Introduction

Maintaining a clean and organized home is an important task of the Home Health Aide/Personal Care Aide. It helps to provide a home free of infection and pests and promotes good hygiene and physical and psychological well-being. This module will explore the purpose of housekeeping and discuss how housekeeping in a patient’s home is different than in one’s own home. We will learn the importance of using proper body mechanics and how to prioritize tasks in order to be as efficient as possible. We will explore different types of cleaning products and why each are used. Finally, we will discuss important housekeeping tasks to be completed in each room of the house, as well as how to do laundry.

Unit A: Importance of Housekeeping in the Home

Housekeeping is an essential task of the Home Health Aide/Personal Care Aide. It helps to enhance a patient’s quality of life. When a patient’s home is clean and organized it helps them to feel better psychologically and it keeps them safer physically (Leahy, Fuzy & Grafe, 2013). During times of illness, there may be much stress, disorganization, and even chaos in the home. Becoming ill and dealing with disease, disability, or injury can be stressful. It can also occupy a great deal of the patient and family’s time, which leads to requiring assistance with keeping their home clean. Helping to keep the patient’s home clean and safe is one important way that Home Health Aides/Personal Care Aides can help the family during their time of need.

Having a clean home is important for infection control. Proper disinfection removes microorganisms. Microorganisms are bacteria, fungus, and viruses that can cause disease. Maintaining a safe and clean home also helps to prevent accidents and further injury or disability. Tidying up on a regular basis allows Home Health Aides/Personal Care Aides to prevent accidental falls.

Many people take great pride in their home. When they are sick or disabled, they may not be able to maintain their home the way they used to or would like. With assistance from a HHA/PCA, they can have a living space that reflects the pride they have in their home. Some patients may not have good knowledge of how to maintain a clean home. With the support and assistance of a HHA/PCA, they can learn proper cleaning techniques and household management skills. Having this knowledge will help to enhance a patient’s independence, self-esteem, ability to feel control in their life, and comfort.

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Unit B: Performing Housekeeping in the Home

We all maintain our own living spaces. Each of us has preferred ways of doing things. We have specific cleaning supplies we might especially like. We may like to perform household tasks in a certain order. We may even feel very particular about other people touching our personal belongings. While Home Health Aides/Personal Care Aides use the housekeeping skills that they already use to clean their own homes, they can also learn new ones in this course.Remember, cleaning another person’s home is very different than cleaning your own home!

The way Home Health Aides/Personal Care Aides do things may be very different from the way their patient does, or prefers to have them done. Remember though, that there is more than one way to complete a task. Remember also that the patient’s preferences are always correct and must be respected. Home Health Aides/Personal Care Aides must always be conscious (aware) of respecting their patient’s belongings, their preferences, and their cultural values and practices (Leahy, Fuzy & Grafe, 2013).

Home Health Aides/Personal Care Aides will be using equipment and cleaning supplies different from their own. They should find out how to use their patient’s equipment correctly. Ask the patient to explain how to use it, read the manufacturer’s instruction booklet, or seek assistance from a supervisor. They should ask their patient to tell them how they would like their home to be cleaned and the cleaning supplies they prefer them to use. Home Health Aides/Personal Care Aides must remember when completing tasks in which they must move the patient’s belongings to always put them back where they were. They shouldn’t take it upon themselves to rearrange their patient’s belongings or furniture. Think about how you might feel if someone came into your home and started to rearrange your things because they thought their way was best! Handle the patient and family’s belongings carefully. Replacing items, especially equipment, can be very expensive.

While it is important to encourage independence and support a patient’s ability to perform household tasks independently, Home Health Aides/Personal Care Aides should always be sensitive to their limitations (Leahy, Fuzy & Grafe, 2013). They may not be able to physically complete a task that others may find very simple. They may also not be able to psychologically handle the extra burden or stress of cleaning or performing other household tasks. Do not be judgmental about their abilities. Instead, Home Health Aides/Personal Care Aides should work with them to find the tasks that they are able to do. Find creative ways to adapt tasks to their abilities. For example, a patient may not be able to stand for long periods of time. However, they may be able to very successfully perform many household tasks seated. They could fold laundry, iron clothing, prepare food, and even vacuum from a seated position!

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Unit C: Ways to Be Safe and Save Energy and Time

Using proper body mechanics is of utmost importance. Proper body mechanics means using the body in an efficient and safe way. Using proper body mechanics prevents Home Health Aides/Personal Care Aides from injuring themselves or a patient. Home Health Aides/Personal Care Aides should always be aware of performing tasks safely, and they should also encourage their patient to do the same. Show a patient safe ways of doing things and good body mechanics. Remember, using proper body mechanics helps prevent injury. This applies to both Home Health Aides/Personal Care Aides and their patients! Review the procedure in Module 12 for how to use Proper Body Mechanics.

Maintaining Proper Body Mechanics

• When standing, keep your feet about hip width apart (about 12 inches). This provides a strong base of support and balance for you to work.
• Always bend at your hips and knees when lifting or stooping, instead of bending at the waist and overextending your back.
• Use the larger and stronger muscles of your thighs, hips, shoulders, and upper arms while bending or lifting objects. This protects your back and smaller muscles from injury.
• Hold heavy objects close to your body when lifting or carrying them.
• Turn your entire body, including your head and legs toward the task you are doing, rather than twisting.
• Remember good posture. Keep your back and trunk straight and aligned with your hips and your head facing forward toward the direction you are working. This prevents twisting, which increases your risk of injury.
• Always raise the bed to waist height when working with a patient who is in bed, or making a bed. This prevents unnecessary bending of your back.
• When pushing, place one leg forward. When pulling, move one leg back. This provides you with a stronger and more stable base of support than if both legs were next to each other.
• Whenever possible, have another person help you with lifting, rolling, or moving patients.
• Have others help you with lifting or moving heavy objects.
• Do not perform tasks that will be physically dangerous to you, or for which you may not physically be capable.
• Keep in mind that when moving a patient, the path or direction in which you are moving must be clear of objects that could get in the way and cause potential injury.
• Always lock the brakes on the bed and wheelchair before transferring a patient. This prevents the bed or wheelchair from moving and causing potential injury to you or the patient.

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Time Management

Prioritizing and staying organized will help Home Health Aides/Personal Care Aides to make the most efficient use of their time and energy. In some households, Home Health Aides/Personal Care Aides may only be required to do a few household tasks. For other households, there may be several tasks for them to complete. It is often helpful to make a list of tasks that must be done. Always follow the Care Plan and perform the tasks it states. If a patient asks a HHA/PCA to perform a task in which they are not comfortable, they should use the good communication skills they learned in this course to speak with them about it. Inform a supervisor and seek guidance from him or her.

Home Health Aides/Personal Care Aides should encourage their patient to assist and perform tasks as they are able. Between both people, they may be able to perform many tasks. This will help promote their self-esteem and independence, while also efficiently using time. Document the time it takes to complete tasks on the Care Plan. Never document a task was completed before it was done.

Always remember that providing personal care to the patient is the FIRST priority of a HHA/PCA. They must never neglect or ignore a patient’s needs in order to complete a household task. It is helpful, however, to learn to plan time and prioritize tasks in order to complete all that is required.

Make a Task List

On a piece of paper, Home Health Aides/Personal Care Aides should write down all the things they must complete during their time in the patient’s home as the Care Plan directs. Look at all the tasks that must be completed during the week and during the month. Some items may only need to be done once per week or month.

Prioritize Tasks

Prioritizing tasks means placing the tasks in order of importance. For example, it is more important to focus on meeting a patient’s needs such as eating and toileting than it is to do household chores such as laundry or vacuuming. This does not mean that the HHA/PCA does not complete the household chores. It means if a patient has an important need such as bathing, toileting, or eating, that those needs should be met prior to completing household tasks such as laundry or sweeping. Home Health Aides/Personal Care Aides can learn to prioritize by using several methods. Here, we will discuss the ABC method and the 1-10 method. You can view these and other helpful time management tips by visiting Planet of Success at: http://www.planetofsuccess.com/effective–time–management/

The ABC Method

Learn to prioritize by the ABC method.

• • A: Tasks which are important and urgent at this time.
  • B: Tasks which are important but not urgent at this time.
  • C: Tasks which are not important and not urgent at this time.

After making a task list, go through it and mark which items should be A, B, or C. Those that are marked A should be completed today. Once those are completed, move on to complete tasks that are marked “B”. Tasks that are labeled “C” can be completed as time allows. Remember though, just because a task is marked “C” does not mean it does not have to be completed. It just may have to be completed at a later time.

Example of a task list using the ABC Method:

A

Provide patient bath

Cook and feed breakfast

Help patient with scheduling doctor appointment

B

Laundry

Make patient bed

Mop kitchen floor

C

Clean out refrigerator

Organize linen closet

Vacuum living room

Grocery shopping

The 1-10 Method

Prioritize using the 1-10 method. Tasks that are most important are ranked “1”, while the least important tasks are ranked “10”. Tasks lists can be organized by priority number or labeled with the priority number. Remember, patient needs and preference will indicate what items will need to be made a priority.

Example of task list using the 1-10 method:

Patient bath#2

Make patient bed#4

Laundry#5

Mop kitchen floor#6

Clean out refrigerator #9

Cook and feed breakfast#1

Vacuum living room#8

Grocery shopping#7

Help patient with scheduling doctor appointment#3

Organize linen closet#10

Tips for Efficient Use of Time

Here are some tips to help Home Health Aides/Personal Care Aides make the most efficient use of their time:

• Break down larger jobs into smaller tasks.
• Be flexible and realistic. It is not always possible to get everything done that is on your task list. Sometimes, unexpected situations come up. Complete the highest priority tasks first.
• Revise the task schedule as needed. Instead of going grocery shopping, which takes a longer amount of time, you may instead be able to do a task you intended to complete later in the week and which takes less time, such as laundry.
• Do two things at once whenever possible. This will help you make the most efficient use of your time. For example, you can put laundry in the washing machine and while the loads are cleaning, work on providing a patient bath or cooking a meal.
• Whenever possible, group tasks that can be done in the same place. This helps to eliminate (remove) unnecessary steps.
• After giving a patient a bath and changing the bed linens, gather up all the dirty laundry that is in the room at the same time. Use a laundry basket or hamper to help make the most efficient use of time and energy. Then, take all the clothing at one time to the laundry area, rather than making several trips.
• When cooking, make more than one meal at a time and freeze some for use at a later time.
• Instead of cooking a small batch of a meal, cook a larger quantity and freeze it into smaller portions.
• Be economical with patient supplies. Being economical means being mindful of waste. Use only the necessary amount of cleaners to get the job done. This avoids waste.
• Use baskets, hampers, grocery bags, and trays to help carry several items at once. This helps to reduce the number of steps you must take to complete a task. However, be careful to not overload yourself or carry too much at once.
• Keep supplies organized and in one place. For example, cleaning supplies can be stored under the kitchen sink in a secure cabinet.
• Use the proper tools for the task to be completed. Know how to use the tools correctly and in a safe way. For example, use a chef’s knife instead of a steak knife for chopping food.
• Clean as you go. If something spills, wipe it up right away before it dries or stains. Cleaning stains is often time-consuming.
• While preparing food, clean during preparation to keep your space clean and clutter-free. This will keep you organized and save time in the long run.
• Remember to always use proper body mechanics. Injuries cost us pain, time, and money. Protect your body.

Self-Check Activity m10-4

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Unit D: How to Get the Job Done

Infection Control

Proper infection control will help to eliminate pests, bacteria, viruses, and fungi. All of these things can lead to disease.Home Health Aides/Personal Care Aides should complete proper hand washing before and after each task. This is the best way to prevent the spread of infection (CDC, 2015). If hot water and soap are not available, use an alcohol based hand sanitizer with at least 60% alcohol (CDC, 2015). Hands should be washed prior to and after contact with the patient and their belongings, prior to and after using the bathroom, prior to, during, and after preparing food, and after changing diapers, handling pets or pet waste, or after coughing or sneezing (CDC, 2015).

Use gloves as appropriate to the situation. Home Health Aides/Personal Care Aides should wear gloves whenever they will come into contact with body fluids such as blood, feces, urine, or saliva. Wear gloves when changing patients, assisting them to toilet, bathing, handling dirty linens, or preparing food. Never reuse disposable gloves. Discard them after one use. Review the Handwashing procedure in Module 12 for proper handwashing technique.Use rubber or household gloves when handling harsh chemicals. These gloves can be sanitized and stored for later use.

Use separate cleaning rags and towels for clean and dirty areas. Only use clean dishcloths and towels in the kitchen for handling food. Use a separate cleaning cloth and rubber gloves for the bathroom. Whenever possible, use disposable wipes or cloths for cleaning areas such as the toilet, which have many microorganisms on its surface.

Ensure food is properly stored and refrigerators and freezers are at proper temperatures. Review module 8 for proper food storage procedures. Ensure that packaged food stored in cupboards is kept closed in air tight seals which will prevent spoilage and invasion of pests. If Home Health Aides/Personal Care Aides notice evidence of pests such as roaches, lice, bed bugs, or mice, they should inform a supervisor. Additional precautions will need to be taken to rid the patient’s home of infestations.

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Basic Supplies and Equipment Needed

To make the most efficient use of time, and to properly clean a patient’s home, Home Health Aides/Personal Care Aides will need to use the appropriate cleaning supplies and equipment.

Basic Cleaning Tools

• Broom, dust pan/brush
• Mop, pail
• Toilet brush
• Rags, scrub brush
• Sponges, dish cloths or dish rags
• Vacuum cleaner, carpet sweeper
• Dust mop, dust cloths
• Cleaning products, cleaning wipes, disinfectant
• Rubber household cleaning gloves

Cleaning Products

There are many types of cleaning products on the market. The type used will depend on the surface being cleaned, the purpose of the cleaning, patient preferences, and what is available in the patient’s home. Home Health Aides/Personal Care Aides should ask their patient if a cleaner is safe on a particular surface.

• All–purpose cleaners: are generally used for many purposes and on many surfaces. They can be used on countertops, cook ranges, walls, floors, and other surfaces. Always check the label to see what surface the cleanser can be used on. Some cleansers are not safe on surfaces such as unfinished wood. When in doubt, ask the patient and/or a supervisor.
• Disinfectants: are used to disinfect (get rid of germs) surfaces. They can be sprayed on surfaces such as faucet handles, doorknobs, light switches, phone handles, refrigerator handles, and other surfaces. Disinfectants come in many forms, such as sprays, wipes, and solutions.
• Bleach: can be used as a disinfectant and cleaner to clean the bathroom and surfaces such as cutting boards, and for laundering white clothing. Never use full strength bleach on surfaces. To make a cleaning solution using bleach, mix 1 teaspoon (tsp.) of bleach to 1 gallon of water (CDC, 2014). Be cautious of spilling bleach on unsafe surfaces and clothing as it will discolor the surface. Never mix bleach with ammonia or any other cleaner (CDC, 2014). Fumes can be toxic and fatal.
• Soaps and detergents: are used for washing dishes and laundry. Follow the manufacturer’s instructions for amount of detergent required for dishwashers and washing machines. Using too much detergent can ruin the appliance.
• Abrasive cleansers: are used for scouring surfaces such as stainless steel sinks and stovetops. These types of cleaners should only be used on certain surfaces as they could ruin surfaces for which abrasive agents should not be used.
• Glass cleaners: are used for glass surfaces such as windows and mirrors.
• Dusting spray: is used for dusting. Dusting spray should be sprayed onto a cleaning cloth and not directly onto the surface to be cleaned.
• Specialty cleansers: are cleansers that are available for special purposes or surfaces. Stovetops, appliances, and electronics may require a specialty cleaner.

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Safety Tips for Home Health Aides/Personal Care Aides Using Equipment and Supplies:

• NEVER mix cleaning products. Dangerous chemical reactions can occur that can harm you or a patient.
• NEVER mix bleach with ammonia or other cleaning products, as the fumes are toxic and can lead to your or a patient’s death.
• Always follow the instructions on the label of the cleaning product and follow them exactly.
• Whenever possible, open windows while cleaning and be cautious of using chemicals such as ammonia or bleach in closed in spaces. Fumes can be toxic and deadly.
• Always find out how to use equipment by reading instruction manuals or by asking the patient or a supervisor.
• Do not overload equipment on electrical circuits.
• Never use electrical equipment near water. This could result in electrocution and death.
• Always unplug electrical appliances before cleaning.
• Never poke or repair electrical equipment with metal objects.
• Never use electrical equipment with a frayed or damaged cord. This could result in electrocution and death.
• When unplugging appliances, grasp the plug at the base to remove from the electrical outlet. Never pull from the cord as this could damage the cord.
• Keep equipment clean and in good working order. Speak to the patient and supervisor if equipment is in need of repair.

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Kitchen Cleaning Tasks

The kitchen should be cleaned after every use. Home Health Aides/Personal Care Aides should encourage family members to do the same.

Kitchen tasks:

• Wash dishes immediately after use
  • Dishes should be washed in hot soapy water using dish detergent.
  • Air dry washed dishes and pots rather than using a dishtowel to save time.
  • If using a dishwasher, learn how to properly use it. Dishwashers can also be used to sterilize items. Some dishwashers require food to be scraped and plates to be rinsed before loading. Many items cannot be washed in a dishwasher, such as electrical appliances, china, crystal, and cast iron. Always check with the patient.
• Put dishes away after they have air dried.
• Clean the kitchen sink and faucet with a scouring or specialty cleaner once per day.
• Wipe and clean surfaces as you work and at least once per day.
• Take out the garbage daily before you leave for the day.
• Sweep the kitchen floor daily and mop at least once per week, or more if needed. Ensure the floor is dry to prevent falls.
• Stove tops should be cleaned with hot soapy water, an all-purpose or a specialty cleaner. Find out the appropriate type of cleaner to use.
• Ovens are cleaned periodically. Some ovens are self-cleaning while others require direct cleaning with a specialty oven cleaner. Be cautious to use rubber gloves and to not inhale oven cleaner as fumes can be toxic. Ensure no children or pets are around when using oven cleaner as ingestion of the cleaner can be deadly.
• Clean out the refrigerator once per week. Discard items that are spoiled. Wipe surfaces of spills and crumbs. Ensure food is properly spaced in the refrigerator to allow good air circulation.
• Wipe the refrigerator door and any spills inside once per day.
• Defrost the freezer when necessary. When defrosting, all food should be removed and stored in a cooler to keep it cool and prevent spoilage. Follow the manufacturer’s instructions on how to defrost the specific unit a patient has.
• Clean inside cabinets, drawers, and cupboards once or twice per year, or as needed.

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Bathroom Cleaning Tasks

The bathroom is a living space that has many bacteria present due to urine, feces, and blood. It is also a damp and moist space, which encourages many types of bacteria to grow.

Bathroom tasks:

• Wash from clean to dirty areas to prevent spreading dirt or bacteria from dirty to clean areas. The toilet should be washed last and a separate rag from other surfaces should be used for the toilet.
• Ensure the toilet is flushed each time it is used. Encourage household members to do this. Close the lid on the toilet prior to flushing after using the toilet to prevent splashing of urine and feces onto other surfaces.
• The shower and shower surfaces should be wiped down after each use. Ensure the cleaner used is safe for the surface. Scouring cleaners are not safe for use on porcelain and tile as it can scratch.
• Shower walls, tub bottom, shower curtains and doors should all be wiped down daily and thoroughly cleaned at least once per week with an all-purpose or specialty cleaner.
• Hair should be removed from drains to prevent clogs after each bath/shower.
• Used towels should be hung to dry or placed in a laundry hamper to be washed, rather than kept on the floor. This is an important safety precaution. Towels on the floor can lead to falls.
• Bath mats and rugs should be hung to dry off the floor. This will also decrease fall risk.
• The sink should be wiped down after brushing teeth, shaving, or washing to rinse the surface of toothpaste, shaving cream, and cleansers.
• Faucets should be disinfected with an all-purpose cleaner or disinfectant solution daily.
• Toiletries and personal items should be stored and kept organized.
• Mirrors and glass surfaces should be cleaned with glass cleaner and kept clean of splashes.
• Wipe the surface of the toilet lid, toilet cover, and flush handle with a disinfectant cleaner daily.
• Scrub the inside of the toilet bowl with a brush and use an all-purpose cleaner with disinfectant at least once per week. Be sure to scrub under the rim of the toilet. The toilet brush should be washed with a disinfectant solution and allowed to air dry before storing.
• Ensure handrails and safety equipment are in good working order on a daily basis. Inform a supervisor immediately if they are not.
• Vacuum or sweep the floor daily. Wet mop at least once per week. Ensure the floor is dry to prevent falls in the bathroom. Always close off access to rooms that have been mopped to prevent falls.
• Ensure hand towels and bath rugs and mats are clean and dry. Replace with clean towels daily.
• Wipe down hampers and waste baskets with a disinfectant cleanser at least once per week.

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Living Room Cleaning Tasks

The living room is often a place family spends a great deal of time. It should always appear tidy and organized. Home Health Aides/Personal Care Aides can encourage the family to pick up after themselves by modeling this behavior.

Living room tasks:

• Pick up clutter as you see it and at least once per day. Encourage and teach family members to do the same.
• Pick up newspapers, magazines, books, and toys as needed and at least once per day.
• Organize items kept in the living room and store them in their appropriate places.
• Vacuum rugs at least once per week. If there is dirt or food crumbs on the floor, you may need to vacuum more frequently. Crumbs from food attract pests.
• Sweep tile or linoleum floors daily. Mop at least once per week and more if floors are dirty.Always ensure a floor is dry after mopping to prevent falls.
• Dust surfaces once per week or more as required. You can use disposable dust cloths, dusting spray, or rags to remove dust.
• Ensure there are no loose rugs and other trip hazards, such as cords, in order to prevent falls.
• Lamps and lighting sources should be checked for good use. Good lighting helps to prevent falls.

Bedroom Cleaning Tasks

The bedroom is a place where many people sleep and rest. To promote good health, hygiene, and rest, the bedroom should be tidied daily.

Bedroom tasks:

• Pick up clutter as you see it and at least once per day. Encourage and teach family members to do the same.
• Beds should be made daily.
• Bed linens should be changed at least once per week or more as needed and whenever soiled or wet. Patients should never be kept in a bed with soiled or wet bed linens.
• Wastebaskets should be emptied daily and wiped down with a disinfectant at least once per week.
• Dirty linens and clothing should be picked up and stored in a hamper for laundering.
• Clean clothing should be folded and stored in their appropriate places.
• Dust surfaces once per week or more as required. You can use disposable dust cloths, dusting spray, or rags to remove dust.
• Sweep daily to remove dirt, dust, and food crumbs. Mop floors if a tile, linoleum, or vinyl surface at least once per week. Vacuum rugs at least once per week.
• Lamps and lighting sources should be checked for good use. Good lighting helps to prevent falls.
• Ensure there are no loose rugs and other trip hazards, such as cords, in order to prevent falls.

Self-Check Activity M10-10
True or False

1. You should look for and remove trip hazards and ensure rooms are well lit on a frequent basis. True or False? ______