Ethical and legal issues of long term care

Chapter review on the ethical and legal issues of long term care. Examples of legal and ethical behavior:

• Being honest at all times
• Do nothing outside of your scope of practice
• Report abuse immediately
• Protect residents privacy at all times
• Document accurately and promptly
• Never accept gifts or money from the resident
• Do not become personally or sexually involved with the residence or family members

The Omnibus Budget Reconciliation Act of 1987 Minimum Data Set (MDS). This is a detailed form with guidelines for assessing the resident. Facilities must complete this form for each resident within 14 days of admission and again each year. The MDS for each resident must be reviewed every three months and a new MDS must be completed when there is any major changes in the residence's condition Ombudsman. The Ombudsman is assigned by law as the legal advocate for the resident. A resident has the right to call the ombudsman at any time. The ombudsman will respond to the resident's complaint within 24 hours.
Residences' rights

• Residents have the right to the best care available
• Residents have the right to be fully informed about their rights and services
• Residents have the right to refuse medication, treatment, and restraints.
• Residents have the right to review their medical record or any information in their chart at anytime.
• Residents have the right to privacy and confidentiality in phone calls and letters and all other personal matters
• Residents have the right to the safety of their personal possessions at all times
• Residents have the right to be informed about transfers and discharges before they occur
• Residents have the right to complain without fear of punishment
• Residents have the right to visitors
• Residents have a right to meet as a group, sometimes called a Residents Council to discuss any issues relating to their facility. Some topics that may be discussed are daily activities, food preparation, concerns and problems regarding staff, and all other issues concerning the resident. Staff may participate in the council meetings if invited by council members.

Signs of abuse and neglect

• Abuse. Abuse is causing physical, mental, or emotional pain or injury to someone in your care.
• Neglect. Neglect is harming a person physically, mentally, or emotionally by failing to give necessary care.
• Physical abuse. Physical abuse is any treatment whether intentional or unintentional that causes harm to a person's body. This can include cutting, slapping, burning, bruising, pushing, shoving, or any rough treatment.
• Sexual abuse. Sexual abuse is forcing a person to perform or participate in sexual acts.
• Psychosocial or mental abuse. Mental abuse is emotionally harming a person by threatening, scaring, or humiliating, intimidating, isolation, insulting, or treating the resident like a child.
• Verbal abuse. Verbal abuse is oral or written words, pictures, or gestures that threaten, embarrass, or insult the resident.
• Financial abuse. Financial abuse is taking advantage of, or improperly using the money, property, or other assets of the resident.
• Involuntary seclusion. Involuntary seclusion is confining or separating the resident into a certain area.
• Substance abuse. Substance abuse is the use of illegal or lethal drugs, cigarettes, or alcohol in a way that harms the resident.
• You must report abuse immediately. If you do not take action to report abuse and it is discovered that you were aware of the abuse you are as guilty as the abuser and you will lose your license.

Any injuries observed on the residents that were not present the last time you observed the resident should be reported immediately. These injuries may be signs of abuse or neglect.
HIPAA Health Insurance Portability and Accountability Act of 1996.
This act was designed to protect all the residence's health information, keeping it private and secure at all times.

• Make sure you're in a private area when relaying private health information on a resident to another staff member. Never talk about residents in public
• Never give information to anyone that is not directly associated with the care of the resident.
  
• Do not leave documents where others can read them

The Patient Self Determining Act (PSDA) This act encourages all people to make decisions about advanced directives. Advanced directives allow people to choose what medical care they wish to have if they cannot make those decisions themselves.
Some examples of advance directives are:

• Living Will. A living will states the medical care a person wants or doesn't want to receive.
• Durable Power of Attorney for Health Care. This document gives a person appointed by the resident the right to make medical decisions for the resident in the event that they cannot make these decisions for themselves.
• Do Not Resuscitate (DNR). This document tells medical professionals not to perform CPR on the resident.