Document up to three regular PCA
visits per day.
The 4th late visit
PCA must be used only for live in PCA’S who have signed an overtime contract
with Independence Plus. Inc. These hours must be between 10PM and 7AM.
There is One
Homemaking visit, chore visit and or
respite visit.
This form
is not to be used for shared care.
Dates of Service:
In order for the time card to be
valid you Must enter the date in mm/dd/yy format for each date you
provide service. The recipient must draw a line through any dates and times
the services were not provided.
Activities:
For each date that you provide care, write your initals next to all activities
you provided Your initials indicate you provided the service as described in
the PCA Care Plan or other agreement. If you provide the service more than
once a day initial only once. The following are general descriptions of
activities of daily living and instrumental activities of daily living:
Dressing- Appropriate
clothing for the day, includes laying-out of clothing, actual applying and
changing clothing, orthotics, prosthetics, transfers, Mobility and positioning
to complete this task
Grooming- Personal
hygiene, includes hair care, oral care, nail care, shaving, applying cosmetics
and deodorant, care of eyeglasses, contact lens, hearing aids and applying
orthotics.
Bathing- Starting and
finishing a bath or shower, transfers mobility, positioning, using soap,
rinsing, drying, inspecting of skin applying lotion.
Eating- Getting food
into the body, transfers, mobility, Positioning, hand washing, applying of
orthotics needed for eating, feeding, preparing meals and grocery shopping.
Transfers- Moving from
one seating/reclining area or position to an other.
Mobility-Moving from
one place to another including using a wheelchair.
Positioning- Moving
the persons body for necessary care and comfort or to relieve pressure areas.
Toileting-
Bowel/bladder elimination and care, transfers, mobility, positioning, feminine
hygiene, using the toileting equipment or supplies, cleansing the perineal
areas and inspecting skin and adjusting clothing.
Light Housekeeping-
Light housekeeping may include washing dishes, putting dishes in dishwasher,
clearing tables, taking out garbage, making bed and cleaning bathroom. This
may also include vacuuming, sweeping, and mopping of floors. This is used for
Homemaker services.
Laundry- Laundry
integral to personal care, includes sorting clothes, putting clothes in washer
and dryer, adding soap and /or dryer sheet, folding and putting away clothes.
Health-related Functions-
Hands on assistance, supervision and cueing for health related task under the
direction of a Qualified Professional or the person’s physician.
Behavior- Redirecting,
intervening, observing, monitoring and documentation of behavior.
Chore- This is a
service in which a client must be pre-approved for before doing this activity.
Respite- This is a
service in which the client must be pre-approved for before doing this
activity.
