Ethical and legal behavior that maintains client’s right.

        Characteristics of professional behavior (examples such as):

1.  Caring
   1. Competent
   2. Conscientious (including personal hygiene)
   3. Courteous
   4. Dependable/Timely
   5. Honest
   6. Team player.

        Summary: Ensure each client’s basic needs are met. Provide a safe, caring, and comfortable environment. Learn appropriate communication skills to build positive relationships and to overcome physical and emotional barriers. Keep a positive attitude, and ask for help in difficult situations or when you feel overwhelmed.

The Client’s Bill of Rights in the home care settings.

Principles and rationale of Client’s Rights (Right to…)

1. Free choice
2. Freedom from abuse and restraints: freedom from any physical or chemical restraint, unless agreed to by client, ordered by the doctor, and necessary to protect a client.
3. Privacy

        Methods to maintain privacy (i.e. not talking about client in public areas such as the dining room, elevators….

        Maintaining privacy while performing client care).

1. Confidentiality of personal and clinical records (Health Insurance Portability and Accountability Act – HIPAA standards);
2. Accommodation of needs;
   1. Physical (independency in care, or self-care).
   2. Psychosocial.

1. Organize and participate in family & resident groups;
2. Participate in social, religious and community activities;
3. Examine survey results and correction plans;
4. Manage personal funds;
5. Information about eligibility for Medicare/Medicaid benefits;
6. File complaints about abuse, neglect or misappropriation of property;
7. Information about advocacy groups;
8. Immediate & unlimited access to family or relatives;
9. Use personal possessions;
10. Notification of change in condition.

        It is important to recognize and accept others beliefs and lifestyles, even if they clash with your own. Every person has the right to quality of life, regardless of age, gender, physical or mental ability, race, culture, religion, beliefs, or lifestyle.

Vocabulary words/terms related to ethical/legal behavior and client rights.

        Personal Care Worker have a legal obligation to uphold clients’ rights and protect them from physical and mental harm. Each client entitled to quality of life that enhances the person’s dignity and self-esteem. Quality care respects individual beliefs and focuses on individuality, strengths, needs, and preferences.

1. Privacy:

• Personal.
• Visits
• Telephone conversation.
• Information about care.

What is Privacy and Confidentiality?

• o   Basic rights of every person
• o   Privacy is the right of an individual to keep personal information from being disclosed
• o   Confidentiality is how we as health care providers/employees treat private information once we and others receive it

        Why are privacy and confidentiality important? No matter where one works in healthcare- the hospital, labs, radiology centers, nursing homes, doctors’ offices, business units IT, or in the patient’s home- it is important to understand what privacy and confidentiality mean.

        Patients, residents, clients have the right to control who will see their protected, identifiable health information. Communications with or about patients involving patient health information will be private and limited to those who need the information for treatment, payment, and healthcare operations. Such communications may involve verbal discussions, written communications, or electronic communications. Only those people with an authorized need to know will have access to the protected information.

        Hospitals and healthcare organizations have always upheld strict privacy and confidentiality policies. Unless you are new to healthcare, this idea will be familiar to you. However, the U.S. government strengthened the laws protecting privacy and confidentiality in response to situations in which private medical information has ended up in the wrong hands.

        There have been cases in which employers have fired good employees after learning of illness that could lead to lost work time and increased insurance costs, people’s medical information has ended up in the newspaper, and medical information has been used to damage other’s reputations.

        With the enactment of HIPAA the Health Insurance Portability and Accountability Act of 1996, patients have the right to keep their medical information kept private and secure. It no longer is an ethical issue- it is the law.

So what is HIPAA?

        HIPAA is a broad law that deals with quite a variety of issues. Part of the focus of the law is to make it easier to move from one health insurance carrier to another. Because of this they must have their medical information and other information moved as well.

        HIPAA provided for healthcare organizations to standardize the way they communicate with one another to make it easier to share information. This is especially important to transmit information electronically.

        With the ease of records transfer it is also easy to sort out patients who have expensive illnesses or potentially use that information to hurt their chances at getting jobs or insurance.

        As a result HIPAA focuses on patient privacy and confidentiality. Under this law it is illegal to release health information to inappropriate parties or to fail to adequately protect health information from release.

        What information do we keep confidential? Confidential information includes patient identity, address, age, Social Security number, and any other personal information that patients are asked to provide.

        Confidential information also includes the reason a person is sick or in the hospital, the treatments, medications that he or she may receive, and other observations about his or her condition or past health conditions.

Penalties associated with violation of HIPAA.

        Civil penalties are fines up to $100 for each violation of the law per person, up to a limit of $25,000. For example, if 100 patient records were released illegally, a healthcare institution could be fined $10,000.

        Criminal penalties for wrongful disclosure can also result in jail time. The criminal penalties increase as the severity of the offense increases. Intentionally selling patient information is significantly more serious than accidental disclosure. These fines can be as high as $250,000 or a prison sentence of 10 years.

         How do we protect our patient’s/client’s privacy? We are committed to protecting their privacy and confidentiality in the following ways:

• Patient/client care or discussion about patient/client care is kept private by closing doors or conducting them in an area where the discussion will not be overheard.
• Patient medical records are not left where others can see them or gain access to them.
• Computerized patient records are closed when the caregiver is away from the computer.
• Written patient information is kept covered from the public.
• Diagnostic tests results are kept private.
• Paper records no longer needed are shredded or placed in closed receptacles for disposal. They are not left in the garbage.
• Information is not disclosed to visitors about a patient/client.
• Physical abuse.
• Sexual abuse.
• Verbal abuse.
• Emotional abuse. (Threats, humiliation).
• Involuntary seclusion.
• Financial abuse.

2. Abuse:

• Physical abuse.
• Sexual abuse.
• Verbal abuse.
• Emotional abuse. (Threats, humiliation).
• Involuntary seclusion.
• Financial abuse.

How do you recognize signs of abuse and neglect?

        Unfortunately, we occasionally read about or hear news reports of abuse and neglect occurring in personal homes. Clients, client’s family member may abuse one another, staff may abuse clients or clients may abuse staff. By law, signs of abuse and neglect are to be reported. Therefore, you must become knowledgeable about this topic. Abuse can be physical or emotional. Some examples of abuse are:

• Pushing, hitting or shaking.
• Pulling hair or ear.
• Tying a client to a bed or chair.
• Locking a client in a room.
• A staff person engaging in any sexual contact with a resident.
• Giving too much medicine on purpose.
• Yelling at or threatening with words.
• Harassing a person.
• Using ethnic slurs.
• Sexual harassment.
• Rape.
• Attempted rape.
• Sexual assault.
• Threatening to make a person leave the home.

        Another form of abuse is “financial abuse.” This involves taking property or money from a client or encouraging a client to hand over his/her assets. Clients have the right to protection of their money and property.

        Neglect is the failure to provide necessary care that results in harm to the client.

        Examples of neglect include:

• Leaving a group of aggressive clients unsupervised;
• A direct care staff person falling asleep while on duty;
• Delaying the normal scheduling of routine medical or dental visits for health maintenance;
• Isolating a client in their room;
• Leaving a client unattended by staff for long periods of time;
• Failing to seek medical help when a client shows symptoms of injury or illness, or if a client complains of pain;
• Delaying assistance with activities of daily living, such as failure to help a client with toileting and causing the client to soil himself/herself.

What should you do if you see abuse or neglect?

        You should ask your supervisor what the home’s procedures are to report suspected abuse or neglect. It is not your responsibility to investigate or confirm the suspected abuse or neglect—only to report what you see. When reporting to your supervisor, it is important to be “objective.” State only what you see or hear, not your interpretation of what you see or what you assume is happening, which is “subjective” information. In other words, just state the facts.

Methods to report abuse, mistreatment or neglect:

1. Chain of command.
2. Agency policy.
3. Community agencies.

Occurrence Reporting:

        Home care agencies are required to report certain events or “occurrences” to the The Health Facilities and Emergency Medical Services Division (Division) by the next business day. Home care agencies report occurrences through an internet portal and may submit them any day of the week or time of day. The Division prepares a summary of all reported occurrences and makes them available to the public. Any identifying information about specific individuals in occurrence reports is redacted from the reports released to the public.

        The Division receives and investigates complaints from any member of the public, including home care clients and their family members, home care workers, other government agencies, and adult protective services. Family members are the most common source of complaints.

ABUSE AND NEGLECT IN THE HOME

        Abuse and neglect in the home is a serious issue. It can consist of physical, sexual, or psychological abuse, or just obvious neglect of a person. The person abused or neglected can be anyone, from an infant to a senior citizen. Very often, when someone suspects abuse or neglect, the incident does not get reported because it is thought to be a family or personal affair that is none of anyone’s business.

        Staff should be taught to recognize signs of abuse and neglect and should be schooled in what steps should be taken for intervention and documentation of the abuse or neglect that was observed.

Definitions

        Physicalabuse is the use of physical force that results in pain, injury, or impairment.

        Sexual abuse is nonconsensual sexual contact of any kind.

        Emotional or psychological abuse is inflicting anguish, pain, or distress from verbal or nonverbal acts.

        Neglect is refusing or failing to fulfill one’s obligation or duty toward a person in one’s care.

        Abandonment is desertion by someone who has the responsibility for providing care.

        Financial or material exploitation is illegal or improper use of someone’s funds, property, or assets.

Signs of abuse or neglect:

• Bite marks, bruises, burns, or welts on the face or body
• Fractures or dislocations
• Unbelievable or inconsistent explanations for injuries
• Behavioral extremes, i.e. withdrawal, aggression, regression, depression
• Inappropriate or excessive fears
• Antisocial behavior, i.e. substance abuse, truancy, running away
• Unexplained crying or “zoning out”
• Exaggerated, startled response to touch
• Avoiding eye contact
• Eating disorders, speech disorders
• Poor hygiene, bedsores, severe diaper rash
• Untreated injury or illness
• Financial discrepancies

Procedure:

1. If there is a potential for violence, staff should leave the home immediately.
2. When any of the above signs are observed during a client visit, it is important that the circumstances be reported immediately to the supervisor and the Director of Client Services.
3. It is necessary to notify the State’s Division of Adult or Child Protective Services if abuse is suspected.  Call the Department of Social Services in the county of the client’s residence.
4. Reporting abuse or neglect may save a victim’s life and is required by State Law.
5. It is urgent that agency staff document clearly and accurately any signs noted and actions taken.

3. Client’s right to voice disputes and grievances.

        Every client has the right to file complaints. A complaint is defined as expressing dissatisfaction or concern about something. A concern can include one or more issues, which, if not addressed, can escalate into a complaint. Clients make complaints about the care they’re receiving to fix issues which are affecting their lives. A complaint can be made by anyone – the client, or the client’s family members, friends, representatives and advocates, as well as aged care staff, carers, health and medical professionals and volunteers.

        Staff in health organizations need to maintain a balance between being neutral/objective and being personal. Tips for complaint handling:

• Be confident in your ability to help.
• Remain flexible – don’t be too rigid in your approach;
• Communicate clearly – check if you’re being understood;
• Know your limits – be willing to get help from someone else or pass the problem on to someone with more knowledge, time or authority;
• Try to remain calm and think clearly;
• Strike a balance between logic and emotion.

4. How to resolve complaints about treatment and care.

• Assessment.
• Information gathering (What happened?)
• Resolution outcome. (Report back to consumer, staff, management).Refer to external organizations if necessary.
• Implementation. (Quality improvement: system, staff training, etc.)

5. Personal Choice/ Independency.

• The patient/ client has the right to personal choice regarding private association, receive and refuse care , communication with other people. The patient/client may send and receive unopened mail unless medically contraindicated. The patient/client has access to stationery, postage and writing implements at their expense. The patient/client has the right to personal choice regarding participation in activities of social, religious, and community nature unless medically contraindicated. The patient/client may use clothing and possessions as space, unless to do so would infringe upon the rights of other patients/clients. The patient/client is not required to perform services for the facility/home that are not included for therapeutic purposes in his/her plan of care. The client has the right to choose a personal care worker.
• Professionals must actively promote independence to help patients/clients take control and to ensure they play a crucial part in the decisions made about their care.

Guidelines to support client’s independence, and assist client to participate in activities.

        Personal Care Worker can help a client with everyday activities while supporting his/her independence and helping the client keep a sense of self-respect.

        Why is helping clients with everyday activities so important?

        Think about all of the little things you need to do each day. Just to start your day you must get out of bed, take care of your personal hygiene (bathe or shower, shampoo hair, brush teeth, etc.), pick out clothes, get dressed and get something to eat. As the day goes on there are many more activities that are so basic that most of us take them for granted. In completing most of these activities many little steps are involved. For example, getting out of bed requires that you are able to roll to the side of the bed, swing your legs over the edge of the bed, place your feet on the floor and stand.

        Now think about what would happen if you couldn’t do these things any longer or had great difficulty in doing them. Like most people, you would find that life was getting more difficult and you might feel frustrated, helpless or vulnerable. For many people, a loss in the ability to do the simple daily things can make them feel badly about themselves and angry with the world around them. If the clients you serve have these kinds of feelings about everyday activities, you can be sure that the quality of their lives will not be as high as it could be. This is important because a major part of what you do as a personal home care agency staff person is aimed at helping people maintain or improve the quality of their lives.

Which activities are important?

        Generally, the kinds of activities that are important to the people in a personal home care are organized into two groups:

• ADLs – This stands for Activities of Daily Living. These are the most basic activities necessary for daily life. They include the following:

1. Eating & drinking;
2. Ambulating – the ability to move about, such as walking with or without devices like canes, crutches, walkers, etc;
3. Transferring – the ability to get in and out of bed, a chair or on and off a toilet;
4. Taking medications;
5. Personal hygiene – bathing or showering, shampooing hair, brushing teeth;
6. Bladder & bowel management;
7. Positioning and changing positions in a chair or bed;
8. Dressing;
9. Securing health care;

• IADLs – This stands for Instrumental Activities of Daily Living. These activities are more complex and include:

1. Using the telephone.
2. Shopping.
3. Doing laundry.
4. Obtaining and keeping clean clothing appropriate for the season.
5. Making and keeping appointments.
6. Writing letters or other correspondence.
7. Taking part in social and leisure activities.
8. Using a prosthetic device – a substitute for a missing body part such as a hand or leg.
9. Managing finances.
10. Driving or arranging transportation.

        As you can see, many activities are part of everyday life. For some of the people you serve, your help with ADLs and IADLs will have a great impact on their ability to participate in and enjoy life. For others, you will be the only way they are able to complete much of what they need to keep safe and healthy from day to day.

What causes changes in ADLs and IADLs?

        Many things can cause a change in a resident’s ability to perform these basic activities. You will learn more about this in later modules. For right now, it is important to know four basic things about changes in ADLs and IADLs: 

1. Some clients have been unable to perform some activities for quite some time—maybe years. These clients have had a longer time to adjust to their loss. Many also know a great deal about how they like to be helped and have strong preferences. For example, Mr. Smith may like to brush his teeth before combing his hair, or he may like to get dressed by putting on clothes in a particular order, or eat, awake or go to bed at a certain time. Wherever possible, it is important to honor these preferences.
2. Other clients have experienced a recent loss of ability. This means that they have had less time to adjust to their losses and may still be learning about how they can best receive help. In some cases the client is also trying to adjust to the fact that they may never recover the ability they’ve lost. Some clients have a high ability to adjust to their loss. Others find it more difficult and may display sadness, anger or frustration. In these cases it is important to know that the angry things a client may say is probably not directed at you, but is really anger at the loss. To overcome and adjust to loss in ability, it is often helpful that clients have a strong sense that they can still have some control in their everyday lives. For this reason it is important to involve clients in choosing how activities will be completed. It is important to encourage them to do as much as they can do on their own.
3. It is likely that a number of clients with whom you work will have experienced loss in the ways their brains function and are unable to remember, solve problems or even be fully aware of what is taking place around them. For some of these individuals, each time you interact with them is like the first. So your patience and understanding are critical elements of being a caring worker. You must accept and honor that their experiences are real for them. You can also provide hints and suggestions for these clients. For example: Mr. Jackson forgets to bring a jacket when going outside in cold weather. You can give him a cue by saying, “Mr. Jones, the weatherman says it is cold outside today. I’m going to get my jacket. Would you like me to get yours?”
4. Finally, some clients will be experiencing a temporary loss in their mental or physical abilities from which they will eventually recover. This loss may be due to a mental illness, an injury or the process of recovering from something like surgery. These clients will not have the same sense of having to make permanent adjustments in how they do things. So, it is not unusual for them to be impatient with the recovery process. Once again, patience and understanding on your part are important tools to use when you interact with these clients. Additionally, they may need encouragement to do as much as possible as part of their recovery. You should always check their support plan to see how you can best assist.

Four general helping rules:

1. The support plan is the starting place for knowing what kind of help is needed by each client. The support plan is the tool that provides the basic information for how you will care for a client. Each support plan should give a clear picture of the client’s needs and preferences. Always make sure you read and understand the support plan for each client you serve.
2. When you are unsure about preferences or if help is needed, ask. Sometimes you will observe a client struggling with a task, or even after having read the support plan, you may not be sure of the client’s needs or preferences. While your immediate impulse might be to simply start helping, it is better to ask first. If you have a client who cannot understand or respond to your questions, try to find out from family members or others who know about the client’s preferences and remember to record this information in the support plan so it is available to all staff. (In some personal home care services, the appropriate procedure is to ask your supervisor to record information in the support plan.)
3. Try to use a “person-centered” approach. A “person centered” approach involves respecting and honoring the uniqueness of each person and respecting that person’s right to be involved in all decisions that impact on his/her life. These include the little decisions about how ADLs and IADLs are accomplished with your help.
4. If you believe the client is in immediate danger of injury, move to help right away. For example, if a client has fallen asleep and is about to fall out of a chair, move to help reposition him/her immediately.
5. Many of the tasks with which you will help clients have been studied and analyzed to find safe, respectful and effective ways for you to assist the client.