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Picture 1:
PCA in Belle Reve's Kitchen
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Personal
Care Attendants (PCAs) at Belle Reve attend to the needs of the residents by
assisting with activities of daily living (ADLs) and instrumental
activities of daily living (IADLs). When a resident comes to Belle Reve,
he/she goes through an assessment by one or more of our social workers,
during which needs, abilities, and goals are assessed. Each resident has a
list of activities with which he/she needs assistance. PCAs help each
individual with his/her specific needs, as directed by the resident's
social worker.
ADLs include activities that are
considered the basic, vital, daily activities for persons and are
identified as bathing, grooming, dressing, dining, toileting,
ambulation/transfer, and assistance with self-medication.
IADLs are considered to be instrumental,
essential activities tailored subjectively to each individual’s needs.
IADLs, unlike ADLs, are not considered basic or vital activities of daily
living, and may not be daily activities. Such activities would include, but
are not limited to socialization, managing personal affairs, financial
management, shopping, housekeeping, correspondence, personal behavior, and
health management.
Training for
all PCAs
includes two weeks training under strict supervision from the PCA
Supervisor prior to working on an unsupervised shift. Additionally, the
PCAs receive one-on-one instruction with the Program Director, Pam Smith, L.C.S.W.
as well as monthly educational in-services in which staff is kept
up-to-date on new policies, practices, and methods in caring for
HIV/AIDS-positive residents. Although not all PCA staff has their Certified
Nursing Assistant Certifications, it is a requirement for any new hire, and
any PCA in a supervisory position must have at least one-year’s experience
with AIDS or other long-term illnesses.
Shifts for PCAs include three
eight-hour shifts or two twelve-hour shifts. PCAs regularly work two per
shift, but are three per shift during school-week afternoons. Weekday
shifts are 7AM to 3PM, 3PM to 11PM, and 11PM to 7AM, Monday through Friday.
Weekend shifts include two twelve-hour shifts, 7AM to 7PM and 7PM to 7AM.
A Family PCA is on duty from 3PM to 7PM
during the school year to assist families with developing parenting skills,
shopping, cooking instruction, household management, cleaning, homework,
and other activities as needed.
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Picture 2:
Sofia Hyde, PCA Supervisor
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Medication
Monitoring
is one important duty of the PCAs, and medications rounds are made on an
hourly basis. Many residents are able to order and/or monitor their own medications.
In those cases, independence is preferred whenever possible. In cases in
which the social worker determines a need for the client to have his/her
medicine monitored, Belle Reve can help in several ways. For those
residents who need help with the monthly ordering of medications, the
Program Director will reorder all medications monthly, adding new
prescriptions as they are prescribed, and having all refills confirmed by
the pharmacy and/or the prescribing physician. Other residents have their medicines
not only ordered for them, but also receive monitoring from the PCAs to
ensure that they are taking each prescription in the prescribed manner at
the correct time.
When AIDS-fighting
medications are taken incorrectly—at the wrong intervals, with the wrong
foods, on an empty stomach, on a full stomach, with other medications, at
the wrong time of day, etc.—the medicine is likely to lose its
effectiveness over time. Missing even an occasional dose of an HIV
medication can render one medication ineffective. Each time that an
HIV-infected person gains resistance to his medication, his choices of
medications become smaller. Often, if a patient has developed a resistance
to one medication, he/she may develop a resistance to an entire class of
similar medications. Since most Belle Reve residents have had serious HIV
illnesses and most have had the disease for a long period of time, most
residents already have acquired immunity to several drugs or several
classes of drugs. For more information on Standard Dosing Schedule for
Anti-HIV Drugs, see Project Inform. This page gives information on
medication type, class, standard dosing, side effects, and correct administering
of the medication. For more information on Adherence, see Ten Medication Adherence Tips.
The PCAs have a
securely locked cabinet containing all medications for those residents
whose medications are monitored. A resident often will have two full
drawers of medications divided by narcotic and non-narcotic, then further
color-coded and divided by time of day that they are taken. The PCA on duty
will look at the medication log on an hourly basis to see who needs
medication. Medications are dispensed as per doctors’ instructions, with
the PCA handing the medication to the resident, and the resident taking the
appropriate medication in the presence of the PCA. As most residents take
multiple medications at multiple times during the day, each with a
different set of instructions, it is important that residents who need
monitoring of this daunting task receive the help they need.
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Picture 3:
PCA in Belle Esprit's Kitchen
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Other PCA
duties
include cleaning—dusting, mopping, sanitizing, scouring, etc.—all areas in the
two houses of Belle Reve and Belle Esprit. Additionally, PCAs prepare three
meals and snacks as needed per day and perform weekly grocery shopping.
Occasionally, a PCA will escort a resident to and from health-related
appointments, a service often performed by the social workers. Furthermore,
the PCAs keep detailed logs on the residents’ daily activities, which are
then reviewed by the Case Manager/Social Worker to determine if any
problems exist or changes need to be made. The bulk of the PCAs’ time is
spent providing individual assistance with ADLs and IADLs with a
PCA-resident ratio of one to six.
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