CHAPTER 2 The Person’s Rights

PATIENT’S RIGHTS The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities  Adopted in April 2003 by the American Hospital Association (AHA)  Refer to handout Slide 2

PATIENT’S BILL OF RIGHTS Slide 3

RESIDENTS’ RIGHTS Omnibus Budget Reconciliation Act (OBRA)  Passed in 1987 by the U.S. Congress  Applies to all 50 states  Requires nursing centers to provide care in a manner and in a setting that maintains or improves each person’s quality of life, health, and safety  Resident rights are a major part of OBRA Slide 4

RESIDENTS’ RIGHTS (CONT’D) Residents have rights relating to their everyday lives and care in a nursing center. Some residents cannot exercise their rights due to incompetence.  A representative may act on his or her behalf. Nursing centers must inform residents of their rights.  Residents’ rights are posted throughout the center. Slide 5

RESIDENTS’ RIGHTS (CONT’D) Surrogacy Decision Makers Law in Arizona Surrogate decision makers; priorities; limitations A. If an adult patient is unable to make or communicate health care treatment decisions, a health care provider shall make a reasonable effort to locate and shall follow a health care directive. A health care provider shall also make a reasonable effort to consult with a surrogate. If the patient has a health care power of attorney that meets the requirements of section , the patient's designated agent shall act as the patient's surrogate. However, if the court appoints a guardian for the express purpose of making health care treatment decisions, that guardian shall act as the patient's surrogate. If neither of these situations applies, the health care provider shall make reasonable efforts to contact the following individual or individuals in the indicated order of priority, who are available and willing to serve as the surrogate, who then have the authority to make health care decisions for the patient and who shall follow the patient's wishes if they are known: 1. The patient's spouse, unless the patient and spouse are legally separated. 2. An adult child of the patient. If the patient has more than one adult child, the health care provider shall seek the consent of a majority of the adult children who are reasonably available for consultation. 3. A parent of the patient. 4. If the patient is unmarried, the patient's domestic partner. 5. A brother or sister of the patient. 6. A close friend of the patient. For the purposes of this paragraph, "close friend" means an adult who has exhibited special care and concern for the patient, who is familiar with the patient's health care views and desires and who is willing and able to become involved in the patient's health care and to act in the patient's best interest. B. If the health care provider cannot locate any of the people listed in subsection A of this section, the patient's attending physician may make health care treatment decisions for the patient after the physician consults with and obtains the recommendations of an institutional ethics committee. If this is not possible, the physician may make these decisions after consulting with a second physician who concurs with the physician's decision. For the purposes of this subsection, "institutional ethics committee" means a standing committee of a licensed health care institution appointed or elected to render advice concerning ethical issues involving medical treatment. Slide 6

COMPETENCY DEFINED competent adj. 1) in general, able to act in the circumstances, including the ability to perform a job or occupation, or to reason or make decisions. 2) in wills, trusts and contracts, sufficiently mentally able to understand and execute a document. To be competent to make a will a person must understand what a will is, what he/she owns (although forgetting a few items among many does not show incompetency), and who are relatives who would normally inherit ("the natural objects of his/her bounty") such as children and spouse (although forgetting a child in a will is not automatic proof of lack of competency, since it may be intentional or the child has been long gone). 3) in criminal law, sufficiently mentally able to stand trial, if he/she understands the proceedings and can rationally deal with his/her lawyer. This is often broadly interpreted by psychiatrists whose testimony may persuade a court that a party is too psychotic to be tried. If the court finds incompetency then the defendant may be sent to a state mental facility until such time as he/she regains sanity. At that time a trial may be held, but this is rare. 4) in evidence, "competent" means "relevant" and/or "material". Lawyers often make the objection to evidence: "incompetent, irrelevant and immaterial" to cover all bases. (See: evidence)

RIGHT TO INFORMATION Access to all records about the person  Medical record  Contracts  Incident reports (never documented in the patient’s chart)  Financial records The person has the right to be fully informed of his or her health condition. The person must also have information about his or her doctor. Slide 8

REFUSING TREATMENT The person has the right to refuse treatment.  A person refusing treatment cannot be treated against his or her wishes. Advance directives are part of the right to refuse treatment.  Living wills  Instructions about life support Report treatment refusal to the nurse.  The person’s care plan may be changed. Slide 9

PRIVACY AND CONFIDENTIALITY Residents have the right to personal privacy.  Staff must provide care in a manner that maintains privacy of the person’s body.  The residents have the right to visit with others in private.  Residents have the right to make phone calls in private.  The right to privacy Health Insurance Portability and Accountability Act – HIPPA standards  Student HIPPA Violation YouTube:  Rite Aid Settlement:  HIPPA  Who is covered  What information is protected  Refer to Handout Slide 10

HIPPA PRIVACY SUMMARY Slide 11

PERSONAL CHOICE Residents have the right to make their own choices.  Choosing their own doctors  Taking part in planning and deciding about their care and treatment  Choosing activities, schedules, and care based on their preferences Personal choice promotes quality of life, dignity, and self-respect. Slide 12

GRIEVANCES Residents have the right to voice concerns, questions, and complaints about treatment or care.  Problem may involve another person.  Problem may be about care given or not given. The center must promptly try to correct the matter. No one can punish the person in any way for voicing the grievance. Slide 13

WORK The person has the right to work or perform services if he or she wants to.  He or she does not work for care, care items, or other things or privileges. Other persons need work for rehabilitation or activity reasons.  Some people like to garden, repair or build things, clean, sew, mend, or cook. Residents volunteer or are paid for their services. Slide 14

TAKING PART IN RESIDENT GROUPS The person has the right to form and take part in resident groups. They can:  Discuss concerns and suggest center improvements.  Support each other.  Plan activities.  Take part in educational activities. Slide 15

PERSONAL ITEMS Residents have the right to keep and use personal items.  Type and amount depend on space needs and the health and safety of others Treat the person’s property with care and respect.  The center must investigate reports of lost, stolen, or damaged items. The person’s property is protected.  Do not go through a person’s property without his or her knowledge and consent. Slide 16

FREEDOM FROM ABUSE, MISTREATMENT, AND NEGLECT Residents have the right to be free from verbal, sexual, physical, and mental abuse. They also have the right to be free from involuntary seclusion. No one can abuse, neglect, or mistreat a resident.  Nursing centers must investigate suspected or reported cases of abuse. Slide 17

FREEDOM FROM RESTRAINT Residents have the right not to have body movements restricted.  Restraints  Drugs Restraints may be used only if required to treat the person’s medical symptoms.  Doctor’s order is needed. Slide 18

QUALITY OF LIFE Residents have the right to quality of life.  Protecting this right promotes quality of life and shows respect for the person. Residents must be cared for in a manner and setting that promote dignity and respect for self. Slide 19

ACTIVITIES Residents have the right to activities that enhance each person’s physical, mental, and psychosocial well-being.  Activities must have a purpose and relate to the person’s needs, interests, culture, and background.  You assist residents to and from activity programs. Slide 20

ENVIRONMENT Residents have the right to a safe, clean, comfortable, and home-like setting.  Allow the person to have and use personal items to the full extent possible.  Provide a setting and services that meet the person’s needs and preferences.  Promote the person’s independence, dignity, and well-being. Slide 21

THE OLDER AMERICANS ACT (OMBUDSMAN PROGRAM) The Older Americans Act is a federal law.  The law requires a long-term care ombudsman program in every state.  Residents have the right to voice grievances and disputes.  OBRA requires that nursing centers post the names, addresses, and phone numbers of local and state ombudsmen where residents can easily see them. Slide 22