First Nations and Inuit Home and Community Care Policies Template Manual

Part 3: Client Care

First Nations and Inuit Home and Community Care Program
Policies Template Manual
Community Logo

Part 3: Client Services
Community Name

Policy: Client Rights
Policy Number: 3.1

Approval:
Date:

Policy

The First Nations and Inuit Home and Community Care Program recognizes and is committed to processes and policies that respect individual and community rights of First Nations and Inuit people. Embedded in these rights are the principles of equity, access, independence and informed client consent. All services provided by the Program support the rights of community members to receive holistic and community-based care. These rights are protected and promoted by the First Nations and Inuit Home and Community Care Program.

Policy Rationale

To ensure that staff are educated about and respectful of client's rights when delivering services.

Policy Details

At a minimum, the First Nations and Inuit Home and Community Care Program expects that all Program staff will ensure that clients and their families are:

• Cared for in a manner that is respectful of their culture, traditional values and beliefs, and lifestyle
• Cared for by trained, competent staff
• Free from abuse, exploitation, discrimination and neglect
• Provided with information which supports their right to make informed decisions and personal choices
• Respected for their informed choice to refuse service and/or to live at risk
• Involved in all aspects of care planning and service delivery
• Guaranteed that personal information gathered by Program staff is protected as private and confidential, to the fullest extent possible. Information is not shared with providers outside of the Program unless the client has provided informed consent. The client is also aware that certain situations may require information to be shared without consent, including information related to criminal matters, as requested by court authorities.
• Informed about how to:
• express concerns with the quality of service
• appeal a decision made by an assessor
• complain regarding any aspect of the service provided

Process Guidelines

The First Nations and Inuit Home and Community Care Program ensures that the detailed rights listed above are supported through ongoing assessment, education and evaluation of:

• The clients' and families' understanding of their rights
• The providers' understanding of client rights
• The ability of clients and families to exercise their rights as detailed
• The providers' understanding of the confidential nature of client information
• The clients' ability to express concerns and to make complaints and appeals
• The responsiveness of the Program

Performance Measurement Suggestions

Indicator: This information is to be developed by communities as they work with their Programs. For an example of the kind of measures that should be identified, refer to the Hiring Policy template.

Formula:

Related Standards

3.1 Services Delivery
3.2 Continuity of Services
3.4 Obtaining Consent
3.5 Client Rights
3.6 Ethical Issues
3.7 Confidentiality
6.4 Information Exchange

Some Suggested References

The First Nations and Inuit Home and Community Care Planning Resource Kit: 3A, 5
Draft Liability Documents: May, sections 5 -- 5.20; June pgs 22, 29, 35

CCHSA AIM Standards, 1999 -- Home Care Services
Provincial/Territorial and Federal Legislation
DIAND/FNIHB Home and Community Care Directives

Review Process:
Dates:

Each community is responsible for developing and putting in place their own procedures. These procedures need to outline the practical steps to be taken to carry out the process guidelines for this policy.

Suggested Procedures

1. Procedure for communicating client rights and responsibilities.
2. Procedure for obtaining verbal and/or written informed client consent.
3. Procedure for assessing eligibility and for notification to clients assessed as ineligible.
   Suggested tools:
   • Written list of eligibility criteria and guidelines
   • Form for tracking decisions for ineligibility

Part 3: Client Services
Community Name

Policy: Client Confidentiality and Privacy
Policy Number: 3.2

Approval:
Date:

Policy

The First Nations and Inuit Home and Community Care Program is respectful of, and committed to maintaining the confidentiality of all client information gathered by staff or sent as referral from other programs and services.

Policy Rationale

To ensure that client information is protected.

Policy Details

All staff of the First Nations and Inuit Home and Community Care Program must be educated regarding confidentiality of client information. This education is provided at the initial orientation and periodic training sessions on an ongoing basis.

All clients are provided with information about their rights during their admission to the First Nations and Inuit Home and Community Care Program. One of these rights is the right to have their privacy protected by the staff. Clients are informed of the need to share information with other health care providers (such as hospital and long term care facilities) to ensure optimum care; however, clients also understand that they have the right not to share information. Confidentiality of all client information is maintained through a variety of processes and procedures, which may include:

• Client information is stored in a secure location that is accessible to authorized individuals only. This storage policy applies to information that is currently being used, as well as information that is being stored
• Client information that is being transmitted for any reason must be done so in a secure manner
• When legislation allows, client information is disposed of in a secure manner
• Informed client consent is obtained before any information is shared with health providers who are not employed by the First Nations and Inuit Home and Community Care Program
• Any release of client information must be authorized by the client or their substitute decision maker when appropriate, except in circumstances beyond the control of the Program, such as requests of court authorities
• The client or their substitute decision maker must authorize, in writing, the release of client information to any other interested parties, such as the media, research facilities, and lawyers. Exceptions to this policy are only allowed when the release of information is required by an official request using Federal/Provincial/Territorial court documents.

All staff and clients are educated regarding the appropriate reporting process for any breach of the confidentiality policy.

Process Guidelines

The First Nations and Inuit Home and Community Care Program has a well-defined process for all aspects of the confidentiality of client information policy. This includes, but is not limited to:

• An orientation for all new staff that includes information about the importance of maintaining client confidentiality. Staff are advised that some challenges they may face in maintaining confidentiality may be:
• Small, intimate communities
• Extended family connections between clients, or between a particular client and Program staff providing direct services to the client
• Co-workers that may be, or are related to clients receiving care
• A client assessment process which includes education to the client on their rights, including their right to have their privacy maintained
• Incidents of breaches in client confidentiality, suspected or actual, are documented as occurrences for quality purposes, are fully investigated by Program management, and, when appropriate, are addressed with the employee involved through progressive discipline procedures
• Detailed instructions are provided to staff and clients for reporting potential or/and actual breach of confidentiality situations when they occur.

Performance Measurement Suggestions

Indicator: This information is to be developed by communities as they work with their Programs. For an example of the kind of measures that should be identified, refer to the Hiring Policy template.

Formula:

Related Standards

3.5 Client Rights
3.7 Confidentiality
6.2 Data Collection and Reporting
6.6 Confidentiality of Information

Some Suggested References

The First Nations and Inuit Home and Community Care Planning Resource Kit: 1, 2, 3A, 4
Draft Liability Documents: May, sections 3.3, 3.21, 4.9, 6-6.8; June, pgs 22, 37-39

CCHSA AIM Standards, 1999 -- Home Care Services
Canadian Health Record Association, Code of Practice and
Principles and Guidelines for Access to and Release of Health Information
Professional Practice Standards
Provincial/Territorial and Federal Legislation
DIAND/FNIHB Home and Community Care Directives

Review Process:
Dates:

Each community is responsible for developing and putting in place their own procedures. These procedures need to outline the practical steps to be taken to carry out the process guidelines for this policy.

Suggested Procedures

1. Procedure for both staff and clients and community members to follow when reporting a breach of client confidentiality to Program management.
2. Procedure for reporting any suspected or confirmed violations of the confidentiality policy (to be included as part of the occurrence reporting procedure).
3. Procedure for progressive discipline of staff, when appropriate, for violations of the policy.
4. Procedure for reporting breaches of client confidentiality involving regulated health professionals, when appropriate, to professional colleges and governing bodies.
5. Procedure for obtaining informed client consent to share information with other providers, when necessary.

First Nations and Inuit Home and Community Care Program
Policies Template Manual
Community Logo

Part 3: Client Services
Community Name

Policy: Consent to Treatment
Policy Number: 3.3

Approval:
Date:

Policy

All clients of the First Nations and Inuit Home and Community Care Program will provide informed consent to the treatment/service plan before any treatment or service is initiated.

Policy Rationale

To ensure that clients are aware of the risks and benefits of treatment and services, and the consequences of declining treatment or services.

Policy Details

All staff of the First Nations and Inuit Home and Community Care Program are responsible to ensure that clients are giving informed consent to the planned treatment/service. This includes clients that are new or returning to the First Nations and Inuit Home and Community Care Program, as well as those clients who are currently receiving Program services.

All staff of the First Nations and Inuit Home and Community Care Program are required to ensure that the client's informed consent is documented in the client record. Staff are also required to ensure informed client consent forms are updated as circumstances change, such as changes in the client's condition, or a change in the client's wishes.

In order to obtain informed consent from the client, all staff must consider:

• The capacity/ability of the client to understand the nature of the treatment/services being proposed
• Literacy challenges the client may face
• Language requirements of the client
• Cultural needs of the client

Process Guidelines

The First Nations and Inuit Home and Community Care Program ensures that all staff are educated about the nature of informed consent. Education includes the type of information that staff must provide to the client. Examples include:

• The nature of the treatment/services being proposed including potential/possible risks and side effects
• Possible/probable consequences should the client refuse to give consent
• How the proposed treatment/services will positively influence the client
• Options to the proposed treatment/services that the client may wish to consider

The First Nations and Inuit Home and Community Care Program educates all staff about the client's right to withdraw consent or to refuse consent to a proposed treatment/services. Staff are also educated about their responsibilities in such a circumstance. These include:

• The requirement to respect the right of the client to refuse or withdraw consent
• The need to immediately notify other members of the health care team of the client's decision (such as physician, clinic staff, or nurse practitioner)
• The responsibility to assist the client to explore options/community linkages/alternative treatments that are in accordance with their wishes
• The requirement to document the reasons for withdrawing consent or refusing services

All clients are provided with information about their rights during their admission to the First Nations and Inuit Home and Community Care Program. One of these rights is the right of clients to give, refuse, or withdraw their informed consent.

Performance Measurement Suggestions

Indicator: This information is to be developed by communities as they work with their Programs. For an example of the kind of measures that should be identified, refer to the Hiring Policy template.

Formula:

Related Standards

3.4 Obtaining Consent
3.5 Client Rights
3.6 Ethical Issues
3.7 Confidentiality
6.5 Program Changes and Improvements

Some Suggested References

The First Nations and Inuit Home and Community Care Planning Resource Kit: 1, 4
Draft Liability Documents: May, sections 5.1-5.20; June, pgs 24, 34-37

CCHSA AIM Standards, 1999 -- Home Care Services
Canadian Health Record Association, Code of Practice and
Principles and Guidelines for Access to and Release of Health Information
Professional Practice Standards
Provincial/Territorial and Federal Legislation
DIAND/FNIHB Home and Community Care Directives

Review Process:
Dates:

Each community is responsible for developing and putting in place their own procedures. These procedures need to outline the practical steps to be taken to carry out the process guidelines for this policy.

Suggested Procedures

1. Procedure for obtaining and documenting informed client consent.
2. Procedure for assessing the competency of clients to give informed client consent.
3. Procedure for obtaining informed consent from a substitute decision maker.