Husband Worried

Kyasi · Jul 4, 2011

It is definitely a HIPPA violation. This is specifically mentioned in our orientation paperwork so I'd be surprised if you didn't sign something stating that you received similar information. I would check your Employee handbook and all that you signed during your orientation to see what the company policy on this is. Honestly, in this day of cell phones, it is very simple to make contact w/ your husband to say "I'm on the west side of town and should be here for about an hour" without giving specifics. Then call when you go to the next home if you feel you must.

I do hear complaints by patients when staff brings someone to work and I have fired people for violation of this policy. A few weeks ago, I even got a complaint from a client because a HHA left her car down the street so a friend could borrow it and a neighbor told the patient's daughter, who called me. Since the person didn't come to the house to get the key and the HHA didn't park it in front of the patient's house, I was able to reason w/the family that this type of thing does happen if staff has to share a car or have repair work done. So if your husband is hanging around in his car a few houses down, he will eventually be drawing negative attention to himself.

As another nurse posted, if you are that fearful, you might want to rethink this type of work. I don't let my husband know every store, bank, library, gas station etc that I venture into in the course of a day (and bad things can happen there) but my cell phone is always in my pocket in case I need it. Heck, hospital parking lots are dangerous during change of shift.

Kyasi

Biggirl71 · Jul 4, 2011

I am a home health nurse and I work in and around Houston. I am here to tell you that I bring my husband with me on calls that are located in parts of town that I am uncomfortable in. I have arrived at some homes to be greeted by what appear to be gang members, in full-on gang attire, 15 of them sitting in the front yard drinking their 40's and not even conversing with me when I ask the question, "who is the patient?" I have NO problem bringing my husband along because in the end, anyone who inquires about my decision to do so, would probably have done the same thing. I DO NOT share personal information with my man about the patient, and I DO NOT bring him in the house with me. A HIPAA investigation would be the last thing I was concerned with in the event something happened. I will also say that generally, when people see I am in scrubs, I get respect because they know I am there to help someone. I also do not carry myself as a victim and I keep my eyes and ear open. If I ever felt unsafe about entering someones home, I wouldn't. Bottom line, HIPAA rules state that private information should be kept confidential unless the person has a NEED to know it. If I am in an unsafe situation, my husband then has a NEED to know. Good luck to you!

cathrn64 · Jul 4, 2011

I don't know where you live, but if the area is that bad, than I would think twice about doing homecare. If it is not a bad area, than know that as stated above, most people recognize that you are there to help. If the area is questionable, go as early in the day as possible. (all the "bad guy's" are still sleeping from the night before.) I have been doing homecare in the Chicago suburbs for 20 years and have never felt the need to bring my husband. Plus, the agencies I have worked for have had a policy that you can request security in unsafe areas, either a private security co, or a cop.

allnurses Guide · Jul 5, 2011

I would NEVER bring a friend or a family member to someone's house with me unless it was an emergency or I had cleared this with the patient/client first.

I have to say though, and maybe this just proves I should do as suggested, get out of this job - even though I may actually want to work in areas with underserved populations - I might also want to continue to live.

Is HIPAA being stretched and contorted and applied to situations that defy common sense - well yes we know that is true. Fire people if you want to but I am just sorry, my life is not worth whatever theoretical damage may occur if someone in the neighborhood has nurses visit them, and someone might figure out ... what? Even if you drive your own car wouldn't your scrubs and nurse-bag be more of a tip-off than parking your car down the street in front of a neighbor's?

Honestly, I don't get it. Nobody needs to know the name, the diagnosis or any other unique factor about your client because you took the bus, (the bus driver and other passengers might see where you are heading) a family member brought you to work, (lots of people only have one car) or you needed to take a taxi that day.

I had my daughter bring me something I forgot from home one time. My partner drove me to work when my car battery died. Are you saying that I should be fired for that? Sometimes I accompany patients on trips using the Access Paratransit vans. Very often there is a complete stranger in that van also. CRTs deliver oxygen. Medical supply companies deliver boxes with 'adult briefs" written on the outside. The pharmacy delivers prescription medicines.

I just cannot get out of my mind the Detroit home health nurse who was murdered in her client's living room and her husband going back to that neighborhood posting flyers and talking to the neighbors - my wife worked at xyz house, she was murdered, and the cops don't seem to care much. If he happened to work for that agency he would've been fired for that. This makes me very sad. But then again I've never had a patient that felt the need to keep their use of home health nurses a secret. In my experience there are a few over paranoid people and yes - we do backflips for them knowing of their fears. The average client wouldn't do that - so why restrict your nurses from doing things that hurt nobody and enhance her feeling of safety and make sure underserved areas aren't a ghost town where a crime victim can't find enough skilled nurses to take care of him or her?

I want to understand the thinking behind this.

caliotter3 · Jul 5, 2011

I would NEVER bring a friend or a family member to someone's house with me unless it was an emergency or I had cleared this with the patient/client first.
I have to say though, and maybe this just proves I should do as suggested, get out of this job - even though I may actually want to work in areas with underserved populations - I might also want to continue to live.
Is HIPAA being stretched and contorted and applied to situations that defy common sense - well yes we know that is true. Fire people if you want to but I am just sorry, my life is not worth whatever theoretical damage may occur if someone in the neighborhood has nurses visit them, and someone might figure out ... what? Even if you drive your own car wouldn't your scrubs and nurse-bag be more of a tip-off than parking your car down the street in front of a neighbor's?
Honestly, I don't get it. Nobody needs to know the name, the diagnosis or any other unique factor about your client because you took the bus, (the bus driver and other passengers might see where you are heading) a family member brought you to work, (lots of people only have one car) or you needed to take a taxi that day.
I had my daughter bring me something I forgot from home one time. My partner drove me to work when my car battery died. Are you saying that I should be fired for that? Sometimes I accompany patients on trips using the Access Paratransit vans. Very often there is a complete stranger in that van also. CRTs deliver oxygen. Medical supply companies deliver boxes with 'adult briefs" written on the outside. The pharmacy delivers prescription medicines.
I just cannot get out of my mind the Detroit home health nurse who was murdered in her client's living room and her husband going back to that neighborhood posting flyers and talking to the neighbors - my wife worked at xyz house, she was murdered, and the cops don't seem to care much. If he happened to work for that agency he would've been fired for that. This makes me very sad. But then again I've never had a patient that felt the need to keep their use of home health nurses a secret. In my experience there are a few over paranoid people and yes - we do backflips for them knowing of their fears. The average client wouldn't do that - so why restrict your nurses from doing things that hurt nobody and enhance her feeling of safety and make sure underserved areas aren't a ghost town where a crime victim can't find enough skilled nurses to take care of him or her?
I want to understand the thinking behind this.

I have never understood the willingness to jump on the stupidity bandwagon myself.

Kyasi · Jul 7, 2011

Most of the situations I deal with are staff who ask friends/family to bring them their lunch or a coke. Some have even gotten permission to bring their kids to the house to meet the patient. Our policy is pretty specific about not doing this. For one, as soon as an item turns up missing, that patient will be the first one to blame the kid, friend who stopped by etc. This happens frequently. It is never the druggie grandson or his friends who did it, it's the HHA or the HHA's friend who knows now where the patient lives. So even with the patient's permission, it often can backfire. Also, the person coming to the house hasn't had background checks, TB testing etc so these are also some of the reasons for this policy.

Having AAA come out to jump a car isn't a HIPPA violation unless you tell the person doing it that you are a nurse and were here taking care of Mrs. H who is a quadraplegic etc. Also, with neighborhood watch like it is (at least in my area) a neighbor can and probably will call the cops if they see someone sitting in his car for too long. I once did a supervisory check on a HHA who I was sure was leaving the home with the client (not allowed in this case) I parked down the street and did a stake out. Sure enough, the owner of the home came out to ask me what I was doing. I just told him I was checking on an employee who worked in a home down the street to make sure he was arriving/leaving as scheduled. He left me alone. (I didn't say which house, patient name, or what kind of work the employee was doing)

I think common sense needs to be used and any unnecessary visits by non-employees should not be done. I just caution everyone to be sure to read your company's policy on this. An employee should bring any lunch and drinks with them that they need during their shift/visit instead of asking a friend to drop something off. A flat tire is something that can't be avoided. While you can give the address your car is at so hubby can come to help, do you have to point out the specific house? Maybe the patient is across the street, or next door... he doesn't have to know which exact house it is. I once locked my keys in the car and my husband worked nearby. I told him what corner I was parked at and waited by the car. He didn't know which house I had come from or what the patient's name was.

Kyasi

allnurses Guide · Jul 7, 2011

Maybe it's the level of alarm combined with the discussion of firing people over this that seems to be at variance with the way people behave most of the time, whether they are the nurse or the client/patient.

I've never seen a home health aide or nurse bring a friend or family member into a home with them unannounced or without discussing it with the client first. That is very unprofessional, and even if it was not a business transaction of sorts, my mama taught me better manners than to ever do something like that. It's like bringing 4 obscure cousins with you to a wedding that you and one other person were invited to. The employee has failed the first test of common sense - if that were me I would be rechecking my applicant pool pretty quickly.

If that person brought a friend into a house without permission again after being given a warning, I couldn't fire them fast enough, for that would tell me a lot about that person's character and qualifications to do the job.

A TB test or background check would then be a secondary issue.

What often happens is that after nurses and clients have worked together for enough time that a sense of trust develops, they might ask to meet the home health employee's husband or child, so they bring them in for a quick hello and I've never heard of a nurse or HHA accused of theft after they've introduced the family member. You do have to be really careful about that though, not so much for the false accusation of a crime, but that it's better to keep the personal/professional boundary line clear.

I wouldn't want anyone to sit outside in their car for more than 30 minutes - that is a gigantic red flag in Beverly Hills or the poorest, most gang-infested areas of the city!! But a neighbor complaining to a patient's daughter who complains to the agency that the employee's car was parked in front of their house and the aide almost being fired for it - I guess I don't understand. We drive our cars to work and there very often are no open parking places directly in front of the home.

My concern really wasn't about visitors as it was that someone knowing what address you happen to be at should something untoward happen is such an egregious breach of HIPAA that you would risk being fired for it, especially when it is being stood up against the possibility of physical harm coming to the nurse or HHA.

As far as having the ability to be "escorted by security or a cop" that was mentioned, I'm not aware of any agency that employs an on-call pool of security guards (though I would love that!!) and there is no way my request for an LAPD officer to come out to walk me to the door would be granted (though I would love that!).

Their helicopter makes fairly regular passes over the areas in question though, and their big spotlight probably acts as a deterrent during evening/night time hours.

Kyasi · Jul 7, 2011

"But a neighbor complaining to a patient's daughter who complains to the agency that the employee's car was parked in front of their house and the aide almost being fired for it - I guess I don't understand. We drive our cars to work and there very often are no open parking places directly in front of the home."

Nurse 156, I think you are referring to something I referenced. Maybe I wasn't clear in my post but I did discuss this with the patient when she called to complain about it and we discussed that this kind of thing happens when staff have car problems or need to share a car. I felt this HHA handled the situation in a professional manner and let the patient know. She did end up backing down then.

All the the situations I mentioned have happened in our agency. I'm the one who has to write out the complaints and follow up on them. It's unbelievable the things I've seen. We have strict rules for this reason.

From what I see happening in nearly every case is this... There is a professional line that isn't always very clear when you do home care. We ask that staff not share personal problems, political views, etc with clients. But it's impossible to care for someone without personal sharing. So that line gets moved back a bit. More and more is shared. A 'friendship' is formed. Then the line keeps moving. The patient would like to meet the HHA's kids and invites them over (on off hours) Then the HHA shares that she is having babysitting problems and the patient allows her to leave early one day. Then it happens again. Now the patient has 'something' on the HHA. She asks for a favor... Our HHA's are there to give personal care (we have ATTN care to do errands and take patients to appts) So the HHA takes some of the patients money (another no no) and runs an errand for her. Now the HHA knows where she keeps her money. Meanwhile, that professional line moves further and further and gets more blurred. Eventually, one or the other gets uncomfortable with the situation. Money is missing and the HHA is accused, or I get a call asking the HHA off the case because the patient is tired of hearing about the Aides problems, or I hear about the kids coming to the house and giving the patient strep throat, the HHA is accused of falsifying time cards, and the list goes on and on. I have seen everything I mentioned and more. Almost every problem I deal with has to do with that professional line being breached in some way.

Having said that, I have done private duty care for 22 yrs and know that it's impossible to give that level of care and not talk, share, become friends etc. But you really have to maintain some sort of professional boundary.

This seems to have gotten off topic from the original post. Sorry for that!

Kyasi

allnurses Guide · Jul 7, 2011

Kyasi - I think we are on the same page! I have partiicipated in so many threads here that discuss situations where the boundary line is absolutely non-existent and it causes problems with loyalties, with the client being given inappropriate control over scheduling and other resources, to where it is almost as if the agency is left out of the loop entirely.

That is what I was trying to say in a different thread about doing unpaid extra favors for clients, clients letting the nurse or HHA leave early as a "reward", and a host of other things that can happen when that dynamic is set up - I am sure you've seen it often.

We don't want to come off as "meanies" or not generous people at all!! We need to have a clear understanding of who is the employer and that is usually the agency (as opposed to private pay contracts).

Thank you for your thoughtful and very complete replies. :)

Kyasi · Jul 8, 2011

I totally agree w/you! Thanks for your input also.

Kyasi

cathrn64 · Jul 9, 2011

Nurse156, I've never had to use it,(i know of other nurses who did) but all of the agencies I have worked for have offered security, if a nurse is going into an unsafe neighborhood. There is no "pool" of security, but they have had policies where they would hire someone if necessary. (a hospital based agency said they would send hospital security if needed, or the non-hospital based would hire from an agency or a police officer)

If I were going into a bad neighborhood in an agency without this policy I would ask about it from my supervisor.

allnurses Guide · Jul 9, 2011

Thanks cathrn64. So far I have not felt a genuine fear at any particular home where I seriously needed to consider asking for an escort. Once I was riding back with my patient in an Access Van (city paid transportation for disabled) and the $##$%# driver would not listen to our directions (he knew better, you see) we ended up on the same street where a little girl had been killed in gang-crossfire. :mad:

It was a no outlet street and in that big white van emblazoned with blue lettering I felt like we were a sitting duck, was truly scared, the adrenaline was flowing and I was feeling very vulnerable at that point. I knew that I would never allow anything like that to happen again even if I had to interrogate every prospective driver myself. Things can turn on a dime.