Consumer Rights, Advocacy, and the Prevention of Abuse, Neglect & Exploitation

1. Consumer Rights, Advocacy, and the Prevention of Abuse, Neglect & Exploitation The Center for Health Care Services

2. Course Objectives • Define and discuss basic, civil and special rights • Recognize staff responsibilities in regards to consumer rights • Identify CHCS Client Rights Officer • Define and discuss consumer advocacy • Name and discuss the classes of abuse • Review the reporting procedure • Outline possible indicators of abuse, neglect & exploitation • Demonstrate competency via written exam

3. Consumer Rights

4. Basic Human Rights Everyone is entitled to many different human and civil rights, benefits, responsibilities, and privileges that are guaranteed by the Constitution and other laws. Human Rights are the basic rights that everyone has: • Right to be free from fear • Right to be protected from physical and psychological harm • Right to be protected from abuse, neglect, and exploitation • Right to receive services in a clean, safe, and humane environment

5. Civil Rights • As Americans, we have the following civil rights: • Freedom of speech • Freedom of religion • Freedom to Vote • Equal protection and due process • Legal representation • Treated with dignity and respect • Freedom of association • Own property and have personal possessions • Privacy for personal needs

6. Special Rights Federal and State laws also give people with mental illness, developmental disabilities, or substance abuse issues additional rights. It must be emphasized that consumers have the same rights as us– and more - simply because of their disability and ability to learn, comprehend and successfully carry out their rights.

7. Special Rights, Continued Consumers have the right to: • Be informed, in a language and format understandable to him/her, of his/her rights, rules of the facility, treatment decisions, risks and fees • Submit grievances and complaints without retaliation • Access to Advocacy services • Be presumed mentally competent unless the court has ruled otherwise • Receive appropriate treatment in the least restrictive (comfortable) setting • Participate in individualized treatment and discharge planning

8. Special Rights, Continued • Give informed consent, withhold consent without prejudice, and withdraw consent at any time: • For selected procedures or particular treatments • For one type of service without limiting access to other services • Request review of their client record including treatment plan • Give or withhold consent to take psychoactive medications, except in an emergency as ordered by a doctor or as ordered by a court. • Be free from excessive or unnecessary drugs • Meet with staff, including professionals, responsible for care • Receive treatment for other physical problems

9. Special Rights, Continued • Make or withdraw advanced directives (living will), if able to do so • Freedom from restraint and seclusion (except when ordered for the purpose of protecting self or others or as part of an approved behavior management plan) • Freedom to go outside for fresh air and sunshine everyday • Protection from unlawful rights restrictions • Safe and discrete transportation

10. Uphold consumer’s rights Allow individuals to exercise their rights Report suspected rights violations Support consumers in exercising rights to fullest extent possible by: Informing and teaching them and their representatives of their rights (advocating) Including the consumer and/or their representative in discussions regarding proposed rights modifications Implement rights restrictions and support restoration of rights YOUR Responsibilities

11. Consumer Rights Handbooks http://www.dads.state.tx.us http://www.dshs.state.tx.us/mhservices/MHConsumerRights.shtm

12. Rights Protection The CHCS Rights Protection Office (RPO) handles: • Complaints, • questions, or • suggestions regarding the health, safety, welfare or legal and human rights of all consumers. All Consumer Rights violations should be reported to this office as quickly as possible during normal working hours. Director of Rights Protection Charlotte Davis, RN, B.S.N., CLNC 3031 IH 10 West San Antonio, TX 78201 (210) 731-1300 ext. 333 cdavis@chcsbc.org

13. Consumer Advocacy

14. What is Advocacy? • “Advocacy” can be understood as involvement in the life of another. • Advocacy is working with other people and organizations to make a difference. • Advocacy is the process of people participating in decision-making processes which affect their lives. What is the purpose of advocacy? • To assist in securing the rights of one’s self or another.

15. To advocate means to recommend. An advocate is: • Someone who supports or defends a cause. • Someone who pleads on behalf of another. • You!

16. The Need for Advocacy • Eliminating discrimination • Reducing vulnerability • Achieving goals • Accessing services that are mandated by legislation to everyone • Achieving equity • Achieving empowerment and independence • Overcoming barriers • Receiving needed accommodation

17. Effective Advocacy Skills • Communication • Assertiveness • Listening • Documenting/ Note-taking • Research • Organization • Time management • Problem solving • Negotiation • Relationship/ Team Building

18. Advocacy Resource Advocacy, Inc. is a nonprofit corporation funded by the United States Congress to protect and advocate for the legal rights of people with disabilities. It is not a part of state or local government. www.advocacyinc.org South Texas Regional Office: Ernesto Sanchez, Manager6800 Park Ten Blvd., Suite 208-N San Antonio, Texas 78213 (210) 737-0499 (Voice/TDD)Fax: (210) 737-2403Intake: (800) 880-8401

19. Advocacy, Inc. Programs • Protection and Advocacy for Persons with Developmental Disabilities • Protection and Advocacy for Persons with Mental Illness • Protection and Advocacy of Individual Rights • Client Assistance Program • Protection and Advocacy for Beneficiaries of Social Security • Help America Vote Act

20. Advocacy, Inc. Programs All Advocacy, Inc. programs provide: • Information and materials (advice and/or written information) • Referrals to programs and services • Legal: investigation, mediation, negotiation, advice, and representation in administrative and legal proceedings • Systems advocacy services including: monitoring and commenting on state agency policies and regulations, legislative activities, and collaboration with other disability organizations regarding public policy • Training for persons with disabilities on their rights, how to advocate for themselves, and how to access services from state agencies • Technical assistance for lawyers and private service providers

21. Prevention of Abuse, Neglect, and Exploitation

22. Class I: Serious physical injury Sexual abuse Class II: Exploitation Non-serious physical injury Excessive force Class III: Verbal or emotional abuse Neglect Negligent Act or Omission Neglect Classes of AbuseTexas Department of Family & Protective Services

23. Class ISerious Physical AbuseSexual Abuse

24. Physical Abuse • An act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused physical injury or death to a person served; • An act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to a person served; or • The use of chemical or bodily restraints on a person served not in compliance with federal and state laws and regulations

25. Acts of Physical Abuse • Striking • Pushing • Shaking • Incitement to Act (Telling or asking someone to act in an abusive manner or to take matters into their own hands)

26. Sexual Abuse As defined in Texas Penal Code, §43.01; §43.21; §22.011 Any sexual activity including but not limited to: • Kissing a person served with sexual intent • Hugging a person served with sexual intent • Stroking a person served with sexual intent • Fondling a person served with sexual intent • Engaging in sexual conduct or any activity that is obscene. • Requesting, soliciting, or compelling a person served to engage in any activity or displaying any activity that is obscene.

27. Sexual Abuse, continued • Engaging in or displaying any activity that is obscene, in the presence of a person served. • Requesting, soliciting, or compelling another person to engage in any activity that is obscene • Committing sexual exploitation (defined as a pattern, practice, or scheme of conduct against a person served, which may include sexual contact, that can reasonably be construed as being for the purposes of sexual arousal or gratification or sexual abuse of any person)

28. Sexual Abuse, continued • Committing sexual assault • Committing aggravated sexual assault against a person served • Causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping, or depicting of a person served if the employee, agent, or contractor knew or should have known that the resulting photograph, film, videotape, or depiction of the person served is obscene or is pornographic.

29. Class IIExploitationNon-Serious PhysicalExcessive Force

30. Exploitation Illegal or improper act or a process of using a consumer or program or the resources of a consumer or program for monetary or personal benefit, profit, or gain. (Personal benefit, profit or gain means to the staff’s advantage.)

31. excerpt from the Employee Handbook, page 7 • As a condition of employment, your relationships with persons served (or previously served) by The Center must be maintained on a professional basis at all times.  • To avoid the appearance of impropriety or exploitation, you must refrain from entering personal, social, or business relationships with any individuals served (or formerly served) by The Center.

32. Examples • A provider accepts refreshments regularly from a consumer. • A consumer washes a provider’s car. • Asking consumer for a cigarette. • A provider charges a consumer $10.00 a month for helping the consumer cash his check at the bank. • A staff charges a consumer for gas or transportation. • A provider uses consumer’s movie card to rent Movies/DVD/Games/etc.

33. Are Gifts Acceptable? From time to time, consumers may want to buy you a soda or give you a gift. Examples: • Consumer wants to buy you a “soda”. • Always explain to the consumer the policy. You may also offer to buy yourself a soda and the consumer to buy their own, then sit down and take a break with the consumer, if possible. • Consumer makes a food dish for you. Offer to leave the item at Center or office for all (consumer / staff) to share. Accept only if it is something that others could partake in.

34. Money Exchange Caution MUST be exercised when having ANYfinancial dealings (“exchange of money”) with consumers. - Selling a product or service (i.e. you are selling your VCR NEVER charge the consumer more than the value of the item) - Purchasing something from a consumer for less than market value. • Paying $1.00 to have a consumer wash your car • Offering $20.00 to a consumer for a $500.00 stereo • Trading a pack of cigarettes for a CD Any actions like these could be consideredExploitation – a Class II Violation.

35. Class IIIEmotional or Verbal Abuse

36. Verbal Abuse Any act or use of verbal or other communication, including gestures to curse, vilify, or degrade a consumer with physical or emotional harm. The act or communication must result in observable distress or harm to the consumer or be of such nature that a reasonable person would consider it harmful or causing distress.

37. Neglect

38. Neglect A negligentact or omission by any individual responsible for providing services to a consumer, which caused or may have caused physical or emotional injury or death to the consumer, OR which placed a consumer at risk of physical or emotional injury or death.

39. Neglect Includes But is not limited to: • FAILURE to establish or carry out an appropriate individual program plan or treatment plan for consumer, if such failure results in a specific incident or allegation involving a consumer • FAILURE to provide adequate nutrition, clothing, or health care to a consumer in a residential program • FAILURE to provide a safe environment for a specific person served, including the failure to maintain adequate number of appropriately trained staff if such failure results in a specific incident or allegation involving a consumer.

40. Classifications of Abuse & Neglect

41. Case Example #1: A client’s care plan clearly states that any assisted lift is to be carried out by two caregivers. It’s been a particularly hectic shift and no one else appears to be available to help. The client needs to be moved; the caregiver is alone and has often completed such a lift single handedly. It’s no big deal. However, in the course of the move the client shifts her weight, the caregiver loses her balance, and the client falls. The fall results in the client breaking a hip. Is this a case of abuse or neglect or neither? How could this have been avoided?

42. Case Answer Neglect: The care plan clearly states that any assisted lift is to be carried out by two caregivers. The caregiver decision to act alone was contrary to the client’s treatment plan and, and through this substantial carelessness caused injury to the client - a broken hip.

43. Case Example #2: While providing home care to a client, a caregiver has occasionally needed to make long distance personal phone calls. After a number of visits, the caregiver finds that the client usually requires up to a half-hour in the bathroom. No assistance is needed during this time. This seems like a convenient time to take care of long distance personal calls without the client’s permission or knowledge. The caregiver uses the client’s phone but always breaks off the conversation at once if the client calls for assistance. What do you have to say about this situation?

44. Case Answer Exploitation: The caregiver’s use of the resident’s telephone was without consent. The caregiver’s actions resulted in long distance phone bills charged to the resident.

45. Case Example #3: A residential specialist overhears a co-worker shout loudly at a resident “Will you shut up! I am sick and tired of cleaning up your disgusting messes! You make me sick!” The residential specialist hears the resident begin to cry. Later that day, he notices that the resident, who is usually very outgoing and has a great appetite, just picks at her food and speaks to no one. What is going on here? What should the residential specialist overhearing the incident do?

46. Case Answer Verbal Abuse: The caregiver has verbally abused the client by shouting intimidating statements that caused mental or emotional damage to a client, exhibited by anxiety, depression, and withdrawal. The client indicated her emotional pain as she begins to cry, then withdraws and does not eat with her usual appetite. REPORT IT!

47. What is NOT Considered Abuse, Neglect, or Exploitation? • The proper use of PMAB Protection and Restraint and/or approved behavior modification techniques. • Actions an employee may reasonablybelieve to be immediately necessary to avoid imminent harm to consumer or others (staff, visitors).

48. Where Staff must Report 1-800-647-7418 Statewide Intake • to be used by CHCS staff or providers to report client abuse, neglect, or exploitation of CHCS consumers receiving mental health or mental retardation services Available 24 hours a day, seven days a week

49. Additional Contact Information Required for Specific Programs: • ICF/MR programs, (MR group homes) 1-800-458-9858 ** • CHCS Foster Care Services: must also immediately notify Licensed Child Placing Agency Administrator (Araceli Renteria) or Administrator’s Designee. ** Contact this number in addition to the statewide intake number.

50. All Abuse, Neglect or Exploitation MUST be Reported IMMEDIATELY When YOU SEE it, HEAR it, or SUSPECT it. No longer than 1 hour from the time you became aware of the incident.