Hospice in an ALF and HIPAA

[Race Mom]

Our hospice is moving to EMR and the facilities are given access to our pt electronic chart (until full implementation we print and fax ALL clinical notes from RN, LCSW, and SCP). I feel this could open us up for a HIPAA violation. I could be completely wrong, but the following just doesn't sound like we are protecting our pt's FAMILY (as hospice, our care is for the whole family, not just the patient).

I have a pt that has a dx process that the spouse could no longer manage at home. This is a young pt. This pt also has a young child. The pt was moved to an ALF very recently.

My concerns:

Child has a volunteer from our hospice, that volunteers for HIM, not pt

Social Work and Spiritual Care will split their visits between pt, spouse, and child.

All notes from these disciplines are "available" for the facility to look at through EMR.

I find that this violates the family's HIPAA rights to their privacy of issues they may be working through, whether d/t pt condition or other issues.

For example: let's just pretend...(seriously)

Spouse confides in social worker that he had multiple affairs during his marriage and he is struggling with it....or...he has met someone new now that spouse is in facility...or...he is suicidal....or he has found out he has been diagnosed with (anything).

Son confides in social worker or volunteer that he is being bullied at school, or that he became sexually active, or that he smoked pot...

(seriously, I made all these examples up)

What business is that of the facility? How will that help them accomplish caring for this pt that needs their skilled services?

In my opinion, it violates the family's right to privacy and their right to protected health information. I was told today that the facility should be getting all notes from all disciplines. Because I feel so strongly that I feel the facility has no right to read these notes as it does not help them provide care to the hospice patient but allows them to read the "novel" of the family.

Please let me know what the rule is on this. I would like to make sure I am following HIPAA and that my company is too.

[klone, MSN, RN]

But again, she didn't say anything about the role of other nurses. She was only clarifying the role of the hospice nurse. If you inferred something else, that's on you.

[MunoRN, RN]

But again, she didn't say anything about the role of other nurses. She was only clarifying the role of the hospice nurse. If you inferred something else, that's on you.

The original question was if it was inappropriate for SNF staff to have access to the same information that the hospice nurse does. The basis for this being inappropriate would be if it in no way affected nursing care for the patient, which the OP made the case for with "hospice cares for the family, not just the patient". I don't see how it's possible not to infer that means the SNF staff cares only for the patient, which is what makes their care different from hospice, which is what makes their access to some of hospice's charting potentially inappropriate.

[MunoRN, RN]

OMG, once again... I am explaining the role of HOSPICE not hospice vs SNF! Hospice provides FAMILY CENTERED CARE! Maybe chiropractors and dentists do to, I have no clue! The SNF for the pt made me sit down for an hour and discuss with their nurse educator why I was stating that a feeding tube was not appropriate for this pt. Nevermind her POST stating NO LIFE SUPPORT. Then they blasted her for choosing this and how difficult it was on THEM! There...there is your difference between hospice nursing and general nursing. (disclaimer obviously needed...not all nurses want to go against a POST nor do all SNF not want to honor the wishes of the dying.)

So you're saying that as far as you know, the SNF nurses also provide family centered care?

[Race Mom, ASN, RN]

So you're saying that as far as you know, the SNF nurses also provide family centered care?

I would guess it is a mix between some being patient-centered and others family-centered. The one I'm talking about has nothing about family mentioned in their marketing. It is all mentioned as patient centered but does include medical and social for the patient, no spiritual offered.

So my next question is...since I hadn't thought about this before all these comments...why do SNF not fax their notes to hospice so that we are better able to meet the needs of our patient and the family based on their assessments? They provide more 1 on 1 as they provide continuous care and could be wonderful at providing hospice with information about how their transition is going or triggers they have noticed for behaviors/emotional situations. Their LCSW has only talked to me in the admission care conference 3 months ago. I have no clue if she is working on anything that we can help her with or vice-versa.

[klone, MSN, RN]

The original question was if it was inappropriate for SNF staff to have access to the same information that the hospice nurse does. The basis for this being inappropriate would be if it in no way affected nursing care for the patient, which the OP made the case for with "hospice cares for the family, not just the patient". I don't see how it's possible not to infer that means the SNF staff cares only for the patient, which is what makes their care different from hospice, which is what makes their access to some of hospice's charting potentially inappropriate.

Okay, let's back up. Part of hospice is also providing care and services to family members. I have NEVER met a SNF or LTCF where an *expected* (and BILLED) part of their service was also to provide ancillary care to spouses and children.

THAT is why hospice care is different from care received at a SNF. Not BETTER. Different.

[toomuchbaloney]

The law requires the hospice to share the POC and other relevant documentation with the SNF for continuity of care.

Most of the SNFs (and their staffs) I have ever worked with spend a minimum amount of time engaged in reading or interacting with hospice documentation. We spend way more time looking at their documentation, in my experience.

[MunoRN, RN]

Okay, let's back up. Part of hospice is also providing care and services to family members. I have NEVER met a SNF or LTCF where an *expected* (and BILLED) part of their service was also to provide ancillary care to spouses and children.

THAT is why hospice care is different from care received at a SNF. Not BETTER. Different.

ALL nurses are expected to provide the basic standard of nursing care, which includes caring for the patient as a part of a larger social structure and incorporating the assessment of that structure into their overall plan of care for the patient. Facilities bill for nursing care, which includes this aspect as well as every other basic nursing expectation despite it not being an itemized part of the bill. In other words, the standards of nursing practice set the expectations, not the billing form.

[MunoRN, RN]

I would guess it is a mix between some being patient-centered and others family-centered. The one I'm talking about has nothing about family mentioned in their marketing. It is all mentioned as patient centered but does include medical and social for the patient, no spiritual offered.

I think you're confusing terminology with what nursing care involves, regardless of the marketing lingo a facility decides to use. All nurses in a primary role of caring for the patient are expected to provide and participate in a holistic plan of care, which of course involves medical, social, spiritual, and the care plans of contributing disciplines, including hospice.

So my next question is...since I hadn't thought about this before all these comments...why do SNF not fax their notes to hospice so that we are better able to meet the needs of our patient and the family based on their assessments? They provide more 1 on 1 as they provide continuous care and could be wonderful at providing hospice with information about how their transition is going or triggers they have noticed for behaviors/emotional situations. Their LCSW has only talked to me in the admission care conference 3 months ago. I have no clue if she is working on anything that we can help her with or vice-versa.

Yes, they should be sharing their notes as well.

[MunoRN, RN]

OMG, once again... I am explaining the role of HOSPICE not hospice vs SNF! Hospice provides FAMILY CENTERED CARE! Maybe chiropractors and dentists do to, I have no clue! The SNF for the pt made me sit down for an hour and discuss with their nurse educator why I was stating that a feeding tube was not appropriate for this pt. Nevermind her POST stating NO LIFE SUPPORT. Then they blasted her for choosing this and how difficult it was on THEM! There...there is your difference between hospice nursing and general nursing. (disclaimer obviously needed...not all nurses want to go against a POST nor do all SNF not want to honor the wishes of the dying.)

I'm having a hard time understanding this post. You state it's not hospice vs SNF but then share a seemingly unrelated rant against SNF staff.

(FWIW the easiest way to tell what someone's artificially administered nutrition wishes are on a POLST is to refer the section that specifically refers to that).

[ktwlpn, LPN]

I'm having a hard time understanding this post. You state it's not hospice vs SNF but then share a seemingly unrelated rant against SNF staff.

QUOTE]

[ClearBlueOctoberSky]

It's true that SNF's don't supple ANCILLARY services to the families of our patients. It is also true that we are patient centered. However, being patient centered means that we include family, because after all, they are an extension of our patient. We support the family in many different ways, from listening to a family member rant about what some may think is small and inconsequential, but it isn't to them, to actually walking them through what Hospice really means.

At least in my facility, it isn't so much the family members that bring up the conversation on Hospice and/or Palliative Care, but it is the Nurse and SW that start that conversation.

What I'm trying to get at is that it irritates me when the assumption is made, as it is through out this entire thread, that I don't provide support for the families of my patients, that it is THE job of a Hospice to do that.

As a pp stated, who do think is there for the rest of the time? The a Hospice Nurse comes once a week, we see aides a little more. The Chaplain and the SW... Every few weeks.

I am lucky in that when we have Hospice in our building, our TEAMS work very well and share the information needed to take care of business, for both the families and the patient. Don 't underestimate the knowledge of the SNF team on the family dynamics, they have dealt with the patient's family far longer than you have.

I am also lucky in the fact the my NHA and my Medical Director don't have a problem with not having the Hospice Agencies that don't play nice with us and embrace that Team effort come back.

Most of the time, it is the facility that will recommend the Hospice Agency, at least it is where I am at.

[Race Mom, ASN, RN]

I am so done with the spin some of you are taking on my original question. OTHERS have assumed that I meant that SNF "don't care for the whole family" and that "hospice is the only one that needs hospice information" and that OP states that it is not SNF vs hospice, yet I make a rant about SNF care of a hospice plan. I am only answering to your spin that YOU are putting on my original question...does the SNF need ALL the information that is gathered on the family that does not relate to patient care or the patient's care plan? You all have spun and spun to make this about how I am not a team player. I can guarantee you that you have me 100% incorrectly "figured out". My "rant" about a SNF is due to the insane, uncalled for, spins that are being put on this simple question. The spinners write about how SNF needs this info to follow the hospice POC. I gave you an EXAMPLE of how this sometimes doesn't matter. SNF not wanting to follow a POST.

And yes, I already agreed that hospice is not with the patient nearly as much as the staff at the SNF. Why this came into the story...nothing to do with my original post. And ClearBlue...just because someone is in a SNF doesn't mean their relationship with SNF is longer than hospice. This pt has been with our hospice for quite some time and WE referred her to this hospice. Our CNA is there M-F and I am there 2-3 times a week. We have volunteers there several times a week as well as bimonthly with SCP and LCSW. I have a great relationship with this facility and they appreciated the referral. This pt has an uncommon disease that I educate on every chance I get.

"Play nice with you???" This should be decided on the level of compassion and care your patient received as they came to the end of their life. I do agree with the team effort part. I guess I just don't know why this was even something you put in your comment about my HIPAA question. Your first paragraph is said perfectly and I agree. However...I NEVER SAID anything about hospice vs. SNF in their role in providing care to the family, NOWHERE! The spinners here have done that and now you all say that I did it! As nurses, we ALL listen to families complain or voice concern about something, and I have discussed what ALF and SNF mean to many families too.

All I wanted to know was if it was a HIPAA violation for us to share "non-pt related" notes of the family's information with the facility. You know...the things that do not aide in the patients care. "Need to know basis".

But, instead of getting a concrete answer, I heard from a lot of people who don't want to help me. I will try to advocate for my pt's family somewhere else and you all can just keep typing away here, putting your spin on such a simple question. It is really sad that nurses have to be so mean to other nurses. Saddens me.

For the other nurses that read what I wrote, as I meant for it to be read, thank you for your input to my HIPAA question!

I have never been so disappointed in comments in the 9 years I've been here on AllNurses.