Abuses & Rights

1. Healthcare Safety Abuses & Rights By Tony Soares

2. The behavior of children may signal abuse or neglect long before any change in physical appearance. Some of the signs may include:  Nervousness around adults  Aggression toward adults or other children  Inability to stay awake or to concentrate for extended periods  Sudden, dramatic changes in personality or activities  Unnatural interest in sex  Frequent or unexplained bruises or injuries  Low self-esteem  Poor hygiene

3. Child abuse and neglect occur in all segments of our society, but the risk factors are greater in families where parents:  Appear uninterested in the care or safety of their children  Seem to be having economic, housing or personal problems  Are isolated from their family or community  Have difficulty controlling anger or stress  Are dealing with physical or mental health issues  Abuse alcohol or drugs

4. If you suspect abuse or neglect may be occurring, report it. To find out how, call information or contact your department of social services listed under government agencies in the phone book. If you think a child is in immediate danger, call the police. Childhelp USA National Child Abuse Hotline15757 N. 78th St.Scottsdale, AZ 85260(800) 4-A-CHILD The hotline offers crisis intervention, information, literature and referrals. APSAC 407 S. Dearborn St., Suite 1300Chicago, IL 60605(312) 554-0166 A multidisciplinary membership society promoting support among professionals who work with victims of child abuse.

5. Physical Abuse A non-accidental act which results in physical pain or injury, it includes physical coercion and physical restraint. Abusive Physical Behavior Includes hitting, slapping, burning, pushing, punching, pinching, biting, arm twisting, cutting, hair pulling, forced confinement in room, chair or bed. Signs of physical abuse Abrasions, Bruises, Burn blisters, Contusions, Rashes, Swelling, Lacerations Lack of awareness, Weight loss, Agitation, Broken bones. Etc. Sexual Abuse Non-consensual sexual contact, language or exploitative behavior. Abusive Sexual behaviorsIncludes rape, indecent assault, sexual harassment, sexual interference. Signs of sexual abuse - Unexplained sexually transmitted disease or infections - Bruising in genital areas or inner thighs - Bleeding from the genital area - Difficulty in walking or sitting not associated with a medical condition - Fear - Agitation - Disturbed sleep - Withdrawal

6. Financial abuse The illegal, improper use and/or mismanagement of a person's money, property or resources. Abusive financial behavior Fraud, Stealing, Forgery, Embezzlement, Reluctance to pay for accounts or debts, Forced changes to a Will, etc. Signs of Financial abuse Loss of jewelry or personal belongings, Expression of fear and anxiety when discussing finances, Unexplained amounts of money missing from bank accounts, Unpaid accounts, Loss of trust, Confusion over ownership of assets, property etc. Psychological/ Emotional Abuse Psychological abuse is language or actions designed to intimidate another person and is usually characterized by a pattern of behavior repeated over time, intended to maintain a 'hold of fear' over the older person. Abusive psychological/emotional behavior Humiliation, Blaming, Name calling, Insults, Silence, Shouting, Coercing, Intimidation, Withdrawal of affection, etc. Signs of psychological abuseFearfulness, Hopelessness, Withdrawal, Low self esteem, Confusion, Sleep deprivation, Anger, Depression, Anxiety, etc.

7. Social abuse Restricting or stopping social contact with others and stopping or restricting activities. Abusive social behaviorIncludes being discouraged or stopped from seeing other people. Signs of social abuse Loss of interaction with others, Sadness and grief of people not visiting, Worried or anxious after a particular visit, Appears shamed, Low self esteem, Withdrawn, etc. Neglect Neglect is the failure of a care giver in a relationship of trust to provide necessities or blocking the provision of basic needs being provided. Neglect can be deliberate or unintended. Abusive neglectful behavior - Not providing adequate clothing, and personal items - Unwillingness to allow adequate medical, dental care or personal care - Inappropriate use of medication - Refusal to permit other people to provide adequate care Signs of neglectful behavior - Poor hygiene or personal care - Absence of health aids (dentures, hearing aids, glasses)- Unkempt appearance, inappropriate, or lack of, clothing - Weight loss - Lack of personal items (photos, ornaments)

8. Rights of Older Persons International Federation of Ageing In December 1991, the United Nations adopted a set of United Nations Principles for Older Persons, recommending that all member governments incorporate them into their programs for older people. IndependenceParticipation Care Self – fulfillment Dignity As the number and percentage of individuals 65 and over has increased in this country, so has the incidence of elder abuse. Unfortunately, the prevalence and nature of this growing problem has generally remained hidden from public view. It is imperative that healthcare professionals become more aware of the scope and many issues surrounding this sensitive topic.

9. Reporting an abusive situation Care staff should report a situation of abuse to their supervisor in any of the previous circumstances Initial response to an abusive situation All staff, once they are aware of an abusive situation, will need to take steps to respond to it. Urgent/Emergency Non-urgent Listen to the older person Reaffirm they have rights Help is available Report Elder Abuse IDOA hotline at 800-252-8966 or 800-279-0400

10. Cultural Competence It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions. What is Cultural Competence? A set of congruent behaviors, attitudes and policies that come together as a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations. Culture shapes individuals' experiences, perceptions, decisions and how they relate to others. It influences the way patients respond to medical services and preventive interventions and impacts the way physicians deliver those services. In a society as culturally diverse as the United States, physicians and others in healthcare delivery need to increase their awareness of and sensitivity toward diverse patient populations and work to understand culturally influenced health behaviors. AREAS OF DISSONANCE 1. Historical DistrustPast injustices may cause minority patients to distrust their providers. Taking time to establish a rapport and explain why the forms are needed and who sees the forms may alleviate these fears. 2. Interpretations of DisabilityPhysicians feel that treatment should include intervention and that biological anomalies should be corrected. However, some cultures believe that the "disability" is spiritual rather than physical or that the "disability" itself is a blessing or reward for ancestral tribulations.

11. Cultural Competence It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions. 3. Concepts of Family Structure and Family IdentityPatient decision-making may include members of the extended family and the community. Providers should consider familial influence on treatment decisions. 4. Incompatibility of Explanatory ModelsIf patients' and providers' ideas differ about the structure and function of the body, for example, causes of diseases being bacteria, virus or the environment versus the "evil eye," "loss of soul" or "curses," it will be difficult to get patients to comply with treatment. 5. Disease Without IllnessPhysicians are well indoctrinated about the dangers of "invisible" diseases like hypertension, high cholesterol and HIV infection, but people in other cultures are not as willing to intervene when there are no symptoms.

12. Cultural Competence It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions. 6. Illness without DiseasePhysicians need to be aware of common folk illnesses that may affect members of a cultural community. "Some may see a medical doctor for relief of symptoms while also going to a folk doctor or traditional healer to be rid of the cause of the illness." In addition, although a few practices may be harmful (or misinterpreted as abuse), most folk medical beliefs and practices are not harmful and do not interfere with biomedical therapy. Providers should not try to change patients' benign beliefs but should educate them on the importance of biomedicine as complementary. A combination of the two forms of therapy may increase patient compliance because this is within the ethno cultural ideals of the patient. 7. Misunderstandings of terminology,language or body languageMonolingual providers who encounter patients who do not speak their language cite this as a barrier to healthcare. Body language can be misinterpreted between cultures. How do I become culturally competent? Listen with sympathy and understanding to the patient's perception of the problem. Explain your perceptions of the problem and your strategy for treatment. Acknowledge and discuss the differences and similarities between these perceptions. Recommend treatment while remembering the patient's cultural parameters. Negotiate agreement. It is important to understand the patient's explanatory model so that medical treatment fits in their cultural framework.

13. Advanced Healthcare Directive What is an advance directive? It tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives. A good advance directive describes the kind of treatment you would want depending on how sick you are. • How can I write an advance directive? • You can write an advance directive in several ways: • Use a form provided by your doctor. • Write your wishes down by yourself. • Call your state senator or state representative to get a form. • Call a lawyer. • Use a computer software package for legal documents. • Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

14. Advanced Healthcare Directive Why are advance directives important to medical care? It allows an individual to participate indirectly in future medical care decisions even if they become unable to make informed decisions. Instructive directives may extend individual autonomy and help ensure that future care is consistent with previous desires. The living will was created to help prevent unwanted and ultimately futile invasive medical care at the end-of-life. When should I refer to a patient's advance directive? It is best to ask a patient early on in his care if he has a living will, or other form of advance directives. Not only does this information get included in the patient's chart, but by raising the issue, the patient has an opportunity to clarify his wishes with the care providers and his family. However, advance directives take effect only in situations where a patient is unable to participate directly in medical decision making. Are advance directives legally binding? Advance directives are recognized in one form or another by legislative action in all 50 states (in Washington, see RCW 11.94). If the directive is constructed according to the outlines provided by pertinent state legislation, they can be considered legally binding. In questionable cases, the medical center's attorney or ethics advisory committee can provide guidance on how to proceed.

15. The Patient's Bill of Rights Patient rights were developed with the expectation that hospitals and healthcare institutions would support these rights in the interest of delivering effective patient care. According to the American Hospital Association, a patient's rights can be exercised on his or her behalf by a designated surrogate or proxy decision-maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor. EACH PATIENT HAS A RIGHT, AT A MINIMUM TO THE FOLLOWING: 1. To be informed of these rights and facility’s rules and regulations; 2. To be informed of services available in the facility, of the names and professional status of personnel providing and/or responsible for his/her care; 3. To be assured of medical care and to be informed of his/her current medical condition, unless medically contraindicated; 4. To participate in the planning of his/her care and treatment; to have the right to refuse medication and treatment; to be informed of available treatment options, including the option of no treatment, and possible benefits and risks of each option;

16. The Patient's Bill of Rights 5. To express grievances to the staff and governing authority and to recommend changes in policies and services; 6. To consent to or decline to participate in proposed research studies or human experimentation; 7. To be free from; mental and physical abuse, exploitation, and chemical, physical or other types of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs or other medications shall not be used for discipline of patients or for the convenience of facility personnel; 8. To be assured confidential treatment of his or her medical/health record, and to approve or refuse the release of the record to any individual outside the facility, except as required law or third-party payment contract; 9. To be treated with consideration, respect and full recognition of his/her dignity, individuality, and right to privacy; 10. To be free from being asked to perform any work for the facility, unless the work is part of patient treatment and is performed voluntarily by the patient. Such work shall be in accordance with Local, State, and Federal regulations;

17. The Patient's Bill of Rights 11. To join with other patients or individuals to work for improvements in patient care; 12. To be assured of exercising civil and religious liberties, including the right to impendent personal decisions; 13. To not be the subject of discrimination because of age, race, religion, sex, sexual preference, nationality, handicap, diagnosis, ability to pay, or source of payment; and 14. To not be deprived of any constitutional, civil and/or legal rights solely because of receiving service from the facility; Patients may call NJ Department of Health Hotline at 800-792-9770, or by mail: NJ State Department of Health, Healthcare Systems Analysis, Inspections Compliance & Enforcement, P.O. Box 360, Trenton, NJ 08625 This list of Patient Rights is an abbreviated summary of the current NJ Law and Regulations governing the rights of patients.

18. U.S. Department of Health and Human Services Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a way that you and your family can have a continuity of health insurance even through job changes and perhaps even unemployment. Just as employees are portable, so should be health insurance, thanks to HIPAA. A few decades ago, people stayed in one or two jobs throughout a whole career. In those days people had no need for HIPAA, because their jobs were stable. But today, in a time when jobs and even careers are constantly changing, HIPAA can make a big difference in your personal welfare, or even the welfare of your family. HIPAA makes it easier for individuals and small businesses to get and keep health insurance. To reduce the cost of health insurance, HIPAA also includes an administrative simplification section to encourage electronic transactions. Due to the electronic transactions, HIPAA also has a host of new regulations to assure the security and privacy of electronically stored medical data. The regulations set standards for electronic transactions, the privacy of all medical records and all identifiable health information and the security of electronically stored information.

19. U.S. Department of Health and Human Services HIPAA is not a guarantee that you will have health insurance, or that you will keep health insurance after a job change. But HIPAA provisions may help you keep insurance during transitions, and they may help you get other insurance if you lose the insurance coverage that was provided by a previous employer. What is the Privacy Rule in HIPAA? The Privacy Rule regulates who can see an individual’s Protected Health Information (PHI). Under HIPAA, anyone can choose to allow or not allow others to collect and/or use their PHI. Why is this Privacy Rule of benefit to individuals? Insurance companies and some physicians have sold the health information they had for profit. Pharmaceuticals can utilize such health information to rationalize benefits from medicines. A person who may be likely to getting AIDS.

20. U.S. Department of Health and Human Services What is Protected Health Information (PHI)? PHI stands for any identifiable health information that could be used against a person. For example, one’s heart rate and blood pressure, demographics, (not height or weight).Individually Identifiable Health Information is information that could be used against a person, including demographic information collected from an individual, and: 1. Is created or received by a healthcare provider, health plan, employer, or healthcare clearinghouse; and 2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of healthcare to an individual; or the past, present, or future payment for the provision of healthcare to an individual; and a. That identifies the individual; or b. With respect to which there is a reasonable basis to believe the information can be used to identify the individual. Physicians have always been bound to protect information revealed by patients or discovered during the course of medical treatment. Researchers also have an obligation to keep this informational confidential!

21. Thank You! Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. tsoares@compsolutionsinc.com Tel: 1-888-201-5680 Ext. 192