Welcome to the Silver Lining online training program that will help to brush-up on your current skills and offer information to learn new skills. It is important to participate in each module because the exam at the end will include questions from each of the modules. You can spend as much time as you like reviewing the information provided in each of the modules.
Please take the test on your own, with no assistance from other resources. At the end of the training, there will be an online test. The test will have 50 questions. You will need to score 80 percent or above. In order to score 80 percent, you must get 40 questions correct. You can take the test as many times as it takes to pass. When you do pass and I am confident that you will, download your certificate, take a clear picture of it and text it to 215-806-5190 or email it to firstname.lastname@example.org.
This requirement must be completed on or before August 1, 2023. No extensions will be granted.
What Services DCWs are Allowed and Not Allowed to Provide?
Silver Lining Home Health Care, Inc. is licensed as a non-medical registry by the PA Department of Health. They mandate what the DCWs are allowed and not allowed to do.
The DCWs are permitted to empty a Foley Catheter Bag and they are permitted to change the Foley bag from day to night but they are not permitted to do anything with the catheter itself. When it comes to a Colostomy Bag, the DCWs are permitted to empty it, change it to a new one but they are not allowed to change the wax wafer.
DCWs are not permitted to give the client any medication directly out of the prescription bottle. They may remind the client that it is time to take their medication and hand them the bottle but they may not remove the medication directly from the bottle. If the client has a medication box, the DCWs are not allowed to fill the box.
DCWs are not permitted to administer eye drops of any kind. They are not permitted to attend to feeding tubes, give fleet enemas, give suppositories and perform wound care. DCWs are not permitted to do Accucheck finger sticks. They are not permitted to prepare insulin or give insulin injections. No injections of any kind may be given by a DCW. Nothing can be done by the DCWs that is invasive to the client.
DCWs are not permitted to use the client’s credit card or checks for any reason. They are not allowed to borrow money from the client or the client’s family and they are not allowed to assist the client with his/her finances. The DCW may be given no more than $50 in cash to make purchases for the client. The DCW must return with a receipt.
DCWs are not permitted to be the client’s power of attorney and they are not allowed to assume guardianship for the client or witness any client signatures on any forms or documents.
DCWs must contact Silver Lining when a client goes on Hospice as Silver Lining works in conjunction with the Hospice Company and the procedures for giving medication is different.
DCWs who do not keep their credentials that are mandated by the state up-to-date will not receive referrals for work and will not be paid for any assignments until their credentials have been made current.
How to Communicate with Silver Lining:
If you need to speak to a Coordinator, the Payroll Department or the Administrative team Monday to Friday 9 am to 4 pm, you must call 215-885-7701. This number will be answered by a live person. If for any reason the staff is working from another location, this number will be answered by our answering service, Holy Redeemer. They do not just answer the incoming calls for Silver Lining so please have patience.
If you need to submit your timesheet or any other form of documentation, you must email it to email@example.com. Your second option is to take a picture of your timesheet and/or documentation and text the picture to 215-806-5190. Lastly, you can fax your timesheet and/or documentation to 215-886-6985. When you email or text your timesheet and/or documentation to the sources noted above, your will receive a message acknowledging your submission. If you do not receive this acknowledgment by the end of the next business day, please contact us at 215-885-7701. If you choose to fax your timesheet and/or documentation, then you will have to call 215-885-7701 to confirm receipt. Sending your timesheet and/or documentation by any other method is not recommended. The other cell numbers that you have for coordinators are work phones and they are not monitored unless the person is on call.
How to Put on Elastic Stockings:
When a client has poor circulation to the legs and feet, elastic stockings are ordered. These stockings help prevent swelling and blood clots and improve circulation. These stockings are called “anti-embolic hose” or “elastic stockings”. They need to be put on before the client gets out of bed. The following is a step by step guide of how to put the elastic stockings on properly.
Alzheimer’s disease causes tangled nerve fibers and protein deposits to form in the brain, eventually causing dementia. The disease gets worse, causing greater and greater loss of health and abilities. There is no known cause of Alzheimer’s disease and there is no cure. Clients with Alzheimer’s disease will never recover. They will need more care as the disease progresses.
Alzheimer’s disease generally begins with forgetfulness and confusion. It progresses to complete loss of all ability to care for oneself. Each person with Alzheimer’s disease will show different symptoms at different times. For example, one person with Alzheimer’s disease may be able to read, but may not be able to use the phone or remember her own address. Another person may have lost the ability to read, but may still be able to do simple math. Skills a person has used constantly over a long lifetime are usually kept longer.
Encourage clients with Alzheimer’s disease to perform Activities of Daily Living (ADLs). Help them keep their minds and bodies as active as possible. Working, socializing, reading, problem solving, and exercising should all be encouraged. Having them do as much as possible for themselves may even help slow the progression of the disease. Look for tasks that are challenging but not frustrating. Help your clients succeed in doing them.
These attitudes will help you give the best possible care to your clients with Alzheimer’s disease:
Guidelines: Communicating with Clients Who Have Alzheimer’s disease:
Guidelines: Use the same procedures for personal care and ADLs for clients with Alzheimer’s disease as you would with other clients. However, there are some guidelines to keep in mind when helping these clients. These general principles will help you give the best care:
Guidelines: Caring for Clients with Alzheimer’s disease:
Below are some common difficult behaviors that you may face when working with Alzheimer’s clients:
Agitation: A client who is anxious, uneasy or nervous may display signs of agitation, such as throwing food, yelling or restlessness. Try to eliminate triggers. Keep routine constant. Avoid frustration. Help client focus on a soothing, familiar activity, such as sorting things or looking at pictures. Remain calm. Use a low, soothing voice to speak to and reassure the client. An arm around the shoulder, patting, or stroking may be soothing for some clients.
Sundowning: When a person becomes restless and agitated in the late afternoon, evening, or night, it is called sundowning. Remove triggers. Provide snacks or encourage rest. Avoid stressful situations during this time. Limit activities, appointments, trips, and visits. Play soft music. Set a bedtime routine and keep it. Recognize when sundowning occurs and plan a calming activity just before. Remove caffeine from the diet. Give a soothing back massage. Distract the client with a simple, calm activity like looking at a magazine. Maintain a daily exercise routine.
Violent Behavior: A client who attacks, hits or threatens someone is violent. Frustration, overstimulation, or a change in routine, environment, or caregivers may trigger violence. Look for ways to avoid these triggers. These are appropriate responses to violent clients:
Pacing and Wandering: A client who walks back and forth in the same area is pacing. A client who walks aimlessly around the house or neighborhood is wandering. Pacing and wandering may be caused by restlessness, hunger, disorientation, need for toileting, constipation, pain, forgetting how or where to sit down, too much daytime napping, or the need for exercise. Remove causes when you can. For example, give nutritious snacks and maintain a toileting schedule. Let clients pace and wander in a safe and secure (locked) area where you can watch them. Suggest another activity, such as going for a walk together.
Hallucinations or Delusions: A client, who sees, hears, smells, tastes, or feels things that are not there is having hallucinations. A client who believes things that are not true is having delusions. Ignore harmless hallucinations and delusions. Reassure a client who seems agitated or worried. Do not argue with a client whom is imagining things. Do not tell the client that you can see or hear his or her hallucinations. Redirect the client to other activities or thoughts. Be calm and reassure client that you are there to help.
Depression: Report signs of depression to the client’s family and to your coordinator immediately. It is an illness that can be treated with medication. Encourage independence, self-care and activity. Talk about moods and feelings if the client wishes. Be a good listener. Encourage social interaction.
Perseveration or Repetitive Phrasing: A client who repeats a word, phrase, question or activity over and over is perseveration. Respond to perseveration with patience. Do not try to silence or stop the client. Answer questions each time they are asked, using the same words each time.
Disruptiveness: Disruptive behavior is anything that disturbs others, such as yelling, banging on furniture, slamming doors, etc. Often this behavior is triggered by a wish for attention, by pain or constipation, or by frustration. When this behavior happens, gain the client’s attention. Be calm and friendly. Try to find out why the behavior is happening. Try to prevent this behavior, by noticing and praising improvements in the client’s behavior. Be tactful and sensitive when you do this. Do not treat the client like a child. Tell the client about any changes in schedules, routines, or the environment in advance. Involve the client in developing routine activities and schedules. Encourage the client to join in independent activities that are safe (for example folding towels). This can prevent feelings of powerlessness. Help the client find ways to cope. Focus on positive activities he or she may still be able to do, such as knitting, crocheting, crafts, etc.
Inappropriate Social Behavior: Inappropriate social behavior may be cursing, name calling or other behavior. As with violent or disruptive behavior, there may be many reasons why a client is behaving this way. Try not to take it personally. The client may only be reacting to frustration or other stress, not to you. Stay calm. Be reassuring. Try to find out what caused the behavior (for example, too much noise, too many people, too much stress, pain or discomfort). Respond positively to any appropriate behavior. It is important to report any physical abuse or serious verbal abuse to the client’s family and to your coordinator.
Inappropriate Sexual Behavior: Inappropriate sexual behavior, such as removing clothes, touching one’s genitals, or trying to touch others can embarrass those who see it. Be matter-of-fact when dealing with such behavior. Do not overreact. This may reinforce the behavior. Be sensitive to the nature of the problem. Try to distract the client. A client may be reacting to a need for physical stimulation or affection. Consider other ways to provide physical stimulation. Try backrubs, a soft doll or stuffed animal to cuddle, comforting blankets, or pieces of cloth.
Although Alzheimer’s disease cannot be cured, there are techniques that can improve the quality of life for clients with Alzheimer’s disease, such as the following:
Some clients spend much or all of their time in bed. Careful bedmaking is essential to their comfort, cleanliness, and health. Linens should always be changed after personal care procedures such as sponge baths, or any time bedding or sheets are damp or soiled, or in need of straightening. Bed linens must be changed frequently for these reasons:
If a client cannot get out of bed, you must change the linens with the client in bed. An occupied bed is made with the client in bed. When making the bed, use a wide stance. Bend your knees. Avoid bending from the waist, especially when tucking sheets or blankets under the mattress. Mattresses can be heavy, so remember to bend your knees to avoid injury. It is easier to make an empty bed than one with a client in it. An unoccupied bed is a bed made while no client is in the bed. If the client can be moved, your job will be easier.
Because one-half to two-thirds of our body weight is water, we need 64 ounces, or eight 8-ounce glasses of water or other fluids a day. Water is the most essential nutrient for life. Without it, a person can only live a few days. Water assists in the digestion and absorption of food. It helps with waste elimination. Through perspiration, water helps maintain normal body temperature. Maintaining fluid balance in our bodies is necessary for good health. Do not limit fluids if a client is incontinent unless his/her doctor has given written instructions to do so for another medical reason.
The fluids we drink – water, juice, soda, coffee, tea, and milk provide most of the water our bodies use. Some foods are also sources of water, including soup, celery, lettuce, apples, watermelon and peaches.
What Is Dysphagia?
Difficulty swallowing is clinically known as dysphagia and occurs when one’s esophagus does not function properly. When a person with dysphagia eats or drinks, they cannot swallow correctly. This swallowing disorder causes discomfort, coughing, choking and even aspiration of food particles and saliva into the lungs, which can lead to a serious, potentially life-threatening infection.
Doctors explain that difficulty swallowing can occur for a variety of reasons, including multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Parkinson’s disease (PD), stroke, and various forms of dementia. These conditions can affect the muscles and/or nerves involved in the process of swallowing. Other conditions can contribute to swallowing difficulties, such as gastroesophageal reflux disease (GERD) and growths in and around the esophagus.
There are recognizable, yet often subtle, signs and symptoms that indicate dysphagia. When these signs occur, it is important for caregivers to address them as soon as possible, doctors urge. Treatment and management will depend on an official assessment called a ‘swallowing study,’ which is commonly performed by a speech-language pathologist (SLP).”
Signs of dysphagia include:
The Connection Between Dysphagia and Dementia:
In Alzheimer’s and dementia patients, some degree of difficulty swallowing will occur during the disease trajectory, and it is a common indicator of disease progression. “In this case, the cause is a loss of gag reflex and/or decrease in level of consciousness, which requires increased care and supervision,” explain doctors.
Dementia progresses differently in each person, so it can be difficult to know what to expect and when. However, dysphagia often presents in late-stage dementia patients who tend to have difficulty communicating and may even be nonverbal. For this reason, dementia caregivers should watch carefully for any signs of swallowing issues. Doctors say aspiration pneumonia is one of the most common causes of death in Alzheimer’s patients.
If swallowing issues present in the early or middle stages of dementia, a family member may misconstrue the subtle signs and assume that their loved one is acting out or does not enjoy the food they are being served. However, perseverance and encouragement can’t solve this dilemma. Undiagnosed and untreated dysphagia could jeopardize a dementia patient’s well-being.
Treatment for Dysphagia:
The first thing to do is make a doctor’s appointment and see if a referral to a speech-language pathologist may be necessary. An SLP will run tests (such as a swallow study, if necessary) to assess the type and severity of a senior’s dysphagia and determine next steps for minimizing choking and preventing aspiration. Swallowing disorders are often managed through diet modification with a focus on texture and moisture levels.
The type of dysphagia diet an SLP prescribes will depend on the cause and extent of a senior’s swallowing difficulties. For some, a normal diet with emphasis on softer foods and smaller bites may be effective, while others may need their foods pureed and their liquids thickened to a certain consistency. Finding the right dysphagia diet requires the expertise of a speech-language pathologist, otherwise incorrect diet modifications can make eating and drinking with dysphagia more dangerous.
10 Ways to Make Meals Easier With Dysphagia:
Caregivers may grow impatient during meals as we sit and wait for each bite or sip to be swallowed. Handfeeding is one of the best approaches for those with more advanced dysphagia, but it can be especially trying. Doctors offer the following suggestions for facilitating mealtimes and promoting safe eating habits.
Struggling to Swallow and End-of-Life Care:
In many instances, such as temporary difficulties that result from a stroke or prolonged intubation, working with an SLP who specializes in dysphagia can maintain or restore a person’s ability to eat and drink safely. Each client is different, which is why a professional assessment is crucial for devising customized care and nutrition plans.
In other cases where dysphagia is related to a progressive neurodegenerative disease like Parkinson’s or Alzheimer’s, swallowing exercises, thickening agents and eating techniques recommended by speech-language pathologists will eventually lose their effectiveness. Sadly, as these conditions progress, so does the severity of swallowing difficulties. Put simply, seniors with late-stage dementia “forget” how to swallow, lose weight and become increasingly frail.
“Once dysphagia becomes so severe that swallowing is no longer possible, the disease may have progressed to the point of considering an evaluation for hospice care,” Doctor’s advise. “For example, weight loss and the inability to feed oneself and swallow are fundamental hospice criteria. An evaluation by a hospice professional would be appropriate to determine if end-of-life care is appropriate.”
Feeding tubes are often presented as an option for preventing dehydration and malnutrition in seniors with severe dysphagia, but this treatment option is an invasive one with limited success. For this reason, many seniors specify their preferences for life-prolonging treatments like tube feeding using written advance directives to guide their caregivers.
What are bedsores?
What causes bedsores?
A bedsore develops when blood supply to the skin is cut off for more than 2 to 3 hours. As the skin dies, the bedsore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and the area can become infected.
A bedsore can become deep. It can extend into the muscle and bone. Once a bedsore develops, it is often very slow to heal. Depending on the severity of the bedsore, the person’s physical condition, and the presence of other diseases (such as diabetes), bedsores can take days, months, or even years to heal. They may need surgery to help the healing process.
Bedsores often happen on the:
What are the stages of bedsores?
Bedsores are divided into 4 stages, from least severe to most severe. These are:
A wound is not assigned a stage when there is full-thickness tissue loss and the base of the ulcer is covered by slough or eschar is found in the wound bed. Slough may be tan, grey, green, brown, or yellow in color. Eschar is usually tan, brown or black.
How are bedsores diagnosed?
Healthcare providers diagnose bedsores by inspecting the skin of those at risk for them. They are staged according to their appearance.
How are bedsores treated?
Specific treatment of a bedsore is discussed with the client and/or the client’s family by their healthcare provider and wound care team and based on the severity of the condition. Treatment may be more difficult once the skin is broken, and may include the following:
Healthcare professionals will watch the bedsore closely. They will document size, depth, and response to treatment.
Can bedsores be prevented?
Bedsores can be prevented by inspecting the skin for areas of redness (the first sign of skin breakdown) every day with particular attention to bony areas. Other methods of preventing bedsores and preventing existing sores from getting worse include:
What is a TIA?
A Transient Ischemic Attack (TIA) is often called a mini-stroke, but it is really a major warning.
TIA is a temporary blockage of blood flow to the brain. Because most TIA symptoms last from only a few minutes up to 24 hours, they are often dismissed and not taken seriously. But this is a big mistake. TIAs may signal a full-blown stroke ahead.
When you first notice symptoms, get help immediately.
TIA Risk Factors:
Anyone can have a TIA but the risk increases with age. If you’ve previously had a stroke, pay careful attention to the signs of TIA, because they could signal a second stroke in your future.
Some common warning signals include sudden onset of the following:
The risk factors are smoking, cardiovascular disease, diabetes and blood clots called embolisms.
Get help immediately if you think you could be having a TIA. Trained medical staff will need to evaluate your condition. Some signs are only visible with hospital equipment.
When a TIA occurs in a young person with no clear risk factors, the patient might be sent to a neurologist for testing to rule out vasculitis, carotid artery dissection and other types of injury or infection.
Warning of Future Strokes:
TIAs are often called “mini-strokes” because their immediate consequences are fairly benign. But the term “warning stroke” is a better label, because a TIA usually foreshadows a full-blown stroke.
TIAs are caused by a clot or blockage in the brain. The blockage is short term. The clot will usually dissolve on its own or it gets dislodged, and the symptoms usually last less than five minutes.
The statistics tell the story:
Facts about Falls:
Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people fall each year but less than half tell their doctor. Falling once doubles your chances of falling again.
What Can Happen After a Fall?
Many falls do not cause injuries. But one out of five falls does cause a serious injury such as a broken bone or a head injury. These injuries can make it hard for a person to get around, do everyday activities, or live on their own.
What Conditions Make You More Likely to Fall?
Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:
Most falls are caused by a combination of risk factors. The more risk factors a person has the greater their chances of falling.
What You Can Do to Prevent Falls:
Falls can be prevented. These are some simple things you can do to keep yourself from falling.
Do Strength and Balance Exercises:
Do exercises that make your legs stronger and improve your balance. Tai Chi is a good example of this kind of exercise.
Have Your Eyes Checked:
Have your eyes checked by an eye doctor at least once a year, and be sure to update your eyeglasses if needed.
If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.
Make Your Home Safer:
Now that you have reviewed all the above information, it is time to see what you have learned.
Please take the following quiz and if you pass, you will have completed a state mandated requirement and be given a Passing Certificate!