Going to Patient's home without patient consent

[RNBecky84]

I work in home care. Normally a physician will send our company a referral for home care. We contact the patient, ask to go to their home for the initial Start-of-Care visit, then start services at that agreed upon visit. Recently our intake team said we are now required to drive out to a patient's home if they don't answer our phone calls/ return our phone calls. Their thought is "we need to do a well check on them". My thought is "they are not our patient's yet a well-check should be completed by the police".

Is this violating HIPAA by having us go to a patient's home without their consent?

Sometimes these patient's aren't aware the original referral even happened, so us going out to see them could be a surprise. What's the difference between me and a door to door salesman at that point.

One of our intake nurses says this violates HIPAA. I don't know if it does but don't want to violate HIPAA rules.

[caliotter3]

As far as I'm concerned, it violates HIPAA and asking to get some dire consequences. If they are that hard up for business, they should light a fire under their marketers.

[Here.I.Stand, BSN, RN]

There is no way ever, EVER, I would go to a pt's house without permission. If pt that were me, I would be livid. If I agree to home nursing, I am very capable of contacting the agency... and knowing that a professional used my medical record to track me down, would feel very violating.

I highly doubt that your agency admin is truly motivated by concern. BUT. Welfare checks are done by police -- NOT nurses.

[Here.I.Stand, BSN, RN]

Another thought: say you showed up to offer the nurse visits. Would the client necessarily feel free to decline? Is the agency satisfied with a "no," or do they expect you to probe and "educate?" The lack of a call-back is an easy, confrontation-free method of opting out. Then have to face the nurse unannounced? In their own home??

[inthecosmos, BSN, MSN, RN, APRN]

Wow, no. Absolutely not. HIPPA violation as the patient didn't consent. Therefore, you're using their PHI without permission.

[NurseCard, ADN]

I'm not understanding the HIPAA violation part.

Usually the patient, while in the hospital, agrees to use a certain

home health agency. THEN at that point, the patient's information

is sent to that home health agency, along with the patient's date

that they will be discharged home.

Nurse that will be doing the Start Of Care visit receives the

patient's information, again because the patient consented to

using that particular home health agency. I believe also, the

patient signs something before leaving the hospital, agreeing

that they will receive post acute care from that particular

agency.

Nurse contacts the patient to set up the start of care visit.

Nurse is unable to contact the patient, or any next of kin.

At THAT point, yes an agency may ask that nurse to just go

ahead and go to the house. For varying reasons, the patient

may not be able to be contacted. Phone may not be working.

Patinet may not be able to hear phone.

Some nurses are okay doing this, some are not. And some

agencies have a policy that the nurse does not go to the

house without having reached the patient first.

Again, though, where is the HIPAA violation? The patient

should have consented to that HH agency already before

a referral ever arrives.

Now, I HAVE been in just a couple of situations in which,

for reason unknown to me.. more than one HH agency

received a referral to see a patient. A couple of times.

[NurseCard, ADN]

Sometimes these patient's aren't aware the original referral even happened, so us going out to see them could be a surprise. What's the difference between me and a door to door salesman at that point.

One of our intake nurses says this violates HIPAA. I don't know if it does but don't want to violate HIPAA rules.

Again... merely going to the house doesn't violate HIPAA. If a doctor or anyone

else just arbitrarily sends a patient's information to the HH agency without

permission, then yes that would be the HIPAA violation.

It is my genuine belief that this DOESN'T exactly happen like that.

SOMEONE gives the doctor permission to refer the patient to HH. It may

be the patient's POA. It may even be the patient, but then the

patient forgets that the doctor mentioned HH, and that the

patient okayed it. I mean, I've called patients on the phone

to set up the initial visit... and had the patient say something like

"Oh, Dr Jones set up home health for me? Wow... okay. Well,

come on out at 1pm, I'll be here".

[NurseCard, ADN]

Another thought: say you showed up to offer the nurse visits. Would the client necessarily feel free to decline? Is the agency satisfied with a "no," or do they expect you to probe and "educate?" The lack of a call-back is an easy, confrontation-free method of opting out. Then have to face the nurse unannounced? In their own home??

I'll admit, I worked for a home health agency that used questionable practices.

However, even they understood that "no means no".

Again though, HH agencies don't just receive the patient's info without

the patient's consent. The patient or the POA *HAVE* agreed to home

health.

There are PLENTY of nurses that will not go to the patient's house if

unable to reach the patient by phone, and that is perfectly fine as

far as I'm concerned. However, again, the mere act of going to the

house is not a HIPAA violation.

[Susie2310]

Even if the patient had consented to home health care when they were in the hospital and had forgotten they had done this, their records will show if they have said they would like to be contacted by phone and whether it is acceptable to leave a phone message. I agree with above posters that the agency nurse showing up at the patient's door when the patient has not already agreed to this nor confirmed their agreement for home health visits over the phone with the agency, is very inappropriate, and violates the patient's rights to their privacy and autonomy. The patient didn't give consent for their PHI to be used in this way. I too would be furious if this happened to me or my family member.

[NRSKarenRN, BSN, RN]

I work in home care. Normally a physician will send our company a referral for home care. We contact the patient, ask to go to their home for the initial Start-of-Care visit, then start services at that agreed upon visit. Recently our intake team said we are now required to drive out to a patient's home if they don't answer our phone calls/ return our phone calls. Their thought is "we need to do a well check on them". My thought is "they are not our patient's yet a well-check should be completed by the police".

Is this violating HIPAA by having us go to a patient's home without their consent?

I'm disagreeing with majority of above advice based on 30yrs in homecare and 10+yrs as Central Intake Mgr: There is no HIPAA violation as written/verbal order obtained from physician/hospital/SNF/insurance company for home care service eval.

Home Health agency is obligated to provide evaluation visit once homecare referral is accepted. For Medicare certified agencies, Medicare requires initial homecare eval within 48hrs of ordered start of care date to determine if patient meets homecare criteria especially homebound status and admission to homecare. Well check IS required with outcome documented along with notifying referral source inablity to reach patient.

Registered Nurse is admitting service when multi-disciplines requested. PT/ST may admit only when they are the primary service being requested. In our Philadelphia urban/suburban area, about 1/4 of our referrals have incorrect phone numbers/ phone service disconnected despite our community/hospital liaisons meeting patients prior to discharge due to forgetfullness, lengthy inpatient stay so bill not paid, financial issues, old age, fear of admitting home issues, cell phone voice mail full/out of minutes,etc.

Difficulty contacting patients has escalated over the past 5 years in my area.

Recommended strategies to decrease patient not found/wellness checks:

1. Referral source needs to provide patient and emergency contact info, so 2 sources to call.

2. Inner city hospitals with highly transient + homeless population: liaisons call phone numbers provided to see if working prior to sending referral to agency, immediately followup with patient to get alternate emergency contact # then possible.

Frail elderly often taken to different home upon children arriving to bring parent home from facility when they see condition of parent so liaisons try to get next of kin #.

3. When prior agency patient. Intake staff compare address+ phone numbers to prior address/phone to see if misplaced digits.

4. Physician referrals: When multiple calls left over 2 days, we contact the physician to request office staff contact patient that homecare being requested: patients often will recognize doctors office # / voice mail left then call agency to arrange eval visit.

6. Liaisons contacted in 24hrs when unable to reach patient: they will make double check phone #, attempt to locate another contact # in chart and male outreach call too reminding patient of request/consent to homecare visit.

5.. When patient unable to be contacted, wellness visit e.g drive-by is done AND we leave printed door knob card which is often successful in getting patient to contact agency:

ABC agency visited your home ______ (date) at request of __________ (insert physician name/hospital) to start home care service for Nursing / Physicial Therapy/ Speech Therapy (circle discipline).

Please call our toll free number: 888-888-8888, a nurse is on call 24hrs a day.

Sincerely,

_______________________ (Professional prints name).

Hope this helps other homecare staff.

[Penelope_Pitstop, BSN, RN]

HIPAA allows the passage of PHI from one protected entity to another for the purpose of treatment (which involves care coordination/case management) as long as it is given in a secure manner. As long as the physician, hospital, rehab unit, etc., has ensured secure delivery of PHI to the HHC agency, there is no violation. The SOC RN is using that information provided for the purpose of treatment as ordered by a provider who has an informed consent on file signed by the patient or designated party for the express purpose of disclosing said information appropriately.

[trytounderstand]

Another thought: say you showed up to offer the nurse visits. Would the client necessarily feel free to decline? Is the agency satisfied with a "no," or do they expect you to probe and "educate?" The lack of a call-back is an easy, confrontation-free method of opting out. Then have to face the nurse unannounced? In their own home??

For the elderly or someone who is recovering and had had a recent stay in a hospital where they may have been treated and learned that "no" does not always mean "no". Because I have seen patients "educated" until they have accepted treatment they did not want or in same cases did not really need just because they were hounded or told they were being noncompliant and it was going in their record.

Showing up unannounced at a new client's home just because they have not answered the phone is wrong. If HH is that concerned that something is amiss and the possible client need helps should HH not contact their primary care provider or hospital/referrer and let this provider contact whoever they have listed as next of kin or emergency contact? On second thought, if they have actually been referred to HH this information should have been provided to them as well.

Then if all else fails have authorities with you to make sure there is nothing amiss at the patient's home and to have proof that the patient is willing for the nurse to enter their home since initial contact with the patient has not been made first. Just showing up could be construed as harassment or violation of patient's privacy. I would think they are not your patient/client until they have accepted your phone call and agreed to a visit before hand.