Preparation Activities
Appendix
Appendix F - Data Collection Tools - Sample 1
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Instructions for First Nations and Inuit Basic Home
and Community Care Monthly Statistics
Recording monthly work done is not only a requirement for
funding, but is a valuable tool for supervising staff, and
program planning. Monthly reports record the care received by
each client by type of service and the amount of time provided
by each care giver.
Each staff should fill out their own form for the month from
their time sheets or client files and submit within the first week
of the next month.
There are three sheets provided:
- the Home Support Statistics to be filled out by each
Home Health Aide/Personal Care Worker, and
- the Nursing and Case Management Statistics sheet to be filled out by the nurse or the nurse assessor, and
- the Total Program Statistics.
The Home Care Director or Coordinator may wish to compile
the data from all staff on the Total Program Statistics sheet
which will show all the services provided to each client from all
the Home Care Staff.
Overview of the Report Form(s)
The forms have four main sections.
Section 1 - Client Information
This consists of columns A, B, C and D which are descriptors of
the client who is receiving the service.
Section 2 - Home Visits
This consists of columns E, F, G and includes all visits to a
client's home.
Section 3 - Home Support Time, Case Management Time
and Nursing Time
This includes columns H, I, J, K, L, M, N, O, P, and Q which
describe the services provided to each client in time and type
of care provided (e.g. home support time, case management
time and nursing time).
Section 4 - Total Client Time and Non-Client Time
This includes column R which on each sheet is the total time
provided to a client, and column S which describes the staff
time that does not directly relate to a particular client.
How to Record Time
- Do not record any time less than 15 minutes.
- When recording time, use decimals to indicate partial hours.
For 15 minutes .25
For 30 minutes .5
For 45 minutes .75
For 1 hour of time 1
Section 1 - Client Information
A - Client Identifier
Each client should be assigned a confidential number which
cannot identify them to an outside person or agency. This
number should be kept by the Home and Community Care
Program in a locked cabinet. No one outside the program
should be able to identify the person receiving the services on
the month end sheets. The number should only be assigned
once. If a client is discharged or deceased, the number should
not be reused.
B - Age Code
The age codes are listed below. The appropriate code can be
circled to make filling out the form easier.
Age Codes
A - under 15
B - 15 - 44
C - 45 - 64
D - 65 and over
C - Sex
Circle the M if the client is male and F is the client is female.
D - Primary Diagnosis Code
Select from the Home Care diagnosis codes (page 124) the
category which best describes why the client is receiving
services. For example a person may be a frail elderly, but did
not require services until she fell and broke her hip. In this
case the primary reason for the service is the fracture.
Section 2 - Home Visits
This section is to be filled out in number of visits and not by
time.
E - Home Visits
The home visits category includes all visits to a client's home
including those in which home care service was provided.
F - Attempted Visits
Those times that the staff went to the client's home but no
services was provided because the client was not home or
other reasons such as refused service. Visits to the home of a
client take time even when service is not provided.
G - Total Home Visits
The totals of columns E and F to give the total times the staff
person went to the client's home in the month.
Section 3 - Home Support Time, Case Management
Time and Nursing Time
Home Support Time
Home Support Time provides a record of home support services
time for each client under the four main categories for home
support services: Home Management, Personal Care and
Respite Services, Meal Services, and Other Client Time related
services.
H - Home Management
This includes the time spent doing home services for the client.
It includes all cleaning, laundry, and seasonal cleaning.
I - Personal Care
Describes the time to provide personal care assistance with
such activities as activation, rehabilitative exercises, bathing,
foot care and hair care to a client.
J - Respite Services
This category includes time spent giving respite to a care giver.
K - Meal Services
This category captures the time spent assisting a client with
meals through any of the following:
- preparing a meal for a client;
- bringing food to a client; or
- providing the client with a meal with others through a
type of congregate dining or elders meal.
L - Other Client Time
This category includes time spent with arranging services for
the clients, charting, reporting client needs to supervisor or
other Home Care Staff, etc.
M - Total Home Support Time
The addition of the columns, H, I, J, K, and L gives the total
hours of home support services provided to an individual client
for the month.
Case Management Time
N - Assessment/Care Coordination
This time category is primarily for the Nurse Assessor, or the
Case Manager. It includes the time spent visiting the client and
supporters to assess the service needs, making the referrals
and setting up the care to meet a client's health needs for
home care services. The time category may include:
- visits to clients and support persons;
- charting;
- consulting with the physician(s);
- consulting with family members;
- case conferencing; and
- time required to set up all aspects of the service.
O - Case Management Code
The case management code will indicate the types of care a
person has received from the case manager or nurse assessor.
Circle the one or two codes which best describe the services
provided in the month.
DC - Discharge Planning is the assistance with planning
and assessing needs for equipment and support and care
before discharge from a medical care facility. It may include
case conferencing, hospital visits, equipment orders, etc.
IA - Initial Assessment is the first full assessment done
for a client to determine the needs for care. It may be the
first request for admission or a readmission of a previously
discharged client.
RV - Reviews is the full or partial review of a clients health
condition to ensure that the home care services are
currently meeting the needs of the client, and to provide
quality control of client care.
CC - Client Conferencing is the meeting with family, or
health and/or other agencies such as social development to
determine how care providers can best work together for
the best care and support of a client.
HL - Hospital Liaison includes hospital visits and
assistance to clients and staff in a medical facility to
promote client care and communication.
OTR - Other care coordination services not listed above.
Home Nursing Time
P - Nursing Time
This time category captures all the activities related to
providing nursing care to a particular client. The time includes
direct patient care, travel to the client's home, all charting,
referrals, and calls to physicians and other members of the
health care team that relate to care for the client.
The Home care nursing service includes:
- performing nursing assessments;
- performing nursing treatments and procedures;
- providing on-going personal care when the Assessment
specifies that the condition of the client is such that a nurse
should perform the service;
- teaching and supervising self-care to clients who are
receiving personal care or nursing services;
- teaching personal care to family members and other
supporters;
- teaching and supervising home support staff providing
personal care;
• initiating referrals to other agencies; and
- "Indirect Nursing Time" - other time spent which is related to
a specific client:
- charting
- consulting with the physician(s)
- consulting with family members
- case conferencing
- arranging for supplies, etc.
- on-Reserve or community travel between clients
Q - Nursing Codes
These codes were developed in 1995 when Medical Services
Branch first took on the mandate for home care nursing.
AP - Acute Post Hospital Care
Involves clients who are post-surgical or have had acute
illnesses which has been diagnosed, treated and the client is
stabilized. The Home Nursing Program would monitor the
client's condition and ensure that the treatment is continued
as per physician's instructions (e.g. Treatment of draining
wounds, post cardiac surgery).
ST - Short Term Active Care
Acute care would provide home nursing care services to
clients who are experiencing an acute illness, but have the
potential for returning to a pre-illness level of functioning
and self care. The main objective of a home care nursing
program would be to control symptoms and prevent
deterioration of the client (e.g. respirator, cardiac disease).
CA - Continuing Active Care
Time limited provides home care nursing to those clients
with an illness/disability who will not return to their previous
level of functioning, but will have the potential for increasing
their level of functioning or self care, and will eventually
function without home care nursing services. The home
care nursing objective is to prevent deterioration and reach
a maximum level of physical and social functioning without
continued home care nursing services (e.g. burns,
bowel/bladder problems).
SC - Sustaining Care
Would provide home nursing treatment services to clients
with advanced disease(s) who cannot be maintained at
home without ongoing home nursing care. The objective for
this group is maintenance of a chronically ill client at home
to their maximum level of functioning with ongoing home
care nursing services (e.g. home dialysis, catheter
maintenance).
PC - Palliative Care
Would provide home care nursing services for those clients
with terminal illness. The objective of the nursing service is
to enhance the client's comfort, dignity and quality of life
and to eliminate and or control symptoms (e.g. HIV/AIDS,
cancer).
Section 4 - Total Client Time and Non-Client Time
R - Total Client Time
The time that the client received from each care giver is totaled
in this column to record the total home care services provided
to the client during the reporting period.
Non-Client Time
S - Non-Client Time
This section describes how work time is used that is not
directed towards a particular client, but is a valuable part of the
program. It may also be used to track sick leave, education
leave and annual leave.
Travel (Non Reserve)
Travel time to and from the community from the base office,
travel to the local hospital or from one community to
another is tracked in this category. The time it takes to
travel between two clients in the community is tracked in
the client time.
Annual Leave
This is the time that a staff takes off according to the
employment policy.
Sick Leave
The time taken off by the staff because of illness. The
amount of paid time allowed will be outlined in the
employment policy.
In Service and Education Leave
Paid time for the staff to attend educational sessions,
classes or workshops which will enhance the skills and
knowledge relevant to the position.
Meetings
Time that the staff has spent attending meetings relevant to
the position, such as interagency meetings.
Group Teaching Time
Time spent teaching, facilitating or participating in a group
education session or clinic. Examples might be diabetes
cooking classes, adult health clinics, Health Fairs, etc.
Preparation Time
The time spent preparing for a group teaching time.
Other Time
Time that is used in time other than those listed on the stats
sheets. Please specify what the time was used for.
Supervision
Time spent relating to the supervision of another staff
member or student. This includes:
- providing direction and guidance;
- assigning caseload;
- preparation time;
- actual time spent in the client's home doing hands-on
supervision; and
- charting time.
Case Load
The box at the bottom of the page on the total program stats
will indicate the number of clients admitted, discharged,
readmitted during the month. The last category for inquiries
will track the number of request for service that required
screening, assistance, etc. but were not admitted to the
program.
Education Sessions/Clinics
Record in this area the types of education sessions held during
the month and the number who attended each session.
Home Care Diagnosis Codes
1-a Conditions of the endocrine
1-b-1 Diabetes - diagnosed in past year
1-b-2 Diabetes - diagnosed over 1 year
1-b-3 Diabetic - newly put on insulin
1-b-4 Diabetes - gestational/pregnant diabetic
1-b-5 Diabetes - early signs of or existing renal disease
1-c Hepatic, Biliary, and pancreatic
2-a Cardiovascular disease/heart, circulatory
2-b Cerebrovascular Disease and or CVA
3-a Genitourinary Condition
3-b Renal Condition
4-a Gastrointestinal
4-b Difficulty feeding (tube feeds, dysphagia, etc.)
5-a Central Nervous System condition
(MS, Parkinsonism, MD, CP)
5-b Dementia, and related conditions (Alzheimer, etc.)
5-c Mental/ emotional condition
6-a Musculoskeletal condition - arthritis type condition
6-b Musculoskeletal condition (fracture, amputation, etc.)
6-c Musculoskeletal condition - other
7 Respiratory condition
8 Skin and subcutaneous condition
9 Communicable disease
10 Cancer
11 Frail elderly
12 Required Nursing Treatment not related to a
diagnostic code
13 Accident victim
14 Severe blindness
15 Severe deafness
16 Auto-immune condition (lupus etc.)
17 Lack of diagnostic information
18 Other
19 Lifestyle related, e.g. addictions
Month End Report
First Nations and Inuit Home Care
Home Support Statistics
Community:
Staff name:
Date: Page: of:
Client Information
A. Client Identifier
B. Age Code: A | B | C | D
C. Sex: M | F
D. Primary Diagnosis Code
Home Visits
E. Home Visits
F. Attempt Visits
G. Total Home Visits
Home Support Time
H. Home management
I. Personal Care
J. Respite Service
K. Meal Services
L. Other Client Time
M. Total Home Support Time
Non-Client Time
S. Travel, Annual Leave, Sick Leave, In Service and Education, Meetings, Group Teaching Time, Preparation Time, Other Time, Supervision
Case Load | Program | Education Sessions/Clinics | Attendance
Admission:
Discharge:
Readmission:
Inquiries:
TOTALS:
Age Codes:
A - under 15
B - 15 - 44
C - 45 - 64
D - 65 & over
Month End Report
First Nations and Inuit Home Care
Nursing Case Management Statistics
Community:
Staff name:
Date: Page: of:
Client Information
A. Client Identifier
B. Age Code: A | B | C | D
C. Sex: M | F
D. Primary Diagnosis Code
Home Visits
E. Home Visits
F. Attempt Visits
G. Total Home Visits
Case Management
N. Asses/Care Coord Time
O. Case Management Code: DC | IA | RV | OC | HL | OTR
Nursing Time
P. Nursing Time
Q. Nursing Code: AP | ST | CA | SC | PC
Total Client Time
R. Total Client time
Non-Client Time
S. Travel (Non Reserve), Annual Leave, Sick Leave, In Service and Education, Meetings, Group Teaching Time Preparation Time, Other Time Supervision
Case Load | Program | Education Sessions/Clinics | Attendance
Admission:
Discharge:
Readmission:
Inquiries:
TOTALS:
Age Codes:
A - under 15
B - 15 - 44
C - 45 - 64
D - 65 & over
Case Management Codes:
DC - Discharge Planning
IA - Initial Assessment
RV - Reviews
CC - Client Conferencing
HL - Hospital Liaison
OTR - Other
Nursing codes:
AP - Acute post hospital care
ST - Short Term Active Care
SC - Sustaining Care
PC - Palliative Care
Month End Report
First Nations and Inuit Home Care
Total Program Statistics
Community:
Staff name:
Date: Page: of:
Client Information
A. Client Identifier
B. Age Code: A | B | C | D
C. Sex: M | F
D. Primary Diagnosis Code
Home Visits
E. Home Visits
F. Attempt Visits
G. Total Home Visits
Home Support Time
H. Home management
I. Personal Care
J. Respite Service
K. Meal Services
L. Other Client Time
M. Total Home Support Time
Case Management
N. Asses/Care Coord Time
O. Case Management Code: DC | IA | RV | OC | HL | OTR
Nursing Time
P. Nursing Time
Q. Nursing Code: AP | ST | CA | SC | PC
Total Client Time
R. Total Client time
Non-Client Time
S. Travel (Non Reserve), Annual Leave, Sick Leave, In Service and Education, Meetings, Group Teaching Time Preparation Time, Other Time Supervision
Case Load | Program | Education Sessions/Clinics | Attendance
Admission:
Discharge:
Readmission:
Inquiries:
TOTALS:
Age Codes:
A - under 15
B - 15 - 44
C - 45 - 64
D - 65 & over
Case Management Codes:
DC - Discharge Planning
IA - Initial Assessment
RV - Reviews
CC - Client Conferencing
HL - Hospital Liaison
OTR - Other
Nursing codes:
AP - Acute post hospital care
ST - Short Term Active Care
SC - Sustaining Care
PC - Palliative Care
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