Monday, September 15, 2008

Health Care & Privacy Laws

For Family Members of Ailing Seniors:
It is clear that family members face severe and potentially profound issues when caring or advocating for family members. Unfortunately, many health care providers do not understand the various Health Care acts that apply to both their clients and their families. Some of these include: Mental Health Act, Public Hospitals Act, Health Protection and Promotion Act, Long-Term Care Act, Occupational Health and Safety Act, Child and Family Services Act. Workers in health care continue to cite the Freedom of Information and Protection of Privacy Act (FIPPA) Legislation when refusing to communicate serious and crucial safety information regarding those in their care. The Personal Health Information Protection Act (PHIPA) governs such workers. Yet, workers fail to communicate with adult children to inform them of the status of their frail parents’ health. Health Care providers and professionals have an obligation to inform family when they feel that seniors may be facing dementia, for example, which might put seniors at risk in their homes. This risk has an impact on the seniors, their neighbours, and the community, in that those who fall end up in hospital. Those who accidentally leave pots on the boil cause fires that tie up emergency services. Those who leave a tap on in an apartment cause flood damage to other residents’ ceilings.

Dr. Ann Cavoukian, Information and Privacy Commissioner for Ontario, is on a personal mission to inform health-care providers and professionals about their responsibility to include family members among those who are privy to the mental and physical health conditions of patients and clients. Health information custodians who collect, use, and disclose personal information can tell them to exercise judgment. In a conflict, PHIPA prevails over other Acts. This includes FIPPA. Health information custodians include professionals: licenced and non-licenced practitioners such as social workers, those working in LTC, or operate health facilities, pharmacies, laboratories, ambulance services, centres, programs, or services for community or mental health purposes.

Disclosure can be made for the purpose of contacting a relative, friends or substitute decision-maker of an individual who is incapacitated, injured, or ill, and unable to consent (PHIPA, sect. 38(1)(c), p. 38) if it becomes necessary to eliminate or reduce a significant risk of serious bodily harm to a person or group (PHIPA, sect. 40, p. 40).

Frail seniors living on their own may be incapable of taking their medications at the right time. This is a serious risk to a senior. It is up to a health-care provider to make the decision to inform family. Many family members may not understand that their ailing relatives are incapable of ADL or IADL when friends and neighbours are covering these duties. The risk of such enabling actions is great to both the senior and his or her family. Disclosure must be forthcoming to protect one and all.

Gulli and Lunau (2008) suggest that while the trend towards collaborative care is a positive one with Family Health Teams in Ontario and Alberta, there simply are not enough health-care practitioners to fill the need. Physicians are no longer willing to work the long hours or to make the house calls that used to be the norm in my parents’ generation. Burnout is a huge problem, as much as the dearth of practitioners.

Once capacity is determined, Concent for institutionalisation is covered here:
Capacity to consent
Determination of incapacity
Persons who may consent
Factors to consider for consent
Authority of substitute decision-maker
Incapable individual: persons who may consent
Appointment of representative
Transition, representative appointed by Board

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