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HIPAA
HIPAA 1
Sex,Drugs&Wheelchairs
TheRightsofNursingHomeResidents
By: Patrick Formato, Esq.1111 Marcus Avenue, Suite 107Lake Success, New York 11042516-328-2300
Sex,Drugs&Wheelchairs
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HIPAA
HIPAA 2
Resident’sRights– Howfardotheyexpand?
1)SexualRelations 2)Drugs/Alcohol 3)Smoking 4)Computer&InternetUse
SexualRelationsintheNursingHome
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HIPAA
HIPAA 3
SexualRelationsintheNursingHome
1)SexualRelations 2)Extra‐maritalrelationships 3)SexualEntertainment
SexualRelations
Abrams, Fensterman, Fensterman, Eisman, Ferrara, Formato & Wolf, LLP
Towhatextentcananursinghomecontrolaresident’ssexualactivities?
Howdoesanursinghomedealwithsexualrelationsinvolvingoneormorepatientswithdiminishedcapacity?
Nursinghomeshouldimplementpoliciesandproceduresregardingsexualityandconsent,includingissuesrelatingtoresidentswithAlzheimer’sanddementia.
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HIPAA
HIPAA 4
SexualRelations
VariousResponsestoResidents’SexualPreferences• Discouragement
– Concerns:Liability,BurdenonStaff,PerceptionthatFamilieswouldpreferabstinence
– PhysicalandPsychologicalrestraints
• SupportiveEnvironment– Facility‐widepolicythatsupportsconsensualsexualrelationships– Developasystemforassessingthecapacityofcognitivelyimpairedresidents
– Accommodateresidentsandstaffmemberswhomorallyobjecttosuchbehavior
SexualRelations MedicalSupportforSexualActivity
Safe‐SexInitiatives
SafetyandPrivacyConcerns– Do‐not‐disturbsigns?– MarriedNursingHomeResidents– Outsidevisitors/partners
InputfromFamily• Shouldanursinghomeendasexualrelationship
ifobjectedbyfamily?
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HIPAA
HIPAA 5
SexualRelationsandLackofCapacity
Facilityand/oremployeesmayfacecriminaland/orcivilliabilityforsexualactsbetweenanindividualandaresidentwholacksthecapacitytoconsenttosexualrelations.
Facilitymayfaceliabilityiftheyencouragesuchact,orfailtostopsuchactfromoccurring.
However,thestandardtodeterminecapacitytoconsenttosexisdifferentthanstandardtomakemedicaldecisionsordealwithfinances.Assuch,determiningcapacitytoconsenttosexualrelationsrequiresadifferentandseparateanalysis.
Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Wolf, LLP
Extra‐maritalRelationships
Abrams, Fensterman, Fensterman, Eisman, Ferrara, Formato & Wolf, LLP
WhatroleshouldtheNursingHomeplayinasexualrelationshipbetweentworesidents,whereoneoftheresidentsismarriedorhasasignificantotheroutsideofthenursinghome?
Doesthenonresidentspouseobject?Ifso,whatshouldbedone?
Whatiftheresidentlacksmentalcapacity? Policyfordealingwithanonresidentspousewhoobjects?
• Counselingofresidentandnon‐residentspouse
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HIPAA
HIPAA 6
Extra‐maritalRelationships Whattodoifthemarriedresidentlacksmentalcapacity?
• Doestheresidenthavetheabilitytoexpresshis/herdesires?• Criticalinterestandvaluesaffected?
– Familybeliefs– Dignity– Religion
• Cantheresidentadequatelyconsidertheseinterestsinmakingadecision?
• BalancingTest:valueofintimaterelationshipvs.valueofcriticalinterestsaffected
SexualEntertainment Whatlimitscananursinghomeplaceonaresident’sdesiretoviewexplicitmaterial?
Toengageinotherformsofsexualentertainment(e.g.,strippers)?
Principlestofollow:• Considertheresident’smentalcapacity• Disruptiontootherresidents
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HIPAA
HIPAA 7
DrugsandAlcohol
DrugsandAlcohol
IllicitSubstances• Strictlyprohibited• CannabisUse.
Source• BroughtinbyResidents• Broughtinbyfamilymembersorvisitors• Inrareinstances,bystaff.
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HIPAA
HIPAA 8
DrugsandAlcohol MedicalMarijuanaLawsinNewYork Willyourfacilityallowmedicalmarijuana?
• Canyoualloworprohibittheuseofmedicalmarijuana?• MarijuanaremainsaSchedule1controlledsubstance.• Howwillnursingfacilitiespreventdiversion?
Marijuanahasbeenapprovedtotreatsevereconditionsorsymptomsofdiseasesincludingcancer,HIVandAIDS,Parkinson’sdisease,MultipleSclerosis,EpilepsyandHuntington’sdisease.
DrugsandAlcohol
Abrams, Fensterman, Fensterman, Eisman, Greenberg, Formato & Wolf, LLP
CertifiedPatientsmaydesignateupto2Caregiverswhoarerequiredtoseparatelyregister.
MaximumoffivepatientsperCaregiver. OnlytheCertifiedPatientorCaregivermayopenorbreakthesealplacedonanapprovedmarijuanaproduct.
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HIPAA
HIPAA 9
DrugsandAlcohol Nomarijuanaproductmaybesold,dispensedordistributedviadelivery
servicewithoutapprovalbytheDOH,exceptaCaregivermaydelivertheapprovedmarijuanaproducttotheCertifiedPatient.
CaregivermaychargetheCertifiedPatientforreasonablecostsincurred inthetransportationanddeliveryofmarijuanatotheCertifiedPatient.
NewYorkandFederalLawleavemanyissuesunresolved
FAQstomedicalmarijuanaregulationssuggestthatfurtherguidanceiscoming.
DrugsandAlcohol Liabilities
• SurveyDeficienciesandImmediateJeopardy• ProfessionalandGeneralLiability• Safetyconcerns
StrategiesforDealingWithDrugProblems• IdentifySourcesofDrugs• Modifysecuritypoliciesandprocedures.• PreventativeMeasures
– screeningvisitorsandtheirbelongings– limitingresidentPASSandinspectingresidentsuponreturn
– drugsniffingdog
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HIPAA
HIPAA 10
AlcoholandDrugsSearchandSeizure
SearchforAlcoholandDrugsinResidentRooms SearchofVisitorsforAlcoholandDrugs
• ExpectationofPrivacyinNursingFacility– Delicatebalancebetweenprivacyrightandhealth,safety,welfareofresident,otherresidents,staffandvisitors
– NursingFacilityasaprivateentity
DrugsandAlcohol StrategiesforDealingWithDrugProblems
• ReferraltoAuthorities– PoliceDepartment– BureauofNarcoticEnforcement
• IssueswithLawEnforcement
• Diversionandtheftbystaff
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HIPAA
HIPAA 11
DrugsandAlcohol Alcohol
• DeficienciesforAlcoholAbuse• IssuesinvolvealcoholconsumptioninthefacilityandwhileonPASS
• InteractionswithPrescriptionDrugs• Safeguardingalcohol
– Ensuringmoderation– Unintendedconsumers– Dispensing
DrugsandAlcohol
HowtodealwithalcoholismordrugaddictioninNursingHomes?
• Outpatientservices• WhatiftheResidentrefusestreatment?
• Dischargeortransfertootherinpatientfacility
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HIPAA
HIPAA 12
SmokinginNursingHomes
Smokingornon‐smokingfacility? FederalGuidelinesforResidentSmoking
• DesignatedAreas• Supervision• Limitationsofcigarettesandlightingsupplies
• EmergencyEquipmentindesignatedareas
SmokinginNursingHomes
NewYorkStateLawsandRegulations• 2013SmokingBan– notallowedongroundsand15feetfromexit/entranceofnursinghome.
• Exception– nursinghomes– Designatedsmokingarea– Notwithin30feetofanybuildingstructure– Includingoverhand,canopy,awning,entrance,exit,window,intakeorexhaust
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HIPAA
HIPAA 13
SmokinginNursingHomes
E‐Cigarettes• NotaconcernforCMS?
Bestpractices• TreatE‐Cigaretteslikeregularcigarettes• LongTermEffects?• Effectsofsecondhande‐smoke?• Protectandrespectnon‐smokers
ComputerandInternetUse
PersonalEquipment
Workstations
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HIPAA
HIPAA 14
ComputerandInternetUse
OnlineShopping• Reasonablerestrictions
SocialMedia(Facebook,YouTube,Instagram)• GenerallyAllowedsubjecttocomputeruseandprivacyrestrictions
• SocialMediausemustrespectprivacyofotherresidentsandsafetyofnursinghome
Questions?