HIPAA (3)

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Facts

HIPAA stands for the Health Insurance Portability and Accountability Act. This is a federal law that protects the privacy of a person’s health information. HIPAA has many rules your agency must follow. Some of these rules apply to you in your role as a home health aide. There may be penalties if you break the HIPAA rules. You could even be fined. HIPAA regulations cover many areas, but privacy of information is one of the most important for you to know about.

Privacy of information means that anything you say or write about a patient must not be overheard or read by anyone unless that person has a right to hear or see the information. He or she can have that right only if the patient has agreed that they may have the information.

Talking on the phone

• Do not talk about a patient over the phone if there is anyone who might overhear. If the scheduler calls you at a patient’s home about a change in assignments, never say anything that might identify any patients.
• When you call to report an observation about a patient, make certain that no one else, other than caregivers, can overhear what you are saying.
• If you receive work-related messages on your home answering machine, do not allow your family to listen to them.
• Do not leave messages on the patient’s answering machine unless the patient asked you to.
• Use your cell phone carefully. Never use the phone to relay patient information in an area where others might overhear the conversation.

Discussions with others

• Use the “need to know” rule. Do not discuss a patient, even with another aide, if there is no need for the other person to know about the patient. Don’t gossip.
• Never discuss a patient in a common area of the office. This includes hallways, open areas, the bathroom, or the reception area.
• Do not discuss one patient inside another patient’s home, even if you are talking with the nurse who takes care of both patients.
• Never discuss the patient with an interested neighbor or even a family member unless you know for certain that person assists in the patients’ care and/or the patient does not object. Ask the nurse or therapist when in doubt.

Paperwork

• Guard your visit notes and other papers so that no one else can see them. Don’t leave papers lying around your house, car, or the office.
• Make certain that all paperwork taken into a home is kept confidential.
• Do not put papers containing patient information into the garbage. Shred this information.

Your Agency Policies

• Learn and follow your agency’s policies on security and confidentiality of patient information.
• Provide information only when you are certain that the patient does not object.
  • If the patient is present, ask if it is all right to discuss the information and give the patient an opportunity to say no.
  • If the patient is not present, you will likely need to ask your supervisor whether or not you should discuss the information. The information you would disclose should be directly related to the person’s need to know, and it should be a person involved in the patient’s health care.

Case Study: Hannah and HIPAA

Hannah recently attended an in-service program on privacy and confidentiality. Before leaving for her first visit, Hannah listens to her voicemail, using the receiver and not the speaker. She deletes the messages containing patient assignments and directions. Hannah rides the bus, so she must take all her papers with her. She keeps them in her closed bag. Her day goes something like this.

The first visit is to Mr. Smith. Just before she is ready to leave, Mr. Smith’s neighbor drops by for a visit and asks Hannah how he is doing. Hannah replies, “It’s good to know you are interested, but I can’t really discuss Mr. Smith with you without his permission. I’m sure he will be glad to see you and you can ask him how he is.”

The second visit is to Mrs. Jones. While helping her into the bathtub, Hannah notices that there is a big bruise on her leg. She needs to report this to the nurse. There are visitors in the kitchen so Hannah uses the phone in Mrs. Jones’ bedroom to call the office.

The third visit is to Mrs. Black. The nurse who has come to do a supervisory visit is also Mrs. Jones’ nurse. As the nurse is leaving, Hannah goes with her to the door and when they are on the porch, she tells the nurse about Mrs. Jones’ bruise.

A staff meeting is next on Hannah’s schedule. As she walks into the busy room, one of her coworkers says, “I hear you’re taking care of the mayor’s wife. What’s she like?” Hannah tells her coworker politely, “We really shouldn’t discuss patients unless we’re having a care conference.”

The fourth visit is to Mr. Blanco, who has severe effects from a recent stroke. At the end of the visit, his daughter asks Hannah what she thinks about his progress. Hannah knows that the daughter is Mr. Blanco’s caregiver and also that information can be shared with her. She answers, “I think he did better with his exercises today and seems to be swallowing better. But you might want to also ask the nurse and therapist what they think of his progress.”

The fifth visit is to Mrs. Johnson. Hannah is preparing her bath, and when she returns, she notices that Mrs. Johnson’s granddaughter is looking through her papers. Hannah picks them up and moves them to the top of the dresser, saying, “Why don’t I get these papers out of your way? I’m sorry I left them there on the table.”

Something to think about

• Review the encounters and statements that make up Hannah’s day. What examples show that Hannah has a good understanding of confidentiality of patient information? List on a separate sheet of paper some examples that you have come across in your own visits.
• Think about your visits last week. What were some confidentiality issues you dealt with?
• How would you respond to a neighbor who asks questions and you know the patient doesn’t want you to share any information?