Sex, Drugs Wheelchairs - Welcome to · PDF fileHIPAA HIPAA 1 Sex, Drugs & Wheelchairs The Rights of Nursing Home Residents By: Patrick Formato, Esq. 1111 Marcus Avenue, Suite 107 Lake

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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Resident’sRights– Howfardotheyexpand?

1)SexualRelations 2)Drugs/Alcohol 3)Smoking 4)Computer&InternetUse

SexualRelationsintheNursingHome

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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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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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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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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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DrugsandAlcohol

DrugsandAlcohol

IllicitSubstances• Strictlyprohibited• CannabisUse.

Source• BroughtinbyResidents• Broughtinbyfamilymembersorvisitors• Inrareinstances,bystaff.

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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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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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AlcoholandDrugsSearchandSeizure

SearchforAlcoholandDrugsinResidentRooms SearchofVisitorsforAlcoholandDrugs

• ExpectationofPrivacyinNursingFacility– Delicatebalancebetweenprivacyrightandhealth,safety,welfareofresident,otherresidents,staffandvisitors

– NursingFacilityasaprivateentity

DrugsandAlcohol StrategiesforDealingWithDrugProblems

• ReferraltoAuthorities– PoliceDepartment– BureauofNarcoticEnforcement

• IssueswithLawEnforcement

• Diversionandtheftbystaff

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DrugsandAlcohol Alcohol

• DeficienciesforAlcoholAbuse• IssuesinvolvealcoholconsumptioninthefacilityandwhileonPASS

• InteractionswithPrescriptionDrugs• Safeguardingalcohol

– Ensuringmoderation– Unintendedconsumers– Dispensing

DrugsandAlcohol

HowtodealwithalcoholismordrugaddictioninNursingHomes?

• Outpatientservices• WhatiftheResidentrefusestreatment?

• Dischargeortransfertootherinpatientfacility

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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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SmokinginNursingHomes

E‐Cigarettes• NotaconcernforCMS?

Bestpractices• TreatE‐Cigaretteslikeregularcigarettes• LongTermEffects?• Effectsofsecondhande‐smoke?• Protectandrespectnon‐smokers

ComputerandInternetUse

PersonalEquipment

Workstations

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ComputerandInternetUse

OnlineShopping• Reasonablerestrictions

SocialMedia(Facebook,YouTube,Instagram)• GenerallyAllowedsubjecttocomputeruseandprivacyrestrictions

• SocialMediausemustrespectprivacyofotherresidentsandsafetyofnursinghome

Questions?