STUDY GUIDE

Working as a Health Care Aide

in Alberta

Legislation Learning Module

April 2020
 Table of Contents
Unit 1: Introduction .............................................................................................................. 1
1.1 Introduction ........................................................................................................................................ 1
1.2 Learning outcomes ............................................................................................................................. 1
1.3 Glossary .............................................................................................................................................. 2
1.4 Exercises ............................................................................................................................................. 3

Unit 2: Legislation related to regulated and unregulated health care workers ....................... 4
2.1 The Health Professions Act of Alberta ................................................................................................ 4
2.2 The Government Organization Act ..................................................................................................... 4
2.3 Accepted definitions for “Activities of Daily Living” and “Restricted Activities” ............................... 7
Activities of Daily Living (ADLs) .......................................................................................................... 7
Restricted Activities ............................................................................................................................ 7
2.4 Assignment of task checklist .............................................................................................................. 8
2.5 Accepting or refusing an assigned task ............................................................................................... 9
Accepting an assigned task ................................................................................................................ 9
Refusing an assigned task ................................................................................................................... 9
2.6 Direct and indirect supervision ........................................................................................................ 10
Direct supervision ............................................................................................................................. 10
Indirect supervision .......................................................................................................................... 10
2.7 Exercises ........................................................................................................................................... 11

Unit 3: Health Information................................................................................................... 12

3.1 What HCAs need to know about the Health Information Act .......................................................... 12
3.2 What clients, family and friends need to know about the HIA ........................................................ 12
3.3 Knowing what client health information you may share ................................................................. 12
3.4 Exercises ........................................................................................................................................... 13
3.5 Some facts about FOIP ..................................................................................................................... 14
Basic principles of the Act ................................................................................................................ 14
FOIP is about confidentiality ............................................................................................................ 14
3.6 We live in an electronic age ............................................................................................................. 15
What is personal information .......................................................................................................... 15
Individual rights under the Personal Information and Electronic Documentation Act .................... 15
3.7 Exercises ........................................................................................................................................... 16

Unit 4: Personal directives .................................................................................................. 16

4.1 Personal Directives Act ..................................................................................................................... 16
Activating a personal directive ......................................................................................................... 16
Personal directives reflect the client’s competency and wishes ..................................................... 17
4.2 Goals of designated care in Alberta ................................................................................................. 18
4.3 Exercises ........................................................................................................................................... 18
 Table of Contents
Unit 5: Protection of persons in care ................................................................................... 19
5.1 Understanding the Protection for Persons in Care Act (PPCA) ......................................................... 19
Definition of abuse ........................................................................................................................... 19
Common factors that increase incident of abuse ............................................................................ 20
Abuse in care .................................................................................................................................... 20
5.2 Duties and responsibilities associated with the PPCA ..................................................................... 20
Duties of the employing agency ....................................................................................................... 20
Protection for the person reporting abuse ...................................................................................... 20
False reporting of abuse ................................................................................................................... 21
Self-care if you are reported to the PPCA Office .............................................................................. 21
5.3 Exercises ........................................................................................................................................... 21
5.4 Continuing Care Health Services Standard ....................................................................................... 22
The 19 standards .............................................................................................................................. 22
5.5 Exercises ........................................................................................................................................... 23
5.6 Dependent adults may require a legal guardian or trustee .............................................................. 24
Capacity assessment ........................................................................................................................ 24
Guardians and guardianship responsibilities ................................................................................... 24
Private guardians .............................................................................................................................. 24
Public guardian ................................................................................................................................. 24
5.7 Trustees and their role ..................................................................................................................... 25
Private trustees ................................................................................................................................ 25
Public trustees ................................................................................................................................... 25
Dependent adults are members of the health-care team ............................................................... 25
5.8 Exercises ........................................................................................................................................... 26

Unit 6: Other legislation ............................................................................................................... 27

6.1 Alberta Mental Health Act ...................................................................................................... 27
Who can be admitted and treated involuntarily?............................................................................. 27
How long can a formal patient be kept? .......................................................................................... 28
6.2 Working alone safely is a shared responsibility ............................................................................... 28
Hazard assessment ........................................................................................................................... 28
Best practices for working alone ...................................................................................................... 28
Proper employee training ................................................................................................................ 29
Effective communication systems .................................................................................................... 29
Safe visit and travel plans ................................................................................................................. 29
6.3 Health care aides and the Canadian Charter of Rights and Freedoms ............................................ 30
6.4 Exercises ........................................................................................................................................... 30
6.5 Applying the HCA role CARE principles to legislation ....................................................................... 31

Unit 7: Module Review ....................................................................................................... 32

Answer key for the exercises ..................................................................................................................... 35

Unit 1: Introduction
1.1 Introduction

B oth the federal government (Government of Canada) and the provincial government (Government of
Alberta), have created legislation to ensure that the rights and safety of health care clients and health
care providers are protected.

In this module, the legislated Acts that affect both the client and the health care provider are discussed as
related to the roles and responsibilities of the health care aide (HCA). By learning about these Acts and
applying them to your everyday work, you will ensure that you have done all you can to keep you and your
clients safe.

The information in this module is some of the most important learning in the HCA training. The philosophy
of health care is that all health care providers are responsible for completing their assignments in the safest,
most competent way possible and are accountable for their actions. By studying and understanding
legislation that guides the care of residents in Canada, and specifically in Alberta, you will have a firm
foundation on which to base the actions and decisions you make while providing care to clients.

It is your responsibility to be aware of, and fully informed, about legislation related to the work you do. You
should attend all information sessions and in‐services your employer may offer when legislation is changed
or updated.

Legislation protects both the client and the health care provider. A competent health care provider is
familiar with these pieces of legislation and refers to them regarding client and worker rights. It is very
important that you seek clarification about how legislation is applied in your workplace and in the care of
your clients. Often, workplace policies and procedures are developed in response to legislation. A number of
health care professionals on the health care team can assist you with any questions concerning the
interpretation and application of these laws.

1.2 Learning Outcomes

Upon completion of this learning module, the HCA will be able to:

1. Define and use terminology related to legislation governing the health care aide (HCA) role and
responsibility.
2. Explain the purpose of the Health Profession Act (HPA) and the Government Organizational Act
(GOA) and how they apply to the role of the HCA.
3. Explain the purpose of the Health Information Act (HIA) and the Freedom of Information and
Privacy Act (FOIP) and how they apply to the role of the HCA.
4. Describe the purpose of the Alberta Health Continuing Care Service Health Standards (CCHSS) and
the impacts for continuing care.
5. Explain the purpose of the personal directive and how the Alberta Personal Directive Act impacts
client care planning.
6. Describe the purpose of Personal Information Protection and Electronic Documentation Act
(PIPEDA) and develop an awareness of problems related to using information technology.
7. Explain the Protection for Persons in Care Act (PPCA) and the HCA’s role and responsibilities
related to this act.

STUDY GUIDE: Working as an HCA in Alberta Page 1 of 41

 8. Describe the purpose of the Adult Guardianship and Trustee Act and how it affects the HCA role
and responsibilities.
9. Explain consent, informed consent, and impaired capacity application to the HCA role.
10. Explain the Mental Health Act and the HCA role and responsibilities related to this act.
11. Describe the Canadian Charter of Rights and Freedoms.
12. Describe the importance of accurate observations, reporting, and recording of client changes as
governed by Alberta health care legislation.

1.3 Glossary
Accountability. The obligation for the professional, ethical, and legal and ethical responsibilities of one’s
activities and actions.
Activities of Daily Living (ADL). These are routine activities people do every day without assistance. There
are six basic ADLs – eating, bathing, getting dressed, toileting, transferring and continence.
Agent. Refers to a person designated in a personal directive to act as a representative and make personal
decisions on behalf of the maker. Province of, Alberta. “Alberta Personal Directives Act.” Alberta Queens
Printer, www.qp.alberta.ca/documents/Acts/p06.pdf.
Confidentiality. No private information about an employee, client or the client’s care is shared with people
who do not have the right or need to know this information.
Consent. Agreement or approval e.g. to medical treatment, health care, or personal care.
Direct supervision. A regulated health care professional is present while an HCA completes a task.
Hazard assessment. Working together with the employer to determine any unsafe working conditions.
Indirect supervision. A regulated health care professional is confident that an HCA can perform a task
independently and safely and is available if help is needed.
Informed Consent. Consent obtained under the legal condition whereby a person is first given complete
accurate, and relevant information so as to fully understand the action or procedure and its potential
implications.
Private Guardian. A friend, acquaintance, or family member who has been appointed by the court to make
decisions on behalf of a client. These decisions do not include financial matters.
Public Guardian. An employee of the government who has been assigned by the courts to make decisions
on behalf of a client. These decisions do not include financial matters.
Restricted activities. Health‐care procedures that have a degree of risk and may be assigned to HCAs only
after specific training, under the supervision of a regulated health care professional, and with the permission
of the client or the client’s family.
Rights. Choices that individuals are entitled to make regarding religion, cultural practices, beliefs, and
personal expression. These are examples of individual rights.

STUDY GUIDE: Working as an HCA in Alberta Page 2 of 41

1.4. Exercises TOC
Terminology Related to Legislation
Fill in the blanks with the correct words from the word list.

Word list: indirect supervision, direct supervision, Informed consent, confidentiality, private guardian, public
guardian, hazard assessment, restricted activity, activities of daily living, religious freedom

1. If your supervisor is present while you perform an assigned task, this is an example of __________.
2. A friend or relative, who is appointed by the court to make decisions on your behalf, but not
financial decisions, is called a ______________________.
3. If the regulated health‐care professional is available to you by phone while you perform an assigned
task, this is called ___________________.
4. You must maintain _____________ about client information.
5. Tasks that clients would normally perform for themselves are referred to as
______________________________.
6. When the client receives, accurate and relevant information about the procedure and gives consent,
is referred as ______________________________.

Check your answers with those on page 35.

STUDY GUIDE: Working as an HCA in Alberta Page 3 of 41

Unit 2: Legislation Related to Regulated and Unregulated Health
Care Workers
2.1 The Health Professions Act of Alberta

T he Health Professions Act of Alberta is the legislation that regulates health professionals in this province.
The Act gives each group of health professionals the responsibility of setting their own standards and
regulations to be self‐governing (Government of Alberta, 2018b).

Examples of regulated health‐care professionals are:

• Registered nurses (RN)
• Registered psychiatric nurses (RPN)
• Licensed practical nurses (LPN)
• Registered dieticians
• Registered social workers
• Physical therapists
• Occupational therapists
• Recreation therapists

Health care aides are unregulated workers, not covered by the Health Professions Act because the HCA
always works under the supervision of a regulated professional in Alberta. The HCA should be aware of the
Act and must understand the concept of restricted activities as defined by the Government Organization Act.
HCAs perform only those restricted activities that they are assigned and trained to do for each specific
client. The HCA’s employer must approve the assignment of a restricted activity from the Government
Organization Act to HCAs. There will likely be a policy and procedure identifying the permitted assignment
of such tasks to the HCA by a regulated health‐care professional such as an RN or LPN. Training for the
restricted activity assigned to an HCA can be provided either by an approved health care aide program or by
an authorized health‐care professional under the direction of the employing agency (Government of
Alberta, 2018b).

2.2 The Government Organization Act

R estricted activities are health services that may be performed only in accordance with regulations. The
Alberta Government Organization Act (GOA schedule 7.1) identifies the restricted activities in Alberta.
Restricted activities are listed in Schedule 7.1 of the Government Organization Act (Government of Alberta,
2018a).

The Health Professions Act that governs regulated health professionals such as registered nurses, authorizes
these professionals to perform certain restricted activities. These regulations also allow others to perform
some of these restricted activities under the supervision of the regulated professional (Government of
Alberta, 2018a).

HCAs are not regulated; therefore, there are no regulations that authorize them to perform restricted
activities. However, an HCA may be permitted to perform certain restricted activities under the supervision
of registered nurses, registered psychiatric nurses, or licensed practical nurses, and other regulated health
professionals (Government of Alberta, 2018a).

STUDY GUIDE: Working as an HCA in Alberta Page 4 of 41

There are regulations for registered nurses, psychiatric nurses, and licensed practical nurses that set out the
restricted activities that may be performed by unregulated practitioners under the supervision of members
of these professions – namely inserting and removing instruments, devices, fingers, and hands beyond the
labia majora and anal verge (Government of Alberta, 2018a).

The three professional colleges of regulated nurses in Alberta, The College and Association of Registered
Nurses of Alberta (CARNA), The College of Registered Psychiatric Nurses of Alberta (CRPNA), and the College
of Licensed Practical Nurses of Alberta (CLPNA)) have co‐operated in developing standards to guide
members in making decisions regarding the assignment of these restricted activities by a professional nurse
to an unregulated health‐care worker (Government of Alberta, 2018a).

HCAs may also perform some of the activities listed in Schedule 7.1 of the Government Organization Act as
surrogates for clients who would otherwise perform these activities for themselves. When such activities are
performed as activities of daily living, they are not restricted activities. For example, giving an injection to a
patient is normally a restricted activity. If that patient, however, is a diabetic and routinely administers an
injection to himself, or a surrogate (family member or an aide) routinely administers the injection, then
assisting with this procedure is not a restricted activity. The HCA may then assist the patient or surrogate to
complete this task in ways such as gathering supplies or assisting with preparing the site for injection
(Government of Alberta, 2018a).

The shared standards that guide the assignment of restricted activities by professional nurses to
unregulated health‐care workers also address the assignment of restricted activities to HCAs when they are
activities of daily living (Government of Alberta, 2018a).

In 2003, the College and Association of Registered Nurses of Alberta, the College of Registered Psychiatric
Nurses of Alberta, and the College of Licensed Practical Nurses of Alberta together created a formal
response to the restricted activities listed in the Government Organization Act (GOA) to help clarify how
regulated (licensed) and unregulated health‐care team members could work within their defined scope of
practice, roles and responsibilities, and training to provide care to clients when restricted activities were
part of the care plan. For example, giving a suppository is considered a restricted activity; however, under
the right circumstances, it can be safely done by an HCA and it is not feasible to have only RNs and LPNs give
suppositories. The document written by these three professional nursing colleges (CARNA, CRPNA, and
CLPNA) outlines a collaborative approach for assigning tasks to the HCA that are outlined as restricted
activities (Government of Alberta, 2018a).

This document states that regulated health‐care professionals must ensure that an HCA has had the proper
instruction and supervised practice and has the competence to complete the restricted activities assigned. It
is the responsibility of the regulated health‐care professional to complete an assessment of clients in his or
her care. Based on the assessment of the client’s health status, the health‐care professional can determine
whether the HCA can be assigned certain restricted activities as a part of the client’s care (Government of
Alberta, 2018a).

If the client’s health status changes and the health‐care professional’s assessment indicate that the client’s
condition is not stable, the care plan must change to reflect the current health status. At this time, the
assignment of the restricted activities to the HCA must be reassessed and a reassignment made, if
appropriate. Each HCA must be individually instructed on how to manage each restricted activity assigned to
each individual client. The HCA may be taught how to do a restricted activity by a health‐care professional
for a certain client. However, if the same HCA is required to do the restricted activity for a different client,
the HCA must be instructed on the restricted activity based on this new client’s needs. Clients must consent
to have the HCA perform the restricted activity as part of their care plan (Government of Alberta, 2018a).

STUDY GUIDE: Working as an HCA in Alberta Page 5 of 41

For example: As an HCA, you may be assigned intermittent catheterizations for Client A as part
TOC
of that client’s care plan. You must receive instruction and demonstrate to the health‐care
professional assigning this task that you are aware of how to perform this task for this client.
Then, if you are assigned intermittent catheterizations for Client B, you must also receive instruction from
the regulated health‐care professional on how to do the catheterizations for Client B. Do not assume that all
tasks for all clients are the same: they are not, and each client has individual and unique needs (Government
of Alberta, 2018a).

Restricted activities can be assigned to HCAs only under very specific circumstances (Government of Alberta,
2018a):
• The restricted activity or task is considered part of the routine activities of daily living for an
individual client.
• The HCA is specifically permitted by legislation or regulation to carry out the restricted activity.
• The HCA has the consent and supervision of a regulated nurse.
• Regulation is in place indicating how regulated members supervise unregulated workers, such as
HCAs while performing the restricted activity.
• The HCA has received instruction and demonstrates competency in performing the task for a
particular client.
• The client will not be at risk if the procedure is performed by an unregulated care provider.
• The client’s needs are stable, and the restricted procedure is an established part of the client’s care.
• The outcomes of the restricted procedure are predictable.
• The client and/or the client’s family have been involved in the development of the care plan and in
the assignment of a restricted procedure to an unregulated care provider.
• The client has been assessed by a regulated health professional, who will continue to be responsible
for the evaluation and the outcomes of the care provided on an ongoing basis.
• If healthy and able, the client would perform the restricted activity for himself or herself, such as
self‐catheterization.

Role and Responsibility Alert! If a restricted activity meets all the above requirements, then that activity
could be considered an activity of daily living for that specific client. The supervisor could assign this activity
to an HCA.

If an HCA has been trained to do a restricted activity for an individual client, the HCA cannot carry out the
same task for another client without specific training. The HCA must be trained in the specific task for each
individual client.

STUDY GUIDE: Working as an HCA in Alberta Page 6 of 41

2.3 Accepted Definitions for “Activities of Daily Living” and “Restricted
Activities”
The Alberta Government Organization Act (GOA) sets out definitions for “activities of daily living” and
“restricted activities.”

Activities of Daily Living (ADLs)

Activities of daily living are activities that individuals normally perform on their own to maintain their health
and well‐being.

ADLs include:
• Routine and/or invasive self‐care activities, including but not restricted to administering oral
medications, removing slivers, and cleaning wounds
• Specifically, taught procedures, which generally result in predictable and stable responses, including
but not restricted to catheterization, maintenance of drainage tubes, and administration of drugs by
injection

This is certainly a broader range of activities than what we as care providers generally think of as activities of
daily living. In fact, ADLs may be more than assisting a client with such activities as bathing, eating,
grooming, or toileting. Keeping this broader definition in mind, ADLs may also include activities such as oral
suctioning, caring for wounds and drainage tubes, catheterizing, tube‐feeding, assisting a client to
administer drugs by injection, and assisting a client to check blood sugars with a glucometer (Government of
Alberta, 2018a).

In a specific situation, it may be reasonable for a health‐care professional to train an HCA who works in
home care to assist a client with an insulin injection, which is considered a restricted activity under the
above‐mentioned Act. For example, a specific client suffers from diabetes, but the person’s medical
condition is stable and the outcome of giving the insulin is predictable. An HCA may be trained to assist this
specific client with a pre‐filled insulin injection on a daily basis in order for this client to maintain his or her
level of health, independence, and well‐being. This particular restricted activity is considered to be a part of
this specific client’s ADLs, as defined in the above‐mentioned Act. The activity is necessary for this client to
maintain his or her level of health, independence, and well‐being. Note that in this case, the insulin syringe
has been pre‐filled by a pharmacist and the HCA is assisting and NOT administering the medication. The HCA
assists the client to administer the injection independently. Breaking the skin barrier is a restricted activity
and therefore the injection is not to be administered by the HCA (Government of Alberta, 2018a).

Restricted Activities
Restricted activities are health‐care procedures or tasks that are considered invasive and carry enough risk
to clients that they may not be performed by health‐care providers in Alberta unless specifically permitted
by legislation or regulation to do so.

The Government of Alberta (GOA) (2018a) [Schedule 7.1, Section 2 (1)] allows for two exceptions in which
restricted activities that an HCA can perform do not need to be considered part of a specific client’s ADLs.
Note that for these exceptions, a regulated health‐care professional must assess the client as being
medically stable and the outcome of the activity being performed must be predictable. So essentially, before
you, as the HCA, perform any restricted activity for your client, ensure that you are permitted to perform it
by your employer’s policies and procedures, that it is acceptable for you to perform the activity for the

STUDY GUIDE: Working as an HCA in Alberta Page 7 of 41

specific client, that you have been appropriately trained and are competent to perform the activity, and that
you follow the client care plan in completing the activity for the client. The two exceptions are as follows:

1. To insert or remove instruments, devices, fingers, or hands beyond the labia majora. This would, for
example, allow health‐care professionals to train HCAs to insert vaginal suppositories.
2. To insert or remove instruments, devices, fingers, or hands beyond the anal verge. This would, for
example, allow health‐care professionals to train HCAs to insert anal suppositories and administer
small‐volume enemas and provide bowel care, including digital rectal stimulation.

Role and Responsibility Alert! The GOA has a list of restricted activities and the HPA is the legislation around
the assignment of such tasks. You must follow the direction of the regulated health‐care professional in
performing these activities and must seek clarification and direction whenever there is a change in the
client’s condition or circumstances. Often these directions are found in the client care plan.

2.4 Assignment of Task Checklist

W hen your supervisor assigns a task to you, it is important that you go through the following checklist.
This will ensure that you are given tasks appropriate to your training and experience and that you
receive the appropriate supervision while performing the task (Government of Alberta, 2013).
• Is the task within the legal limits of the role of the HCA?
• Is the task part of your responsibilities as listed in your job description?
• Do you have the proper training to perform the task competently? (Training can be part of your
educational preparation or can be delivered by health professionals in the agency that employs
you.)
• Do you have adequate experience to safely perform the task, given the client’s condition and needs?
• Do you understand the purpose of the task?
• Can you perform the task safely under the current circumstances?
• Do you have the right equipment and supplies to safely complete the task, and do you know how to
correctly use the equipment and supplies?
• Are you comfortable performing the task?
• Do you have concerns about performing the task?
• Is there a client specific care plan in the home that outlines the assigned task?
• Did you review the task with your supervisor and the regulated health‐care professional, and do you
understand what the supervisor expects? Were you given clear instructions and directions by the
supervisor or health‐care professional assigning you the tasks?
• Are you receiving the appropriate type of supervision for your level of demonstrated competency?
• Do you know where, and how to seek assistance in an urgent situation?

Role and Responsibility Alert! The amount of supervision that you require will depend on your experience,
the complexity of the task, and the client’s condition. The less experience you have performing a task, the
more complex the task, and the more complex a client’s condition, the more supervision you will need when
performing the assigned task.

STUDY GUIDE: Working as an HCA in Alberta Page 8 of 41

2.5 Accepting or Refusing an Assigned Task TOC

Y ou have one of two choices when your supervisor or health‐care professional assigns a task
to you. You can either accept it or refuse it. Ensure that you go through the “Assignment of Task
Checklist” before you accept an assigned task (Government of Alberta, 2013).

Accepting an Assigned Task

Once you accept an assigned task, you are responsible for your actions and for completing the task
according to your training and the agency policy and procedures. What you do, or fail to do, can harm your
client. You are ultimately responsible for your actions, even if you meant no harm to the client, but caused
harm because of neglect, failure to follow policy or instruction, failure to follow the care plan, or a lack of
competency to perform the task (Government of Alberta, 2013).
• Make sure that you know how to perform the task competently and safely.
• Make sure that you know why you are performing the task.
• Ask for help if you are unsure or have questions or concerns about what you are required to do.
• Communicate what you did and your observations of the client during the task to your supervisor.
• Make sure that you document all the facts and client response to the activities as required.
• Notify your supervisor immediately if the client’s condition has changed since the last time you
performed the activity for that client.

Refusing an Assigned Task

You must have a good reason to refuse an assigned task because refusing to provide care could harm a
client. You must not refuse an assigned task simply because you do not want to do it. This behaviour could
put the client’s health and well‐being at risk and could also cost you your job (Government of Alberta, 2013).
An HCA may refuse a task under the following circumstances:
• The task is beyond the legal limits of the role of the HCA.
• According to the agency policy, the HCA is not permitted to do the task.
• The task is not in the HCA’s job description.
• The HCA is not trained to perform the task.
• The HCA does not have the experience to safely perform the task.
• The client’s condition has changed.
• The appropriate health‐care professional is not available to supervise.
• The supervisor’s or health‐care professional’s directions and instructions are incomplete or unclear.
• The HCA does not know how to use the supplies and equipment or proper supplies and equipment
are not available.
• The supervisor’s or health‐care professional’s requests are illegal, unsafe, unethical or against
agency policy.
• The task could harm the client.

STUDY GUIDE: Working as an HCA in Alberta Page 9 of 41

Role and Responsibility Alert! If you have concerns and are hesitant to carry out an assignment or a request
from your supervisor or regulated health‐care professional, you must communicate your concerns to your
supervisor. You cannot simply ignore the request.

If the task is within the legal limits of your role and in your job description, but you do not feel comfortable
carrying out the task, your supervisor or regulated health‐care professional can help you in any of the
following ways:
• Answer your questions.
• Demonstrate the task and stay with you while you perform the task or until you feel comfortable
and safe in carrying out the task under indirect supervision.
• Familiarize you with the supplies and equipment.
• Observe you performing the task and provide feedback.
• Set up further training.

2.6 Direct and Indirect Supervision

Direct Supervision
Health care aides require direct supervision performing assigned tasks until they can demonstrate
competency and are comfortable in performing the assigned task. This means that the supervisor or health‐
care professional must be physically present with the client and directs the HCA while the task is being
performed. Direct supervision is also required in the following situations (Government of Alberta, 2013):
• The client’s needs are complex.
• The client’s condition requires regular assessment and evaluation.
• The task is too complex.
• The HCA has not been trained to do the task.
• The step‐by‐step task that the HCA is trained to do requires modifications due to the client’s
condition or needs.
• The HCA is performing the task on the specific client for the first time.

An example of a situation in which direct supervision by the supervisor would be necessary is bathing a
client who has a fractured hip or a hip replacement. HCAs receive basic training in assisting clients to bathe
but do not generally receive training in how to bathe a client who is recovering from surgery. Such a client
has more complex needs, and the task of bathing this client is more complex. The HCA’s basic training does
not prepare him or her for giving this type of care.

Indirect Supervision
HCAs are under indirect supervision once they have demonstrated competency with a task. This means that
the supervisor is not physically present with the client while the HCA performs the task but is accessible if
needed for assistance. Indirect supervision is appropriate in the following situations (Government of Alberta,
2013):
• The client’s needs are stable.
• The HCA is able to complete the step‐by‐step tasks that she is trained to do.

STUDY GUIDE: Working as an HCA in Alberta Page 10 of 41

In the example of the client who has had recent hip surgery, the HCA must be trained to carry out a step‐by‐
step bathing procedure. When the client’s needs are assessed as stable, then the supervisor will trust that
the HCA can carry out the task of bathing without the supervisor being physically present. The HCA can then
bathe the client with only indirect supervision.

2.7 Exercises
A. Case Study 1: Supervision and Assignment of Task I
You are employed in home care and have been asked to visit Mr. Tisdale and change his medicated patch.
The patch is placed on his chest, and the medication in the patch helps relieve his chest pain. In your
training, you had very little experience giving medications and your training allowed you to administer only
certain specific medications. You remember having given a suppository once to a client and eye drops to
another client, but you were never trained to administer medicated patches. You are informed that
changing medicated patches is part of your role as an HCA.

1. What do you do when asked to perform this task?

B. Case Study 2: Supervision and Assignment of Task II

This is your first job in a continuing‐care facility, and you are asked to start Mr. Samuel’s tube feed. You have
seen nurses do the tube feeds, but have never assisted with the procedure. In your training, you remember
reading some information about tube feeds, including the reasons why some clients need to have tube
feeds and the complications to watch for when a client is being tube‐fed.

You remember that a tube is inserted through the stomach or small intestine so that nutritional
supplements can flow through the tube from a feeding bag. You were trained to position the client properly
for a tube feed, set up the tube‐feeding equipment, observe for complications while the tube feed is being
administered, and clean the equipment following the tube feed.

You are aware that one of your main responsibilities is to observe and report any concerns to your
supervisor such as if the tube feed is not flowing if the feeding bag is empty, or if the client is complaining of
any discomfort. You were never trained in how to ensure that the feeding tube is in proper position in the
stomach or small intestine. You were also not trained in how to administer the tube feed.

1. What do you do when asked to perform this task?

Compare your answers with those on page 35.

STUDY GUIDE: Working as an HCA in Alberta Page 11 of 41

Unit 3: Health Information TOC

3.1 What HCAs Need to Know About the Health Information Act

T he Health Information Act (HIA) sets out rules that govern the collection, use, and disclosure of health
information. These rules apply to all health‐care providers operating in the public health system.
Healthcare providers are allowed to share client information with other health‐care workers without the
client’s consent if the information is needed for client care or treatment. (Health Information Act 2018,
Government of Alberta, 2018c)

The client’s health information (but usually not the client’s name) will be used to:
• Provide the client with the appropriate health services and permit the agency to do its job
• Educate and train staff and physicians
• Evaluate agency services so that the agency can make improvements to service
• Conduct research (approved by the ethics committee)
• Monitor community health
• Manage health systems to coordinate services and set priorities
• Respond to concerns and review the work of staff members and physicians

3.2 What Clients, Family and Friends Need to Know About the HIA
The care centre will let family and friends know where the client’s room is and how the client is doing in
general (Government of Alberta, 2018c).
• Informal caregivers will be provided with enough information in order to care for the client when
the client is discharged home.
• If the client requests no information be released, the right to privacy will be respected. No
information will be released to family and friends except when required by law.
• Only appropriate or needed information will be released.

3.3 Knowing What Client Health Information You May Share

If a client or a client’s legal guardian believes that health information has not been kept private and the HIA
has not been followed, the person may file a complaint with Alberta’s Information and Privacy
Commissioner. If it is determined that the rules have been broken, individual health care workers or the
employer they work for can be fined up to $50,000.

Families will ask HCAs for health information because of the hands‐on role the HCA plays in client care.
Therefore, as an HCA, it is important that you recognize what information you can share and how you can
assist the clients’ families when they request detailed information from you (Health Information Act 2018,
Government of Alberta, 2018c).

Keep the following points in mind when handling these requests:

• Family members and friends ask questions regarding a loved one’s health because they are
concerned or want to be helpful.
• All family and friends making information requests should be treated with respect.
STUDY GUIDE: Working as an HCA in Alberta Page 12 of 41
 • All family and friends may be given general information such as where the client’s room is and a
general statement of how he is doing.
• Not all family and friends have the right to detailed information about a client, the client’s condition,
physician assessment, or test results.
• If visitors are requesting more than general information, politely refer the visitors to the health‐care
professional in charge. Ensure that the health‐care professional is aware that visitors need to talk to
him or her.
• Do not give out information over the telephone and do not fax information; this is the role of the
health‐care professional.
• Only the client or the client’s legal guardian has the right to access the full medical information.
• Although information may be shared among members of the health‐care team, the regulated
health‐care professional decides whether to share information and how much information should
be shared.

3.4 Exercises
A. Case Study 1: A Request for Client Information
You are working the afternoon shift in a designated supportive living facility with another HCA. You are
being indirectly supervised by a nurse from home care. Just after supper, you receive a phone call from an
old friend of Joe, who is one of the clients. The friend would like an update on the client’s recovery from
recent surgery and would also like to know whether the client has received any visitors this week.

1. Which of the following responses would be the most appropriate for you to make in this situation?
a. “The client’s brother has just left because Joe is too tired for visitors.”
b. “I think you should come in and see for yourself how Joe is doing.”
c. “May I take your name and number? I will have the home care nurse call you.”
d. “I am sorry but I don’t think you have a right to this information.”

See the correct answer on page 36.

STUDY GUIDE: Working as an HCA in Alberta Page 13 of 41

3.5 Some Facts about FOIP TOC

T he Freedom of Information and Protection of Privacy Act (FOIP) has applied to health‐care
bodies since October 1, 1998. The purpose of the Act is to make public bodies such as governments,
schools, and health‐care organizations accountable for the way they collect, use, and share information
about an individual (Alberta Freedom of Information and Privacy Act, 2018).

Basic Principles of the Act

1. People have a right to know their own personal information.
2. People have a right to privacy. Only those people who need to see an individual’s personal
information are allowed to do so.
3. Individuals have a right to request that corrections be made to the information about them that is in
the custody or control of a public body.
4. Individuals and organizations have the right to request an independent review of any decision made
by a public body under the FOIP Act.
5. The public has the right to access records held by public bodies unless otherwise indicated by FOIP.

As an HCA, you will be required to apply the principles of the Act when providing client care. You must
maintain client confidentiality. A client’s chart is a confidential record. You are legally and ethically obligated
to keep all client information confidential. Your employer trusts that this information will be held in strict
confidence. Do not give out any information about a client unless directed to do so by your supervisor.
(Alberta Freedom of Information and Privacy Act, 2018).

Note: An individual must give written permission for someone else to use that individual’s personal
information.

FOIP Is About Confidentiality

As an HCA, you will be required to apply the principles of the FOIP Act when providing client care.
You must (Alberta Freedom of Information and Privacy Act, 2018):
• Maintain client confidentiality
• Remember that a client’s chart is a confidential record
• Know that you are legally and ethically obligated to keep all client information confidential
• Never give out any information about a client unless directed to do so by your supervisor
Your employer trusts that this information will be held in strict confidence.

STUDY GUIDE: Working as an HCA in Alberta Page 14 of 41

3.6 We Live in an Electronic Age

W ith the increased use of electronic money exchange and record keeping, it has become necessary for
the Government of Canada to pass legislation to help protect the personal information that has been
collected through business transactions. This includes information obtained by home‐care agencies and
other care providers as well as information employers have obtained about employees (Government of
Alberta, 2013).

What is Personal Information?

Personal information includes:
• Name, race, ethnic origin, religion, marital status, and educational level
• Email address and messages
• Age, height, weight, medical records, blood type, DNA code, fingerprints, and voice print
• Income, purchases, spending habits, banking information, credit/debit card data, loan or credit
reports, tax returns
• Social insurance number and other identification codes

Individual Rights under the Personal Information Protection and Electronic

Documentation Act
Alberta has both the Freedom of Information and Protection of Privacy Act (FOIP) and the Health
Information Act (HIA) to protect client health records. However, the Personal Information Protection and
Electronic Documentation Act protects the information of employees collected as part of the employment
and payroll process (Office of the Privacy Commissioner of Canada, 2018).

Under the Act, individuals have the right to (Office of the Privacy Commissioner of Canada, 2018):
• See their personal information after submitting a request in writing
• Request that their personal record be corrected if there are errors
• File a complaint if they are not being granted access to their records in a reasonable amount of time
and at no charge
Unionized employees often seek the assistance of a union representative when they wish to view their
personnel file (Office of the Privacy Commissioner of Canada, 2018).

Chart A: Appropriate and Inappropriate use of Information Technology in Health Care

Appropriate Use Inappropriate Use
• Reduce paperwork • Over dependency on technology
• More accurate and up-to-date • Susceptibility to network hackers
information about care • Health care providers forget to log off
• Enables health care providers to make computers, making it vulnerable for
the best possible decisions others to view
• Helps health care providers to coordinate • Using computers, tablets, smartphone for
care inappropriate uses, while at work, or in a
• Increase patient safety client’s room, e.g. Facebook, Twitter,
• Efficient client coordination Snapchat, Instagram, etc.

STUDY GUIDE: Working as an HCA in Alberta Page 15 of 41

3.7 Exercises TOC
Read each statement and then circle T for true or F for false.
1. A client’s health information can be used to educate and train staff and physicians. T F
2. A care facility is not allowed to disclose the client’s room number to visitors. T F
3. Only the client or the client’s legal guardian has the right to access the client’s full medical
information. T F
4. The FOIP Act states that people have the right to know their own personal information. T F
5. A client’s chart is not part of his confidential information. T F
Check your answers with those on page 36.

Unit 4: Personal Directives

4.1 Personal Directives Act (PD)

Y our client has the right to make their own decisions unless directed by a court of law or if under the age
of legal consent, in which case the parent or legal guardian has the right to make choices or decisions for
care. This means that the client has the right to make decisions about their life and well‐being, including the
right to choose to live at risk.

The Personal Directives Act became law in Alberta on December 1, 1997. A personal directive is a legal
document that gives instructions and/or names a person to make decisions in the event the person becomes
incapable of making their own decisions. It can be handwritten, typed, or printed on a computer printer. It
must be signed, witnessed, and dated. Making a personal directive is optional and voluntary in the province
of Alberta. It can be created for short‐term use (for a few days) or for the remainder of your life such as in a
progressive condition like Alzheimer’s disease. With a personal directive you are providing instructions for
your life as well as your death (Government of Alberta, 2017).

Instructions in a personal directive can include all personal matters, except financial matters.

A personal directive deals with (Government of Alberta, 2017):

• Medical treatment that an individual wants or does not want
• Accommodation (living arrangements)
• Who the individual wants to live with
• Choices about personal activities, such as those involving recreation, employment, and education
• Any other personal and legal decisions (not financial)

Note: A personal directive cannot be used to request illegal actions.

Activating a Personal Directive

There is a legal process that needs to be completed before a personal directive can be used for decisions. Do
not act on a personal directive before checking with your supervisor to ensure that it has been legally activated.

Family and friends do not automatically have a legal right to make decisions for a client unless they are
named as the agent(s) in the personal directive or have been court‐appointed as the legal guardian.
STUDY GUIDE: Working as an HCA in Alberta Page 16 of 41
An agent is a person the client names in the personal directive to make a personal decision on the client’s
behalf. An Agent must (Government of Alberta, 2018):
• Be 18 years old at the time the personal directive takes into effect.
• Have the mental capacity to make the decision on the client’s behalf

If the client does not appoint a family member or a friend, or if they are not willing to act as the client’s
agent, they may appoint someone by office (e.g. the executive director of an association) as the agent,
without providing a specific name, if they are not providing a service to the client. If they are providing a
service to the client then they have to appoint a specific name. If there is no one else able and willing, the
client can ask the Public Guardian to act as a sole agent (Government of Alberta, 2015).

If a family member or friend who is not named an agent wants to make decisions on behalf of a client who
has an activated personal directive, the HCA must:
• Inform the family member or friend that decisions may only be made by agents named in the
personal directive
• Provide general information on the well‐being of the client
• Encourage the family member or friend to bring concerns to the supervisor
• Inform the supervisor of the requests of the family member or friends

Personal Directives Reflect the Client’s Competency and Wishes

Client competency can change. When this occurs, any decisions must be reassessed by the professional care
team. If you observe any change in the client’s competency, report this to your supervisor so that an
assessment may be done and areas of competency and decision making may be adjusted. Record all
observations and actions in the client chart according to employer policy and procedures (Government of
Alberta, 2017).

Any competent client has a right to modify or cancel his personal directive at any time. You must contact
your supervisor for direction if the client makes this request.

STUDY GUIDE: Working as an HCA in Alberta Page 17 of 41

4.2 Goals of Designated Care in Alberta TOC

G oals of care are instructions that guide the client and their collaborative care team about
the general focus of their care, and where they might want their care to take place. After speaking with
the client and/or your Agent, a doctor or nurse practitioner will write the client’s Goal of Care Designation as
a medical order. Finding out the client’s goal of care is not just about finding out what their wishes are, but
also to have a better understanding of who your client is on a more personal level (Goals of Care, 2018;
Alberta Health Services, 2018).

The Goals of Care Designation are usually kept in the Green Sleeve that most facilities in Alberta recognize.
The Green Sleeve should go with your client when they have appointments, procedures, or are admitted to a
facility.

There are 3 general approaches to Goals of Care (Goals of Care, 2018):

Medical Care (M) – Medical tests and interventions are used to cure or manage an illness as well as
possible, however resuscitative or life support measures are not used. This is appropriate when
resuscitative and life support measures won’t work or when the person chooses not to have these
treatments. Medical care can be given in many Locations, depending on the person’s wishes and values
as well as if it’s appropriate medically.

Resuscitative Care (R) – The focus is to extend or preserve life using any medical or surgical means. This
includes, if needed, resuscitation and admission to the intensive care unit. Talk to your health‐care team
about which Goal of Care designation best reflects your health circumstances and your wishes and
values.

Comfort Care (C) – The focus of care is to provide comfort to ease a person’s symptoms without trying
to control the underlying illness. This is for people who have a life‐limiting illness, when treatments can’t
influence the course of that illness. This care can be given in any setting.

4.3 Exercises
A. Reflection Activity: Personal Directive
Review the information you have read about personal directives and write a personal directive reflecting
your wishes.

STUDY GUIDE: Working as an HCA in Alberta Page 18 of 41

Unit 5: Protection of Persons in Care TOC

5.1 Understanding the Protection for Persons in Care Act (PPCA)

A lberta passed the Protection for Persons in Care Act (PPCA) in 1998 to ensure the safety of people who
receive care in Alberta health‐care facilities. The Act promotes the prevention and reporting of abuse of
adult Albertans who receive publicly funded care or support services. This includes people who receive
services from hospitals, nursing homes, lodges, group homes, facilities, and other health‐care agencies
funded to provide support and care in the province of Alberta. The Act was updated in 2015 and now
includes mental health facilities and care homes (Alberta Health, 2015).

Under the terms of the Act, anyone who reasonably believes that a person in care has been abused must
report that abuse to an appropriate authority. The Act requires you to report abuse only if you believe a
person has been abused. It is not up to you to investigate whether it is abuse or not. You need to ensure the
safety of your clients and protect them from abuse. Before reporting abuse, you must ask yourself what a
reasonable caregiver would do in similar circumstances with similar experience and education. Failure to
report suspected abuse can lead to a fine or imprisonment. You may not report abuse anonymously;
however, your identity will be protected if you do make a report (Alberta Health, 2015).

There are several avenues to report abuse. One is to call 1‐888‐357‐9339 to report abuse or suspected
abuse of persons in care. You report to the RCMP if the client’s life is in danger or the alleged abuse is
criminal in nature. You report to a professional regulating body such as CLPNA if the alleged abuser is a
licensed health‐care provider. You report to the Mental Health Patient Advocate if the alleged abused
person is detained in a care facility or under a community treatment order (Alberta Health, 2015).

Roles and Responsibilities Alert! As a member of the health‐care team, you are required to safeguard the
client. Many of those you will care for cannot protect themselves and will need you to advocate for them. If
you are aware of, or reasonably believe, abuse has or is occurring you MUST report to the appropriate
authority; failure to do so can result in a fine (Protection for Persons in Care Act, 2015b; Alberta Health,
2015).

Definition of Abuse
Abuse, according to the Protection for Persons in Care Act, is defined as (Alberta Health, 2015b):
• Intentionally causing bodily harm
• Intentionally causing emotional harm through such acts as threatening, intimidating, harassing,
humiliating, coercing, or restricting social contact
• Intentionally administering or prescribing medication for an inappropriate purpose
• Subjecting the person in care to non‐consensual sexual contact, activity, or behaviour
• Intentionally misappropriating (using wrongly) or improperly or illegally converting money or other
valuable possessions of the person in care
• Intentionally failing to provide adequate nutrition, medical attention, or other necessities of life
without a valid consent

STUDY GUIDE: Working as an HCA in Alberta Page 19 of 41

Common Factors That Increase the Incidence of Abuse
Investigators have identified a number of common factors that seem to increase the incidence of abuse.
They are:
• Lack of co‐operative teamwork resulting in the client being caught in the middle
• Concerns about family dynamics causing problems for residents and staff
• Failure to report abuse by management
• Residents feeling threatened that they will be punished if they report abuse

Abuse in Care
The most common types of abuse in care are:
• Emotional
• Financial

The most prevalent abusers are (in the following order):

• Service providers
• Co‐residents
• Family

5.2 Duties and Responsibilities Associated with the PPCA

Duties of the Employing Agency
The employing agency also has specific duties listed in the Act (Alberta Health, 2015b).
• Every agency must require that each new employee and new volunteer provide a criminal record
check.
• Every agency has a duty to protect the clients from abuse and to maintain a reasonable level of
safety for clients.
• Every agency must make sure that all clients, employees, and service providers are aware of the
content and requirements of the Act.
• Employers must have policy and procedures that reflect the Act.
• The employer will conduct an internal investigation separate from the external investigation.

Protection for the Person Reporting Abuse

The Act protects from punishment those persons reporting abuse. No employer can in any way punish a
person or service provider who makes a report of abuse. The employer can be fined for punishing a person
who makes a report of abuse. Any person who discontinues or threatens to withdraw care of the client
because abuse has been reported can be fined (Protection for Persons in Care Act 2015, Alberta Health,
2015b).

STUDY GUIDE: Working as an HCA in Alberta Page 20 of 41

False Reporting of Abuse
The Act attempts to protect persons from false or malicious reporting of abuse. False or malicious reporting
of abuse is a serious offense with serious consequences.

Any person who reports abuse to cause harm to another or without reasonable or probable ground that
abuse has occurred may be fined.

Self‐Care If You Are Reported to the PPCA Office

It is important to ensure that you seek support and professional assistance if the stress of undergoing the
investigation is interfering with your ability to function effectively in your personal and professional life.
Most agencies have an employee assistance program through which a care provider can seek confidential
counseling if required (Alberta Health, 2015b).

5.3 Exercises
A. True and False: PPCA
Read each statement and then circle T for true or F for false.
1. You can report abuse anonymously. T F
2. One of the most common groups of abusers is caregivers. T F
3. Neglect is one type of abuse. T F
4. You may lose your job if you report that a client has been abused. T F
5. If you suspect abuse, the most important thing you should do is ensure the client’s safety. T F

B. Case Study 1: PPCA

Read the following case study and then answer the questions that follow.
As you are walking down the hallway one day, you pass a client’s room where the door is partially closed.
Suddenly you hear what sounds like a slap, and the client says “Ouch, that hurt.” When you enter the room,
the client has some tears on her cheeks, but the HCA working with her says, “It’s OK. I have everything under
control in here.” When you ask the client whether she is OK, she just hangs her head and keeps crying.

1. What should your first action be?

2. Is this a reportable incident? If so, how do you report the incident?
3. What should you do if you know that the HCA working with the resident is on probation and could
lose her job if there is one more complaint about her?

Check your answers with those on page 36.

STUDY GUIDE: Working as an HCA in Alberta Page 21 of 41

5.4 Continuing Care Health Services Standard TOC

W hat is the Continuing Care Health Services Standard (CCHSS)? They are legislated,
minimum requirement standards that apply to all health care providers (HCP’s) working in home care,
supportive living, long term care or adult programs, whether employed by Alberta Health Services (AHS) or
other services providers. They were created to ensure that HCP’s are providing quality safe care for
continuing care clients. 19 standards were created (CCHSS, 2018).

The Goals of the Standards are to:

• Better meet the health care needs of clients
• Help HCP’s to give care in a more person‐centred way
• Improve the quality of client care

It is important for HCAs to be aware of the Standards as they ensure that quality and safe care is being
provided to clients.

The 19 Standards (Listed in order)

• Standardized Assessment and Person‐Centred Care Planning
• Case Management
• Access to Physician or Nurse Practitioner Services
• Client Access to Information
• Palliative and End of Life Care
• Assistive equipment, technology and medical/surgical supplies
• Sharing of client information
• Health care Providers
• Staff training
• Risk management
• Infection Prevention & Control
• Medication Management
• Nutrition and Hydration Management
• Oral care assistance and bathing frequency in publicly funded supportive living and long term care
facilities
• Safe bath and shower water temperature
• Restraint management
• Continuity of Health care
• Concerns resolution on health care and forming a council
• Quality improvement reporting

STUDY GUIDE: Working as an HCA in Alberta Page 22 of 41

5.5 Exercises
C. CCHSS Multiple Choice Questions
Follow the link and download the Continuing Care Health Services Standard Information Guide.

Using the above document answer the following questions:

1. What is the main goal of the 19 Continuing Care Health Services Standards?
a. To give politicians something to do
b. To keep Albertans happy
c. Quality safe client care for all continuing care clients
d. To make more work for everyone

2. Which standard addresses the client’s needs and corresponding goals and interventions?
a. Medication Management
b. Quality improvement reporting
c. Standardized Assessment and Person‐Centred Care Planning
d. Case Management

3. Which standard would cover the following information: a documented procedure available to all
Regulated Health Care Providers on how to access the on‐call Physician or Nurse Practitioner outside of
regular daytime or evening shifts?
a. Continuity of Health care
b. Concerns resolution on health care and forming a council
c. Health care Providers
d. Access to Physician or Nurse Practitioner Services

4. An Operator/ Facility must establish, implement and maintain documented policies and procedures to
ensure: Circle all that apply:
a. Training for staff in person‐centred care
b. Training of health care aides involved in the provision of medication management
c. Training for all HCP’s in fall prevention and management
d. Training in 9.2(a) through 9.2(e) occurs within six months from the date of hire, and every 3 years after
e. Training for all HCP’s in methods to ensure safe bath and shower water temperature
f. Training for all staff in infection prevention and control practices

Check your answers with those on page 37.

STUDY GUIDE: Working as an HCA in Alberta Page 23 of 41

5.6 Dependent Adults May Require a Legal Guardian or Trustee TOC
In Alberta, a dependent adult is defined as an individual who:
• Is 18 years or older
• Is continuously or repeatedly unable to safely care for himself or herself
• Has a mental disability caused by a developmental delay, acquired brain injury, chronic mental
illness, or a disease associated with aging.

Capacity Assessment
A capacity assessment is done only if there are valid reasons to believe the independent adult doesn’t have
the ability to make their own decisions (Adult Guardianship and Trusteeship Act, Government of Alberta
2015a).

A health care professional, called a capacity assessor, checks to see if the adult understands:
• The facts they should consider when making a decision
• What could happen if they choose one option over another
Capacity is assessed to help determine whether or not:
• a personal directive should be enacted to give the agent authority to make a personal decision, or
• one of these decision‐makers should be appointed for an adult:
o co‐decision‐maker
o guardian
o trustee

Guardians and Guardianship Responsibilities

The needs of dependent adults vary from one individual to another. As the needs and capacities of adults
vary, so too do the responsibilities of the guardian. All guardians, both public and private, are appointed by
the courts (Adult Guardianship and Trusteeship Act, Government of Alberta 2013).

Private Guardians
A private guardian is an individual who is 18 years of age and over, usually a friend or relative, who has been
appointed by the court. This person must agree to:
• Act in the best interests of the dependent adult
• Encourage the dependent adult to do as much for himself or herself as the person can. A private
guardian does not need to live in Alberta.

Public Guardian
The Public Guardian is a government official who can act as a guardian for a dependent adult under the
terms of The Adult Guardianship and Trusteeship Act. Guardianship is handled by the Office of the Public
Guardian, which is part of the Ministry of Seniors and Community Supports. This office supports private
guardians and assists them in their role (Adult Guardianship and Trusteeship Act, Government of Alberta,
2015a).

STUDY GUIDE: Working as an HCA in Alberta Page 24 of 41

Both private and public guardians may be responsible for all or some of the following areas (Government of
Alberta, 2015):
• Where the dependent adult will live
• Social activities
• Personal contacts
• Employment
• Education and training
• Licenses and permits
• Legal matters that do not include finances
• Health care
• Daily living routines

Note: A guardian’s responsibility NEVER includes financial matters.

5.7 Trustees and Their Role

Private Trustees
Private trustees are friends or family members who have been appointed by the court to assume
responsibility for a dependent adult’s financial matters.

Public Trustees
The Public Trustee is a government official who can make financial decisions on behalf of a dependent adult
under the terms of The Adult Guardianship and Trusteeship Act if there is no suitable private trustee
available. Trusteeship is handled by the Office of the Public Trustee, which is part of the Ministry of Seniors
and Community Supports. This office supports private trustees and assists them in their role. Role and
Responsibility Alert! If there are legal guardians or trustees in place for clients, there should be a copy of this
legal record on the client’s personal care chart. If you are not sure who the legal decision maker is for health,
personal, or financial matters, you must ensure that you clarify this with a healthcare professional. It is
important for you to ensure that you are taking directions for your client from the appropriate alternative
decision maker (Adult Guardianship and Trusteeship Act, Government of Alberta 2015a).

Dependent Adults Are Members of the Health‐Care Team

As a member of the health‐care team, you may be required to attend family conferences. It is important to
know that if a client is a dependent adult and has a legal guardian, the guardian will attend the conference
on the client’s behalf. It is possible for a client to be competent to make some decisions in his or her life, but
not all decisions. For example, a client may not be able to consent to medical procedures because he does
not understand the consequences and risks of the procedure; however, this same client may be able to
decide who he wishes to have visits from and who he does not want to see (Adult Guardianship and
Trusteeship Act, Government of Alberta, 2015a).

STUDY GUIDE: Working as an HCA in Alberta Page 25 of 41

The Adult Guardianship and Trusteeship Act focuses on the client’s ability to participate in life decisions.

The Act has key elements that help focus on ability rather than disability. There is a range of supportive and
substitute decision‐making options (Government of Alberta, 2015a):
• Supportive decision making: This allows an adult with the capacity to choose a supporter to help
the adult to make decisions in personal matters. The supporter has access to the client’s personal
health information. The client can discontinue this arrangement at any time.
• Co‐decision‐making orders for personal matters. This order takes place when a client has significant
cognitive impairment but retains the ability to make some decisions with the assistance of another
person.
• Specific decision‐making provisions. When a client has no personal directive or guardian, healthcare
professionals may need to approach relatives to make specific decisions on the client’s behalf in
emergency or crisis situations.
• Temporary guardianship or trustee orders. A court order is required to appoint someone to make
decisions on behalf of an adult who is in danger of death, serious harm, or financial loss. The court
order lasts only 90 days.
• Guardianship and trustee orders. These options remain available for adults assessed as incapable,
but there is a more thorough screening process of the applicants for private guardianship. It is
important that as part of the health‐care team, you support the client in remaining independent in
those areas in which he or she is still able to make choices.

In general, the guardian must be informed of any medication change, treatment change, upcoming
appointments, and change in client condition. The representative from the Office of the Public Guardian has
the right to review the client’s entire chart. Private guardians must be referred to the regulated health‐care
professional to have questions answered about the client’s condition, lab results, and diagnosis
(Government of Alberta, 2015).

5.8 Exercises
A. Fill in the Chart: Consent, Impaired Consent, and Capacity Assessment
In your own words, write out the definitions of each of these terms.

Consent

Informed Consent

Capacity Assessment

Compare your answers with those on page 37.

STUDY GUIDE: Working as an HCA in Alberta Page 26 of 41

Unit 6: Other Legislation TOC

6.1 The Alberta Mental Health Act

Alberta Mental Health Act (the Act) has been around since 1990, however many important changes have
been made over the years. The current Act came into effect in 2009, and updates were made in 2010.

The Act applies to individuals with a mental health disorder in certain situations. The Act explains how a
person with a mental health disorder can be apprehended, detained, and/or given treatment in a facility or
community‐based setting. It also explains the client’s rights in these circumstances.

The Act describes actions the health care settings and/or legal system can take in certain serious or critical
situations to protect and/or treat clients with a mental health disorder and also protect the health and
safety of other people in the community (The Alberta Mental Health Act, Government of Alberta, 2010).

There are 3 main actions that can be enforced or taken in certain situations:
• Apprehension and detention
o Ordered to be picked up by the police and taken to a facility to be examined.
o Held against his/her will.
• Admission and treatment
o Two doctors separately examine the client and both decide for the client to stay in the
facility to get help, the doctor can admit the client to the facility involuntarily as a formal
patient.
o Once admitted, doctors will recommend treatment to help his/her recovery. The patient or
substitute decision‐maker will discuss treatment options.
• Community treatment orders
o Doctor’s order to follow a supervised mental health treatment and care plan for a certain
length of time while staying in the community vs. staying in a facility.
o Meant to prevent the cycle of being admitted to a facility, released, getting ill while in the
community, and then getting admitted again to a facility.

Who can be admitted and treated involuntarily?

The following three criteria must be met to be admitted without consent:
1. Mental disorder – must have a mental disorder or appear to be suffering from a mental disorder.

2. Likely to cause harm to themselves or others, or to suffer serious mental or physical deterioration or
serious physical impairment – after the doctor examines the client and is of the opinion that if the
person in not admitted they are likely to experience worsening mental health, physically ill or be at
risk for hurting themselves or others.

3. Unsuitable for admission to a facility other than as a formal patient – generally understood to mean
the client refuses to be admitted voluntarily.

STUDY GUIDE: Working as an HCA in Alberta Page 27 of 41

How long can a formal patient be kept?
The first certificate (Form 1) expires within 24hrs from the time you get to the hospital unless another
doctor sees the client within that time and issues another certificate. When two admission certificates are
issued, it allows the hospital to keep the client as a formal patient up to one month from the date of the
second certificate.

The client must be assessed regularly to see if they meet the conditions of the admission certificates. If they
do not meet all three of the criteria, the certificates are canceled, or discharged to community settings (The
Alberta Mental Health Act, Government of Alberta, 2010).

For more information, check out the Alberta Mental Health Act

For more information on mental health in Alberta, go to https://alberta.cmha.ca/

6.2 Working Alone Safely is a Shared Responsibility

T he Occupational Health and Safety Act defines working alone as a situation in which an employee is
working alone at a work site, where assistance is not readily available should the worker become sick or
injured or require some other form of assistance to maintain the worker’s safety.

Health care aides working in home care, group home, or designated supportive living settings may find
themselves working alone in two of the five categories described in the Occupational Health and Safety Act
(Working Alone Safely: A guide for employers and employees, Government of Alberta, 2000).

These categories are:

1. Employees who travel away from the office to meet clients
2. Employees who are at risk of violent attack because their work site is isolated from public view

Hazard Assessment
Both the employer and the employee have a responsibility when a hazard assessment is being completed.
During the hazard assessment, the employer and the employee work together to identify unsafe working
conditions for the employee who works alone. During this process, any records of previous unsafe incidents
should be reviewed to ensure that the hazards listed in the record have been corrected. Then an analysis of
the current working conditions must be made. Input from employees is very important for the success of the
hazard analysis. This also applies to individuals providing care in facilities where risk is present. Employees
must know how to alert each other for assistance in case of emergency. (Working Alone Safely: A guide for
employers and employees, Government of Alberta, 2000).

Best Practices for Working Alone

Some best practices that apply to all working alone situations are:
• Proper employee training
• Management’s commitment to the health and safety of their employees
• Effective communication systems available
• Awareness of personal safety
STUDY GUIDE: Working as an HCA in Alberta Page 28 of 41
 • Awareness of how to use the protocols for communication while working alone or in case of
emergency
• Assessing the hazards of the workplace
• Taking corrective actions or measures to prevent or minimize hazards or incidences from occurring.

Proper Employee Training

It is important that all employees be trained in the limits and scope of their job as well as in how to handle
hazards such as verbal threats and unpredictable client behaviours. The employee must review and
understand the employer’s policies and procedures for working alone safely.

Effective Communication Systems

If an employee is working alone, there must be an easily accessible phone or other communication systems
that give access to an individual designated to assist the employee who is working alone and needing
assistance.

Safe Visit and Travel Plans

Employees who travel from a home base to visit clients in their own home are at risk while they are traveling
and while they are visiting. Therefore, detailed safe travel and safe visit plans should be developed.

Safe Travel Plans

Safe travel plans should include:
• Properly maintained vehicles
• First aid and emergency supplies
• A travel plan submitted by the employee. In the case of HCAs traveling to visit rural clients, this
would include a list of the clients and scheduled visit time as well as checking in when arriving at and
leaving a client’s home.

Safe Visit Plans

These plans may include:
• Asking a client’s family to be in attendance during the visit
• Assigning two staff members to the client if there is an identified risk
• Meeting the client at an alternative location, such as making plans to bathe the client at a lodge or
care facility, if there is an assessed risk of working alone with a client
• Ensure that there is an effective communication system and a resource person readily available to
you as a worker
• Reporting incidents of when the caregiver’s safety was, or could have been, at risk.

STUDY GUIDE: Working as an HCA in Alberta Page 29 of 41

6.3 Health Care Aides and the Canadian Charter of Rights and Freedoms

T he Charter is long and complicated, but it is of vital importance that you understand some parts of it
when you are working as part of a health‐care team. Some of the key rights and freedoms that pertain
directly to your role as an HCA are discussed below. (The Canadian Charter of Rights and Freedoms,
Government of Canada, 2017).

Freedom of religion. As part of a care team, you must support the clients’ freedom to practice their faith
even if a faith expression is very different from your own. Most importantly, you must never try to “convert”
a client to your own faith expression or religion. At times of illness and stress and during dying and after
death, honouring the religious practices of individual clients and their families is very important.

Freedom of thought. Life would be easier if we all thought the same way, but it would also be much less
interesting. Your client may belong to a different generation than you or have been raised with different
religious, cultural, and social beliefs than yours. This does not mean that one of you is right and one of you is
wrong. What it does mean is that you, as a trained health‐care provider, must never argue with or criticize
the client for the way he or she thinks. Set personal and professional boundaries and listen to the client in
an open and non‐judgmental way. Never try to debate who is right and who is wrong. Share your personal
thoughts only in a general and non‐threatening way.

Freedom of expression. This freedom can apply to many areas of the client’s life, but one particularly
important aspect for HCAs is the freedom of sexual orientation. Not all of your clients or coworkers will be
heterosexual. This may be uncomfortable for you, but it is not the HCA’s role to be judgmental. Each client is
an individual no matter what a person’s social, religious, or sexual orientation may be. As a trained health‐
care provider, you must first look at each individual as a unique and valuable person with strengths and
weaknesses. Never judge a person on just one aspect of who the person is, and never try to change that
aspect of the person.

It is easy to say we will honour each person’s rights as they are guaranteed under the Charter; however, it is
sometimes very challenging to do so. Stop, think, and consider before speaking or acting when you find
yourself assigned to work with a client whose religious, social, or cultural background does not fit with your
own. If you are really struggling with your client assignments, talk to your supervisor.

6.4 Exercises
A. Case Study 1: A Violation of the Charter
Read the following case study and answer the questions that follow.

A First Nations resident named Linda lived in a continuing‐care facility. She had several chronic
conditions, including partial blindness. Linda was a Christian; however, she also followed some of her
People’s traditional teachings and practices. Around her neck, she always wore a “medicine bag,” which was
sacred to her. Some of the staff were very critical of the medicine bag and called it “a filthy rag” and a lot of
“hocus pocus.” One day when the staff was giving Linda a bath, they decided to cut the medicine bag off and
throw it in the garbage. Before throwing it out, they opened the medicine bag and looked inside. Linda
became very upset about the actions of the HCAs and complained to the nurse. When the staff was asked to
explain why they acted the way they did, they replied that it was “just a dirty old thing filled with garbage”
and that it could “cause infections.”

1. Which of Linda’s rights and freedoms were violated?

STUDY GUIDE: Working as an HCA in Alberta Page 30 of 41

 2. Why do you think that the HCAs reacted the way they did about the medicine bag?

3. What would your own reaction to this client’s practices have been?

Compare your answers with those on page 37.

6.5 Applying the HCA Role CARE Principles to Legislation

O ne question you should ask yourself each time you learn new theory in this program is “How can I use
this information to become a skilled HCA?” One of the ways is to take the information you have learned
and apply it using the model.

C When you give compassionate care to a client, it is important to ensure that all of your actions will be
helpful and not harmful. By knowing and following the legislation that guides the HCA role and
responsibilities, you can ensure that you honour your clients’ individual rights and freedoms in a way
that is personal and meaningful to them. You will encourage your clients to make decisions for
themselves and remain as independent as possible.

A Accurate observations are vital. The Protection for Persons in Care Act requires vigilant observation and
the Adult Guardianship and Trusteeship Act requires the members of the health‐care team to recognize
when an individual’s cognitive ability is changing. The “working alone safely” guidelines of the
Occupational Health and Safety Act make an observation of unsafe or hazardous work conditions
mandatory.

R Always report and record in a timely manner. Report and record any specific care needs of a client based
on culture, religion, or social background. Report abuse according to the Protection for Persons in Care
Act and employer policy and procedures. Remember the Health Information Act and Freedom of
Information and Protection of Privacy Act when making verbal or written reports. Client confidentiality is
vital.

E Ensure client comfort and safety. This is your first obligation at all times. Share information only with
those people who are official guardians and the health‐care team. Prevent and report any suspected or
observed abuse immediately. Always ensure that the client is safe as a first step in the case of abuse.
Understand what is in a client’s personal directive, and plan care in a way that honours the client’s
wishes after the client is no longer able to help plan his or her own care.
STUDY GUIDE: Working as an HCA in Alberta Page 31 of 41
Unit 7: Module Review TOC

Multiple Choice Practice Questions

Select the best answer.

1. Your supervisor has assigned to you the task of starting a tube feed. She is going to watch you do the
procedure. This is an example of
a. indirect supervision
b. direct supervision
c. change of role and responsibilities
d. new task instruction

2. When you are assigned a task, you can refuse the assignment when
a. you are too busy to do any more work
b. the client’s condition is stable
c. a new staff member wants a chance to do the procedure
d. you have never done this task for this client before and have not received instruction on this
task, which is a restricted activity

3. Activity is restricted when

a. there is a degree of risk involved
b. the task is non‐invasive
c. the doctor has decided that it is a restricted activity
d. supplies to complete the procedure are expensive

4. Health care aides are unregulated health‐care workers who work under the direction of
a. the client’s family or legal guardian
b. the president of the care facility
c. the regulated health‐care professional
d. the Health Care Aide Professional Association

5. The Health Information Act ensures that

a. the family can always get the client’s full medical history
b. if the client does not wish to have any information disclosed, this wish will be respected
c. all health‐care organizations in the community automatically receive all clients’ information
d. a client is given a copy of his chart when he is discharged from the hospital

6. When a request for information on a client’s condition is made, the responsibility of the HCA is to
a. refer the person making the request to the health‐care professional in charge of client care
b. tell the person making the inquiry to call back and make an appointment to talk to a nurse
c. explain that this is not your area of responsibility and there is nothing you can do to help
d. ask to see proof of guardianship and, if this is the legal guardian, give this person the client’s
chart to read

STUDY GUIDE: Working as an HCA in Alberta Page 32 of 41

7. As an HCA, you must keep client information confidential because
a. some information on the chart may not be correct
b. you have a legal and ethical obligation to maintain confidentiality
c. the client may define confidentiality differently than you
d. a client does not have the legal right to know about his or her personal information

8. A client may not make a personal directive if

a. he is under the age of 18
b. he is mentally competent
c. he is physically disabled
d. he is married

9. An agent named in a personal directive must

a. have a medical background
b. live in the same province as the client
c. be a relative or spouse of the client
d. agree to act as the agent for this client

10. Which of the following decisions is not a part of the personal directive?
a. Where the client would like to live
b. Who the client would like to associate with
c. Financial decisions made by the client
d. Medical treatments the client will accept

11. The Protection for Persons in Care Act is designed to protect

a. home care clients
b. clients seen in emergency rooms
c. clients receiving treatment in a walk‐in clinic
d. clients who live in care facilities

12. What is one of the certification criteria under the Mental Health Act?
a. Suffering from a physical disability
b. Clients who are mentally healthy
c. Clients you are likely to cause harm to them or to others.
d. A client is suitable for admission to a facility

13. One of the two most common types of abuse in care is

a. physical
b. religious
c. financial
d. sexual

14. Upon witnessing abuse, the first thing an HCA should do is

a. ensure that the client is safe
b. investigate what has happened
c. document the incident in the client’s chart
d. problem‐solve with the abuser

STUDY GUIDE: Working as an HCA in Alberta Page 33 of 41

15. A public guardian
a. is assigned to each client who comes into care
b. is appointed by the court
c. is chosen by the client or the client’s family
d. works for the Government of Canada

16. One employee responsibility when working alone is to

a. have a friend to text when in trouble
b. refuse to travel alone in a car
c. never take a lunch or coffee break
d. follow a safe visit plan

Check your answers with those on pages 37 and 38.

STUDY GUIDE: Working as an HCA in Alberta Page 34 of 41

 ANSWER KEY FOR THE EXERCISES
1.4. Terminology Related to Legislation TOC
1. If your supervisor is present while you perform a task, this is an example of direct
supervision.
2. A friend or relative who is appointed by the court to make decisions on your behalf, but not financial
decisions, is called a private guardian.
3. If the regulated health‐care professional is available to you by phone this is called indirect supervision.
4. You must maintain confidentiality about client information.
5. Tasks that clients would normally perform for themselves are referred to as activities of daily living.
6. When the client receives, accurate and relevant information about the procedure and gives consent, is
referred to as informed consent.

2.7 Exercises
A. Case Study 1: Supervision and Assignment of Task I
• You are required to tell your supervisor that you have not been trained in this task and have never
administered medication by application of medicated patches.
• You need to be trained by a health‐care professional from the agency. Even after training, you would
administer the medication only under direct supervision until you could demonstrate competency in
performing that task on that particular client.
• You must check agency policy regarding the types of medications that HCAs are allowed to
administer.

B. Case Study 2: Supervision and Assignment of Task II

• Inform your supervisor of the tasks that you feel comfortable doing and request adequate training in
the tasks that you cannot do because you have no training or experience in them.
• Ask your supervisor to demonstrate the task and then to observe you doing the task until you feel
comfortable and safe in performing the task under indirect supervision.
• Ask your supervisor to observe you performing the task and to provide feedback.
• Ask your supervisor to set up further training in tube feeding. The agency must arrange to have
health‐care professionals provide training and direct supervision until the HCA can demonstrate
competency in the following procedures: checking the feeding tube position, administering tube
feedings, and flushing of feeding tubes and bags. After the HCA has demonstrated that she is
competent in these procedures, she can perform them under indirect supervision unless the client’s
condition becomes unstable or the tube feeding procedure is changed.

STUDY GUIDE: Working as an HCA in Alberta Page 35 of 41

3.4 Exercises TOC
A. Case Study 1: A Request for Client Information
1. Which of the following responses would be the most appropriate for you to make in this situation?
c. “May I take your name and number? I will have the home care nurse call you.”

3.7 Exercises
A. True and False: The Health Information Act and FOIP
1. A client’s health information can be used to educate and train staff and physicians. T
2. A care facility is not allowed to disclose the client’s room number to visitors. F
3. Only the client or the client’s legal guardian has the right to access the full medical information. T
4. The FOIP Act states people have the right to know their own personal information. T
5. A client’s chart is not part of his confidential information. F

5.3 Exercises
A. True and False: PPCA
1. You can report abuse anonymously. F
2. One of the most common groups of abusers is caregivers. T
3. Neglect is one type of abuse. T
4. You may lose your job if you report that a client has been abused. F
5. If you suspect abuse, the most important thing you should do is ensure the client’s safety. T

B. Case Study 1: PPCA

1. What should your first action be?
Your first action should always be to ensure client safety. If you believe that the HCA providing care
slapped this client, then do not leave the client alone. Quietly ask the other caregiver to leave or stay
in the client’s room until the care is complete.

2. Is this a reportable incident? If so, how do you report the incident?

If you have reasonable grounds to believe that abuse has happened, you must report the abuse. Call
the toll‐free number to make the report to the government office and follow your employer’s policy
and procedure for reporting abuse. Remember, never allow yourself to be talked out of or threatened
out of making the report if you believe abuse has occurred.

3. What should you do if you know the HCA working with the resident is on probation and could lose her
job if there is one more complaint about her?
Your responsibility is to the client’s safety. Although you may feel sorry for the other staff member,
your first duty is always to the client. It is up to your manager to determine the action to take with the
staff member after the internal investigation has been completed and policy and procedure have been
followed.

STUDY GUIDE: Working as an HCA in Alberta Page 36 of 41

5.5 Exercises TOC
C. CCHSS Multiple Choice Questions
1. c
2. c
3. d
4. a, b, c, e, f

5.8 Exercises
A. Fill in the Chart: Consent, Impaired Consent, and Capacity Assessment
In your own words, write out the definitions of each of these terms.

Consent: Agreement or approval e.g. to medical treatment, health care, or personal care.

Informed Consent: Consent obtain under the legal condition whereby a person is first given complete
accurate, and relevant information so as to fully understand the action or procedure and its potential
implications.

Capacity Assessment: A capacity assessment is done only if there are legitimate reasons to believe
the adult doesn’t have the ability to make their own decisions

6.4 Exercises
A. Case Study 1: A Violation of the Charter
1. Which of Linda’s rights and freedoms were violated?
The client’s freedom of religion was violated. In addition, her right to privacy was violated. The staff
had no right to look into the medicine bag. It was personal and sacred.

2. Why do you think that the HCAs were so upset about the medicine bag?
It appears that the HCAs did not understand the traditional First Nations religious practices and
perhaps were prejudiced against this woman. In addition, they may not have accepted that this client
practiced parts of two different religions.

3. What would your own reaction to this client’s practice have been?
Answers will vary.

Unit 7: Module Review – Multiple Choice Practice Questions

1. Your supervisor has assigned to you the task of starting a tube feed. She is going to watch you do the
procedure. This is an example of
b. direct supervision

2. When you are assigned a task, you can refuse the assignment when
d. you have never done this task for this client before and have not received instruction on this task,
which is a restricted activity
STUDY GUIDE: Working as an HCA in Alberta Page 37 of 41
3. Activity is restricted when
a. there is a degree of risk involved

4. Health care aides are unregulated health‐care workers who work under the direction of
c. the regulated health‐care professional

5. The Health Information Act ensures that

b. if the client does not wish to have any health information disclosed, this wish will be respected

6. When a request for information on a client’s condition is made, the responsibility of the HCA is to
a. refer the person making the request to the health‐care professional in charge of client care

7. As an HCA, you must keep client information confidential because

b. you have a legal and ethical obligation to maintain confidentiality

8. A client may not make a personal directive if

a. he is under the age of 18

9. An agent named in a personal directive must

d. agrees to act as the agent for this client

10. Which of the following decisions is not a part of the personal directive?
c. Financial decisions made by the client

11. The Protection for Persons in Care Act is designed to protect

d. clients who live in care facilities

12. What is one of the certification criteria under the Mental Health Act?
c. Clients you are likely to cause harm to them or to others.

13. One of the two most common types of abuse in care is

c. financial

14. The first thing an HCA should do if she witnesses abuse is

a. ensure that the client is safe

15. A public guardian

b. is appointed by the court

16. One employee responsibility when working alone is to

d. follows a safe visit plan

STUDY GUIDE: Working as an HCA in Alberta Page 38 of 41