ENSURING QUALITY CARE RESIDENTS RIGHTS September 2019 Safety, - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

RESIDENTS RIGHTS

September 2019 Safety, Oversight and Quality Unit

PURPOSE AND KEY TERMS

The purpose is to assist the learner in understanding residents living in the AFHs to still have control over their own lives. This section also reviews the various legal documents typically encountered by the AFH provider and reviews the provider’s responsibilities.

• Advocacy
• Advance Directive
• Conservatorship
• Guardianship
• Physician Orders for Life-

Sustaining Treatment (POLST)

• Power of Attorney
• Representative payee

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OBJECTIVES

The learner will be able to:

Recognize the resident’s right to make their own decisions Examine how we all take risks every day Describe the purpose of the legal documents outlined in this section Explain when someone else is legally responsible for making choices for the resident and the limits of the decision making

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INTRODUCTION

People do not lose their rights just because they are older or have a

• disability. Residents have a right to:
• Take chances
• Refuse treatment
• Associate with anyone they choose
• Make informed decisions
• Make poor decisions, etc.

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INTRODUCTION CONTINUED

Society often feels the older or disabled population must be kept safe at all costs. The Oregon Legislature developed a Residents’ Bill of Rights (SDS 0305A (10/13)) for the use in AFHs (AFH):

• A copy of the Residents’ Bill of Rights is in the Appendix: Mandatory Forms.

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INTRODUCTION CONTINUED

As an AFH provider you must let residents know of their rights and help them remain as independent as possible (OAR 411-050-0655(9)(a)). Reviewing the Residents’ Bill of Rights when they are admitted, assures residents in your home they will still have control over their own lives.

• Can also be used as a teaching tool for a resident’s family who is requesting

you to do things a resident does not want.

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INTRODUCTION CONTINUED

Your role is to provide information and advocacy for the individual and to support independent choice.

• A resident has the right to resist choices made:
• By family members
• Medical professionals
• Even make decisions contrary to what you think is best

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INTRODUCTION CONTINUED

Unless a resident has a legally appointed guardian, they have the right to make decisions, even ones you don’t agree with or have concerns

• about. If you see indications a resident can no longer understand the

consequences of their decisions, contact DHS Aging and People with Disabilities, the medical professional involved and the family to determine how to proceed.

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RISKS OF LIVING

All of us take risks every day of our lives. We:

• Shower alone even though we may slip and fall;
• Drive or take the bus though we may have an accident; and
• Are willing to take risks and feel the choice is worth the risk.

Disabled and older adult have the right to take risks. They have to:

• Think about what the choices are and make their choice based on the

information available; and

• Face the consequences of their choices.

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RISKS OF LIVING

CONTINUED

Your obligation as an adult foster home provider is to be sure the resident has as much information as possible to help in making a decision, including a realistic assessment of the consequences

• f the decision.

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RISKS OF LIVING CONTINUED

For example, a resident refused to follow a diabetic diet, you would:

• Continue to offer appropriate foods
• Talk to the resident about your concerns
• Try and urge the person to keep on track
• Give information about what could happen if they continue to choose not to

follow medical orders

• Inform their doctor
• Express your concerns to the resident and document the situation and how

you handled it in the resident’s record

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LEGAL AUTHORITY

Many times people think they have more power than they really have and so you must have a basic understanding of legal authority in order to act in the best interest of the resident. You are required by the AFH rules to determine if the resident has someone who can legally make choices for the resident.

• When you find out someone has been given authority to act on behalf of a

resident you must get a copy of the legal papers.

• You must also know what authority, if any, the authorization actually gives to

the person.

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POWER OF ATTORNEY

A power of attorney gives another individual (called the attorney-in- fact) the legal authority to act for a resident under certain conditions.

• The resident can choose a spouse, a relative or friend

A general power of attorney gives the attorney-in-fact authority to conduct most business for the resident in regards to financial concerns. A limited power of attorney allows the attorney-in-fact to conduct certain business transactions. Limits are defined in the resident signed document.

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POWER OF ATTORNEY CONTINUED

The power of attorney does not take away the resident’s right to make their own decisions about financial matters. It does not give anyone the authority to make medical decisions for the resident.

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POWER OF ATTORNEY CONTINUED

The power of attorney must be in writing and signed by the resident:

• The resident must be able to understand the authority he/she is giving to the

attorney-in-fact at the time the power of attorney is signed

• The power of attorney can be notarized or witnessed, but it is not required

A resident can revoke a power of attorney at any time by notifying the attorney-in-fact in writing.

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REPRESENTATIVE PAYEE

Social Security allows a person to be the representative payee for another person receiving benefits:

• The benefit must be used for the person entitled to the money. A resident can

request a person be named a representative payee if he or she is not able to manage benefits.

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REPRESENTATIVE PAYEE CONTINUED

The resident, or someone on the resident’s behalf, must apply to the agency issuing the benefit. The representative payee must account to the agency for all the funds used and saved annually:

• If the resident does not want a representative payee, or wants to change the

representative payee to a different individual, the resident must ask the agency to make that change.

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CONSERVATORSHIP

A conservator is named when a person cannot effectively handle his/her finances. Is set up by the courts and must:

• Handle money and property for the resident’s benefit
• Report yearly to the court on how the resident’s money was managed

A conservator does not have the power to manage or handle personal affairs such as where the resident lives, medical care, who the resident associates with, etc.

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CONSERVATORSHIP CONTINUED

It is considered financial exploitation and abuse if you as an adult foster provider become the power of attorney or conservator for any resident in your home (OAR Division 411 Chapters 020 and 050).

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ADVANCE DIRECTIVE

Allows a resident to give written instruction to the doctor and a person named by the resident to direct the person’s care if they become unable to speak for themselves:

• The person named is called a “health care representative”

The resident must be able to give directions and understand what he or she is signing when completing an Advance Care Directive.

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ADVANCE DIRECTIVE CONTINUED

Oregon law requires the use of the specific Advance Care Directive

• form. Two witnesses are required. Only one of the two witnesses can

be related to the resident:

• An AFH provider can be one of the witnesses when the form is signed by a

resident, but cannot be named as the health care representative for a resident in the providers care.

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Physician Orders for Life-Sustaining Treatments (POLST)

Physician orders for life-sustaining treatment (POLST) is a document to assist in further honoring individuals’ treatment preferences at the end

• f life.
• It does not replace a valid Advance Health Care Directive, but it is a means for

a physician or a nurse practitioner to communicate their orders, based on the individual’s wishes, in the event life-sustaining treatments become necessary.

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Physician Orders for Life-Sustaining Treatments (POLST) CONTINUED

The POLST form is bright “watermelon” pink and easily recognizable in an emergency. If a resident has a POLST, the original document (photocopies are not acceptable) must be given to the responding emergency personnel.

• If the resident moves from your home, the form must go with them

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Physician Orders for Life-Sustaining Treatments (POLST) CONTINUED

What is the POLST Registry?

• In 2007, the Oregon Legislature passed Senate Bill 329 enabling Oregon to

launch the nation’s first 24-hour electronic POLST Registry on December 3,

• 2009. First responders and providers are able to call the registry from the field

and be informed of a patient’s orders.

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GUARDIANSHIP

A guardian is appointed by the courts. When someone applies to be a guardian, the court must decide whether or not the resident is incapable of making informed decisions regarding living situations and/or care choices.

• A guardian is considered only after all other options have failed

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GUARDIANSHIP CONTINUED

A legal guardian can be given the right to override the express wishes

• f a resident but they must still act in the resident’s best interests:
• The court spells out the specific authority
• A copy of the order must be kept in the residents record
• The guardianship ends when the resident dies or when the court agrees the

resident no longer needs a guardian

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DISCUSSION/QUESTIONS

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