the patient bill of rights - baycaretraining.baycare.org/itk/bill_of_rights/bill_of_rights.pdfthe...

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THE PATIENTA Patient Rights Module:

BILL OF RIGHTSMay be copied for use within each physical

location that purchases this inservice.

©1998-2016

A Client Care Module:

Activity & the Elderly

RIGHTS...AND RESPONSIBILITIES!

Inside ThisInservice:

Developing Top-Notch CNAs, One Inservice at a Time

Patient Rights—A BriefHistory!

2

High Quality Care 3

A Clean, Safe Environment 4

Participation in Care 5

Protection of Privacy 6

Discharge PlanningServices

7

Billing and InsuranceIssues

8

Nursing Home and HomeCare Rights

9

Final Tips 10-11

America was founded on the beliefthat every individual is entitled tocertain rights—like life, liberty, and thepursuit of happiness. And, we don’t loseour rights just because we get sick,need home care, or move into anursing home or assisted living facility.Wherever we go, our rights go withus!

However, it’s common for people tofeel powerless when they are ill orinjured. That’s why it’s so importantfor your patients to learn about theirrights. All patients have the right to:

High quality care,

A clean and safe environment,

Be involved in their own care,

Protection of privacy,

Professional dischargeplanning services,and

Help with bill andinsurance claims.

While there are a fewdifferences between therights of a hospitalpatient, a nursing home or

assisted living resident, and a homecare client, you’ll find that the basiclist of healthcare rights is the samefor everyone.

"We have the Bill of Rights. What weneed is a Bill of Responsibilities."

~ Bill Maher

Isn’t it true that there is aresponsibility to go along with everyright? For example, when teenagersgain the right to drive a car, they alsotake on the responsibility of adheringto the speed limit. Or, when peoplehave the right to vote in elections,they must be responsible for learninghow to complete a ballot!

Healthcare rights are no different.Health care requires a team

effort between patients,families, and healthcare

workers. It’s not enoughfor a patient to sit backand say, “I know myrights. Now, take care of

me and make me well!”Patients have

responsibilities, too!

NOTE: We know that some of you work with “ clients,” some with “ patients,” andsome with “residents.” However, when people talk about healthcare rights, they usually say“patient rights.” So, to simplify things, we will refer to all people who need health care as“patients.”

The first Patient Bill of Rights was approved by theAmerican Hospital Association in 1973 and wasrevised in 1992. The Bill of Rights used by yourorganization today likely contains similar rights.

In 1987, the Nursing Home Reform Act was passed.This is a federal law that outlines certain rights forresidents of nursing homes—especially those whoare covered by Medicare and Medicaid. This law alsorequires each state to have its own rules aboutpatient rights. (The state law can be tougher thanthe federal law, if desired.)

In 1996, HIPAA (The Health Insurance Portability andAccountability Act) was passed. HIPAA ensuresmany patient rights, including the right to portabilityof medical coverage for pre-existing conditions. But,most importantly, HIPAA privacy regulations requirethat patients’ personal health information must beprotected and kept confidential. Access to patientinformation must be limited to only thoseauthorized, and only the information necessary for atask can be available to outside sources.

HEALTHCARE REFORM

On March 23, 2010 the Affordable Care Act, (headedby President Obama) was passed to end some of theworst abuses of the insurance industry.

New patient rights under this law includes theright to:

Receive cost-free preventive services: Newhealth plans must cover routine physicals,preventive screenings, vaccinations, andcounseling without any cost to the patient.

Keep young adults on a parent’s plan untilage 26: Parents can now keep children ontheir plan until they turn 26 years old, if needed.

PATIENTS’ RIGHTS—A BRIEF HISTORY!

A Patient Rights Module: Patient Bill of Rights © 2016 In the Know, Inc. Page 2

Choose a primary care doctor, ob/gyn, andpediatrician: New health plans must allowpatients to choose their own primary care doctor,pediatrician, or OB-GYN without a referral.

Use the nearest emergency room withoutpenalty: New plans can’t require priorapproval or higher copayments or co-insurancefor out-of-network emergency room services.

Under the Affordable Care Act, insurancecompanies are no longer allowed to:

Deny or limit coverage to kids younger than 19because of pre-existing conditions.

Put lifetime limits on benefits of people withcostly conditions like cancer.

Cancel a policy without proving fraud. This stopsthe practice of insurers canceling coverage –often at the time patients need it most.

Deny claims without a chance for appeal.

Grab your favorite highlighter! As you read through thisinservice, highlight five things you learn that you didn’tknow before. Share this new information with yoursupervisor and co-workers!

Over the next few pages you will learn about thebasic rights all patients are granted, including theright to:

High quality care. A clean and safe environment. Be involved in their own care. Protection of privacy.

Be prepared to leave care. Help with bill and

insurance claims.

Be sure to ask yoursupervisor if yourworkplace offers anyadditional patient rightsyou need to know about.

© 2016 In the Know, Inc. Page 3A Patient Rights Module: Patient Bill of Rights

High quality care means patients have the right to:

Expect their healthcare workers to be considerate and respectful.

Receive care without discrimination because of their race, culture,religion, age, gender, or physical disability.

Assume their healthcare workers are honest and ethical.

Be allowed to live a high quality of life, free from unnecessaryphysical or chemical restraints.

Be able to keep and use their personal belongings . . . and havethose belongings treated carefully and respectfully.

Know the identity of healthcare workers involved in their care.(They also have the right to be told if any of their caregivers arestudents or trainees.)

Along with this right, patients have a responsibility to:

Show respect for their healthcare team—regardless of the race,color, age, sex, or religion of each healthcare worker.

Be considerate of any other patients who may be close by.

As you go through your work day, be sure to:

Show sensitivity to the beliefs and needs of every patient. Forexample, you are a home health aide caring for Mrs. Green, avegetarian. Show your respect for Mrs. Green by learning aboutvegetarian diets and by fixing her nutritious vegetarian meals.

Address your patients the way they prefer. (Tobe safe, call your patients Mr. or Ms. unless theyask you to call them by their first name. And,avoid using terms like “Honey” or “Sweetie.” Itmay offend some of your patients.)

Don’t touch your patients’ personalbelongings unless it’s necessary. If you do

handle their belongings, be careful andput the items back where you foundthem.

Do your best to go along with yourpatients’ personal preferences every

day . . . such as letting them decide whichclothes they’d like to wear or which foodsthey’d like to eat.

Wear your name tag every day andremember to identify yourself when youenter a patient’s room.

THE RIGHT TO HIGH QUALITY CARE

This inservice is really all about patientrights . . . but as a nursing assistant . . .you have rights too!

You have the right to:

Be paid (at least) the minimum wagefor the work you perform. Thecurrent federal minimum wage is$7.25. Your state may have adifferent minimum wage. You areentitled to the higher of the two.

Be treated with respect regardless ofyour race, color, religion, sex, sexualorientation, or national origin.

Work in an environment free fromdangerous or hazardous conditions.

Reasonable accommodations forany disabilities you may have.

Receive inservice training on allhealth and safety standards andpolicies and procedures youremployer requires you to perform.

Along with these rights, yourresponsibilities are to:

Perform your job duties honestly,ethically, and professionally.

Be a reliable and trustworthy teamplayer.

Put your patient's needs first.

Seek out ways to improve anddevelop your skills by participatingin additional training opportunities.


A clean and safe environment means patients have the right to:

Expect that their healthcare workers will keep them safe fromabuse and neglect.

Expect that their healthcare workers will keep them safe fromharm or injury.

Know the healthcare organization’s policies for handling acomplaint.

Make suggestions or complaints about their care—withoutbeing afraid of the consequences.

Have a prompt and fair response to any complaint.

Take their complaint to the state if they are not satisfied withhow an organization handles it.

Switch to a different healthcare facility or agency if desired.


Cooperate with the rules of your workplace.

Consider the rights of other patients and/or their healthcareworkers.


Make sure your clients know how to make a complaint.(Remember, we can all learn from patient suggestions andcomplaints. They help us develop our customer service skills.)

Encourage your patients to tell you when they are unhappy withor worried about their care. The more your patients come totrust you, the less likely they are to take legal action whenproblems arise.

Stay calm if your supervisor tells you that a patient has made acomplaint. Let your supervisor hear all the facts about thesituation. (And, you may be asked to document the incident.Stick to the facts.)

Avoid complaints…

Help every patient in need—not just those who are assignedto you. It violates patient rights to ignore a patient just becausehe or she is not one of “yours.” It might also be consideredneglect. (Remember...abuse and neglect are not justviolations of patient rights. They are also illegal!)

Review your patient’s plan of care frequently to make sureyou are providing the proper care.

THE RIGHT TO A CLEAN & SAFE ENVIRONMENT

One of the best ways to make sureyou and your co-workers areprotecting ALL of your patients’rights is to open the discussionand talk about it!

Here is a conversation starter youcan use to get the discussionrolling:

Have you ever witnessed apatient’s rights being violated?

If so, what specific right wasviolated?

Who was involved?

Was the patient harmed?

Did you do anything toprotect the patient? Why orwhy not?

What would you dodifferently now after readingthis inservice?

“Working safely may get old, but sodo those who practice it.”

~Author Unknown

©2016 In the Know, Inc. Page 5A Patient Rights Module: Patient Bill of Rights

THE RIGHT TO BE INVOLVED IN CARE

The right to be involved means every patient has a right to:

Receive current information about their diagnosis, treatment,and prognosis. This includes learning about any risks involved ina particular treatment and what the alternatives might be. Theymust also be told how long a treatment will take and if a certaintreatment is experimental.

Make decisions about their own care.

Change their minds about healthcare treatments and services.

Refuse care (after being told what might happen if they do).

Have an advance directive if they want one. . . including a livingwill or a healthcare power of attorney.


Ask for more information if they don’t understand something.

Go to all scheduled doctor appointments.

Follow the plan of care that they help create.

Provide a copy of any living will or other advance directive.


Help your patients understand any information you give them.If your patient does not speak English, let your supervisor knowthat an interpreter may be needed.

Let your supervisor know if your patients are asking questionsabout their illnesses, treatments, or medications. A nurse ordoctor can answer those important questions.

Honor any advance directive. For example, if your patienthas a “Do Not Resuscitate” order, make sure you know whatto do if he or she stops breathing during your care.

Help your patients follow any exercise plans that have beenset up for them by a physical or occupational therapist.

Allow your patients to refuse care if they wish—but besure to document the situation and let yoursupervisor know. (Keep in mind that a patient’smedical insurance may have rules about paying forcare that the patient keeps refusing!)

Encourage your patients to participate in theirpersonal care. Even if they aren’t strong enough tobathe by themselves, they can probably wash theirfaces or comb their hair. The more they do forthemselves, the more independent they will remain!

Think about your patients and askyourself, “What am I doing for mypatients that they may be able to do(only when safe) with less help oreven without any help from me?

Here are some ways your clientsmay be able to participate intheir own care:

Prepare foods (cut meats,butter bread, add seasonings).

Feed self using fork or spoon. Brush hair or teeth. Wash face. Wash self after being helped

into tub. Choose clothing.

Get dressed. Get up and down from

seated position. Walk. Participate in ROM

exercises. Stretch. Take self to commode. Wipe perineal area

after toileting.

Now, think of some moreways you can help yourpatients to participate intheir own care!


THE RIGHT TO PROTECTION OF PRIVACY

Protection of privacy means every patient has a right to:

Be informed of the privacy practices of the healthcare providerwhich outlines how their medical information is used, shared,and protected.

Decide who can have access to their personal records, and howmuch information will be accessible.

Expect confidentiality from every healthcare worker whoprovides care.

Expect healthcare employees will only have access toinformation needed to provide care. For example, dietary aideswill not have access to laboratory results that have no effect onthe dietary needs of the patient.

In addition to keeping medical records private, patients have aright to:

Expect privacy during their care.

Be allowed to visit privately with friends or family members.

Have private telephone conversations.

Receive personal mail.


Share any personal information that effects their health.

Respect the privacy of their healthcare workers.


Keep all patient information confidential, including informationthat you write or say.

Don’t share confidential information about patients with yourfriends or family—even if it seems like an interesting thing totalk about.

Avoid talking about your clients in the hallways, elevator, orlunch room. You might accidentally violate a patient’s right toconfidentiality. No one outside your healthcare team has theright to know who your patients are or what is wrong with them.

Respect your patients’ privacy during personal care. Forexample, keep a sheet over your patient during a bed bath. Or,close the bathroom door while your patient uses the toilet.

Knock before entering a patient’s room or bathroom.

Give your patients privacy when they have visitors or when theyare speaking on the telephone.

You are caring for a patient who hashad a stroke and cannot speak.While you are feeding this patient, awoman you have never met entersthe room and asks how the patientis progressing and if there isanything she can do to help.

What should you do? You mayassume this is a family memberand volunteer the information.

But, what if you find out later thatthis is relative that the family hastried to keep away from the patientbecause it upsets her?

Or, what if you learn later that thisis a mentally ill person who was inthe facility to visit someone else butgot confused?

How will you determine if it isokay to disclose informationabout your patient to thisindividual? And, whatinformation can you to give?

The rule states that you can giveinformation to a person who has arole in taking care of the patient ifyou believe that releasing theinformation is in the patient'sinterest and relates to the person'sinvolvement in the patient's care.

Discuss your answers to thesequestions with your supervisorand co-workers and find out howthey would handle the situation.


THE RIGHT TO DISCHARGE PLANNING SERVICES

Working with clients in the home oftenrequires coming up with creativesolutions to uncommon problems.

THE PROBLEM: You are caring fora woman who was just dischargedhome. During your first visit withyour new patient a neighbor knockson the door and is invited in to visit.

The neighbor tells you she has afriend who gets home visits fromthe same agency you work for.After a few minutes you realize youknow the patient she is talkingabout.

She asks you if you know her friendand then begins to ask questionsabout the friends health status.

WHAT YOU KNOW: You knowHIPAA laws require you to protectpatient’s private health information.But, you feel this friend is justgenuinely concerned.

GET CREATIVE: Think of 3creative replies you could use to(kindly) let this friend know that youare not at liberty to share anypatient’s personal healthinformation.

TALK ABOUT IT: Share your ideaswith your co-workers andsupervisor and find out how theywould solve the problem.

Discharge planning services means every patient has a right to:

Access to professional staff to deliver discharge planning services.

Receive education, training, or counseling in how to perform self-care after being discharged. Or, if self-care is not an option, thepatient's family or primary caregiver must receive the training onhow to care for the patient upon discharge.

Be transferred or referred, along with necessary medicalinformation, to appropriate facilities, agencies, or outpatientservices, as needed, for follow–up care.

Refuse or request a change to the discharge plan if it doesn'tmeet the individual’s needs. For example, the patient may refusethe discharge plan if it includes transferring to a facility that has arecord of poor care or is too far away.


Be involved in the discharge planning process.

Ask questions or request clarification if instructions are unclear.


Document and report to your supervisor if your patient indicatesa desire to talk to someone about the possibility of returning tothe community.

Document and report to your supervisor if your patient tells youhe is uncertain, afraid, or unwilling to return to the community. Ifpossible, find out the reason why thisindividual feels this way.

Always document your patient’s physicaland mental abilities clearly and accurately.This will help the discharge planning teamdevelop a clear picture of what type ofsupport will be needed upon discharge.

As discharge nears, talk to your client aboutwhat will happen “next.” Ask your patientand their family if they have been given clearinstructions, understand those instructions,and are willing and able to carry out theplan.

If your patient or the family indicate thatmore information is needed, a call to thenurse or the discharge planning team mayhelp clear up any misunderstandings.


THE RIGHT TO UNDERSTAND BILLING AND INSURANCE

You are assigned to care for a newpatient. As you orient him to hisroom and help him unpack hisbelongings . . . he confides in youthat he does not have healthinsurance and will not be able topay for the care he receives.

He grows angry and tells you,“Doctors and insurance companiescharge too much anyway and theyusually end up making people sickerinstead of better.”

How would you respond to thissituation?

Do you feel your employershould have to provide care forpatients who can’t pay?

Who is the best person in yourworkplace to talk to about thissituation?

Does your employer have a planin place to help patients whoare uninsured or unable to pay?

Understanding billing and insurance means patients have theright to:

Know how much a particular treatment or service will cost—andhow much of this cost will come out of their pocket. The onlyexception to this right is in an emergency situation.

Review their own health care records if they want to. If they readsomething in their record that they don’t understand, they havethe right to have it explained to them.

Receive detailed billing statements that outline exactly what isbeing charged.

Dispute any charges they feel were not provided.

Receive the same quality of care—regardless of their ability to paytheir health care bills.


Give necessary information for insurance claims.

Work with the billing department to make paymentarrangements, when necessary.


Understand that when patients receive health care. . . they aregenerally charged separately for each individual procedure andsupply used . . . right down to an individual aspirin. These chargescan add up quickly and billing statements can be confusing andoverwhelming.

Carefully document the care you provide and the supplies you useon the right patient. For example, if youperform a cath on Ms. Jones butaccidentally chart it on Ms. Smith, it is Ms.Smith who will be charged for theprocedure and the supplies. If this type ofmistake happens too often, your employercould be charged with fraud and possiblylose the license to provide care.

If your patient or patient’s family membershave questions about particular fees orcharges, provide a name and contactinformation for someone in the billingdepartment. If you don’t know the nameand number of someone in the billingdepartment . . . ask your supervisor!

"My doctor gave me sixmonths to live, but when I

couldn't pay the bill, he gaveme six months more."

~ Dick Wilson


NURSING HOME AND HOME HEALTH RIGHTSHOME HEALTH CARE PATIENT RIGHTS

Clients receiving care at home have the right to:

Receive care in their own homes—but not if it’sunsafe. For example, if Mr. Brown’s medicationneeds to be refrigerated—and his home has norefrigerator—then home care is not an option!

Choose where and how they want to live—even ifthat environment seems unpleasant to us. Forexample, a client whose home is infested withroaches may not bother your client at all . . . and youcan’t force her to exterminate!

Be told about the state home health “hotline”—atelephone number they can call with questions orcomplaints about home care agencies.

Be told what to do in anemergency. Should they call theagency? Page the nurse? Call theirdoctor? Call the police?

Request a certain caregiver. Forexample, Mrs. Brown likes Tony to beher aide because he is strong and shefeels safe when he helps her transferto her wheelchair. But, Mrs. Tuckerasks the agency not to send Tonybecause she feels uncomfortable

having a male help her with personal care.

Home care clients have a responsibility to:

Provide a safe environment for you and the othermembers of your healthcare team. If you feelunsafe in a client’s home—discuss the issue withyour supervisor immediately. (If you feelphysically threatened, leave the client’s home rightaway and call your supervisor from the nearesttelephone.)

Be under the care of a physician during the timethey receive home care. The physician signs youragency’s plan of care. Your clients have aresponsibility to go to all scheduled doctor’sappointments.

Notify your agency if they are not going to behome at the time of a scheduled visit.

NURSING HOME PATIENT RIGHTS

Residents of nursing homes and assisted livingfacilities have the same rights they used to have whenthey lived in their own homes. This includes:

Having family members visit anytime . . . 24 hoursa day.

Refusing to see a particular visitor.

Managing and spending their own money (ordeciding who will manage it for them).

Bringing in their own furniture.

Wearing their own clothes.

Participating in theactivities of their choice,including religiousobservances.

Visiting with their spouse inprivate.

Sending and receivingpersonal mail.

Leaving the nursing hometo go shopping, run errands, or visit friends.Depending on state rules, they may also have theright to leave the facility overnight.

Moving freely about the facility without restraints(as long as they aren’t a danger to themselves orothers).

Along with these rights, patients have aresponsibility to:

Balance their rights with those of their fellowresidents. For example, Mr. Jones has the right tomove about freely, but that doesn’t mean he canenter another resident’s room without permission.

Follow the safety rules set up by the nursing homefor all residents. For example, if the facility has adesignated smoking area, then Mrs. Winters mustnot smoke in her room.


TIPS FOR HONORING YOUR PATIENTS’ RIGHTS

Listen to your patients when they tell you what they need. Eachpatient is different—even if they have the same health problems.Make an effort to treat every patient as an individual.

Include the patient’s family in making healthcare decisions if thatis what the patient wants. But keep in mind that the patient hasthe right to privacy, too.

Make it a habit to explain what you are going to do with apatient—before you do it! Your patients will be better prepared andmore able to cooperate if they know what’s going on. Forexample, explain to Mr. Wilson that you’re going to help himchange position in bed—before you pull down his blanket andsheet!

Remember that it’s possible for strangers to use illegal electronicdevices to listen in on cell phone conversations. If you are talkingto your supervisor about a patient over a cell phone, don’t use thepatient’s last name.

If you travel from patient to patient during your work day, becareful to keep your patient documentation private. Don’t letyour next patient see what you wrote about your previouspatient.

Don’t gossip about your patients with anyone—even othermembers of the healthcare team. It’s not necessary to sharepersonal information about a patient unless it makes a differenceto the patient’s health. For example, let’s say your patient, Mrs.Parker, told you a secret . . . that many years ago, she had an affair.This information has no impact on her current health and is noone else’s business.

Be honest with your patients and their family members at alltimes. If they ask you a question that you can’t answer, try saying:“I don’t know, but I’ll check with my supervisor.” (But be sure youfollow through by discussing the issue with your supervisor.)

Put your own needs aside during the work day. Your job is to putyour patients’ needs first. By doing this, you’ll be protecting theirhealthcare rights—and showing your patients that you are trulyconcerned about them.

Encourage your patients to tell you or your supervisor about acomplaint first—so that you have a chance to make things better.(But remember, all patients have the right to take their complaintto the state if they are unhappy with how your workplace handlesthe situation.)

1. Every American is entitled tocertain rights. And, we don’t loseour rights just because we getsick, need home care, or moveinto a nursing home or assistedliving facility.

2. The first Patient Bill of Rights wasenacted in 1973. And, although ithas been amended and improvedover time, the patient bill of rightsused by your organization todayprobably contains rights verysimilar to the original bill.

3. Today, all patients have the rightto; high quality care, a clean andsafe environment, involvement intheir own care, protection ofprivacy, professional dischargeplanning services, and helpunderstanding billing andinsurance claims.

4. Every right comes with aresponsibility. And, healthcarerights are no different. Health carerequires a team effort betweenpatients, families, and healthcareworkers.

5. This lesson covers the basic rightsthat all patients have. But, yourworkplace may offer additionalpatient rights you need to knowabout. Be sure to read yourworkplace Patient Bill of Rights.


TIPS FOR HONORING YOUR PATIENTS’ RIGHTS - CONT.

Now that you‘ve read this inservice onpatient rights, take a moment to jotdown a couple of things you learned

that you didn’t know before.

Avoid using “slang” words that your patients may notunderstand. This includes medical slang and abbreviations. Forexample, don’t say, “Mrs. Williams, you need extra fluids to flushout that UTI of yours.” or “Mr. Matthews, you’ll get a “decube” if yousit in that chair all day.” Mrs. Williams may not know that UTI is shortfor “urinary tract infection.” And, Mr. Matthews may not knowthat “decube” is short for “decubitus”—or that a decubitus is abed sore! If your patients don’t understand what you are saying,they’ll have a hard time cooperating with you.

For patients who don’t speak English, try communicating withpictures. Cut out magazine photos of personal care items like atoothbrush, a comb, a brush, shampoo, a bathtub, etc. Have yourpatients point to the items they want you to help them with next.

Encourage independence in your patients by letting them makedecisions about their care every day.

Never threaten your patients to get them to cooperate. Forexample, it’s wrong to say, “If you don’t take a bath right now,you can’t watch TV this afternoon.”

Don’t force care on a patient even if you know the patient will bebetter off. For example, you can’t force a patient to eat his luncheven if you are worried that he has been losing too much weightlately. (But be sure to document the fact that the patient refusesto eat.)

Balance your loyalty to your co-workers with the safety and well-being of your patients. Report any violations of patient rightsthat you witness.

Make sure you speak up for patients who can’t—or won’t—speakup for themselves. Because you spend so much time with yourpatients, you have the opportunity to notice if their needs arebeing met. They are counting on you!

WHAT’S THE BOTTOM LINE?

Make sure you’ve read the Patient Bill ofRights for your workplace.

And, to protect your patients’ rights, treatthem the way you would want to be treated

if you were in their place.

the patient bill of rights - baycaretraining.baycare.org/itk/bill_of_rights/bill_of_rights.pdfthe...

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