Lesson 2 - Client Rights
A client does not give up his/her basic human rights when they start receiving services or move to a community care setting.
To safeguard these basic freedoms, federal and state “client rights” laws have been established to help make sure a client maintains independence, self respect, and dignity.
In-home client rights
Federal and state laws give the client the right to:
- Be told before services begin that these rights exist and what they are;
- Take part in choosing, planning, and changing any services he/she receives;
- Voice a grievance about services or lack of services without fear of punishment;
- Have his/her clinical and personal records kept confidential;
- Have his/her property treated with respect;
- Interpreter/translation services at no cost and without significant delay;
- Live free from abuse and physical or chemical restraints;
- An administrative hearing when he/she does not agree with a decision regarding benefits (DSHS clients only). In addition, clients living in a community care setting, also have the right to:
Freedom of choice
Freedom of choice is important to most clients. The loss of home, housework, job, strength, and/or health can limit a client’s sense of freedom and independence.
Protect and safeguard a client’s freedom to choose what and how he/she wants things done. A client’s well-being depends on continuing to make decisions about his/her own daily routines.
The client will have a life long routine for how he/ she likes personal care tasks done. Ask about and respect the client’s choices. Unless the client asks you to do something inappropriate or unsafe, his/ her wishes should be followed.
The client is the person to decide and choose:
Balancing a Client’s Right of Choice and Safety
As a caregiver, you cannot follow your client’s choices at all costs. If a client’s choice places his/ her safety or well-being at risk or somehow could cause harm to others, use the following guidelines.
1. Explain to the client why you are concerned.
2. Offer safe alternatives that could meet what the client wants and allows the choice to remain his/hers.
3. Report your concerns to the appropriate person in your care setting, if you can’t negotiate a safe solution.
4. Document your concerns, what you did, and who you reported it to.
If you are concerned that a client’s actions put him/her in immediate danger to themselves or others, call 911.
Confidentiality
As a caregiver, you come to know very private and confidential information about your client.
A client has a legal right to expect that his/her medical, financial, personal matters, and records will be kept private and confidential - unless the information is needed by another care team member. Your professional relationship with a client is based on this right to confidentiality.
All care team members are bound by confidentiality laws and professional ethics. When there is a need to share confidential information with other care team members, make sure you:
You may not share confidential information with others outside of the care team without written permission from your client.
If you are asked to share confidential information by someone outside of the care team, tell the person it would be best if he/she asked the client directly. If the person keeps on, explain you cannot talk about the client’s private affairs.
Do not talk about a client outside of work - even if you don’t use a client’s name. Even in casual conversations a client’s privacy can be jeopardized.
In most states, all adults have a right to make their own decisions about medical care. The following is a summary of the types of decisions a client can make.
Informed consent
Health care providers are required to give the client enough information to make
an informed decision about health care treatments, including:
The right to refuse treatment
A client has a legal right to refuse treatment, medications, or services. As a caregiver, you (or other care team members) cannot force a client to do anything – even if you think it is in his/her best interest.
If you are concerned that a client’s refusal of treatment, medications, or services is putting him/her in jeopardy, use the steps mentioned above for balancing a client’s right of choice and safety (explain your concerns, offer safe alternatives, report, and document).
For more information about a client refusing to take medication, see next Lesson.
Emergency personnel and advance directives
In an emergency, you need to know if a client has advance directives and where
they are located. If you are an Individual Provider (IP), you must call 911* even if you know a client has a Living Will, DNR/No Code, or POLST form that states they don’t want life-sustaining treatment. Make sure you know where a client’s advance directives are so you can give them to the Emergency Medical Technicians (EMTs) when they arrive. It must be the original - not a copy.
If a client is receiving hospice services, the hospice plan of care should include who to call in an emergency. It may or may not be 911. This is something to know about and plan for in advance. See The Services Lesson for more information about working with hospice.
If you work in an adult family home or boarding home, there may be another person at your facility designate d and specially trained to handle medical emergencies. Find out what policies you are to follow where you work.
To safeguard these basic freedoms, federal and state “client rights” laws have been established to help make sure a client maintains independence, self respect, and dignity.
In-home client rights
Federal and state laws give the client the right to:
- Be told before services begin that these rights exist and what they are;
- Take part in choosing, planning, and changing any services he/she receives;
- Voice a grievance about services or lack of services without fear of punishment;
- Have his/her clinical and personal records kept confidential;
- Have his/her property treated with respect;
- Interpreter/translation services at no cost and without significant delay;
- Live free from abuse and physical or chemical restraints;
- An administrative hearing when he/she does not agree with a decision regarding benefits (DSHS clients only). In addition, clients living in a community care setting, also have the right to:
- Choose his/her activities, schedules, health care, clothing, and hairstyle.
- Interact with people both inside and outside the facility including family, friends, his/her doctor or other health care providers;
- Refuse treatment, medications, or services;
- Manage his/her financial affairs;
- Send and receive unopened mail;
- Access to a telephone and privacy while using it;
- Privacy, including within his/her room and during personal care;
- Have his/her own personal property (as space permits and where it does not violate the rights, health, or safety of other clients);
- Be able to stay at the facility and not be transferred or discharged (unless certain conditions are met);
- Examine the most recent survey or inspection reports, including any plans of correction.
Freedom of choice
Freedom of choice is important to most clients. The loss of home, housework, job, strength, and/or health can limit a client’s sense of freedom and independence.
Protect and safeguard a client’s freedom to choose what and how he/she wants things done. A client’s well-being depends on continuing to make decisions about his/her own daily routines.
The client will have a life long routine for how he/ she likes personal care tasks done. Ask about and respect the client’s choices. Unless the client asks you to do something inappropriate or unsafe, his/ her wishes should be followed.
The client is the person to decide and choose:
- When and how services are delivered;
- When and what to eat;
- When to go to bed and when to get up;
- What clothing to wear and hairstyle (even if it isn’t what you would choose);
- How to spend his/her leisure time.
Balancing a Client’s Right of Choice and Safety
As a caregiver, you cannot follow your client’s choices at all costs. If a client’s choice places his/ her safety or well-being at risk or somehow could cause harm to others, use the following guidelines.
1. Explain to the client why you are concerned.
2. Offer safe alternatives that could meet what the client wants and allows the choice to remain his/hers.
3. Report your concerns to the appropriate person in your care setting, if you can’t negotiate a safe solution.
4. Document your concerns, what you did, and who you reported it to.
If you are concerned that a client’s actions put him/her in immediate danger to themselves or others, call 911.
Confidentiality
As a caregiver, you come to know very private and confidential information about your client.
A client has a legal right to expect that his/her medical, financial, personal matters, and records will be kept private and confidential - unless the information is needed by another care team member. Your professional relationship with a client is based on this right to confidentiality.
All care team members are bound by confidentiality laws and professional ethics. When there is a need to share confidential information with other care team members, make sure you:
- Share only what is needed and in the best interest of the client;
- Do not gossip;
- Do not have the discussion in a public area where others may overhear.
You may not share confidential information with others outside of the care team without written permission from your client.
If you are asked to share confidential information by someone outside of the care team, tell the person it would be best if he/she asked the client directly. If the person keeps on, explain you cannot talk about the client’s private affairs.
Do not talk about a client outside of work - even if you don’t use a client’s name. Even in casual conversations a client’s privacy can be jeopardized.
In most states, all adults have a right to make their own decisions about medical care. The following is a summary of the types of decisions a client can make.
Informed consent
Health care providers are required to give the client enough information to make
an informed decision about health care treatments, including:
- The nature of the treatment;
- Reasonable alternatives;
- The relevant risks, benefits, and uncertainties related to each alternative.
The right to refuse treatment
A client has a legal right to refuse treatment, medications, or services. As a caregiver, you (or other care team members) cannot force a client to do anything – even if you think it is in his/her best interest.
If you are concerned that a client’s refusal of treatment, medications, or services is putting him/her in jeopardy, use the steps mentioned above for balancing a client’s right of choice and safety (explain your concerns, offer safe alternatives, report, and document).
For more information about a client refusing to take medication, see next Lesson.
Emergency personnel and advance directives
In an emergency, you need to know if a client has advance directives and where
they are located. If you are an Individual Provider (IP), you must call 911* even if you know a client has a Living Will, DNR/No Code, or POLST form that states they don’t want life-sustaining treatment. Make sure you know where a client’s advance directives are so you can give them to the Emergency Medical Technicians (EMTs) when they arrive. It must be the original - not a copy.
If a client is receiving hospice services, the hospice plan of care should include who to call in an emergency. It may or may not be 911. This is something to know about and plan for in advance. See The Services Lesson for more information about working with hospice.
If you work in an adult family home or boarding home, there may be another person at your facility designate d and specially trained to handle medical emergencies. Find out what policies you are to follow where you work.