Chapter 2 – The Person’s Rights

Objectives

• Define key terms and abbreviation used in Chapter 2.
• Explain the purpose of The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities.
• Describe the purposes and requirements of the Omnibus Budget Reconciliation Act of $1987$ (OBRA).
• Identify resident rights guaranteed under OBRA.
• Demonstrate strategies to protect resident rights in day-to-day practice.
• Describe the ombudsman’s role and legal authority.
• Promote PRIDE (Personal and Professional Responsibility, Rights and Respect, Independence and Social Interaction, Delegation and Teamwork, Ethics and Laws) for residents, families, and yourself.

Key Terms

• Involuntary seclusion – separating or confining a person against his or her will or without consent.
• Ombudsman – an advocate who supports, protects, and promotes another person’s needs, interests, and rights.
• Representative – a person legally empowered to act on the patient’s or resident’s behalf when the individual cannot do so.
• Treatment – care provided to maintain/restore health, improve function, or relieve symptoms.

Key Abbreviation

• OBRA – Omnibus Budget Reconciliation Act of $1987$ (federal law; enforced by CMS).

Context & Rationale

• People wish to know their diagnoses, treatments, and to participate in all decisions.
• Federal & state statutes ensure specific rights for hospital patients (Patient Care Partnership) and for nursing-center residents (OBRA).

The Patient Care Partnership (American Hospital Association)

• Replaces the older “Patient Bill of Rights.”
• Emphasises a cooperative relationship among doctor, health team, and patient.

Six Core Expectations

• High-Quality Care
▸ Required skill, compassion, respect.
▸ Patient may request identity of all caregivers, students, or trainees.
• Clean & Safe Setting
▸ Policies to prevent mistakes, abuse, or neglect.
▸ Duty to disclose unexpected/significant events (what happened & care changes).
• Involvement in Care
▸ Informed consent: benefits, risks, alternatives, research status, long-term effects, post-discharge needs, costs.
▸ Patient supplies history, allergies, drugs, insurance info, goals, values, spiritual beliefs.
▸ Advance directives (living will, power of attorney) shared with team.
▸ Counseling/chaplain access for difficult decisions.
• Protection of Privacy
▸ Confidential relationships & records.
▸ “Notice of Privacy Practices” explains use/disclosure of information & how to request copies.
• Preparing to Leave the Hospital
▸ Follow-up sources, disclosed financial interests, permission to share info with community caregivers, self-care teaching.
• Help With Bills & Claims
▸ Hospital submits insurance/Medicare/Medicaid claims.
▸ Financial counselling for uninsured persons.

OBRA $1987$ – Resident Rights Framework

• Applies to all $50$ states; enforced by CMS.
• Mandates nursing centers maintain or improve each resident’s quality of life, health, and safety.
• Includes minimum training & competency evaluation for nursing assistants (Chapter 3).

Core Resident Rights (Box 2-2 highlights)

• Dignity & respect; quality care.
• Exercise rights as residents & U.S. citizens (e.g., voting).
• Oral & written explanation of rights/rules in a comprehensible language or format (interpreters, large print, sign language, simplified terms).
• Access to and copies of all records (at personal expense).
• Refuse treatment and experimental research; create advance directives.
• Receive Medicare/Medicaid benefit information.
• File complaints on abuse, neglect, property misuse.
• Manage personal finances.
• Choose & be informed about own physician.
• Be informed—promptly—of accidents, status changes, transfers, room/roommate changes, or legal rights updates.
• Privacy & confidentiality (records, communications, care, visits, resident meetings).
• Voice grievances without retaliation; view survey results & correction plans.
• Perform services voluntarily or for pay; never required to work for care.
• Send/receive unopened mail; purchase mail supplies.
• Receive information protecting persons with I/DD or mental-health disorders.
• Possess & use personal items/clothing.
• Self-administer drugs if safe.
• Freedom from restraints, verbal/sexual/physical abuse, bodily punishment, mistreatment, involuntary seclusion.
• Choice over activities, schedules, healthcare, social/religious/community involvement.
• Home-like, comfortable environment (temperature, lighting, sound, closet space, spouse/partner visits any reasonable hour).
• Attain/maintain highest practicable function.

Practical Strategies to Protect Rights (Nursing-Assistant Focus)

• Information Requests
▸ Refer all record/condition questions to the nurse; respond: “I’m sorry, I’m not allowed to give that information. I will notify the nurse.”
• Refusing Treatment
▸ Determine what is refused & why.
▸ Explain consequences & offer alternatives.
▸ Continue all other services; document & report.
• Privacy Measures
▸ Close curtains, doors, blinds; remove resident from public view; ensure proper draping.
▸ Obtain consent for observers (e.g., students).
▸ Provide private areas/phones; ensure calls are unheard.
▸ Deliver unopened mail within $24$ hrs; post outgoing mail within $24$ hrs on postal days.
• Personal Choice
▸ Facilitate resident selection of physicians, clothing, activities, meal times, bedtimes.
• Grievances
▸ Listen, document, relay to charge nurse; ensure no retaliation.
• Work/Volunteer Opportunities
▸ Reflect resident interest or rehab need; record in care plan; never coercive.
• Personal Property
▸ Label items; investigate loss/damage; avoid searching belongings without resident plus co-worker witness.
• Freedom From Abuse & Neglect
▸ Recognise abuse definitions (physical, verbal, sexual, mental, intimidation, deprivation).
▸ Report suspicions immediately; centers cannot hire individuals with abuse findings on state registry.
• Freedom From Restraints
▸ Doctor’s order required; never for staff convenience or discipline; only to treat medical symptoms (Chapter 15 details).
• Quality of Life & Dignity (Box 2-3)
▸ Courteous tone, eye contact, proper title/name, touch with permission.
▸ Knock, wait permission, maintain drape, respect social status.
▸ Support independence in dining, dressing, grooming, mobility.

Surveyor Focus Points

• Observation of privacy practices—knocking, exposure prevention, labeling clothes.
• Interaction style—tone, addressing by name, involvement in choices (TV, music).
• Resident activity facilitation—transport, readiness, ADL support.
• Documentation & explanations of rights.
▸ Assume surveyors always observe & listen; maintain professionalism.

Ombudsman Program (Older Americans Act)

• Each state must provide a long-term-care ombudsman.
• Roles
▸ Investigate/resolve complaints.
▸ Ensure access or discharge assistance.
▸ Supply information on long-term-care services.
▸ Monitor nursing-center conditions.
▸ Support resident/family councils, resolve family conflicts, assist with complex problems.
• Nursing centers must post local/state ombudsman contact information.
• When to involve
▸ Concerns about care/treatment.
▸ Interference with rights, health, safety, or welfare.

PRIDE Framework (Focus on PRIDE)

• Personal & Professional Responsibility – be accountable for quality care.
• Rights & Respect – uphold HIPAA $1996$ privacy safeguards; protect all resident rights.
• Independence & Social Interaction – encourage participation in activities; respect privacy in visits & calls.
• Delegation & Teamwork – adapt schedules/assignments to resident needs; communicate & cooperate.
• Ethics & Laws – follow facility policy, HIPAA, OBRA, and state regulations.

Activity Programs

• Goal: enhance physical, mental, psycho-social well-being.
• Must reflect resident interests, culture, lifestyle, capabilities; create belonging & usefulness.
• Types: large group (bingo), small group (cards), paired, solitary (letters, computer).
• CNA Responsibilities
▸ Prepare resident (elimination, grooming, assistive devices, correct attire).
▸ Allocate $15–20$ minutes for transport.
▸ Communicate politely with co-workers for help.
▸ Provide ADL help during activities (bathroom, eating).
▸ Use resident-room time efficiently when resident away.

Environment Requirements

• Safe, clean, comfortable, home-like; adjustable to preferences (showers vs. tubs, schedule, call-light placement, meal choices).

Ethical & Legal Implications

• Consent: no treatment or restraint without informed consent.
• Privacy/HIPAA: protect PHI (Protected Health Information) in all formats.
• Mandatory Reporting: abuse, neglect, misappropriation of property.

Review Questions Snapshot (use for self-test)

• Know Patient Care Partnership facts vs. federal law status.
• OBRA applicability to $50$ states.
• Residents’ right to choose doctors, refuse care, file grievances, form groups.
• Mail privacy, work requirements (voluntary only), abuse-free environment.
• Proper addressing, privacy practices, dignity-promoting behaviors.
• Ombudsman duties & employment status (not employed by center).

Problem-Solving Scenario: Refusal to Eat

• Resident has the right to refuse food.
• CNA Actions
▸ Investigate reason (taste, nausea, preference, cultural, emotional).
▸ Offer alternatives, involve dietitian.
▸ Report refusal to nurse for assessment and possible care-plan revision.
• Center Duty
▸ Provide palatable alternatives; document intake; monitor weight/nutrition; respect choice while ensuring resident informed of risks.

Connections & Real-World Relevance

• Resident-right violations can lead to legal penalties, loss of CMS certification, civil lawsuits, and ethical distress.
• Upholding rights builds trust, improves satisfaction, and enhances quality measures.
• Understanding OBRA & Patient Care Partnership is critical for passing state competency exams and daily practice.