a product message image
{' '} {' '}
Limited time offer
SAVE % on your upgrade

Page 1


49 East Huntington Drive Arcadia, CA 91006 626-821-0822 telephone 626-821-6068 fax bah@barlowhospital.org

Barlow at Home


Patient’s Bill of Rights and Responsibilities ....................................................1 Notice of Privacy Practices ................................................................................2 Scope of Care and Objectives............................................................................9 Duties of Home Health Aide .............................................................................10 Hour of Services and Scheduling of Visit .......................................................10 Non-Discrimination Policy and Complaint Information .................................11 Advanced Directives .........................................................................................12 Definitions ..........................................................................................................14 Emergency Preparedness Plan........................................................................16 Basic Home Safety............................................................................................21 Storage, Handling and Access of Supplies and Gas .....................................21 Emergency Procedures ....................................................................................23 Earthquake Survival ..........................................................................................25 Consent to Photograph / Computerized Notes...............................................26 Notice of Privacy, Outcome and Assessment Information Set .....................27



As a patient, you have the right to:

As a patient you have the responsibility to:

    

 

  

Be treated without regard to race, color, religion, sex, gender preference, national origin, handicap or decisions regarding advance directives. Have you and your property treated with dignity, consideration and respect by the qualified professional staff. Know in advance of Agency charges, payment policies and if you will be responsible for any payment. Be informed in advance both verbally and in writing of any changes in charges and/or payment responsibilities. Participate in the development of the plan of care/services as well as the discharge plan of care/services. Be informed of all treatments the agency is to provide, along with the name and functions of any person of the affiliated agency who is providing care/services. Confidentiality of all records, and to refuse any records to any individual outside the agency, except in the case of client transfer to a health care facility or as required by law or third party payment contract. Have you and your family educated on your illness and the treatment required, so that you may both be able to understand treatment plan. Have access to or receive a copy of your clinical record upon written request. Receive timely notice prior to impending transfer, discharge, continuing care requirements, and other available services if needed at the time of discharge from the Agency Services. Voice grievances to the agency regarding lack of respect, without being subject to discrimination or reprisal. Privacy and security. Contact the sate regulator to file a complaint. Patients have a right to choice of language.

  

   

     

Agree to accept all caregivers without regard to race, color, religion, sex, age, gender preferences, handicap, or national origin. Remain under a doctor’s care while receiving skilled Agency services. Provide the Agency with all requested insurance and financial records, and assume responsibility for services not covered by a third party payer. Provide the Agency with a complete and accurate health history. Sign required consent and release forms. Participate in developing and following your plan of care. Accept the consequences for any refusal of treatment on choice of noncompliance including changes in reimbursement eligibility. Provide a safe home environment in which your care can be given. Treat Agency personnel with respect and consideration. Inform the Agency of any problems or dissatisfaction with care. Notify the Agency when unable to keep appointments. Provide a copy of an advance directive, if one exists. All rights and responsibilities are assigned to the person(s) legally authorized as a client’s representative.

The State of California Department of Health address and contact number are listed bellow: 5555 Ferguson Drive, Suite 320 Commerce, California 90022 Hotline (800) 228-1019 The State of California Department of Health has Home Health Hotline for this purpose of receiving questions or complaints about home health agencies.



NOTICE OF PRIVACY PRACTICES FOR BARLOW AT HOME (Referred to in this document as “the provider”) THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY HAVE ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). This notice describes how we may use and disclose your protected heath information to carry out treatment, payment, or health care operations, along with other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in other cases. Your “protected health information” means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your heath care provider that relates to your past, present or future physical and mental health condition. I. Uses and disclosures of Protected Health Information The provider may use your protected health information to give treatment, obtain payment for treatment and to conduct other healthcare operations. Your health information may be used or disclosed for these purposes only. However, if your authorization is given, or if HIPAA Privacy Regulations or State Law otherwise permits it, the information may be used or disclosed for other purposes. Disclosures of your protected health information for the purposes described in this notice may be made in writing, orally, or by facsimile. A. Treatment. We will use your protected health information to provide, coordinate, or manage your health care along with any other related services that will be needed. This may include coordinating or managing your health care with a third party for treatment purposes. For example, we may disclose your health information to a pharmacy to fulfill a prescription, to a laboratory to order a blood test, or to a home health agency that might be providing care in your home. We may also disclose you protected health information to other physicians who may be treating you, or consult your physician with respect to your personal care. In some cases, we may also disclose your protected health information to an outside treatment provider if needed. B. Payment. Your protected health information will be used, as needed, to obtain payment for the services that we provide. This may include communication with your health insurer to get approval for the treatment that is recommended. For example, if we recommend a hospital admission, we may need to disclose information to your health insurer so that we may have approval prior to the hospitalization. We may also disclose protected health information to your insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. In order to get payment for your services, we may need to disclose your protected


heath information to your insurance company to demonstrate the medical necessity of the services or, as required by your insurance company, for utilization review. We may disclose patient information to another provider involved in your care for the other provider's payment activities. C. Operations. We may use or disclose your protected health information for our own health care operations so that we may facilitate the function of the provider, as well as provide quality care to all patients. Health care operations include such activities as:      

Quality assessment and improvement activities. Employee review activities. Training programs including those in which students, trainees, or practitioners in health care can learn under supervision. Accreditation, certification, licensing or credentialing activities. Reviewing and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs. Business management and general administrative activities.

In certain situations, we may also disclose patient information to another provider or health plan for their health care operations. D. Other uses and disclosures. As part of treatment, payment, and healthcare operations, we may also use or disclose your protected health information for the following purposes:    

To remind you of an appointment. To inform you of potential treatment alternatives or options. To inform you of health-related benefits or services that may be of interest to you. To contact you to raise funds for the provider or an institutional foundation related to the provider. If you do not wish to be contacted regarding fundraising, please contact our Privacy Office.

II. Uses and disclosures beyond treatment, payment and health care operations permitted without authorization or opportunity to object. Federal privacy rules allow us to use or disclose your protected health information without your permission or authorization for a number of reasons including the following: A. When Legally Required We will disclose your protected health information when we are required to do so by any Federal, State or local law. B. When There Are Risks to Public Health. We may disclose your protected health information for the following public activities and purposes:







VI. Our Duties. The provider is required by law to maintain the privacy of your health information and to provide you with this notice, which states our duties and privacy practices. We are required to abide by the terms of this notice as it may be amended periodically. We reserve the right to make changes to the terms of this notice and have new provisions effective for all protected health information we maintain. Should the provider make any changes to their notice of privacy practices, a revised copy will be provided vial mail or in-person contact. VII. Complaints. You have the right to express complaints to the provider and as well as the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may file a complaint about the provider by contacting their Privacy Office via telephone or mail. Contact information for the provider is stated below. We encourage you to express any concerns you may have regarding the privacy of your information. No retaliation will be shown against in any way for filing a complaint. VIII. Contact Person. For all issues regarding patient privacy and your rights under the Federal Privacy Standards, please contact the provider’s Privacy Officer. Information regarding matters stated in this notice may also be requested by contacting the Privacy Office. Any complaints against the provider may be sent to: 49 E. Huntington Drive Arcadia, CA 91006 ATTN: Lyn Tom, Administrator The Privacy Officer can be contacted by telephone at (626) 821.0822 IX. Effective Date. This notice is effective April 14, 2003


SCOPE OF CARE AND OBJECTIVES Barlow at Home is a multilingual agency that provides home health care services. Barlow at Home is dedicated to providing quality, innovative and cost-effective home health services to individuals who are homebound and are in need of skilled, rehabilitative and support services. Our home health care team consists of Registered Nurses, Licensed Vocational Nurses, Certified Home Health Aides, Physical Therapists, Occupational Therapists, Speech Therapists and Medical Social Workers. PROFESSIONAL SERVICES AVAILABLE SKILLED NURSING SERVICES: • Skilled observation and assessment. • Diabetic Management • Wound Care • Medication Supervision • Intravenous Therapy • Total Parenteral Nutrition • Pain Management • Respiratory Treatments • Patient/Family Health Teaching • Incontinence Care HOME HEALTH AIDE SERVICES: • Total Personal Care • Transfer and Gait Training • Patient/Family Teaching OCCUPATIONAL THERAPY SERVICES: • Activities of Daily Living Training • Adaptive Equipment Training • Energy Conservation Technique • Modalities to Decrease Edema • Fine and Gross Motor Activity PHYSICAL THERAPY SERVICES: • Assessment of rehabilitation needs • Therapeutic Exercises • Transfer and Gait Training • Patient/family teaching.


The Home Health Aide has been specially trained to provide assistance to the patient in performing activities of daily living. This training includes completion of an accredited course, receiving state certification, and competency testing by Barlow at Home to ensure that you will receive the best care. The registered nurse will assess your needs for a home health aide and with your consent and input, we will develop a plan of care. In addition to taking vital signs and noting changes in a patient’s condition, the plan of care will outline the frequency of visits and activities that the aide will be assigned. The registered nurse will be checking you every two weeks to evaluate how well the plan of treatment is meeting your needs.

for a free loaner

You may contact: Convalescent Aide Society 626-793-1696

Please leave a clear message if the do not answer your call. high please refer to care plan located

on the back of the cover page.


In accordance with the Title VI of the Civil Rights Acts of 1964 and its implementing regulations, Barlow at Home will directly, through contractual or other arrangements, admit and treat all persons within the facility as well as referrals to or from the facility. Staff privileges are granted without regard to race, color or national origin. In accordance with Section 504 of rehabilitation Act of 1973 and its implementing regulations, Barlow at Home will not directly, through contractual or other arrangement, discriminate on the basis of handicap in admissions, access, treatment or employment. In accordance with the Age Discrimination Act of 1975 and its implementing regulations, Barlow at Home will not directly, through contractual or other arrangements, discriminate on the basis of age in the provision of services, unless age is a factor necessary to the normal operation or achievement of any statutory objective.

Lyn Tom (Administrator) (626) 821-0822 at the office


, allow you to have more control over

Barlow at Home recognizes your right to decline medical or surgical treatment to the extent permitted by law.

In the absence of an Advance Directive or a physician’s order not to resuscitate, Barlow at Home will provide all care necessary to sustain life.

Barlow at Home will not discriminate against you on the basis of whether or not your have signed an Advance Directive.



WHAT IF I CHANGE MY MIND? You may change or revoke any of these documents at any time as long as you communicate your wishes. DO I HAVE TO FILL OUT ONE OF THESE FORMS? No, you do not have to fill out any of these forms if you do not want to. You may talk with your doctors and ask them to write down what you have said in your medical chart. You may also talk with your family about the health treatment you wish to receive. Although, your doctor and family will have a clearer idea of what you want if it is in writing. WILL I STILL BE TREATED IF I DON’T FILL THESE FORMS OUT? Absolutely, you will still receive medical treatment. We just want to inform you that if you are too sick to make these decisions, someone else will have to make them for you. Remember, A DURABLE POWER OF ATTORNEY FOR HEALTH CARE allows you to name an agent to make decisions regarding health treatment on your behalf. This person has the ability to make most medical decisions for you, but they cannot make decisions involving life-sustaining treatment when you cannot speak for yourself. Besides naming an agent, you can also use the durable power of attorney to state when you would or would not want to receive particular types of treatment. If you don’t have someone to name to make decisions when you can’t, you can sign a Natural Death Act Declaration. This Declaration states that if you are terminally ill or permanently unconscious, you do not want to receive life-prolonging treatment. It is the policy of Balow at Home to support your right to actively participate in health care decision-making. You are encouraged to seek further information and communicate your preferences and values about medical treatment to your loved ones. If you become incapacitated, this will guide those individuals who are legally authorized to make the medical decisions as you wish. DEFINITIONS: 1. Capacity to make health care decisions: The ability to understand and appreciate the nature and consequences of health care decisions, including the benefits and risk of alternatives to any proposed health care and to reach an informed decision. 2. Capacity to appoint a health care agent: The ability to understand and appreciate that someone else will make health care decisions for the individual, and the individual is able to select and designate another to make those decisions.



EMERGENCY PREPAREDNESS PLAN There are many measures you can take to reduce the damages from earthquakes and other nature disasters. If you wish, please ask your clinician for additional information. The front pages of your telephone book also provide detailed information. DURING AN EMERGENCY Remain calm and take cover. Think through the consequences of any action you take. Try to be calm and reassure others. EVACUATION PLAN If you must evacuate, take with you: • First Aid Kit • Your medication • Flashlight • Radio and batteries, important documents • Cash • Sleeping bag • Food/water • Extra clothes and eye glasses • Cell phone If you or your family member is dependent on electrical operated equipment such as an oxygen concentrator or ventilator, your durable medical equipment company will contact you as soon as possible and arrange for your continued electrically operated equipment needs. It is your responsibility to keep an ample supply of medications and other supplies such as water, food, flashlights, and batteries at all times. AFTER AN EMERGENCY In the event of an earthquake or other natural disaster, Barlow at Home has developed the following plan to assist you in continuing your home health care. Our clinical and support staff will make every attempt to contact you in a timely manner. When the phone services have been restored, please await our phone contact. We will determined your status and in the mean time, will develop a plan to assist you in continuation of your care. You are to carry out prescribed care as previously instructed by your nurse or/and therapist, as safety permits. The supervisory nurse will also contact the necessary staff members to assist in patient care. The prioritizing of Barlow at Home patients will be made in the following manner. A. Those identified with a medical condition needing critical nursing measures that cannot be postponed such as insulin, pain management, draining wounddressing changes, etc. B. Patients discharged from hospitals that have been referred to the agency, but have not yet been seen by Barlow at Home’s clinicians. C. Patients receiving ongoing, non-critical home health care. If you reach us by phone and feel that you need medical assistance, call 911 or go to the nearest hospital. Normal services provided by Barlow at Home will resume at the earliest time possible, as safety permits. 16


• • • • • • • • • •

Do not use throw rugs. Wear slippers with rough bottoms; wearing socks or slippers without rough bottoms on uncarpeted floors may be slippery and unsafe If you have stairs, use the railing for support. Do not use a cane or walker when you are going up or down steps. Move furniture out of walkways; if the lights are off you may fall over objects left in the center room. Replace light bulbs as needed; poor lighting will increase the chance of an accident. Place adhesive strips on the bottom of the tub. Be sure mats have no skid. If extra support is needed in the shower, use a shower chair or install a rail; towel racks should not be used as “grab bars” as they are not made to support your body weight. Keep pets under control and out of pathways.

STORAGE, HANDLING AND ACCESS OF SUPPLIES AND OXYGEN SUPPLIES Keep supplies in a dry, safe place that is not in the general traffic areas. Use a clean towel to cover the supplies when not in use to protect them from water and dirt. Remember, if sterile supplies get wet they can no longer be used. Supplies should only be used for the patient. OXYGEN (O²) Access/storage

• •

Unless you have a preference, Barlow at Home will contact a Durable Medical Equipment Company to obtain equipment that is needed. The Durable Medical Equipment Company is responsible for delivering the equipment and providing instruction on its use. All Oxygen tanks must be secured. If you have not been supplied with an Oxygen stand, please contract the office and we will contact the supplier to get you one.



Barlow at Home uses several companies to obtain equipment. If you have a preference, the agency will contact the equipment company of your choice.

Ambulation Aids: General Guidelines:

• • • •

Aids must never be used to get a standing position or when using stairs. With canes, the hand piece should be at the hip level and must be used on the patient’s stronger side. A walker is safe to push down only when the four legs are on level ground. Remember the feet should be stationary while the walker is moving forward. The walker should be slightly picked up and slide across the ground.

The nurse or therapist will instruct you on guidelines for other equipment. EMERGENCY PROCEDURES 1. Emergency medical procedures are to be used in instances when: the attending physicians order is not immediately available or until the physician can be reached. a. In all emergencies, medical attention will be secured as soon as possible. b. If it is not possible to reach the patient’s attending physician, the paramedics may be called to render services and arrange transport to an emergency room. c. The staff member will remain with you until the paramedics arrive. 2. Each of the staff member involved in providing client care must be currently CPR certified to institute cardiopulmonary resuscitation as required. 3. Until medical assistance can be obtained, the following first aid measure will be enacted (after initial assessment of the situation), to determine which of the following steps should be taken. A. Convulsion. 1. Do not restrain the client. 2. Protect the client against injury. 3. If necessary, provide an airway. 4. Have someone call the attending physician. 5. Observe duration and type of seizure activity. 6. Report observations to the physician. B. Heavy Bleeding. 1. Apply firm pressure directly over wound. 2. Raise bleeding part higher than the rest of the body when possible. 3. Keep the patient lying down. 4. If bleeding cannot be immediately controlled, call paramedics. 5. Report observations to the attending physician. 23


Adjustable wrench for turning off gas.


The undersigned hereby authorizes the staff of Barlow at Home to take pictures of wound progress to determine effectiveness of the treatment. I understand that these pictures may be shared with the attending physician. I understand that the photographs will become a part of my clinical record retained by the agency.

I have been informed that Barlow at Home, the agency providing home health services to me, my have some or all of my medical information on computers. I understand that all medical records will be kept confidential. 26






Profile for BARLOW

Barlow at Home Patient Handbook  

This handbook provides important and helpful information for patients.

Barlow at Home Patient Handbook  

This handbook provides important and helpful information for patients.

Profile for barlow