High-Acuity In-Home Caregiver (CNA, RN, or Complex Care Specialist) – Adams County

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High-Acuity In-Home Caregiver (CNA, RN, or Complex Care Specialist)

Job Overview

Caregivers First Choice is seeking an exceptionally skilled and vigilant caregiver, such as a CNA, RN, or an experienced complex-care professional, to provide comprehensive 1:1 in-home care for an adult client living with a progressive neuromuscular condition. Advanced disease progression has left the client non-weight-bearing and fully dependent on a caregiver for all daily activities. This is a high-acuity role where ordinary daily tasks carry real clinical risk and require careful, nuanced monitoring and medical-device management. All care hours are authorized and classified under Health Maintenance Activities (HMA).

Core Clinical Responsibilities

  1. Advanced Medical Device & Line Management

    • Enteral feeding tube (G-tube): manage positioning during transfers and dressing changes, administer prescribed feeds and water flushes, and perform port changes.
    • Indwelling urinary catheter: provide daily site care and monitor for infection, perform periodic drainage throughout the day, and monitor and record fluid output.
    • Implanted medication pump: monitor the pump site and lines during hygiene and care tasks to prevent pulling, twisting, or displacement, and monitor the PDA device to ensure proper bolus dispensing.
    • Non-invasive ventilation (AVAPS/BiPAP): assist with the ventilation mask setup and removal as needed, perform regular cleaning and maintenance of equipment, and monitor nightly ventilation support for respiratory weakness.
  2. High-Risk Medical Monitoring & Emergency Response

    • Aspiration precautions: maintain strict 1:1 monitoring during meals, fluids, medication, and mouth care. The client is at high risk for silent aspiration, where food or fluid can enter the lungs without coughing.
    • Allergy and anaphylaxis response: monitor during and after meals for signs of a severe allergic reaction, check vitals, manage symptoms, and follow the prescribed emergency rescue protocol.
    • Respiratory therapy: track pulse oximetry, administer cough-assist treatment when oxygen saturation falls below the prescribed threshold, and administer prescribed inhalers as needed.
    • Vital-signs tracking: monitor and document blood pressure, heart rate, oxygen saturation, and temperature to catch subtle changes in stability.
  3. Skilled Mobility, Postural Adjustments, & Skin Integrity

    • Dependent transfers: perform safe single-point, full-body transfers to and from bed, wheelchair, shower chair, and toilet, with full support of the head and cervical spine.
    • Repositioning and weight shifts: provide frequent offloading and postural changes throughout the day to redistribute weight and prevent pressure injuries over bony areas.
    • Skin assessment and topical care: perform routine skin checks, monitor the cervical spine area for skin disruptions or issues in the surrounding area, and carefully apply prescribed topical treatments, with extra care around fragile skin and scar areas.
  4. Specialized Medication Administration via G-Tube

    • Medication scheduling: prepare and administer prescribed oral medications and gastrointestinal protocols through the G-tube as scheduled.
    • Suspension and administration: follow pharmacy suspension guidance for dissolving and administering tablets through the G-tube.
    • Flushing regimen: perform pre- and post-administration water flushes and verify tube patency to keep the tube clear and functioning.
  5. Prescribed Therapeutic Exercise Plan

    • Program compliance: carry out a prescribed daily home exercise program, which may be split into shorter sessions based on the client’s tolerance.
    • Passive range of motion: provide guided passive range of motion stretches to manage limb contractures, stabilizing the limbs throughout.
    • Resistance thresholds: watch closely for signs of resistance or discomfort and stop short of painful end-ranges.
    • Orthotic and compression care: ensure proper fit of prescribed orthotics, such as ankle-foot orthoses, incorporate the use of compression socks into the daily care routine, and check for skin irritation.
  6. Personal Care, Hygiene, & Community Accompaniment

    • Hygiene support: provide full hands-on help with bathing, hair washing, styling, and nail care.
    • Safe shaving: provide careful shaving and hair removal around contracted joints and areas of reduced sensation, minimizing the risk of skin tears.
    • Bowel care: manage a prescribed bowel-care regimen, including extended toileting support and peri-care.
    • Community accompaniment: accompany the client to medical appointments and community outings, providing 1:1 support and help tracking care instructions, including support for memory and concentration challenges.

Required Qualifications and Key Skills

  • Licensure: CNA or RN preferred, or an experienced complex-care provider with a verifiable track record in high-acuity home health or specialized care.
  • Device Competency: Hands-on experience with G-tubes, indwelling catheters, cough-assist machines, and non-invasive ventilation (AVAPS/BiPAP).
  • Aspiration & Allergy Awareness: Clinical focus to maintain safety during feeding and medication tasks, and the judgment to recognize and respond to allergic emergencies.
  • Physical Stamina & Mechanics: Able to perform repetitive single-point transfers for over 200 pounds and precise positioning safely and comfortably.
  • Cognitive Support & Communication: Strong observation and charting skills, and patience supporting a client with memory and attention challenges.

Available Shifts

Care requires consistent multi-shift coverage. Please share your availability for our morning and afternoon/evening shifts, seven days a week. Specific hours are confirmed during the interview.

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