Attendant Care Education ACE Granite State Independent Living

Attendant Care Education (ACE) Granite State Independent Living Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Jenny’s Story This is my Journey: Jenny’s Road to Independence with GSIL’s Personal Care Services After suffering a major Spinal Cord Injury (SCI), Jenny talks about her recovery and experience in the Personal Care Attendant (PCA) program at Granite State Independent Living. PCA Journey Video: http: //youtu. be/-e. X 3 x. E_MIh 0 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

https: //www. youtube. com/watch? v=Gdhu-8 DXS 3 I 3 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

4 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Granite State Independent Living, a bit of history • GSIL was established In 1980 • GSIL is the only Independent Living (IL) Center in New Hampshire • As the IL Center for NH, GSIL provides services to individuals on Medicaid who have a disability as well as the elderly and those who are chronically ill • GSIL supports 5 core services under the IL umbrella: § Information and Referral § Peer Support § Skills Training § Advocacy § Transitional Services Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Independent Living Philosophy The Independent Living philosophy represents that people with disabilities should have the same civil rights, options, and control over the choices in their lives as do people without disabilities. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

What is Consumer Direction? Consumer: At GSIL we refer to the person requiring services as a consumer. (Other known terms for consumer are client or customer). Consumer Direction: Allows consumers to chose the Who, What, Where, & When of care: – – Who they want for Attendant Care Workers What non-medical services will be performed Where the services will be rendered, either home or at work When they want services to be provided Consumer Direction: Gives the consumer the ability to run their own program including: – – – Interviewing Hiring Training Scheduling Supervision and management of the Attendant Care Workers coming into their home Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Consumer-Direction or Self. Direction • Helps people of all ages with all types of disabilities maintain their independence at home by choosing the services and supports that work best for them • The Consumer-Directed Program is the largest and longest running program at Granite State Independent Living, with over 800 Attendant Care Workers (ACW) helping our consumers with their needs Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Research Supports Consumer- Direction Research has shown that consumer-directed ACW programs: • Improve a consumer’s health outcomes, because they are in control • Improve consumer satisfaction with how they lead their lives • Reduce a consumer’s unmet personal care needs by providing individualized service • Provide a cost savings by allowing a consumer to remain at home longer and not be institutionalized • Reduce the use of high cost services (ie: Nursing, LNA), because basic services are provided • Does not increase the incidence of fraud and abuse Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org 9

Programs associated with GSIL • • • PCA: Personal Care Attendant Program PCSP: Personal Care Service Provider Program HCSP: Home Care Service Provider Program CED: Community Economic Development Deaf and Hard of Hearing Information and Referral Transportation Employment Transitional Services Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Personal Care Services Personal Care Attendant Personal Care Services (PCA) Program (PCSP) Program q With PCA, services are Must be Medicaid eligible q q Must be 18 or older and have a severe physical disability q q Must require a wheelchair for mobility; q Must require at least 2 hours of personal care daily q q Family members cannot be employed as an Attendant Care Worker (ACW) in the PCA Program q Agency Directed (HCSP) Program Must be eligible for the Medicaid Choices for Independence (CFI) Waiver q Must have the ability to selfpay for services or be eligible for the Medicaid Choices for Independence (CFI) Waiver Must be 18 or older with a chronic illness or disability or a q Must be a senior or adult 18 senior needing services years or older, with long or short-term care needs or a Does not need to be a senior or adult 18 years or a wheelchair user chronic illness or disability May have a personal care rep (PCR) manage their care q Does not need to be a wheelchair user Services are provided at home, work, or in the community, and q May have an authorized rep to may also be provided in a long Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● assist with managing program q Services can be provided in www. gsil. org -term care facility the home or to access the q Family members may be employed as an ACW q

People First Language • • • Incorrect: Correct: Incorrect: Correct: He/She is disabled/handicapped/crippled He/She is a person with a disability He/She is wheelchair bound/bed bound He/She is a person who uses a wheelchair He/She is blind He/She is a person who has a visual impairment He/She is deaf/dumb He/She is a person who has hearing impairment He/She is retarded/mentally defective He/She is a person with developmental disability He/She is a crazy/a schizo/a mental patient He/She is a person with schizophrenia/ is a person with mental illness Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

GSIL is the Co-employer for all Attendant Care Programs ü ü ü Process all new hire paperwork Process employee criminal record Verify timesheets/hours/and pay worker Ensure proper payment and payroll taxes, workers compensation and liability insurance Administer benefits Answer worker related questions Monitor quality of care Record/report injuries Responsible for fostering a healthy and safe work environment Mailing employee W-2 report at end of each year Ensuring compliance with all NH and federal labor laws Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

GSIL Roles and Responsibilities • Provide RN Service Coordinator oversight for PCA Program • Provide Service Coordinator oversight for PCSP Program • Provide ongoing skills training for consumers • Provide employee management support for consumers • Provide Human Resources support for consumers and their workers • Provide consumer/worker mediation & conflict resolution support • Maintain “My GSIL” website consumer portal, providing access to all information necessary to manage the consumer directed program • Manage and update the ACW Registry • Bill Medicaid for the services provided Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Consumer Responsibilities The Consumer is responsible for: • Using the Consumer Reference Sheet to develop a list of daily tasks for their ACW • Confirming hours daily and signing timesheets weekly or follow the Telephonic clock in/clock out process of reporting time and tasks • Submitting timesheets to GSIL in timely fashion according to policy • Participating in bi-monthly contact with their LTS coordinator • Abiding by the policies and procedures of GSIL as noted in the handbook • Developing an emergency back-up plan • Supplying attendant care workers with gloves Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Attendant Care Worker (ACW) Roles and Responsibilities Attendant Care Workers Must: • • • Make a commitment to maintain confidentiality Be able to perform duties of the job Have sensitivities to individuals with disabilities Be dependable, responsible, patient, have effective communication and interpersonal skills. Demonstrate a willingness to be trained and supervised by a consumer with a disability Provide quality care Dress appropriately Review the consumers reference sheet (also referred to as a care plan) and provide only authorized services Report true and accurate times & tasks that match care plan Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Attendant Care Worker Billable Tasks Specific job duties are detailed on each consumer’s care plan (reference sheet) & may include: • Assisting consumers with personal care activities such as bathing, washing hair, grooming, shaving, nail care, skin care, and oral hygiene • Assisting consumers with housekeeping tasks which may include: sweeping, mopping, dusting, laundry, meal prep (including modified diets), and grocery shopping. • Assisting consumers with transfers(slide board, stand pivot, Hoyer, & etc. ) • Assisting with toileting or specific bowel and bladder programs and equipment (including emptying catheter bags, incontinence supplies, ostomy care) • Assisting with medication administration (except injectable meds), repositioning, range of motion exercises. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Plan of Care (Also referred to as Consumer Reference Sheet) • GSIL uses person-centered planning to assure that each consumer has a personalized plan of care created with them around their specific needs • Only tasks listed on this plan of care may be done during your work shift - these are detailed on each consumer’s reference sheet • If it is not on the plan of care and the consumer is asking for it Please contact LTSC to have it added to POC as long as the task is an allowable task Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Plan of Care Tasks not allowed • “Heavy” housework, such as washing windows and walls • Emptying a litter box, giving a dog a bath • Any animal related task unless it is for a qualified Service Animal or MD ordered companion animal, and listed on plan • Yard work including mowing, raking, and trimming • Putting up or taking down holiday decorations • Playing cards or games Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Important Miscellaneous info. . • Housekeeping tasks are for consumer only: If other people live in the home you are not responsible for cleaning up after them and you cannot do family laundry, dishes, meal preparation, & etc. • Have appropriate relationships and maintain boundaries with consumers • Social Media Conundrums: Should you or shouldn’t you? • Never borrow money from your consumer or accept gifts/or money • Hours worked as a PCA or PCSP are not counted towards LNA hours NOTIFY GSIL IF CONSUMER IS ADMITTED TO HOSPITAL OR INPATIENT FACILITY Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Roles of LTS RN Coordinators and LTS Coordinators • Conduct face to face visits every 60 days • Develop & review person-centered care plan with consumer • Provide skills training to consumers to ensure compliance and assist with managing their ACW’s. • Act as a resource for consumers and ACWs • Collaborate with consumer to ensure a safe work environment for Attendant Care Workers • Assist consumer with recruitment of ACWs as needed Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Communication • The importance of listening: Carefully listen to what your consumer is trying to say. Try not to interrupt, stay alert, be open to suggestions, and never try to finish sentences. • Following and Clarifying Directions: Your consumer would rather have you seek clarification than complete a task incorrectly. If you think you heard something wrong, ask to have it repeated, or repeat back what you heard to see if that is correct. • Negotiations with supervisor: There will be times when you need to work with your supervisor creatively to have both your needs met. Work towards a comfortable compromise by discussing challenges and possible solutions • Difficult conversations: Set aside time to discuss issues that come up. Describe your concern clearly using “I” statements. Allow time for both to share concerns: its not a contest to see who wins. Remember that working through a problem together can lead to a stronger working relationship. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

De-Escalation Techniques Sometimes people experience events in their lives that they react to in a manner that might be challenging for the worker in the home. Here, we discuss some techniques to diffuse a difficult situation. • Be empathetic and non-judgmental – Try to remember that whatever that person is going through at that moment might be the most important thing in their life. • Respect personal space – If possible stand 1. 5 to 3 feet away from someone who is escalating. If you must enter someone’s personal space to provide care, explain your actions so that the person feels less confused or threatened. • Use non-threatening non-verbal techniques – The more a person loses control the less likely they are to hear words. Keep your body language and tone neutral. Be mindful of your gestures and facial expressions. • Avoid overacting – Remain calm, rational, and professional. This can help how you respond in situation and will help your consumer to regain control. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

De-Escalation Techniques, Continued • Focus on Feelings – Watch and listen carefully for the person’s real message. Use supportive words and phrases such as “That must be scary” lets the consumer know you hear their concerns. This may result in a positive response. • Ignore Challenging Questions – When someone challenges your authority, redirect their attention to the issue. Focus on the person not the challenge. How can you work together to solve the problem. • Set Limits – Be clear, speak simply, and offer the positive choice first. • Allow Silence for Reflection – Silence can be a powerful communication tool and all the chance to reflect on what’s happening. • Allow time for decisions – If someone is upset they can’t think clearly. Stress rises when someone is rushed. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

De-Escalation Techniques, Continued • REMEMBER 4 SIMPLE RULES • It’s better to solve the situation than be right, e. g. never correct the person or personalize your comments • Show empathy, e. g. use active listening and validate the persons feelings • Look like you mean it, be aware of posture, tone, facial expressions, and use eye contact when appropriate • Provide productive solutions not absolutes, ask “What can I do to help you? What do you see as a solution to this problem? ” Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Establishing and Maintaining Boundaries • Boundaries define the limits and responsibilities of the people with whom you interact with in the workplace. • Remember that both parties hold the right and responsibility of maintaining boundaries and respect goes both ways. • Keep your personal life personal, do not bring it into the work place. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Boundaries What are Professional Boundaries? • Clearly established limits that allow for safe connections between workers and consumers. • Being friendly, not friends. • A clear understanding of the limits and responsibilities of your role. The Importance of Boundaries: • • Role modeling to the consumer healthy communication and professional relationships. Avoiding the “rescuer” role. Avoiding burn-out (“compassion fatigue). Staying focused on helpful and appropriate services to the consumer. Consequences of loose or poor Boundaries: • • Compassion fatigue – the worker’s role may not feel sustainable. Consumer may feel betrayed, abandoned, and/or poorly served. Workers may act unethically. Workers and consumers may be emotionally attached. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Boundaries, Continued Money $$ • Example: The worker tells the consumer that they are having money problems and that they won’t be able to get to work because they won’t have gas money. The consumer gets worried that they won’t have help, so they give the worker gas money. The worker accepts the money and promises to pay back the consumer. Remember, it’s never appropriate for a worker to ask a consumer for money, tell a consumer about their private life or accept money from a consumer, even if its offered. Nor should you lend money to consumers if asked. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Sexual Harassment The EEOC (Equal Employment Opportunity Commission) defines sexual harassment as: “Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature, when this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance, or creates an intimidating, hostile, or offensive work environment” Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Examples of conduct that may be unlawful • • • Unwanted invitations, notes, or flirtations Offensive jokes, pictures, or comments Same sex harassment Inappropriate touching Inappropriate texts, emails, postings Sex as an implied condition of employment (Quid Pro Quo) • Harassment by a customer, consumer or vendor Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Employees’ Responsibility § Don't ignore what is happening. Do not let behaviors that seem small keep happening, because they most likely will get worse instead of better. Tell the offender that you dislike their behavior and it needs to stop immediately. § Don't let someone accuse you of not having a sense of humor, you are simply asking to be treated with respect. § Don't blame yourself for what is happening. It is the harasser who is responsible for what is happening. § Know your rights for a harassment-free environment. Sexual harassment is illegal and you have the right to complain to the proper authorities when it happens. § Reach out to your Coordinator or Human Resources immediately. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Remember It’s not the intent of the action, it’s the impact the action has Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

SAFETY IN THE WORKPLACE Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Fire Safety • Make sure you know location of fire extinguishers • Call 911 in event of fire! Safety for you and your consumer first • Know your surroundings • Know where emergency exits are in the event you need to exit in a hurry • Make sure the exists are cleared • Talk to your consumer about an evacuation plan BEFORE an emergency 34 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Fire Hazards Electrical Hazards: • Check for frayed wires that can cause electrical fires • Make sure outlets aren’t overworked Emergency Preparedness: • • • Make sure smoke detectors are working Have a fire extinguisher in the home Know how to operate appliances and equipment Discuss and practice evacuation routes Have a SALI form on file with NH EMS Discuss concerns with your consumer and coordinator as needed Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org 35

General Emergency • In the event of emergency the ACW may need to call 9 -1 -1 (know the address you’re calling from) • Notify GSIL once emergency is over to inform of circumstances • Remember to fill out change of status form and note this on your timesheet once the emergency is resolved Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Work Safety • • Avoid coming into contact with any needles/sharps Avoid any repetitious movements/activities Familiarize yourself with toxic house hold cleaners (if any) Use standard precautions and proper handwashing techniques to avoid spread of germs and bacteria Don’t overexert yourself Lift with legs not back Get plenty of rest Eat a well balanced diet • If you get hurt on job you MUST call GSIL within 24 hours of incident 37 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Body Mechanics Always Wear shoes that will protect your feet from injury, give you a firm foundation, and keep you from slipping. Keep your feet flat on the floor and separated about 12 inches. Keep your back straight, lower your body to get close to the object. Bend from your knees. DO NOT bend at the waist. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Transfer Equipment in the Home In home transfer equipment may include: • • • Hoyer Lifts Slide Boards Stand pivot Stand lifts Barrier free lifts Whatever the transfer method, the consumer or designated representative will train you Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org 39

YOU TUBE: Childs Play Safe Lifting https: //www. youtube. com/watch? v=Mh. GUk. W AA 9 WM 40 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Change of Status or Condition in your Consumer A change in status might include: • Difficulty Breathing • Witnessed fall • Uncontrolled bleeding • Choking • Allergic reaction • Development of decubitus ulcer • Witnessed loss of consciousness • Change in sleep pattern • Missed dose of medications • Unresponsive consumer • General malaise/fatigue • Chest pain Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

What to do if you have concerns regarding a consumer’s health Remember • Discuss your concern with your consumer • Fill in the status change bubble on your timesheet • Complete the change of status form • Report the concern to LTS Coordinator Your consumer is an adult and has the same rights and choices to make healthcare decisions that you do. Our job is to ensure that each consumer is informed of concerns and aware of options. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Universal Precautions The term, “universal precautions” refers to the practice of safety that includes treating all human blood and other potentially infectious material (OPIM) as if known to be infectious. Ways to protect yourself and your consumer are: – Always wash your hands before and after providing direct care – Always wash your hand before preparing, serving, and feeding meals – Wear gloves whenever blood is present, visible, or when handling bodily secretions (such as vomit, urine, stool), when cleaning urinals, urinary bags, bedpans, soiled linens, or laundry – Wear gloves when coming into contact with any open areas or breaks in skin, dirty dressings, or providing oral care – Use gloves when cleaning dirty tissues, or cleaning up sputum Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Proper Hand Washing Techniques • Wash your hands with warm water and soap • Scrub between fingers, under nails, and up to your wrists • Wash for a period of 30 -45 seconds (as long as it takes to say ABCs) • Rinse with fingers facing down towards the drain • Thoroughly dry your hands 44 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Bloodborne Pathogens Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

What is a Bloodborne Pathogen? • Microorganisms that are in the blood or other body fluids that can cause disease in humans Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Common Types of Bloodborne Pathogens • Hepatitis B (HBV) • Hepatis C (HCV) • Human Immunodeficiency Virus (HIV) • Ebola Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Potentially Infectious Bodily Fluids • • Blood Saliva Vomit Urine Semen or vaginal secretions Stool Mucus Tears Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Infection Control The basic way to prevent the spread of infection is to remember the infection triangle. Three things need to be linked together to create an infection. These are: – The infectious microorganism (germ) – The susceptible host (patient or worker) – The transmission (spread of the germ) to a susceptible host All of these things must be present for an infection to occur. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

INFECTION TRIANGLE GERM HOST TRANSMISSION Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

How do Germs, Viruses and Infections Spread? • Droplet contact - coughing or sneezing • Direct physical - touching an infected person including sexual contact • Indirect physical – touching soil or a contaminated surface • Airborne - if organism lives outside body • Fecal oral route - e. g. consuming contaminated food or water 10/31/2020 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Things that can Affect an Individual’s Susceptibility to Infection: • Stress • Nutrition • Genetic makeup • Low white blood cell counts e. g. a person with leukemia • Compromised immune systems, recent illness Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Spinal Cord Injuries Spinal cord injuries of any kind can result in: • pain • stinging • loss of movement • loss of sensation • loss of bladder or bowel control • muscle spasms • loss of sexual function • difficulty breathing or swallowing Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Two Types of Spinal Cord Injuries Complete Incomplete • A complete spinal cord • An incomplete spinal injury means that there cord injury means that are no functioning there is some function nerves remaining that remains below the level of injury Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Autonomic Dysreflexia • A serious, sometimes emergency condition, referred to as an AD reaction • It is response to an abnormal stimuli (usually below the level of injury) • When the spinal cord is injured, the signal that something is wrong is unable to get to the brain. This may lead to the activation of autonomic nerves causing blood vessels to constrict causing a spike in blood pressure above the level of injury Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Autonomic Dysreflexia, Continued Indications that a consumer may be experiencing AD: 1. 2. 3. Flushing (redness of the face and neck) Sweating Complaint of a pounding headache What should you do: 1. 2. 3. Talk to your consumer and ask them if they are experiencing an AD reaction Follow their instructions If issue is not resolved or symptoms become worse call 9 -1 -1 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Neurogenic Bowel and Bladder • Sometimes individuals with SCI or other nerve based disability may have a condition called neurogenic bladder or neurogenic bowel • In these cases the consumer will not be able to urinate or have a bowel movement without assistance • If you work for a consumer who lives with supported independence in the community and requires additional care for these issues, you will receive specialized training 57 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Blind and Low Vision • Blindness does not affect intelligence or hearing. Be yourself, relax, and speak directly to the person who has the visual impairment in a normal voice. Always identify yourself, and when you leave, say you are doing so • Just because a person has a visual impairment doesn’t mean they cannot be an important part of society • Never pet or talk to service dogs while they are working. Always ask permission if you want to pet a service dog • When dining out, offer to read the menu including prices. Always mention how a door opens right or left, stairs up or down. Never rearrange articles or furniture when working Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Common Disabilities • • Muscular Dystrophy Multiple Sclerosis Cerebral Palsy Dementia Alzheimer’s Hearing Impaired Morbid Obesity 59 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Catheter Care Foley or Suprapubic You will receive specialized training if you work for a consumer with a catheter Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Urine Drainage Catheters Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Types of Catheters • Suprapubic- located lower abdominal area. The catheter tube goes directly into the bladder • Male Foley- Inserted directly into bladder through the penis • Female Foley- Inserted directly into the bladder through the urethra • Condom catheter, external catheter for men • Intermittent catheterization uses a “straight catheter” Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Cleansing the Site • Wash hands with soap and water, dry, apply gloves • Using warm, mild soapy water clean around the abdominal site or the genital area • In men- you may need to retract the foreskin, in women, separate the labia and always clean front to back Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Cleansing the Site, Continued • Cleanse the actual catheter from the insertion site away from body. Do not pull or push the catheter itself • Rinse area and gently dry, securing the catheter to the abdomen or leg Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Changing the Drainage Bag • Wash hands with soap and water and apply gloves • Empty urine from drainage bag into the toilet, urinal, or other receptacle • Pinch catheter with fingers to stop urine flow into bag and disconnect the bag from tubing Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Changing the Drainage Bag, Continued • Wipe connector with alcohol pad • Wipe connector to new bag with a new alcohol pad • Connect the clean bag to the catheter at the connector then release your finger “pinch” • Check all connections and straighten kinks or twists. Bag should be hung below the bladder Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Anatomy of Skin Made up of 2 layers - epidermis & dermis Largest organ of the body - 10% of body’s weight Has six functions: § Protection § Sensation § Thermoregulation § Excretion § Metabolism § Body image Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

68 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Pressure Ulcer Prevention https: //www. youtube. com/watch? v=Sych. By. VGF 0 69 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Stages of Pressure Ulcers STAGE 1 STAGE 2 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

STAGE 3 STAGE 4 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

It’s the Law: You MUST Report Elder Abuse can take form in many ways: • Physical • Emotional • Verbal • Financial • Sexual • Neglect • Self-neglect For more information on reporting Elder abuse or to report abuse call 1 -800 -949 -0470 Calls are confidential Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

HIPAA • Health Insurance Portability and Accountability Act (1996) • Protects personal Health information • Gives you rights over your health information • Sets limits on who can look at and receive your health information Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Confidentiality and HIPAA • • • All information is confidential Do not talk to your family members or friends about your consumers Do not show others where your consumers live Do not mention other consumer’s names or info when caring for your consumer Do not discuss your consumer’s health or finances with others Do not enter other rooms of the house that you don’t have permission Never go through a consumers mail unless they asked for help. Report any employee who you think may have breeched personal health information If you have any doubts ask your coordinator or a GSIL Human Resources assistant at 1 -800 -826 -3700 Any HIPPA violation can be grounds for termination Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Consumers and Attendant Care Worker’s Responsibilities in Medicaid Compliance Carin Philbrick Director of Performance Excellence Debbie Krider Compliance Officer Chief Operating Officer Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

What is Compliance? Granite State Independent Living has a responsibility to follow all of the regulations that apply to our organization. This means we put systems and policies in place to ensure that we are in compliance with all regulations. We want to ensure that you, as a GSIL attendant care worker, are in compliance with these regulations. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

What is Medicaid Fraud? Medicaid Fraud is the providing of false information intentionally to misrepresent services rendered in order to increase their reimbursement from Medicaid. Examples: • • Timesheets submitted early & pre-signed by the worker or consumer Submitting timesheets for services not provided Submitting timesheets for hours worked when the consumer is in the hospital Submitting timesheets for hours worked when the worker is out sick, left early, or came in late Submitting timesheets for services that are not on the Care Plan Signing the consumer’s name. Using their signature stamp without permission Altering timesheets after the consumer has signed them Submitting a timesheet for transporting the consumer on the PCSP program Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

How Does GSIL Find Out About Possible Medicaid Fraud? • Service Coordinators discover it • Attendant Care Workers inform GSIL • Individuals report it anonymously to GSIL • Consumer’s friend, family or neighbor calls GSIL • The Medicaid Fraud Unit becomes aware of it from someone reporting it directly to them and they contact GSIL • Another agency in the Consumers home informs GSIL • During a redetermination, it is discovered • A Consumer’s Case Manager • The Attendant Care Workers friend, ex spouse, boyfriend/girlfriend reports it to GSIL Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Medicaid Fraud, Continued • Please remember that submitting inaccurate timesheets is considered fraud. • Committing fraud against Medicaid is a Federal offense and punishable under the Federal False Claims Act: “ any person or entity that knowingly submits a false or fraudulent claim for payment of United States Government funds is liable for significant penalties and fines”. • The fines include a penalty of up to three times the Government’s damages, civil penalties ranging from $5, 500 to $11, 000 per false claim, and the costs of the civil action against the entity that submitted the false claims. • The federal False Claims Act applies to any Federally funded program. The False Claims Act applies, for example, to claims submitted by healthcare providers to Medicare or Medicaid” (GSIL bills claims through Medicaid). Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

To be Compliant Don’t work while your Consumer is in the hospital or rehabilitation facility. l Make sure you write in the hours and tasks that are performed. l Make sure you update the timesheet hours if you leave early or come in late. l Make sure you are only performing tasks that are approved on your Consumers Care Plan. l Do not bill for transportation for PCSP, it is not a billable service. l Make sure that you and the Consumer review the timesheet together and sign it together. l Make sure you understand how to accurately fill out your timesheet. If you make up days or hours when you are out sick make sure you record it on the actual day worked. l Report any timesheet errors to payroll immediately l Bill only for services provided Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org l Double check your timesheet for accuracy l

Questions or Concerns? – It is both the responsibility of the worker and the consumer to make sure timesheets are accurate, signed and reviewed on a daily basis. Any and all questions, suspicions, mistakes should be directed towards the consumer’s coordinator as soon as possible at 603 -228 -9680. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

82 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

How to Complete a GSIL Timesheet • Complete correct program (if you are working PCA and PCSP then 2 timesheets are needed) • Complete week starting (Saturday) and week ending (Friday) • Make sure you put your first and last name • Ensure consumer’s complete first and last name • Complete time starting and time ending (this is real time in 15 minute increments) make sure to fill in am or pm bubble • Total day time in far right column (this is totaled by quarters (. 25, . 50, . 75, . 00) • Make sure you sign and your consumer signs at the bottom • Complete the tasks at the bottom of the time sheets daily. • Submit every Tues by 5 pm to payroll@gsil. org or faxing to 2253304 83 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Advance Time and Attendance Telephonic Timesheets • GSIL is implementing a new program • Telephonic Timesheet verification system • Employee’s will be given an individualize Pin number • Call 1 -800 number • Type in Employee ID #, the consumer ID #, and Job Code # • At end of shift call 800 # follow prompts, record # of tasks completed and record each task # then hang up • Time will be in real time • No more paper timesheets • Consumers and Employees will have a guide books • Training will be provided • This is a Federal Mandate for Medicaid funded programs • If consumer has PCA and PCSP then calls will need to be made to sign in under the different job code 84 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Advance Time and Attendance Telephonic Timesheets CLOCK IN CLOCK OUT • When you arrive for your shift you must call 1 -855 -552 -8463 (using consumer’s designated phone) • You will hear “Welcome to GSIL clock in service”, listen for the instructions • To start a shift Press 1 to clock in • Enter your employee # (the test employee # is 99999) • Enter the consumer ID # (the test consumer # is 99999) • Enter the program ID # (the attendant care training # is 002) • You will hear “Thank You your clock time has been stored, good bye”. Hang up at this point to begin shift • When shift is complete call 1 -855 -552 -8463 • You will hear “Welcome to the GSIL clock in service” • To end a shift, press 2 to clock out • Enter your employee # (test employee ID is 99999) • Enter the consumer ID # (test consumer ID is 99999) • Enter the program ID # (ACW training # is 002) • Enter the number of tasks completed • Enter the 1 st task completed (these are located on the Consumer reference sheet) • Enter the 2 nd task completed and so on until all tasks are entered. • At the end you will hear “Thank you, your clock time has been stored. Good bye” 85 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Missed punches are considered any adjustments needing to be made to the time sheet and / or any codes (tasks, program, consumer, employee) inputted Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

MISSED PUNCHES Instructions to Report Missed Punch Your ACW should complete the electronic Missed Punch form which can be accessed online at www. gsil. org as soon as possible. *This is a preferred option to reporting missed punches, it is timelier for GSIL to process payroll. The missed punched form must be completed by the ACW. For the ACW to access the Attendant Hub: On GSIL’s homepage, click on the Become a Care Attendant link, then click on the Attendant Hub link (top right-hand side of home page). Click the ACW Missed Punch Form link to access the form. For the Consumer to View the missed punch form: My GSIL: Click on My. GSIL (top right-hand side of home page) – then click on My GSIL login (that will bring you to the login page) Scroll down to the username and password area. Please use your Username and Password, if you do not have your codes please contact your LTS Coordinator. Your ACW needs to Fill out the form in its entirety and click the ‘Send to GSIL’ button. Your consumer will be contacted to verify the hours worked and tasks performed prior to payment of wages. Your ACW may call 603 -717 -0893 to directly speak with a Payroll Associate during GSIL’s regular business hours of Monday thru Friday, 8 am – 5 pm. If outside of GSIL’s regular business hours, please have your ACW leave a voicemail. Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

MISSED PUNCHES CONTINUED Your ACW may call 603 -717 -0893 to directly speak with a Payroll Associate during GSIL’s regular business hours of Monday thru Friday, 8 am – 5 pm. If outside of GSIL’s regular business hours, please have your ACW leave a voicemail. Instructions to Report Missed Punch A toll-free call can be placed at 1 -855 -552 -TIME (1 -855 -552 -8463). Once connected, you will hear the following: a. ‘Welcome to the GSIL clock in service’ 1. b. ‘To report a missed punch or timesheet issue, please Press 4’ – Press 4 to be connected to the GSIL Payroll Department Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

TRAVEL TIME • TO CLOCK in Process for Travel Time • Description: The authorized travel time is the time spent to travel from one consumer to the next consumer consistent with GSIL policy. • Call 1 -855 -552 -TIME (1 -855 -552 -8463) toll-free or 603 -922 -7455 again to clock in to Travel Time from the consumer’s designated phone. • The primary phone number for the ACW to dial into is your designated phone number(s). • Travel Time is recorded when traveling directly from one shift to the next shift. • The ACW will follow the Clock in Process • a. Enter the Consumer’s ID # for where you are departing from. • b. Enter 012 for the Program ID to clock in to the Travel Time program • ACW will hang up to end call and begin traveling to your next shift Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

TRAVEL TIME CONTINUED • Upon the ACW completion of Travel Time by arriving at your next shift, the ACW will call 1 -855 -552 -TIME (1 -855 -552 -8463) toll-free or 603 -9227455 to clock out from Travel Time by using your designated telephone. • The ACW will follow the Clock Out Process • a. Enter the Consumer’s ID # at your home (arrived) • b. Enter 012 for the Program ID to clock out of the Travel Time program. • c. Enter 0 for the number of tasks completed. • The ACW will hang up to end call and end your Travel Time. To begin next shift, call 1 -855 -552 -TIME (1 -855 -552 -8463) toll-free or 603 -922 -7455 to clock in from the consumer’s designated telephone Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

GSIL Registry • Are you looking for more hours? • Join The • GRANITE STATE INDEPENDENT LIVING REGISTRY • It Works For You • • The GSIL Registry is the primary place where our CONSUMERS, SERVICE COORDINATORS & RECRUITMENT COORDINATOR search when they need to hire ATTENDANT CARE WORKERS. • • It’s fast… it’s easy… it’s free… and it works for you! • Go to www. gsil. org to sign up for the registry • or call Jo. Anne at 410 -6568 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Attendant Care Hub • Place to go to see what’s new for ACWs • Watch educational videos on a variety of topics • Send friends who may be looking for job and get your referral bonus. • www. gsil. org click on “become an ACW” log on • gsilhomecare is the user name • choices is the password • LOTS OF GREAT INFORMATION 92 Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Stress Management Take care of yourself – Keep appointments with health professionals. – Take time for yourself that’s meaningful (engage in a favorite hobby, exercise, or soak in a hot bubble bath) Keep your sense of humor – Being able to laugh at yourself or see humor in a difficult situation can reduce stress Use community and social resources – Don’t become the victim of burnout. Seek help either with GSIL or other local community agencies where they may have support groups of caregivers or other attendant care workers that you could share with. Explore the employee assistance program Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Frequently Asked Questions Who do I call if I didn’t receive a paycheck? – You should contact the Concord office 603 -228 -9680 and ask for payroll Who should I contact if my consumer is in hospital? – You should contact the LTS Coordinator who works with you consumer or contact GSIL directly Should I come to work even if I don’t feel well? – It is important to take the time you need to rest and recover as well as protect your consumer from unnecessary germs Is it OK to be friends with the person I work with? – It is a very easy to become close to someone you assist many times during the week. If you become friends it is important that you know when you’re on the clock as an attendant and off the clock as their friend Concord Main Office ● 21 Chenell Drive, Concord, NH 03301 ● 800. 826. 3700 ● 888. 396. 3459 (tty) ● 603. 225. 3304 (fax) ● www. gsil. org

Congratulations on watching GSIL’s Online ACE Training! To show your participation, please complete the mandatory quiz and timesheet located here: https: //www. gsil. org/ACE-training-quiz