abuse (psychological): The infliction the extent that he\/she loses self- of mental anguish. control of his\/her actions. Abuse (material): The illegal or \u2022\t By any other acts of similarly unethical exploitation and\/or use serious nature requiring the aid of of funds, property, or other assets the Family Court. belonging to another person. c.\tAbuse Procedures An Abused Child: A child the age of eighteen (18) whose parent or At each Client contact, the Nurse other person legally responsible for his\/ or Home Health Aide (HHA) will her care: observe for signs and symptoms of abuse or maltreatment of the Client \u2022\t Because of mental (or) physical or family. impairments can no longer provide for the basic needs: food, The Nurse or HHA will notify his\/her clothing, shelter, (or) medical care; supervisor, case manager and\/or physician of any signs or symptoms \u2022\t Protect themselves from neglect, of actual or suspected abuse or abuse, or hazardous situations; maltreatment. \u2022\t Commits (or) allowed to be If the individual is in immediate committed against the person a danger, the Nurse or HHA will call sexual offense as defined in the 911 and report the situation. New York State Penal Law; The Nurse or HHA will notify True A Maltreated Child: A child under Care who will notify the appropriate the age of eighteen (18) who has had government agency. serious physical injury inflicted upon him\/her other than accidental means Clients have a right to be free from or whose physical, mental or emotional mental, physical, sexual and verbal condition has been impaired or is in abuse, neglect and exploitation by danger of becoming impaired as a result anyone, including staff, students, of the failure of his parent or other volunteers, other Clients, visitors or person legally responsible for his care to family members. exercise a minimum degree of care: Any reports of abuse or suspected \u2022\t In supplying the child with abuse will be investigated by the adequate food, clothing, True Care and reported to the shelter, education, medical, proper authorities in compliance or surgical care. with state statutes. \u2022\t In providing the child with proper All disclosures made to Adult supervision or guardianship. Protective Services (APS) and Child Protective Services (CPS) will be \u2022\t By unreasonably inflicting or documented in the Client\u2019s record in allowing to be inflicted, harm or a accordance with the Agency\u2019s Policy. substantial risk of harm. 72 HHA HANDBOOK |","APS is a state mandated program True Care honors all Advance which is provided to assist adults Directives from its Clients. An age 18 or older who are victims or \u201cAdvance Directive\u201d is written suspected victims of neglect, abuse instructions relating to the provision or hazardous situations or because of health care when an adult of mental or physical impairments becomes incapacitated, including, can no longer provide for their basic but not limited to, a Health Care needs for food, clothing, shelter, Proxy, consent for an order not to or medical care, or who have no resuscitate (DNR), and a living will. one willing and able to help in a responsible manner. All types of b.\t Health Care Proxy protective services can be reached by dialing 311. A document delegating to another adult, known as a \u201chealth care Administration of Children\u2019s Services agent\u201d the authority to make health (ACS) is a state mandated program care decisions on behalf of the which is provided to assist children individual making the appointment under the age of 18 who are victims if that individual in the future or suspected victims of neglect, becomes incapable of making his or abuse or hazardous situations. her own health care decisions. (Telephone: 1-800-342-3720. All types of protective services can be c.\t\tDNR reached by dialing 311. Consent to or request for the True Care will obtain and document Issuance of an Order Not to the name of the person he\/she spoke Resuscitate (A \u201cDNR Order\u201d): Under to and a state registry number. this Order, health care providers are not to attempt Cardiopulmonary Appropriate reporting forms will be Resuscitation (\u201cCPR\u201d) in the event the completed and forwarded to the Client suffers cardiac arrest. A request protective company. Copies of all for such an Order can be expressed paperwork will be maintained for in a Health Care Proxy or living will. the Client\u2019s record. d.\t Living Will The assessment, signs, and symptoms of abuse or mistreatment A document which contains and all follow-ups will be specific instructions concerning the documented in the Client\u2019s record. individual\u2019s wishes about the type of health care choices and treatments 2.\t Advanced Directives that he\/she does or does not want to receive, but which designates an a.\t Overview agent to make health care decisions. A Client may authorize another e.\t Resuscitation person to make medical decisions if they become incompetent through If there is a no Do Not Resuscitate utilization of a Health Care Proxy or (\u201cDNR\u201d) order and there is a Advance Directive. potential need for resuscitation call 911. Nurses may initiate CPR only if trained and certified to do so. | HHA HANDBOOK 73","3.\t Home Safety \u2022\t Use night-lights in the bedroom, a.\t Overview bathroom and hallways. As part of our home care evaluation \u2022\t Have light switches at both ends and assessment, the Client\u2019s home of stairs and halls. Install handrails will be assessed by the registered on both sides of stairs. nurse for any safety concerns and advise the Client of any actions we \u2022\t Turn on the lights when you go feel should be taken to make the into the house at night. home a safer environment. The following is a general list of safety \u2022\t Keep flashlights handy. measures that the Client should be aware of and should observe. Bathroom b.\t General Precautions \u2022\t Add grab bars in the shower, tub and toilet areas. \u2022\t Use only Underwriters Laboratories (UL) approved \u2022\t Consider sitting on a bench or electrical equipment. stool in the shower. \u2022\t Avoid overloading electrical \u2022\t Use non-slip adhesive strips or a systems. mat in the shower or tub. \u2022\t Store medicine and poison in \u2022\t Do not add bath oil (or any oily childproof containers and out of substance) to water. reach of children. \u2022\t Consider using an elevated \u2022\t Post emergency telephone toilet seat. numbers near the phone. Flooring \u2022\t Keep emergency supplies on hand such as a flashlight, portable radio, \u2022\t Secure rugs and glue vinyl flooring canned food and bottled water. so they lie flat. Remove or replace rugs or runners that tend to slip, \u2022\t Learn first aid and CPR. or attach non-slip backing. \u2022\t Immunize children and pets. \u2022\t Paint the edges of outdoor steps and any steps that are especially \u2022\t Observe all safety narrow or are higher or lower recommendations for all than the rest. equipment. \u2022\t Fix any holes in carpeting or \u2022\t Avoid the use of extension cords. wrapped floors If used, do not string the cord over a doorway or under a rug. \u2022\t Wear non-slip, low heeled shoes or slippers that fit snuggly. Don\u2019t c.\t Fall Prevention walk around in stocking feet. Lighting \u2022\t Keep floors dry, wipe up any spills immediately. \u2022\t Have a lamp or light switch that you easily reach without getting \u2022\t Ensure that carpets are firmly out of bed. attached to the stairs. 74 HHA HANDBOOK | \u2022\t Have your hearing and eyesight","tested. Inner ear problems \u2022\t Keep snow and ice off entrances. can affect balance. Vision \u2022\t Paint outside stairs with a mixture problems make it difficult to see potential hazards. of sand and paint for better traction. Keep outdoor walkways \u2022\t If you feel dizzy or light headed, clear and well lit. sit down or stay seated until your head clears. Stand up slowly to Medical Considerations avoid unsteadiness. \u2022\t Use helping devices, such as \u2022\t Purchase a step stool with high canes or walkers, when necessary. and sturdy handrails. Repair or \u2022\t Watch your alcohol intake. More discard wobbly step stools. Do not stand on a chair to reach things. than two drinks per day can cause Store frequently used objects unsteadiness. where you can reach them easily. \u2022\t Review medications with your doctor or pharmacist. Some drugs, Home Environment including over the counter drugs, can make you drowsy, dizzy, or \u2022\t Keep telephone and electrical unsteady. cords out of the pathways. \u2022\t Exercise regularly to improve muscle flexibility and strength \u2022\t Remove all extraneous clutter in your house. | HHA HANDBOOK 75","d.\t Fire and Burn Prevention \u2022\t Hospital beds and hydraulic lifts should be checked monthly to Fire Prevention maintain good working order. \u2022\t Develop and practice a fire \u2022\t Insert electrical plugs only into escape plan. appropriate grounded outlets. \u2022\t Install smoke detectors and test \u2022\t Equipment that is broken or needs monthly. to be repaired or replaced should be reported to True Care \u2022\t Never smoke in bed or when tired. 5.\t Standard (Universal) Precautions \u2022\t Make sure lit cigarettes are never unattended and are extinguished Standard precautions (also referred when finished. to as Universal Precautions) are a set of infection control practices that \u2022\t Label flammable liquids and store healthcare personnel use to reduce away from heat or sparks. the transmission of microorganisms in healthcare settings. \u2022\t Keep a fire extinguisher available. Standard precautions are a way of \u2022\t Place guards around fireplaces, preventing and controlling the spread radiators and heaters. of infection that can be transferred by contact with blood, bodily fluids, \u2022\t Space heaters should be at least non-intact skin (including rashes) and three feet away from objects and mucous membranes. people, and should be in a good working condition. Standard precautions protect both healthcare personnel and Clients from Burn Prevention contact with infectious agents (germs). \u2022\t Check water temperature in Standard precautions include the shower and tub before bathing appropriate use of hand hygiene and Personal Protective Equipment (PPE). \u2022\t Use flame resistant clothing and PPE can be obtained from any True bedding. Care office at no cost to the Home Health Aide. PPE includes gloves, masks \u2022\t Keep pot handles turned in and disposable gowns. toward the stove. Standard precautions should be used \u2022\t Keep hot food and drinks away by all healthcare personnel when from counter or table edges. caring for all Clients regardless of the Client\u2019s diagnosis and whether 4.\t Home Care Equipment or not the Client is known to have a All assistive devices, such as; wheel communicable infection. Standard chairs, walkers and canes should be in a precautions should be used for all good working order. Clients all of the time. \u2022\t Always lock the wheelchair when transferring to or from bed\/chair\/ commode. \u2022\t Commodes should be sturdy and cleaned after each use. 76 HHA HANDBOOK |","6.\t Transmission-Based Precautions Some examples of infections that would require the home health aide to use Transmission-based precautions are droplet precautions: the second level of basic infection control and are used in addition to 1.\t Pneumonia standard precautions for Clients who may be infected with certain infectious 2.\t Flu agents (germs). The Registered Nurse and\/or Coordinator will notify the home 3.\t COVID-19 health aide of the type of additional or special PPE needed for the Client. Airborne precautions are used for diseases or very small germs that are There are three types of transmission- spread through the air from one person based precautions to another. Required PPE for airborne precautions is a respirator mask or N95 1.\t Contact Precautions mask. Some examples of infections that would require the home health aide to 2.\t Droplet Precautions use airborne precautions: 3.\t Airborne Precautions 1.\t Tuberculosis Some infections require the Home Health 2.\t Measles Aides to follow more than one type of transmission based precaution due to 3.\t Chicken Pox the nature of the infection. For example, if a Client has shingles, both contact and 4.\t Shingles airborne precautions are used in addition to standard precautions. 7.\t Bloodborne Pathogens Contact precautions are used for Clients Bloodborne pathogens are infectious with certain known or suspected infections microorganisms (germs) in human that can be infectious if soiled surfaces blood that can cause diseases in are touched. Required PPE for contact humans. Some examples of these precautions include a gown and gloves. diseases include Hepatitis B, Hepatitis C and HIV. Needlesticks and other Some examples of infections that would sharps-related injuries may expose require the home health aide to use workers to bloodborne pathogens. contact precautions: Exposure to bloodborne pathogens 1.\t MRSA can be controlled in several ways: 2.\t c.diff\/Diarrheal illnesses 1.\t Personal Protective Equipment (PPE) 3.\t Certain open wounds \u00b0\t Gloves, masks, eye protection 4.\t Shingles (with open blisters) and protective disposable gowns are available to all HHAs in all 5.\t COVID-19 True Care offices. If you are in need of supplies but cannot go to Droplet precautions are used for the office during regular working diseases or germs that are spread in hours due to your work schedule, tiny droplets caused by coughing and sneezing. Required PPE for droplet precautions is a surgical mask. | HHA HANDBOOK 77","call the office to arrange for the secure screens. PPE to be mailed. \u2022\t Keep chair or stools away 2.\t Employee Training from windows \u00b0\t All HHAs are trained upon hire and at least annually not to b.\t Preventions Choking or Strangulation handle lancets, needles or other \u2022\t Crib slats should be 2 3\/8 inches sharp objects if possible and that apart or less. HHAs should wear gloves when they may come in contact with \u2022\t Do not tie anything around the infectious materials (blood and infant\u2019s neck. bodily fluids). \u2022\t Remove loose or small parts 3.\t Hepatitis B Vaccination from toys. \u00b0\t This vaccination is recommended and available free of charge to \u2022\t Avoid bottle propping. all HHAs. \u2022\t Burp the infant well before putting B.\tClient Safety \u2013 Pediatrics them into the crib. 1.\t Overview \u2022\t Keep drapery cords tied up high If there are small children in the house, or cut short. these safety measures should be observed in addition to general Client \u2022\t Tie plastic bags in a knot and discard. safety guidelines. \u2022\t Avoid playing with balloons. 2.\t Home Safety a.\t Precautions for Children c.\t Preventing Burns \u2022\t Keep the sides of the crib in \u2022\t Avoid holding an infant when the highest position, with the cooking or handling hot liquids. mattress in the lowest position. \u2022\t When using a high chair or \u2022\t Place safety caps on unused feeding chair, always secure the electrical outlets. child with straps. \u2022\t When the child is in an infant seat, \u2022\t Keep kitchen doors closed place on the floor, never on a or gated. table or counter. \u2022\t Place gates at the head and foot \u2022\t Keep vaporizers out of the of stairways. child\u2019s reach. \u2022\t Put guards on windows; \u2022\t Test water temperature before 78 HHA HANDBOOK | bathing the baby d.\t Preventing Drowning \u2022\t Do not leave a child unattended in a bath or pool. \u2022\t Place locked fences around pools. \u2022\t Empty tub or sink when not in use. \u2022\t Never leave buckets of water unattended. \u2022\t Keep the toilet lid closed.","e.\t Preventing Injuries \u2022\t Be sure you have the directions to \u2022\t Keep sharp items out of the the location. child\u2019s reach. \u2022\t Pad sharp corners of furniture. \u2022\t Carry your bag with the strap \u2022\t Supervise when near glass tables across your body for safety and or mirrors. comfort, not over your shoulder. \u2022\t Secure small rugs. \u2022\t Keep fans out of reach. \u2022\t Be sure you have True Care\u2019s \u2022\t Avoid toys with sharp or office number with you. breakable parts. \u2022\t Keep cleaning products, \u2022\t Be sure you know who assigned medications and other ingestible you to the Client. Call that person poisons out of reach. if you have any problems. If you can\u2019t recall the name of the f.\t Car Safety coordinator, call the office and \u2022\t Always use an unexpired, give your Client\u2019s name and ask to approved car seat and follow speak to their coordinator. all manufacturer instructions. \u2022\t Never leave children alone in \u2022\t Download the HHAeXchange App the car. on your phone. \u2022\t Keep doors locked while driving. \u2022\t Avoid litter and loose objects \u2022\t Have your mobile phone on hand inside the car. to clock in and out, to call the \u2022\t Provide a safe enclosed play area; agency and make emergency calls do not allow children to play in if necessary. driveways or streets. \u2022\t Disposable gloves, face masks, C.\tEmployee Safety and other Personal protective equipment, commonly referred to True Care has developed the following as \u201cPPE\u201d. suggestions in connection with your safety while traveling to your assignments \u2022\t The Orientation Handout on how to clock in and out properly. 1.\t Before You Go To Work a.\t Required Materials for Work \u2022\t The Client is not obligated to \u2022\t Be sure you have the Client\u2019s provide food for aides, please name, address and phone bring your own snacks or lunch number. \u2022\t Live-in aides must bring his\/her own food, clothes & toiletries that should last the entire length of the stay. The Client\/Client\u2019s family is responsible for providing the HHA a place to sleep (bed, sofa bed, cot or air mattress.) 2.\t Uniform Regulations Scrubs are recommended but not required. Any color tops are acceptable. All attire worn to a Client\u2019s home must be clean and | HHA HANDBOOK 79","neat. No shorts, miniskirts, halter tops, hats from an attacker or purse snatcher. (unless for religious beliefs) or cut offs are Approach the building from the other allowed. You are a health care professional side of the street whenever possible. and expected to dress accordingly. Observe to make sure the entrance is clear of any obstructions and is well SHOES: No heels or sandals for safety lit. Identify yourself to the store owner, reasons. Sneakers are permitted, however doorman, and local policeman if you they offer little protection for your toes if frequently service the area. something should drop on them. 6.\t Transit Safety Do\u2019s and Don\u2019ts JEWELRY: Wedding band, post earrings, and an inexpensive watch are permitted. Do: No hoop earrings, no dangling earrings, bracelets, or necklaces. Facial jewelry (ex: \u2022\t Exit immediately when you arrive nose or lip rings) are not allowed. at your train station. HATS: May only be worn during working \u2022\t Keep jewelry out of sight. hours for religious purposes only. \u2022\t Always stay near other passengers. 3.\t Grooming and Hygiene \u2022\t Always have your Metro Card Long hair must be tied back. Nails should or exact change ready before be short and neatly filed. Long designer heading to work. nails are not permitted. Appropriate hygiene (bathing, deodorants, no heavy The Registered Nurse and\/or Coordinator colognes\/perfumes or make up) is expected will notify the home health aide of the at all times. type of additional or special PPE needed for the Client 4.\t Employee ID Card Do Not: Every employee will be issued a photo ID card. This card must be worn at all \u2022\t Sleep on the subway or bus. times when on assignment. Clip your ID card to your collar. This is part of your \u2022\t Sit near the door with your bag on uniform and MUST be worn at the floor or on the door side. all times when assigned to a case. This is the property of True Care and \u2022\t Stand near the edge or at the end must be returned if you leave our of the platform. employment or if your employment is terminated. If lost, True Care will \u2022\t Home Health Aides are not provide a replacement card and you permitted to accept rides from must report it immediately. Clients or their families, neighbors, or other strangers. 5.\t Be Aware \u2022\t Take your wallet out of your People asking for information may purse\/bag in a crowd. be trying to get your attention away All subway stations have identifying lamps at the entrance from the street. When lit: \u2022\t RED \u2013 means the entrance is closed 80 HHA HANDBOOK |","\u2022\t YELLOW \u2013 means no one is on Do not attempt a visit if duty and you may only enter with a Metrocard. \u2022\t The building appears abandoned \u2022\t GREEN \u2013 means someone is on \u2022\t Do not enter a building if duty at this station. there are groups of people hanging around outside and \u2022\t If possible, use a station with you feel threatened. someone on duty, even if you have to walk further. Call True Care \u2022\t All token booths have telephones \u2022\t If the problem is more serious for emergencies. such as a violent fight, leave the area and call True Care, perhaps \u2022\t Each train is in radio contact with from a local police precinct or a Transit Police. supermarket. \u2022\t If you need assistance or directions, \u2022\t NEVER make a visit to a Client ask the token booth attendant. to whom you have not been assigned. If someone asks you to During Rush Hours provide service, tell him or her to call True Care. \u2022\t Wait in off-hours waiting areas and board the train in the center. | HHA HANDBOOK 81","7.\t Hand Hygiene contact with a Client\u2019s blood or body fluids. If a glove tears or is a.\t Overview punctured, it is to be removed immediately, hands hygiene should Hand hygiene (i.e. hand washing or be performed, and a new pair of use of alcohol-based hand rubs) has gloves is to be used. Gloves are to been shown to terminate outbreaks be disposed of after each use. They in health care facilities, to reduce should never be reused. transmission of antimicrobial resistant organisms (e.g. methicillin Examples of times when gloves are resistant staphylococcus aureus) to be worn are: and reduce overall infection rates. \u2022\t Examining a Client for the Hand hygiene can be accomplished first time. by washing your hands with soap and water or using an alcohol-based \u2022\t Emptying urine collecting bags. hand rub when your hands are not visibly soiled. Alcohol-based hand \u2022\t Bathing an incontinent Client. rubs significantly reduce the number of microorganisms on skin, are fast \u2022\t Cleaning up blood spills or acting and cause less irritation. When body fluids. your hands are visibly soiled, you should wash with soap and water. \u2022\t Providing mouth care. The use of gloves does not eliminate \u2022\t Changing chux, diapers, perineal the need for hand hygiene. Likewise, pads (sanitary napkins). hand hygiene does not eliminate the need for gloves. Gloves reduce hand \u2022\t Examining an infant without contamination by 70%-80%, prevent a diaper on. cross contamination and protect Clients and health care personnel \u2022\t Changing a diaper. from infection. Alcohol-based hand rubs or soap and water should be The purpose of this policy is to used before and after each Client provide a systematic approach just as gloves should be changed for the use of disposable gloves before and after each Client. to protect against blood borne pathogens and other potentially Health care personnel should infectious materials. Glove usage avoid wearing artificial nails and reduces the number of bacteria on keep natural nails less than one hands by more than 80%. However, quarter of an inch long if they care please realize wearing gloves for Clients at high risk of acquiring does NOT eliminate the need for infections (e.g. Clients in intensive appropriate hand hygiene. care units or in transplant units). Gloves cannot provide complete b.\t Disposable Gloves protection against bacterial contamination. Glove manufacturing Disposable gloves are to be worn guidelines are designed to eliminate whenever there is a possibility of most glove defects; however, a limited percentage of gloves will 82 HHA HANDBOOK | have small holes that could provide a passageway for microbial transfer.","| HHA HANDBOOK 83","Glove removal may be a source of lotions or creams with latex hand contamination, if gloves are gloves, as they may adversely not removed correctly. affect the integrity of latex gloves. It is crucial to wash hands before \u2022\t Barrier integrity may be impacted putting on and after removal of by storing gloves near heat or cold gloves. Hands should also be extremes, sunlight, UV, fluorescent washed when the integrity of the lights, or X-rays. gloves has been compromised (torn, etc.) during use. If there is no visible \u2022\t Heavily-fragranced lotions may (or any perceived) contamination of precipitate hand irritation if worn hands, maintaining hand hygiene under gloves. with alcohol-based hand rubs is appropriate after glove removal. \u2022\t Gloves should ALWAYS be Gloves should be changed any time changed between Clients and you switch from a contaminated during Client care if moving from a task to a clean task. Gloves worn contaminated body site to a clean are typically made from natural body site. rubber latex or synthetic non-latex materials. Latex free gloves must be \u2022\t Synthetic gloves are available for used by latex allergic employees or use by latex allergic employees or on latex allergic Clients on latex allergic Clients. The following guidelines should \u2022\t Select an appropriate glove for be followed: use when exposed to chemicals. \u2022\t Always use gloves if exposed to \u2022\t Both examination (non-sterile) blood and body fluids capable gloves AND surgical (sterile) gloves of transmitting blood borne are available for specific tasks. infection. 8.\t Masks & Protective Eye Wear \u2022\t Always use gloves if exposed to potentially infectious material Masks\/Protective eye wear are NOT such as pus, feces, respiratory routinely necessary in home care secretions or skin lesions. to prevent the transmission of HIV Aids and other pathogens. Masks\/ \u2022\t Always use gloves when you have Protective Eye wear should be worn non-intact skin (i.e. cut, scrape, during procedures where there is and\/or burns) on your hands. a possibility of blood, excretions, or secretions coming into contact \u2022\t Medical gloves should NEVER be with the mucous membranes washed or reused. of the mouth, nose, and eyes or as advised by the agency. When \u2022\t Wear the correct size gloves. needed, protective eye wear is to be requested from the supervisor. \u2022\t Fingernail length should be After each use, they are to be approximately (1\/4 inch) to washed in soap and water. minimize glove tears and maintain glove integrity. Home Health Aides who decline a flu shot are required to wear \u2022\t Avoid use of petroleum-based masks. Masks are also required for 84 HHA HANDBOOK |","protection from other pathogens. in the receptacle as taught, True The agency will inform the home Care employees should remind health aide when a mask is required. the Client to do so. Under no circumstances should the employee 9.\t Sharps pick up and dispose of the used needle with bare hands. If the a.\t Overview Client is incapable of the task, the employee may use tongs, forceps, Sharps represent a potential source or a similar instrument to pick and of injury and bloodborne disease dispose of the used needle in the transmission if improperly handled receptacle. Disposal of sharps: and disposed of. Sharps are defined as needles and syringes, lancets, \u2022\t Sharps are to be placed in an scalpel blades, scissors, clamps, and appropriate container (puncture any other sharp instruments that resistant container). are used for Client care. It is outside of the scope of practice for a home \u2022\t Containers must be sealed at health aide to administer an injection all times. or draw blood, but the home health aide should encourage the Client to \u2022\t When containers are \u00be full they observe safety with their sharps. If may be securely sealed and the home health aide identifies any disposed of with household waste safety concerns the agency should or brought to a lab for disposal. be notified immediately. \u2022\t If you pierce or cut your skin b.\t Prevention of Injury by Sharps with a sharp, you must flush the affected area for five (5) minutes Needles are not to be recapped, with soap and water. You must purposely bent, or broken by hand, also immediately contact your removed from disposable syringes, supervisor or the Coordinator to or otherwise manipulated by hand. report the incident and discuss After use, disposable needles and treatment options as needed. syringes, scalpel blades, and other sharps, must be placed in a puncture 10.\tBody Fluids resistant container for disposal. Blood and Body Fluid Spills Reusable sharp items should be placed in a puncture resistant \u2022\t All spills of blood or body fluids container, cleaned and sterilized. are to be washed with soap (household detergent) and water; c.\t Disposal of Sharps \u2022\t A freshly prepared 1:10 solution of The supervising nurse will instruct household bleach (1 part bleach the Client\/family to place sharps to 10 parts water) is to be used in an impervious, non-breakable to wipe the area after it has been container (bleach bottle, coffee can, washed; and etc.) and carefully seal it prior to disposal with household waste. \u2022\t Gloves are to be worn during the cleaning process. If the Client does not place a needle | HHA HANDBOOK 85","\u2022\t Clothing\/Linen: Clothing or bed Client\u2019s family\/caregiver, notify your linens that are soiled with blood supervisor at once or body fluids are handled with gloves and placed in a plastic bag c.\t Infection Control until they are washed. Clients should be taught to cover 11.\tTuberculosis (TB) their mouth and nose when coughing, sneezing or laughing. a.\t Overview Persons entering the room should wear masks if the Client is coughing Tuberculosis is a highly contagious and unable to cover his\/her own respiratory disease that mainly mouth. Hand washing and good affects the lungs. The bacteria that housekeeping practices should causes tuberculosis are spread be maintained. Tuberculosis is from person to person through transmitted through the air, not by tiny droplets released in the air by direct contact. Therefore, there are coughing or sneezing. Risk factors no special precautions necessary for include visiting certain countries handling dishes, laundry, bed linens, where tuberculosis is common (most clothes and personal articles. countries except Australia, New Zealand, Canada, USA and Western D.\t General Europe), being immunosuppressed or having close contact with Emergency\/Disaster Preparedness someone with tuberculosis. a.\t Infection Control It is the policy of True Care to have all of its employees who have direct The emergency\/disaster contact with Clients, to be tested preparedness plan is activated during the 12-month period prior to when there is an emergency or employment. disaster as declared by True Care. You will receive comprehensive b.\t S\u0007 igns and Symptoms of training and information about the TB exposure. company\u2019s emergency and disaster preparedness and response plans \u2022\t Elevated temperature during orientation and each year during annual training. As a general \u2022\t Weight loss matter, the types of emergencies to which this policy and those \u2022\t Fatigue emergency response plans apply are: \u2022\t Night sweats \u2022\t Weather emergencies or natural disasters \u2022\t Anorexia \u2022\t Accidental causes like fire, \u2022\t Cough transportation accidents or explosions. \u2022\t Blood-tinged sputum \u2022\t Mucoid\/purulent sputum If you notice any of these signs and symptoms in your Client or 86 HHA HANDBOOK |","\u2022\t Societal causes like bioterrorism, high risk Clients will be contacted as hostage situations, violent crimes a priority to confirm staffing and if or bomb threats. they have necessary supplies. If an HHA is with a Client they must stay \u2022\t Outages of resources like a with the Client until relief arrives, black out, transit strike or a if applicable. If a caregiver should labor disruption. stay with the client for several consecutive days, the expectation \u2022\t Disease outbreak or epidemic or of the agency is that the caregiver other public health emergencies will only work during those hours like H1N1, COVID-19, Ebola, etc. that he or she would have otherwise worked for that same client. Unless The HHA will be contacted medically necessary or authorized regarding the emergency if needed by the agency, the caregiver should to work or to cancel the aide\u2019s only work the number of hours that shift. Information may be through he or she is otherwise authorized. a phone call, text message or The rest of the time in the home email. It is the responsibility of the should be used by the caregiver for HHA to ensure that their contact rest or other personal matters. If a information is accurate and up to Client needs to be evacuated the date and to check and respond to HHA will stay with the Client during all messages in a timely manner. the process and report to True Care the location of the evacuation. If an b.\t Care during an emergency HHA is not able to report to work, they will notify True Care right away During an emergency the Client so alternative care can be arranged. has to be fully cared for and supported. Services and care will | HHA HANDBOOK 87 continue whenever possible. All","Scan here for a digital copy. truecareny.com E C M\\\\ True Care is a licensed Home Care Agency that provides outstanding home care service in the New York Metropolitan area. Our services are available to all regardless of race, age, color, disability, religion, sex, or sexual orientation. We are committed to providing the highest level of care and maintain excellence in staff, procedures, and responsiveness. 9 \t\u0007117 Church Avenue Brooklyn, NY 11218 m\t 718-854-8783"]