Health Care Aide Role & Responsibility - Module 2

Legislation Governing Health Care Aides (HCAs) & Related Regulations

Health Professions Act (HPA)

• Purpose: Governs regulated health professionals working in Alberta.
• Regulated Professionals Included:
  • Registered Nurses
  • Registered Psychiatric Nurses
  • Licensed Practical Nurses
  • Registered Dieticians
  • Registered Social Workers
  • Physical Therapists
  • Occupational Therapists
  • Recreational Therapists
• HCA Status: Currently, Health Care Aides (HCAs) in Alberta are considered unregulated workers and are therefore NOT covered by the HPA.

Restricted Activities in Alberta

• These are identified by the Alberta Government Organization Act.
• Examples of Restricted Activities:
  • To cut a body tissue or administer anything by invasive procedure.
  • To insert or remove instruments, devices, fingers, or hands beyond:
    • The cartilaginous point of the ear.
    • The nasal passages narrowing.
    • The pharynx.
    • The opening of the urethra.
    • The labia majora.
    • The anal verge.
    • Into any artificial opening in the body.
  • To insert pressure, liquid, or air into the ear.
  • To set or reset a fracture.
  • To reduce a dislocation.
  • To prescribe medication.
  • To administer a vaccine or parenteral nutrition.
  • To prescribe or administer blood products.
  • To prescribe or administer diagnostic contrast.
  • To fit an implant or prosthesis.
  • To manage the delivery of a baby.

Delegation of Activities

• The Alberta Government Organization Act:
  • Authorizes regulated health professionals to perform restricted activities.
  • Authorizes others (including HCAs) to perform some of these activities under the supervision of a regulated health professional.
• Restricted Activities as Activities of Daily Living (ADLs):
  • When restricted activities are performed as part of a client's normal ADLs, they are not considered restricted activities.
  • Example: If a patient normally injects themselves with insulin $4$ times a day, an HCA may assist by gathering supplies or preparing the injection site. However, the HCA may NOT inject the insulin, as breaking the skin barrier is a restricted activity unless specifically delegated under strict conditions or it is part of the client's self-care they are merely assisting with.
• Exceptions to ADLs (Restricted activities that may be delegated even if not part of patient ADLs):
  • To insert or remove instruments, devices, fingers, or hands beyond the labia majora.
  • To insert or remove instruments, devices, fingers, or hands beyond the anal verge.
• Conditions for Delegation (Regulated Health Professional's Responsibilities): Before delegating to an HCA, the regulated health professional must ensure:
  • Proper instruction has been provided.
  • Supervised practice has occurred.
  • The HCA demonstrates competence to complete the activity on that particular client.
  • The client's condition is stable.
• Specific Requirements for Restricted Activities Assigned to HCAs:
  • The restricted activity or task is part of the routine activities of daily living for an individual client.
  • The HCA is specifically permitted by legislation or regulation to carry out the restricted activity.
  • The HCA has the consent and supervision of a regulated nurse.
  • Regulation is in place indicating how regulated members supervise unregulated workers, such as HCAs, while performing the restricted activity.
  • The HCA has received instruction and demonstrates competency in performing the task for a particular client.
  • The client will not be at risk if the procedure is performed by an unregulated care provider.
  • The client’s needs are stable, and the restricted procedure is an established part of the client’s care.
  • The outcomes of the restricted procedure are predictable.
  • The client and/or the client’s family have been involved in the development of the care plan and in the assignment of a restricted procedure to an unregulated care provider.
  • The client has been assessed by a regulated health professional, who will continue to be responsible for the evaluation and the outcomes of the care provided on an ongoing basis.
  • If healthy and able, the client would perform the restricted activity for himself or herself, such as self-catheterization.

Activities of Daily Living (ADLs) Breakdown

• Routine and/or invasive self-care activities (not restricted to):
  • Administering oral medications.
  • Removing slivers.
  • Cleaning wounds.
• Specifically taught procedures (generally result in predictable and stable responses, not restricted to):
  • Catheterization.
  • Oral suctioning.
  • Maintenance of drainage tubes.
  • Assisting in the administration of drugs by injection.
  • Assisting the patient to use the glucometer.

Case Study Application

• Scenario: An HCA is trained and has been performing intermittent catheterization for Mr. Jones for $4$ months as part of his daily routine. The HCA is then assigned to Mr. Jack, who also requires intermittent catheterization for urinary retention, but the HCA has not been specifically trained for Mr. Jack.
• Answer: The HCA cannot perform the catheterization for Mr. Jack without being specifically trained for that particular client. Delegation requires demonstrated competency for that particular client and an established part of that client's care plan.

Assignment Task Checklist for HCAs

Before performing an assigned task, an HCA should consider the following:

• Is the task within the legal limits of the role of the HCA?
• Is the task part of your responsibilities as listed in your job description?
• Do you have the proper training to perform the task competently? (Training can be part of your educational preparation or delivered by health professionals in the agency).
• Do you have adequate experience to safely perform the task, given the client’s condition and needs?
• Do you understand the purpose of the task?
• Can you perform the task safely under the current circumstances?
• Do you have the right equipment and supplies to safely complete the task, and do you know how to correctly use them?
• Are you comfortable performing the task?
• Do you have concerns about performing the task?
• Is there a client-specific care plan in the home that outlines the assigned task?
• Did you review the task with your supervisor and the regulated health-care professional, and do you understand what the supervisor expects?
• Were you given clear instructions and directions by the supervisor or health-care professional assigning you the tasks?
• Are you receiving the appropriate type of supervision for your level of demonstrated competency?
• Do you know where and how to seek assistance in an urgent situation?

Types of Supervision

• Direct Supervision: The health professional must be physically present. Required until the HCA is competent in performing the task.
• Indirect Supervision: The health professional is not present but is available for consultation if help is required.

Client Information and Rights

Health Information Act (HIA)

• Purpose: Sets out rules governing the collection, use, and disclosure of health information.
• Disclosure to Family/Friends: Care centres can generally inform family and friends about the client’s room location and general well-being.
• Client's Right to Restrict Information: Clients can choose to not have any information shared with their family.
• Confidentiality Obligation: You are legally and ethically obligated to keep all client information confidential.

Freedom of Information and Privacy (FOIP) Act

• Purpose: Governs access to information and protection of privacy in public bodies.
• Key Principles:
  1. Individuals have a right to know their own personal information.
  2. Individuals have a right to privacy; only those who need to see an individual’s personal information are allowed to do so.
  3. Individuals have a right to request corrections to information about them that is in the custody or control of a public body.
  4. Individuals and organizations have the right to request an independent review of any decision made by a public body under the FOIP Act.
  5. The public has the right to access records held by public bodies unless otherwise indicated by FOIP.

Personal Directive (PD)

• Definition: A legal document that provides instructions and/or names a person to make decisions in the event the individual becomes incapable of making their own decisions.
• Requirements for Validity: Can be handwritten, typed, or printed; must be signed, witnessed, and dated.
• Nature: Making a personal directive is optional and voluntary.

Goals of Care (GOC) Designations

• These designations outline the scope of medical interventions a client wishes to receive.
• R (Resuscitative Care - Level 1): Patients receive all possible interventions.
  • Chest compressions: $ext{✓}$
  • Intubate: $ext{✓}$
  • ICU (Intensive Care Unit): $ext{✓}$
  • Surgery: $ext{✓}$
  • Site Transfer: $ext{✓}$
  • Symptom control: $ext{✓}$
• M (Medical Care - Levels 2 and 3): Focus on medical treatment without full resuscitation.
  • Level 2:
    • Chest compressions: $ext{X}$
    • Intubate: $ext{✓}$
    • ICU: $ext{✓}$
    • Surgery: $ext{✓}$
    • Site Transfer: $ext{✓}$
    • Symptom control: $ext{✓}$
  • Level 3:
    • Chest compressions: $ext{X}$
    • Intubate: $ext{X}$
    • ICU: $ext{✓}$
    • Surgery: $ext{✓}$
    • Site Transfer: $ext{✓}$
    • Symptom control: $ext{✓}$
• C (Comfort Care - Level 1 and 2): Focus on comfort and symptom management.
  • Level 1 (Can consider, if required for symptom control):
    • Chest compressions: $ext{X}$
    • Intubate: $ext{X}$
    • ICU: $ext{X}$
    • Surgery: $ext{✓}$
    • Site Transfer: $ext{✓}$
    • Symptom control: $ext{✓}$
  • Level 2:
    • Chest compressions: $ext{X}$
    • Intubate: $ext{X}$
    • ICU: $ext{X}$
    • Surgery: $ext{X}$
    • Site Transfer: $ext{X}$
    • Symptom control: $ext{✓}$

Personal Information Protection and Electronic Documentation Act (PIPEDA - Alberta Context)

• Purpose: Protects the information of employees collected as part of the employment and payroll process.

Inappropriate Use of Technology

• Forgetting to log off your computer.
• Checking into other people’s health records or your own while logged in at work.
• Using social media while at work.
• Posting pictures of clients or information about clients on social media anytime.

Protection and Safety Legislation

Protection for Persons in Care Act (PPCA)

• Reporting Obligation: Anyone who reasonably believes that a person in care has been abused must report that abuse to an appropriate authority.
• Consequences of Failure to Report: Can lead to fines or imprisonment.
• Scope of Application (Persons in Care receiving services from):
  • Hospitals.
  • Nursing homes.
  • Lodges.
  • Group homes, facilities, and other health-care agencies funded to provide support and care in the province of Alberta.

Continuing Care Health Services Standards (CCHSS)

• Nature: Legislated, minimum requirement standards.
• Applicability (All health providers working in):
  • Home care.
  • Supportive living.
  • Long Term Care.
  • Adult Programs.
• Key Standards Include (but are not limited to):
  • Standardized Assessment and Person-Centred Care Planning.
  • Case Management.
  • Access to Physician or Nurse Practitioner Services.
  • Client Access to Information.
  • Palliative and End of Life Care.
  • Assistive equipment, technology, and medical/surgical supplies.
  • Sharing of client information.
  • Health care Providers.
  • Staff training.
  • Risk management.
  • Infection Prevention & Control.
  • Medication Management.
  • Nutrition and Hydration Management.
  • Oral care assistance and bathing frequency in publicly funded supportive living and long-term care facilities.
  • Safe bath and shower water temperature.
  • Restraint management.
  • Continuity of Health care.
  • Concerns resolution on health care and forming a council.
  • Quality improvement reporting.

Dependent Adults (Alberta Definition)

• An individual who:
  • Is $18$ years or older.
  • Is continuously or repeatedly unable to safely care for himself or herself.
  • Has a mental disability caused by a developmental delay, acquired brain injury, chronic mental illness, or a disease associated with aging.

Alberta Mental Health Act

• Purpose: Explains processes for individuals with mental health disorders regarding:
  • Apprehension.
  • Detention.
  • Treatment in a facility or community-based setting.
• Client Rights: Also explains the client’s rights in these circumstances.
• Formal Patient Requirements: For a person to be considered a formal patient, the doctor's examination must find:
  1. Mental Disorder: The person must have or appear to be suffering from a mental disorder.
  2. Likelihood of Harm/Deterioration: If not admitted, the person is likely to cause harm to themselves or others, or to suffer serious mental or physical deterioration or serious physical impairment.
  3. Unsuitable for Voluntary Admission: Generally means the client refuses to be admitted voluntarily.

Occupational Health and Safety Act (OHS)

• Increased Risk Factors for HCAs:
  1. Employees who travel away from the office to meet clients.
  2. Employees who are at risk of violent attack because their worksite is isolated from public view.

The Canadian Charter of Rights and Freedoms

• Relevant Freedoms that May Affect Care:
  • Freedom of religion.
  • Freedom of thought.
  • Freedom of expression.