In the home health care setting licensed providers typically work.docx

In the home health care setting licensed providers typically work.docx

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Inthehomehealthcaresettinglicensedproviderstypicallywork

Descriptionofprogram:

ReviewofProfessionalBoundariesfortheLicensedNon-AgencyProvider.

TargetLearner:

OhioHomeCareLicensedNon-AgencyProviders

FacultyDevelopmentTeam:

JulieStevensRN,IMIRSInvestigator

Mi’ChaelHocaLSW,ProviderMonitor

KarenLordanM.Ed,BSN,ProviderMonitor

TargetedRule（s）fortheProgram:

OAC5101:

3-45-10（A）（8-18）

OAC5101:

3-45-10（B）,（C）,and（D）

OAC5101:

3-1-17.6

Objectives:

AttheendofthisSelfStudyModuletheOhioHomeCareLicensedNon-AgencyProviderwillbeableto:

1.Identifythemeaningof,andimportanceofestablishing,andmaintainingprofessionalboundaries.

2.IdentifyhowtomaintainconfidentialityandprotectpersonalandmedicalinformationbelongingtotheOhioHomeCareConsumer.

3.IdentifyOhioHomeCareProgramrequirementsrelatedtodocumentationandmaintenanceofdocumentationfortheOhioHomeCareConsumer.

4.IdentifyinformationandreportableeventstobereportedtotheOhioHomeCareCaseManager（CM）andthecorrecttimeframesforreporting.

5.IdentifythespecificactionsthatarenotacceptablebehaviorsandarenotpermittedundertheOhioHomeCareConditionsofParticipation.

6.Identifywhatisimpermissibleinvolvementinconsumer’slegalmattersandidentifylimitationsofaproviderascaregiver-notdecisionmaker,andexceptionslistedintheConditionsofParticipation.

ReviewofProfessionalBoundariesforthe

LicensedNon-AgencyProvider

Introduction:

Inthehomehealthcaresetting,licensedproviderstypicallyworkone-on-onewiththeirpatientsandoftenspendmanyhoursinthepatient’shome.Itisnotsurprisingthatboundaryissuesoccurmorefrequentlyinthehomecaresettingasopposetootherareassuchasanemergencydepartmentormedical-surgicalunit.LicensedprovidersparticipatinginTheOhioHomeCareProgramfacemanychallengesastheconsumer’softenrequirelongtermandsometimesintensivecarewithintheirhomes.Someofthemanyattributesthatlicensedhealthcareproviderspossessarecompassion,empathy,andthedesiretoadvocatefortheirpatients.TherecansometimesbeafinelinebetweenutilizingtheseattributestoprovidecarefortheOhioHomeCareConsumerandviolatingprofessionalboundaries.ThismoduleisdesignedtoeducatetheOhioHomeCareLicensedProvideronmaintainingprofessionalboundariesasoutlinedintheOAC5101:

3-45-10ConditionsofParticipation.

TheImportanceofEstablishingandMaintainingProfessionalBoundaries:

Professionalboundariesarenecessarytoperformobjectiveassessments,carryoutordersappropriately,makeprofessionalclinicaldecisions,provideeducation,andexercisegoodclinicaljudgmenttodetermineandmeettheneedsoftheconsumer.Withoutprofessionalboundariestheprovider’sjudgmentbecomesimpairedandcanpreventtheproviderfromdeliveringadequateandappropriatecare,recognizingpotentialhealthandsafetyrisks,andcommunicatingappropriatelywithothermembersofthehealthcareteamsuchasthephysician,casemanager,andotherproviders.

Anexampleofthiswouldbethenursewhohasprovidedcareforaconsumerfor5yearsandhasdevelopedafriendshipwiththeconsumer.Thenursevisitstheconsumerfrequentlyofftheclockandtheygooutinthecommunitytogether.Thenursehasgottentoknowtheconsumeronapersonallevel.Thenursenoticestheconsumerhasbecomeverydepressedaboutherdiseaseprogression,butthenursedoesn’tthinkmuchofitbecausetheconsumerhasshownsignsofdepressioninthepast.Theconsumerhasinformedthenursethatsheisreadytodieandjustdoesn’twanttogoonanylonger.Thenursewhobelievessheknowstheconsumerwellandthinkssheisjustventing,tellstheconsumerthatsheisjusthavingabadday,andtomorrowwillbebetter.Thenursedoesn’taskanyfurtherquestionsanddoesn’treportthecommenttoanyone.Shearrivesthenextdayforhershiftandfindstheconsumerdeadinherbedsurroundedbypillswithasuicidenotenexttoher.

Hadthisnursemaintainedprofessionalboundaries,whensheheardtheconsumerstatethatshewasreadytodie,thenursewouldhaveassessedtheconsumerfurthertodeterminewhetherornotshewasincrisisandwhetherornottheconsumerhadasuicideplan.ThenursewouldhaveintervenedbycontactingEMS,police,physician,andcasemanager.Thenursewouldhavecollaboratedwiththerestoftheteammemberstoensurethehealthandsafetyoftheconsumer.Instead,theblurredlinebetweentheprofessionalnurseandtheconsumer’sfriendpreventedherfromseeingclearwarningsignsthattheconsumerwassuicidal.

Probablytheeasiestwaytomaintainboundariesistoestablishthemimmediately.Thenursesetsthestageofhowtheprovider–consumerrelationshipproceeds.Iftheprovidercomesintotheconsumer’shomeandbeginstalkingabouthis/herpersonallifeandfinancialsituationtotheconsumer,theconsumerreceivesamessagefromtheproviderthat“anythinggoes”.Iftheproviderrefrainsfromdiscussinghis/herpersonalissuesandkeepstheconversationfocusedontheconsumerandtheconsumershealthneedstheconsumerwilltypicallyfollowthatlead.Themaintenanceofprofessionalboundariesisnotonlynecessarytoprotectthewelfareoftheconsumerbutalsotheprovider.Theprovider’swhobecomeverycomfortablewithconsumersanddiscusspersonalissuesoftenfindthemselvesreceivingadviceandassistancefromtheconsumer.Thefocusthenshiftsfromtheconsumertotheprovider,leavingtheproviderinapositionthathe/shemaymisssomething,notprovideadequatecare,orevenplacetheproviderinapositionoffindinghim/herselfacceptingmonetaryassistancefromtheconsumer.Allofwhichcanputtheprovidersprofessionallicenseandprovideragreementinjeopardy.

Theoldadage“FamiliarityBreedsContempt”bearsalotofweightinthehomecaresetting.Whenprofessionalboundariesarenotmaintainedthelevelofrespecttheproviderandconsumerhaveforeachotherdiminishesandoftenleadstodisputes,disagreements,argumentsandquiteoften,“contempt”foroneanother.

TheProviderConditionsofParticipationareexactlyastheysound.InorderfortheprovidertoparticipateintheOhioHomeCareProgram,theprovidermustcomplywiththeconditionssetforthintheOhioAdministrativeCode.Theprovidershouldfamiliarizehim/herselfwiththeconditionsofparticipationandalsoeducatetheconsumerontheconditionswhichwillassistinmaintainingprofessionalboundaries.

TheConditionsofParticipationcontainprogramrulesthatifviolated,oftenleadtothedeteriorationofprofessionalboundaries.Thismodulewillreviewtheconditionsofparticipationthatrelatedirectlyandindirectlytothemaintenanceofprofessionalboundaries.

Confidentiality:

HIPAAortheHealthInsurancePortabilityandAccountabilityAct,wassignedintolawbyPresidentBillClintononAugust21,1996.ThisFederallawprohibitsthereleaseofhealthinformationwithoutthepatientsconsent.Itistheprovider’sresponsibilitytoprotectthepersonalandhealthinformationoftheOhioHomeCareConsumer.Maintainingtheconsumer’sconfidentialityisimportantinmaintainingprofessionalboundaries.TheOhioHomeCareproviderisonlypermittedtosharetheconsumer’sprotectedhealthinformationwithotherteammemberslistedontheASP,CareStar,andtheBureauofCommunityServices/representativesoftheOhioHomeCareProgram.Theprovidermaynotreleaseanypersonal,medical,orbillinginformationwithanyoneotherthantheabovementionedentitieswithoutwritten,signedconsentfromtheconsumerandthenthecasemanagershouldbemadeawareofthereleaseofinformation.

Documentation:

Copiesofalldocumentationmustbemaintainedwithintheconsumer’shomeandtheprovidermustretaintheoriginals.Documentationwithintheprovider’shomeshouldbekeptinasecure,lockedlocationwhereothermembersofthehouseholdorvisitorstothehomedonothaveaccess.Alldocumentationmustbekeptforaminimumof6years.Documentationthatissavedtoacomputerorportablemediadevicesuchasadiscorflashdrivemustalsobestoredinamannerthatotherpeoplecannotaccess,forexample,portablemediadevicesshouldbelockedupwiththedocumentation.Documentationshouldn’tbesavedtocomputersunlesstheprovideristheonlyonewhowillhaveaccess.Althoughthecopiesofdocumentationmustbeleftintheconsumer’shome,theconsumerdoeshavetherighttodiscardthedocumentationifheorshechooses.Theprovidershouldurgetheconsumertokeepdocumentationandmaintainitinasecureplacewithintheconsumer’shomewherehe/shecanaccess,butisnoteasilyaccessedbyotherpeoplecominginandoutofthehome.Theconsumercanthendeterminewhom,ifanyone,heorshewouldliketosharethedocumentationwith.Documentationmustreflectbutisnotlimitedtothefollowing:

✓Theconsumer’snameanddateofservice.

✓Arrivalanddeparturetimes.

✓Tasksperformed/notperformed

✓Datedsignatureofprovider

✓Datedsignatureofconsumerorotherrepresentativeverifyingservicewascompleted.

✓Documentationmustbecompletedbytheproviderandsignedbytheconsumerbytheendofthevisit/shiftinwhichserviceswererendered.

Maintainingwellorganizeddocumentationwithintheconsumer’shomegivestheconsumerasensethattheprovideriscommittedtoprofessionalismanddeliveringqualitycare.Maintainingwellorganizeddocumentationwithintheprovidershomeenablestheprovidertoreviewandcomparepastnotesand485’s/plansofcareeasilyandcomplywithdocumentationrequestsmadebyrepresentativesoftheOhioHomeCarepr