3 CARE PLAN LEVELS
Please circle the Care Plan Level of care required at this time to match the Staff Members Experience and Skills Level in preforming the Task & Duties within Their scope of practice.

Level 1. Adult Companion No Hands-on Personal Care

1. Assist Patient In/Out of Bed, Chairs, Car and On/Off of Toilet (Patient must be able to bare their own weight and stand with assistance)
2. Assist Patient In/Out Bath/Shower, Grooming
3. Assist Patient with Dressing/Undressing
4. Assist Patient with Planning/Preparing and Serving Meals/Eating, Clean Kitchen, Removing Trash
5. Assist Patient with Medication Reminders
6. Assist Patient with Cleaning/Sanitizing Bathroom
7. Assist Patient with Changing Linens, Making Bed, Wash/Dry/Fold Laundry
8. Assist Patient with Sweeping, Mopping and Vacuuming
9. Assist Patient with Straitening Living Area, Clean Glass and Dust
10. Assist Patient with Therapeutic Socialization, Activities, Exercise
11. Assist Patient by Supervision, Observation and Monitoring

Level 2. PCA Includes 1+2 Personal Care Assistant Hands-On Personal Care

1. Patient Personal Hygiene - (Mouth & Bottom care)
2. Bath/Shower, Bed Bath & Hair washed in bed
3. (Peri Care) clean Bottom, change diaper
4. Med’s from medication tray
5. Fluid in-put measure amounts
6. BM & Urine out-put measure amounts
7. Transfer Patient with gait belt if able to bare their own weight and stand with assistance or Hoya Lift.
8. Range of Motion Exercises with Rotation every 2-4 hours
9. Work with Mental Cognitive Disabilities, Dementia Patient
10. Observe/Report on Clinical Notes - Patient Weekly Narrative Report by Case Manager

Level 3. CNA Includes 1+2+3 Certified Nursing Assistant Hands-On Personal Care

1. Trachea cleaning and suction - CNA Only
2. Monitor oxygen line levels - CNA Only
3. Colostomy bag care - CNA Only
4. Catheter care - CNA Only
5. Feeding tube procedures & care – CNA Only
6. Dialysis Patient (Hemodialysis or Peritoneal Dialysis) – CNA Only
7. Treat bed sores – CNA Only
8. Vitals (Temp, BP, Pulse, Respirations, Weight) CNA Only
9. Pain Management Monitoring CNA Only with RN Orders
10. Diabetic blood sugar finger stick monitoring & procedures CNA Only
11. Give Pre-drawn Injections CNA Only with RN Orders
12. Observe/Report on CNA Clinical Notes with RN Orders - Patient Weekly Narrative Report by Case Manager