D34 PAITENTS RIGHTS.docx

Little Rock/North Little Rock

2.

MEMORANDUM NO. 136-006

RIGHTS AND RESPONSIBILITIES OF VA PATIENTS AND RESIDENTS OF COMMUNITY LIVING CENTERS (CLC) AND THEIR RESPECTIVE FAMILY MEMBERS

1. PURPOSE: To define the rights and responsibilities of patients treated in the Medical Center, including the affiliated Community Based Outpatient Clinics (CBOC), and residents in the Community Living Centers (CLC), and their respective family members and to establish procedures for communicating this information to patients and residents.

2. POLICY: The Central Arkansas Veterans Healthcare System (CAVHS) provides care under the guidance of organization policies and procedures that consider the patient or resident to be an individual with personal value and belief systems. The administrative and clinical staff follow these policies and procedures to support the patient's or resident’s right to exercise cultural and spiritual beliefs that do not interfere with the well-being of others or the planned course of medical therapy for the patient. All patients who are admitted to this Medical Center and residents admitted to the CLC will be informed of their rights and responsibilities (Attachment A).

Family members of VA patients and residents of the CLCs have certain rights and responsibilities (Attachment B).

3. RESPONSIBILITIES:

a. The Chiefs of Central Business Office (CBO), Nursing Service (NS), and Mental Health Service (MHS) are responsible for ensuring that patients or residents are informed of their rights and responsibilities upon admission to this Medical Center.

b. All Medical Center employees are responsible for ensuring that patients or residents are treated in a courteous, dignified, and compassionate manner, and fully understand their rights and responsibilities.

c. All Medical Center employees are responsible for knowing that patients or residents have several ways to address their concerns. These may include meeting with the treatment team, patient representatives, and/or the Ethics Advisory Committee, depending on the nature of the problem.

d. Members of the treatment team are responsible for ensuring that the psychosocial, cultural, and spiritual needs of patients or residents are met utilizing Medical Center resources such as Social Work Service, Mental Health Service, and Chaplain and Voluntary Services, as well as available community resources. For Procedures concerning the process for restricting patient/resident communication, see Attachment C.

4. PROCEDURES:

a. Each patient or resident who is admitted to this Medical Center will have access to a copy of the “Patient Handbook”. This booklet will also be available to outpatients in patient care areas throughout the Medical Center.

b. In those cases where the patient or resident is too ill to understand the information, every attempt will be made to ensure that the person accompanying the patient or resident is aware of the availability of the Patient Handbook. If the patient or resident is unaccompanied, the information will be conveyed to the patient or resident, or significant other, by the appropriate treatment team member (i.e., social worker, nurse manager) when appropriate.

c. Patient or resident rights and responsibilities will be provided to all new employees during their initial orientation. Any employee who observes patient or resident abuse or is aware of violations of patient's or resident's rights must report the incident to their immediate supervisor, and complete the required information in the Joint Patient Safety Reporting System web portal found at: https://patientsafety.csd.disa.mil/. The web portal can also be accessed from a CAVHS computer using Internet Explorer VA Shortcuts>National>Joint Patient Safety Reporting System link. If the web portal cannot be accessed, our contingency is to complete a hard copy of the VA Form 10-2633, Report of Special Incident Involving a Beneficiary, which is located on the “S” Drive>Applications>Patient Safety.

d. Members of the treatment team will provide referrals to resources within the Medical Center and, if needed, community resources to ensure that the psychosocial, cultural, and spiritual needs of the patient/resident can be accommodated within the organizational policies and procedures of this Medical Center.

5. REFERENCES:

a. The Joint Commission Comprehensive Accreditation Manual for Hospitals.

b. VA IB 10-88, P91985 Rights and Responsibilities of VA Patients and Residents of Community Living Centers (CLC), dated January 15, 2013.

c. VA IB 10-88, P96280 Rights and Responsibilities of Family Members of VA Patients and Residents of Community Living Centers (CLC), dated January 15, 2013.

6. RESCISSION: Medical Center Memorandum 136-6, dated May 5, 2015.

7. REVIEW: Central Business Office, (136/NLR).

/s/

MARGIE A. SCOTT, M.D.

Medical Center Director

Attachments (3)

Attachment A-1

RIGHTS AND RESPONSIBILITIES OF PATIENTS AND RESIDENTS

The Veterans Health Administration (VHA) is pleased you have selected us to provide your healthcare. We want to improve your health and well-being. We will make your visit or stay as pleasant for you as possible. As part of our service to you, to other veterans, and to the nation, we are committed to improving healthcare quality. We also train future healthcare professionals, conduct research, and support our country in times of national emergency. In these activities, our employees will respect and support your rights as a patient or resident. Your basic rights and responsibilities are outlined in this document. Please talk with VA treatment team members or a patient advocate if you have any questions or would like more information about your rights.

I. Respect and Nondiscrimination

You will be treated with dignity, compassion, and respect as an individual. Your privacy will be protected. Consistent with Federal law, VA policy, and accreditation standards of the Joint Commission, Veterans and their family members will not be subject to discrimination for any reason, including reasons of age, race, ethnicity, religion, culture, language, physical or mental disability socioeconomic status, sex, sexual orientation, or gender identity or expression. You will receive care in a safe environment. We will seek to honor your personal and religious values.

The Medical Center respects the patient’s/resident's right to make decisions about his or her care, treatment, and services, and to involve the patient’s/resident's family in care, treatment, and services decisions to the extent permitted by the patient or surrogate decision-maker. ‘Family’ is defined as a group of two or more persons united by blood, or adoptive, marital, domestic partnership, or other legal ties. The family may also be a person or persons not legally related to the individual (such as a significant other, friend or caregiver) whom the individual considers to be family. A family member may be the surrogate decision-maker, as defined in VHA Handbook 1004.02, if authorized to make care decisions for the individual should he or she lose decision-making capacity or choose to delegate decision making to another. The Medical Center allows a family member, friend or other individual to be present with the patient for emotional support during the course of stay. The Medical Center allows for the presence of a support individual of the patient’s/resident's choice, unless the individual’s presence infringes on others’ rights or safety, or is medically or therapeutically contraindicated. The individual may not be the patient’s surrogate decision-maker or legally authorized representative. The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and gender identity or expression.

You or someone that you choose has the right to keep and spend your money. You have the right to receive an accounting of any VA held funds.

Treatment will respect your personal freedoms. In rare cases, the use of medication and physical restraints may be used if all other efforts to keep you or others from harm have not worked.

Attachment A-2

As an inpatient (short- or long-term care) or a community living unit resident, you may wear your own clothes and keep personal items. This depends on your medical condition.

As an inpatient (short or long-term care) or community living unit resident, you have the right to social interaction and regular exercise. You will have the opportunity for religious worship and spiritual support. You may decide whether or not to participate in these activities. You may decide whether or not to perform tasks in or for the Medical Center.

As an inpatient (short or long-term care) or community living unit resident, you have the right to communicate freely and privately. You may have or refuse visitors. You will have access to public telephones. You may participate in civic rights.

As a long-term care patient or community living unit resident, you can organize and take part in “patient” groups in the facility. Your family also can meet with the families of other patients or residents.

In order to provide a safe treatment environment for all patients/residents and staff you are asked to respect other patients/residents and staff and to follow the facility’s rules. Avoid unsafe acts that place others at risk for accidents or injuries. Please immediately report any condition you believe to be unsafe.

II. Information Disclosure and Confidentiality

You will be given information about the health benefits that you can receive. The information will be provided in a way you can understand.

You will receive information about the costs of your care, if any, before you are treated. You are responsible for paying for your portion of costs associated with your care.

Your medical record will be kept confidential. Information about you will not be released without your consent unless authorized by law (i.e., State public health reporting). You have the right to information in your medical record and may request a copy of your records. This will be provided except in rare situations where your VA physician feels the information will be harmful to you. In that situation, you have the right to have this discussed with you by your VA provider.

You will be informed of all outcomes of care, including any injuries caused by your medical care. You will be informed about how to request compensation for injuries.

III. Participation in Treatment Decision

You, and any persons you choose, will be involved in all decisions about your care. You will be given information you can understand about the benefits and risks of treatment. You will be given other options. You can agree to or refuse treatment. You will be told what is likely to happen to you if you refuse treatment. Refusing treatment will not affect your rights to future care but you take responsibility for the possible results to your health.

Tell your provider about your current condition, medicines (including over-the-counter and herbals) and medical history. Also, share any other information that affects your health.

Attachment A-3

You should ask questions when you do not understand something about your care. Being involved is very important for you to get the best possible results.

You will be given, in writing, the name, and professional title of the provider in charge of your care. As our partner in the healthcare, you have the right to be involved in choosing your provider. You also have the right to know the names and titles of those who provide you care. This includes students, residents, and trainees. Providers will properly introduce themselves when they take part in your care.

You will be educated about your role and responsibilities as a patient or resident. This includes your participation in decision-making and care at the end of life.

If you believe you cannot follow the treatment plan, you have a responsibility to notify your provider or treatment team.

You have the right to have your pain assessed and to receive treatment to manage your pain. You and your treatment team will develop a pain management plan together. You are expected to help the treatment team by telling them if you have pain and if the treatment is working.

As an inpatient or community living unit resident, you will be provided any transportation necessary for your treatment plan.

You have the right to choose whether you will participate in any research project. Any research will be clearly identified. Potential risks of the research will be identified and there will be no pressures on you to participate.

You will be included in resolving any ethical issues about your care. You may consult with the facility’s Ethics Advisory Committee and/or other staff knowledgeable about healthcare ethics.

If you or the Medical Center believes that you have been neglected, abused, or exploited, you will receive help.

IV. Complaints

You are encouraged and expected to seek help from your treatment team and/or a patient advocate if you have problems or complaints. You will be given understandable information about the complaint process available to you. You may complain verbally or in writing, without fear of retaliation.

V. Additional Rights and Responsibilities of Community Living Center Residents

Because the CLC serves as your home for short or long-stay services, you have the following additional rights and responsibilities as a CLC resident:

Staff will knock on your bedroom door prior to entry.

You have the right to receive care from the same staff member every day to the extent that consistent assignment is possible.

Attachment A-4

You may have visitors at any time of the day or night provided visitors are respectful of you, your need for privacy and the privacy of others. You may refuse visitors at any time.

You have a right to conjugal visits and you have a right to privacy during those visits.

Your care will be delivered in a setting that resembles home. Therefore, you will be invited to have your meals in a designated dining area and you will have access to those activities that contribute to meaningful use of time.

In preparation for being discharged to your own home, you and or your care giver may be invited to participate in activities that prepare you to go home such as self-administration of medications and treatments.

You and your care givers have a right to attend treatment planning meetings and participate in household or resident council.

Attachment B-1

Rights and Responsibilities of Family Members of VA Patients and Residents of CLCs

The Veterans Health Administration (VHA) is pleased to provide health care to Veterans. We will provide personalized, patient-driven, compassionate, state-of-the-art care. Our goal is to make the experience as positive and pleasant as we can. As part of our service to Veterans and to the Nation, we are committed to improving health care quality. We also train future health care professionals, conduct research, and support our country in times of national emergency. In these activities, our employees will respect and support the rights of patients and residents of community living centers (CLC) as well as your rights as a family member. This document outlines the basic rights and responsibilities of family members. Please talk with the VHA treatment team or a patient advocate if you have any questions or would like more information about these rights and responsibilities.

I. Nondiscrimination and Respect

Our staff will create a treatment environment based on dignity, compassion, and respect. Consistent with Federal law, VA policy, and accreditation standards of The Joint Commission, Veterans and their family members will not be subject to discrimination for any reason, including for reasons of age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, or gender identity or expression.

We seek to honor the cultural and personal values, beliefs, and preferences of all patients, CLC residents, and their families. When a loved one is involved in support and care of a VA patient or resident, VA considers a patient or resident's family to include anyone related to the patient or resident in any way (for example, biologically or legally) and anyone whom the patient or resident considers to be family.

Please help us offer care in a safe and respectful manner by treating patients, CLC residents, other family members and staff with respect and following the facility's rules. Family members are not allowed to do things that threaten the care of patients or interfere with staff members' ability to do their job.

II. Keeping Health Information Private and Secure

The Veteran's private health care information will be protected to the fullest extent authorized by law. Information about the Veteran may be disclosed to you if the Veteran authorizes the release or if you are the Veteran's personal representative.

Please respect the privacy of patients, residents, and other family members and do not reveal private health care information that you may overhear or otherwise become aware of.

III. Partnering in Care

Families are valued members of the VA care team. As members of the care team we encourage you to:

Share your insights, opinions and observations about the Veteran's care and progress.

Attachment B-2

Let the nursing staff know right away if you feel that the Veteran's condition has changed.

Tell us right away if you are worried about the Veteran's care or treatment. Please ask questions if you do not understand the purpose of any part of the Veteran's care.

If you are a family member of a CLC resident, you have a right to participate and share your voice and opinions in family and resident or household councils.

IV. Family Members' Role in Treatment Decisions

Veterans have a right to make their own health care decisions as long as they are able to understand and tell their doctor and health care team what they want. Veterans have a right to include or not include others, such as family members or friends, in decisions about their care.

Veterans have a right to express their preferences about future medical care in an advance directive. This includes the right to name a health care agent who will make health care decisions on their behalf if they can no longer communicate for themselves. We will respect these preferences.

If you are asked to make health care decisions for a Veteran in VHA, the treatment team will offer you:

Treatment options based on the Veteran's unique medical circumstances and needs.

Information you can understand about the benefits and risks of these treatment options.

An interpreter or assistive device, if needed, to help you understand the Veteran's medical circumstances and treatment options.

As the health care decision maker, you generally have the same rights and responsibilities as the Veteran would have in making treatment decisions.

You may agree to or refuse any treatment option offered by the treatment team. Refusing treatment will not affect the Veteran's right to future care.

Your decision about whether to accept or refuse treatments must be based on what you know the Veteran would want. If you do not know what the Veteran would want, the treatment team is available to help you consider what decisions are in the Veteran's best interest.

When you are the health care decision maker, please:

Share accurate and complete information about the Veteran's medical history to help us develop the best treatment plan.

Take part in discussions and decisions about the Veteran's care.

Attachment B-3

Help the treatment team understand how they can provide care that takes into account the Veteran's cultural and personal values, beliefs, and preferences.

Talk with the treatment team when you think the Veteran's treatment plan may need to be changed.

Let the treatment team know if you are not willing or able to follow the treatment plan. If the treatment team understands why the plan may be a problem, they may be able to make changes that address your concerns.

Help us plan for the Veteran's move to the next level of care.

V. Visiting the Veteran

Family visits can help you support the Veteran as he/she copes with illness or injuries. Schedule your visit to meet the Veteran's medical and emotional needs. For example, many patients get tired easily, so short visits may be better.

VA Community Living Centers have unrestricted visiting hours.

On VA acute care inpatient units, medical staff may need to restrict visiting hours or place other visiting restrict ions if medical or safety concerns require it. You will be promptly informed about any visitor restriction and the reason for it.

Please keep a close eye on your children for their own safety and the safety of others. Children should never be left unattended.

At times, patients or CLC residents may not wish to have visitors or may wish to set other limits on visits. We will respect the Veteran's wishes for visits.

VI. Concerns or Complaints

If you need advice on how to resolve an ethical concern about the Veteran's care, you may speak with the Medical Center's Ethics Advisory Committee.

You are encouraged and expected to seek help from the VA health care treatment team and/or a patient advocate if you have problems or complaints. You will be given understandable information about the complaint process in your preferred language. Any privacy complaints will be addressed by the facility Privacy Officer. You may complain verbally or in writing, without fear of retaliation.

If you believe that you or the Veteran has been neglected, abused, or exploited by VA staff, please report this promptly to the treatment team or patient advocate. You will receive help immediately.

If you have concerns about the quality of the health care that the Veteran is receiving, you may contact the VHA Office of the Medical Inspector at 1-800-634-4782.

Attachment B-4

If you believe the organization has failed to address or satisfy your concerns about health care quality and safety, you may contact the Joint Commission's Office of Quality Monitoring at 1-800-994-6610. If you believe that the organization has failed to address your concerns about suspected criminal activities, fraud, waste, abuse, or mismanagement, you may contact the VA Office of the Inspector General at 1-800-488-8244 or email vaoighotline@VA.gov.

Attachment C

PROCESS FOR RESTRICTING PATIENT/RESIDENT COMMUNICATION

1. Restriction can be of any form of communication—visitors, mail, telephone calls, access to language interpreters, etc.

2. When it is the treating team's opinion that a form of communication may affect the patient/resident's medical care (cause injury or deterioration), damage the environment, or cause infringement on the rights of others, the physician will discuss the restriction(s) with the patient/resident and/or family. The discussion will be documented in the progress notes and orders will be appropriately written either electronically or on the doctor's order sheet.

3. The Mental Health staff will be consulted to render their opinion if a form of communication affects the patient psychologically. The treating physician will discuss the restriction with the patient or resident and/or family. The discussion will be documented in the progress notes and orders will be written.

4. The patient's or resident's condition and the form of communication will be monitored to assure that the patient's or resident's rights will not be violated if the restrictions no longer apply.