In the healthcare setting, ethical behavior includes

1. 1. 1. respecting patient choice,
      2. protecting patient confidentiality, privacy, and security, and
      3. administering health care services according to professionally-accepted standards of practice.

A caregiver’s ethical behavior is necessary to patient healing and recovery! Home health can advance the healing process but it can present a dangerous opportunity for violation of patient boundaries & rights, especially for patients who are compromised physically, mentally, and emotionally.

Ethics violations negatively impacts patients on many levels...

• • Patients may take longer to recover if not encouraged to participate in their own care and make their own decisions.
  • Changing the careplan without the patient's full understanding and consent violates patient control and impedes the recovery process.
  • Sharing information with indirect parties violates the integrity of the careplanning process.
  • Imposing unwanted care or services if the patient is competent, however necessary according to professional opinion, also violates patient rights.

Respecting Patient Choice

Federal rules and regulations allow several rights for home health care consumers. These rules and regulations require that an Agency representative provides an explanation of the patient’s rights verbally and in writing. The explanation and confirmation of patient/POA understanding should occur before services begin.

Patient Advisory of Their Rights and Responsibilities

1. By law, the admitting clinician is required to furnish a written and verbal explanation of the patient’s rights - Patient Rights and Responsibilities - to the patient/power of attorney (POA) at the beginning of the patient’s very first or “admission” visit.

2. The admitting clinician should ask the patient/POA to verbally recall the written explanation before the end of the visit.

3. To assure complete and accurate explanation of patient rights to the patient by the admitting clinician, the Agency may perform an admission survey call to the patient after the admission visit has been performed to confirm the patient’s/POAs understanding.

Patient Advisory of Information About Advance Directives

1. After explaining patient rights, the admitting clinician should explain the Agency’s policies and procedures regarding Advance Directives.

2. If the patient is unable to make informed decisions and no competent decision maker has been appointed on behalf of the patient, the Agency should ask for a competent person (family member, lawyer, physician, etc.) to act as the patient’s Power of Attorney.

3. Written Information About Advance Directives: For the competent patient or POA, the admitting clinician should provide a written and verbal explanation of Information About Advance Directives. The need for an Advance Directive is especially necessary in cases of patients with terminal illness.

4. Furnish Blank Living Will/POA; Consultant for LW/POA: If an Advance Directive has not been drafted by the patient/POA, the admitting clinician should furnish a blank copy of a Living Will and a Power of Attorney for the patient/family to develop independently. This form should also document a knowledgeable community resource for consultation on Advance Directives. The admitting clinician also documents any and all discussions with the patient/POA regarding the Advance Directive on the Information About Advance Directives.

5. On File: Living Will/POA: The admitting clinician should include a copy of the Advance Directive to be filed in the patient’s chart. All caregivers assigned to the patient should be advised of the patient’s Advance Directive when oriented to the patient’s careplan.

6. Caregiver Conflict: If a caregiver has a conflict with an Advance Directive of a patient for which they are caring, the caregiver has the right to refuse to provide care. All concerns and conflicts should be directed to the Clinical Supervisor.

Patient Advisory of Complaint Process

1. The admitting clinician is required to provide written information and explain the patient's right to voice a complaint without fear of retribution, coercion, and any unnecessary interruption in services,

2. The HHA is required to provide pertinent contact names and telephone numbers for the patient/POA to use if s/he wishes to log a complaint about the Agency. The explanation form is titled Complaint Policies and Procedures. Confirmation of the patient’s/POA’s understanding occurs during the admission survey call.

Patient Advisory of Description of Services and Informed Consent for Care

1. During admission the clinician is required to explain all of the risks and benefits of the services that the patient’s physician has ordered. The admitting clinician uses a Description of Services and Informed Consent for Care form to document explanation of care and informed consent by the patient/POA.

Patient Advisory of Liability for Payment

1. At the time of admission, the clinician explains who is responsible for the payment of home health care services.

2. The admitting clinician must detail the exact costs of home health care services on a Liability for Payment form.

3. The admitting clinician is also required to explain that, in the event of changes in responsibility for payment, the Agency is required to notify the patient - verbally and in writing - of the change 15 days before the change goes into effect. Again, the patient’s informed consent is required, after complete explanation, by signing a Liability for Payment form.

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