Organizing Program Books

Program Management Book

This should be your Go-To Book! Get a large 3” binder and label it “Program Management Book”; divide into sections: Budget, Staffing, Supplies, Food/Meals, and Inspections/Maintenance, whatever else you want. Print out monthly budget reports, staff reports, meal count forms and whatever other agency budget related documents and file in your book. Make it point, and schedule time, to review your program’s monthly expenses at least once a month if not more often. Staying on tops of costs is the best way to avoid budget shortfalls. Keep grocery receipts in a top loading sheet protector. Keep a running list of all staff working in the programs, and have their phone numbers listed as well. Always have a list of guardian names and numbers.

Client Meeting Book

A larger binder with dividers for each client in your program. In each section, keep copies of relevant docs you might need to reference at meetings (Service Agreements, Protocols, MARS, etc.). Add in sheets of lined paper for note keeping. This book should be with you at all times so you have access to it for unplanned meetings that get scheduled on a moments’ notice.

Client Books

Residential programs must have client training binders. The purpose of these books is to give staff the info they need to work with their assigned clients. Client books should contain all pertinent information on the client:

  • Demographics- name, age (DOB), guardian info and contact
  • Diagnoses
  • Medications
  • History/Most Recent physical
  • Health care proxy/DNR if applicable
  • Copies of all programs, protocols and services staff are expected to deliver

Managers can set this system up in two ways:

  •        Have one big binder, with a section for EACH client. This method saves shelf space and manager      time with book management, however it might limit staff ability to review info on clients.
  • Individual binders for each client:

Set them all up the same! Makes audits easier. Assign staff to maintain books- to do monthly paperwork turnover and keep copies in the book.

At the end of each month, paperwork is removed from binders, reviewed, progress notes written, MARS and QA reports completed and the documents filed away by the 5th of the next month.

Purchase expandable files to hold previous month paperwork- one for each client. A 5” file will hold a years’ worth of documents. Purchase cardboard document/file boxes to store all the old paperwork- an average file box with hold 2-3 years’ worth of paperwork.

Color Coding Books

In many group homes I have managed, client books are COLOR CODED. Client A will have all blue books. Client B would have all Green Books. And so on. In many homes, each client has a MEDICAL INFO book, a CLIENT INFO book and a MAR. Color coding the books to a client helps staff find information quickly. Remember, we’re not managing books for ourselves. We are providing staff with tools to do their job effectively. We are not doing this to make our jobs easier. However, if we can combine both goals to a workable and efficient system, all the better for everyone!

NEVER KEEP MARS in Client Books. MARS SHOULD BE KEPT IN A SEPARATE BOOKS.

 

Two Week Notices Are Very Important

We have seen high turnover for years in Long Term Care; not just DSP’s, but program managers, Coordinators, Administration… The work is hard and there are few benefits to sticking it out. DSP’s in particular have a very high rate of turnover. It’s not uncommon to hear of DSP’s leaving an agency to go work down the road at another organization for a dime more per hour. This is leads into this topic of this article: Giving proper notice.

In most lines of work, across all the various industries, people give 2 week notices. They do this in order to give the employer a chance to replace them. In human service organizations, there are often several openings for direct care staff to begin with. When another DSP leaves, it just compounds staffing issues even more. If an DS is scheduled to work many shifts but suddenly quits, it leaves ALL those shifts open and often unfilled. Who suffers? The clients fist and foremost. Then the DSP’s left behind to do the extra work. Management has to fill the position and do all the human resource things associated with this: Background checks, abuse registry check, hiring, orientation, mentor-ship if there is any, and on the job training.

I understand the reasons for wage shopping in jobs in this field. Money is tight and people need to make a living. Some people would laugh at a dime an hour increase in pay but when you’re living paycheck to paycheck every dime counts. Still, it is so important to leave on good terms. When an DSP or anyone else quits without a notice, they almost always end up on the “No-re-hire” list- which is important if one wants to get a decent reference. Trust me- a bad reference is not a good thing in this work. And very often, the Director of one human service provider agency is friends with many directors of many provider agencies- they usually have a network. They warn one another about staff who quit without notice as well as staff who are placed on LOA pending an abuse investigation.

Some other reasons for two week notices:

In the future at another agency, you might end up working with some of the program managers and DSP’s of the facility you left. One of those former program managers could be a Director of an agency you want to work at.
You may want to come back to this facility in the future. Now you think I’m truly crazy. You’d never want to work for this horrible organization again! Well, remember that whole turnover thing? 5 years down the road, the new management of the facility may very well increase pay rates and offer better benefits. You would love to go back now. But you can’t because there’s that “No Re-hire” comment attached to your SS number.
There are financial benefits to giving notice. If you have any vacation time accrued you may lose it if there is a policy about giving two week notices. Also, consider any health insurance facts as well. You will lose coverage.

As well there are some valid reasons to NOT give any notice:

An employee has been physically abusive.
A supervisor has sexually harassed you.
Your mental health is being seriously endangered by job stress.
You have not been paid the agreed-upon wage or wages have been withheld for an unreasonable length of time.
You have been asked to do something which is clearly unethical or illegal.
Personal or family circumstances are such that you need to leave the job.
A crisis has happened in your life, and there is no way you can continue on the job.

Remember it WILL be the residents who suffer the most when you leave. If you have relationships with them, cutting out without notice will be especially painful for them. It will feel like a death in their family. Only you can decide but it seems to me there are better reasons to give the 2 week notice than there are to just walk off the job.

Observation Skills for DSP’s

When we think about it, DPS’s are the eyes, ears, hands and nose of clients’ medical teams (PCP, agency nurses). We use these senses when providing care and with the right skill, we can assist the team with valuable information that may avert a serious problem. Things get confusing though when we make judgments about the things we’re seeing, feeling, smelling and hearing.

There are two types of observations.
Subjective and objective.

Objective observations are fact. They are measurable.
• Vital Signs
• Bruises
• Open Areas and other skin conditions
• Blood in urine
• Urine output from a cath

Objective observations are reported in the same manner by many people. They are not biased and they do not rely on statements and guesswork.

Subjective observations are made by the patient:
• “I have a headache”
• “I feel sick to my stomach”
• “My sugar levels are off”

How we observe
Using our eyes we see things:
• Broken skin, open areas, cuts, bruises
• Blood- in urine, in and around the mouth
• Changes in the patient’s ability to walk, speak, eat

Using our hands we feel things:
• Pulse
• Skin temperature (warm, cool)
• Lumps and bumps under the skin

Using our ears we hear things:
• B/P readings
• Respiration problems (wheezing, coughing)
• Patient’s statements

Using our noses we smell things:
• Body odors
• Foreign odors not normal to what we are doing (gas and oil, chemicals and the like).

Subjective observations are reported by the individual and are just as important as objective observations, except they are not measurable.

The medical team need to know when clients have complaints such as those listed above. DSP’s cannot pass judgment on these statements.
It’s not in our role to do so. Our job is to REPORT the statements, accurately and without added
flair. I often see DSP’s report observations- with their own opinion added in. This isn’t necessary and it’s not good to do. Just the basics is all that is needed. If you’re asked for more information, like, “What do you think is going on?” then by all means give your opinion. But don’t offer it up front as part of the observation.

Examples of DSP statements that are not correct:
Incorrect:
“Mrs. Smith says she has a headache. She does this whenever it’s her bath time!”
Correct:
“When I went to assist Mrs. Smith with her bath she stated that she had a headache.”

Incorrect:
“Mr. Jones ambulated ten feet today; he said his foot hurt…yesterday he was fine and walked a hundred feet and his foot didn’t hurt! He’s being lazy.”
Correct:
“Mr. Jones ambulated ten feet today.”

Incorrect:
“Ms. Hawthorne had a really loose BM and it smells like C Diff.”
Correct:
“Ms. Hawthorne had a loose BM that was very foul smelling.”

I think we get the picture here. Many of the things we know from experience with our work turn out to be true. Ms. Hawthorne probably does have C Diff…we can tell by the odor. BUT it’s not up to us to report that as fact. Are we absolutely sure Mr. Jones is being lazy? What makes us assume that? IS it possible that his foot really does hurt? As DSP’s, our job is NOT to make assumptions and diagnose conditions. We observe, we report. It’s pretty simple. No need to embellish our reports with our own opinions. We’re not always right.

Observations must be accurate.
Observations must be made in a timely manner and when necessary the medical team must be notified of unusual findings.
Observations must be free of our opinions and bias.
Report patient statements word for word…directly quoted. Don’t add your own thoughts.

Everything You Want To Know About Being a Direct Care Professional

You’re thinking about becoming a DSP. You’re excited and want more information about this career. Some questions you might have deserve answers, and here we will try to do that.

What is a DSP?
Direct Support Professional, also known as personal care assistants, caregivers, home health or personal care aides, residential counselors and CNAs give assistance to people who are sick, injured, mentally or physically disabled, or the elderly and fragile. DSPs provides a variety of supports to people with disabilities in their homes or on the job. Most of these individuals need assistance with a variety of day-to-day events such as: household chores, getting ready for work, going out and having fun with friends and family, meeting new people and being active members in community organizations and places of worship, running errands like going to the bank, the doctor, or the grocery store, or performing work tasks.

As a direct support professional, you will spend most of your shift in direct contact with the people who need assistance.

  • DSPs support many people who have physical disabilities and who need assistance such as transferring from a bed to a wheelchair, from a wheelchair onto a toilet, or from a wheelchair into a bathtub. Although in many situations you will have equipment to assist you, to support these individuals it will be important that you are able to lift 50 pounds or more. Some individuals may also need assistance with all of their self-care needs, including help in changing adult disposable briefs.
  • Some of the people who receive supports from DSPs have challenging behaviors. This might mean that, depending on the situation, a person who you are supporting could yell at you, call you names, pinch you, spit on you, throw something at you or hit you. This may sound scary at first, but with training, many new direct support staff with no prior experience have learned how to respond to people in a way that helps them calm down and move on. It is critical to pay attention to the training. Many people who have challenging behaviors also work with psychologists or behavior specialists. These professionals work with direct support staff to develop and implement plans designed specifically to help people with challenging behaviors learn new positive ways of expressing themselves.

The Direct Support Professional maintains positive and professional relationships with the individuals served, their families/guardians, their peers, community partners and government agencies and assists in the implementation of Individual Support Plans for individuals based on assessments, objectives, and goals.

Direct support professionals may be expected to take a course in medication administration, first aid, and CPR. Once trained, you will give medications to people to whom they are prescribed. Direct support staff may also provide certain prescribed medical treatments, such as tube feeding, glucose testing, or administering suppositories. You will be expected to document all of the medications you administer and all of the treatments you provide each and every time you complete these tasks. You will also be responsible for monitoring the general health and safety of all the people who you support. The training for all of this is comprehensive.

Will I Make A Good Direct Support Professional?

How do you know you will be good at direct support work? Here are some of the traits of a good direct support professional:

  • Caring and compassionate
  • Honest and loyal
  • Accepting of others as they are
  • Flexible and dependable
  • Punctual
  • Shows initiative and creativity
  • Hard working and a team player
  • Interested in learning
  • Good at communicating with others
  • Respectful of other people

Am I qualified to be a DSP?

Qualifications, based upon average state requirements as well as typical agency requirements:

  • High school graduate or equivalent.  Additional experience with people with developmental disabilities preferred or as required by regulations.  Must be 18 years of age, or older.
  • As applicable, must possess a valid driver’s license and good driving record.
  • Additional certifications may be required by regulations. – Some positions may require access to vehicle in sound operating condition and proof of current auto insurance.
  • Clear background checks as defined by regulations and policies. –
  • Ability to lift at least 50 pounds. Ability to do daily standing, bending, and lifting. Must be able to stand for 8 hours at a time.
  • Interest in assisting people supported to achieve personal outcomes and to provide person centered supports. Must possess good verbal, reading, and written communication in English; basic math skills; and basic computer skills. Ability and willingness to successfully complete and apply training.
  • Must be certified to be free of communicable diseases by a physician (Tuberculosis/TB); have the ability to work effectively and harmoniously with others.

 2) Why be a DSP?
If you’re looking at a career in human services, being a DSP is a great way to really test yourself on this goal. Being a DSP exposes you to many members of the health care team: Doctors, nurses, therapists, social workers, service coordinators, program managers and others in action. You’ll soon know whether you have what it takes to further yourself in **residential** as it is often called; you may decide you want to start as a DSP and work your way up.
If you’re looking for a quick job to pay bills for a few months becoming a DSP might not be the right choice for you. Training requirements differ from state to state and agency to agency, but one thing is common: Assisting people with disabilities is hard work! It is physically demanding and you will need patience and compassion. You will want to pay close attention to your training to learn about all the skills required to do this work. Unlike CAN training where one learns the bulk of skills prior to job placement, DSPs often are expected to learn skills on the job.

Career DSP: You won’t get rich doing this for a living. DSPs don’t earn a high salary. You should be very aware of this. Many of who have been doing this for a long time notice new DSPs coming into the field, who get disillusioned over the pay. We’re paid by the hour; that rate is dependent upon several factors which include how much experience one has; what region of the country one works in and where employment is at.

In general, DSPs who work in a group home supporting disabled people earn an average of $10 to 14/hr to start, depending upon experience, level of education and any certifications and trainings already completed. DSPs can earn up to $18/hr as a national high.

3) Where can DSPs work?

  • Agencies that provide residential and day services to disabled people (Easter Seals for example)
  • Local Staffing Agencies
  • School Districts

4) How does one become a DSP?
It’s not hard: Apply for a position at any one of the above mentioned agencies. Almost all will hire you and train you. In many states there are mandated training requirements which can only be accessed once you are employed.

5) What Can I Expect during My first 90 days of employment at an Agency?

  • An orientation that lasts anywhere from 4 days to 2 weeks
  • CPR class
  • Resident Rights
  • Infection Control
  • Skills required to effectively manage and redirect physical behaviors
  • Agency policy and procedures
  • Abuse/Neglect Training/Reporting Requirements

 

There are many opportunities for DSPs to learn, grow and even become certified by national groups- one of the benefits to inquire about for employment would be whether agency provides access to such certification.

Good luck! If you choose to be a DSP, you will be rewarded in many ways.