Chapter 11

1. Chapter 11 Legislation: The Client’s Rights and Your Rights

2. Foundation • Foundation of good client–worker relations is understanding: • Support worker rights • The client’s rights • Legal responsibility

3. Client Rights and Boundaries • Ethics is concerned with what you should or should not do. • Legislation is a body of law that governs the behaviour of a country's residents. • Makes sure that all clients receive safe and skillful care • Protects client’s rights • Courts protect the client and the support worker’s rights.

4. Client Rights and Boundaries • A right is something to which a person is justly entitled. • Moral rights are based on a sense of fairness or ethics and are based on moral principles. • Legal rights are based on rules and principles outlined in the law and enforced by society.

5. Canadian Charter of Rights and Freedoms • Federal legislation that applies to all Canadians, regardless of where they live • Lists the basic rights and freedoms to which all Canadians are entitled • The right to equality without discrimination based on race, ethnic origin, colour, religion, sex, age, or mental or physical disability.

6. Basic Rights of People Receiving Health Services • The Human Rights Code of each province and territory is intended to: • Prevent discrimination • Promote and advance human rights

7. Basic Rights of People Receiving Health Services • Laws governing health care have different titles across the country. • Box 11-1: Examples of Extended, Continuing Care, and Community Care Legislation (p. 140) • An act is another term for a specific law. • Most health care acts consist of general requirements for maintaining health, safety, and well being.

8. Basic Human Rights in Canada • All residential facilities in a province or territory must abide by rules. • If they do not, this could result in removal of their licence. • Concern is for the rights and freedom of people using health care services.

9. Bills of Rights • Manitoba and Ontario have created bills of rights for clients. • Some facilities and agencies write their own bills of rights, based on provincial or territorial laws.

10. Client Bill of Rights • Generally, all clients have the following rights: • Right to be treated with dignity and respect • Right to privacy and confidentiality • Right to give or withhold informed consent • Right to autonomy • Pictographic version of Residents’ Bill of Rights: • Figure 11-1 (p. 141)

11. Client Bill of Rights (Cont’d)

12. Bills of Rights • Box 11-3: Ontario’s Residents’ Bill of Rights (p. 142) • Box 11-4: Ontario’s Bill of Rights for Community Care Clients (p. 143) • Being treated with dignity and respect is the guiding principle of caregiving • DIPPS

13. Dignity and Respect • Facility is client’s home and should provide the same freedoms as the resident’s home. • Respecting the person’s dignity and independence is a basic and important part of support work. • Treating a person with dignity provides emotional support and greatly contributes to quality of life. • Box 11-5: Respecting the Client’s Right to Dignity (p. 145)

14. Confidentiality • Means respecting and guarding personal and private information about another person • Information should only be shared among team members involved in the client’s care. • Information about your employer, your co-workers, and other clients is private. • No matter how well you know a client, do not discuss personal matters or personal problems. • Use acceptable speech and language.

15. Privacy and Confidentiality • Right to receive care in private, in a way that does not expose the body unnecessarily – only those persons involved in the care should see the person’s body. • Information about the client's care, treatment, and condition is confidential. • Box 11-6: Respecting the Client’s Right to Privacy (p. 145) • Electronic privacy – do not discuss clients via computer.

16. Privacy • Client has the right to privacy at all times – during bathing, telephone calls, financial advice, toileting, conversations with family. • PSW must respect this right at all times. • Should ask permission for everything that you do to the client • Be proactive – do not wait to be told.

17. Sharing Information • Discuss only the information that the person needs to know in order to give the care – keep all information in the workplace. • Report to RN or RPN your observations – other co-workers may need to know some but not all information. • Avoid gossip – do not discuss a resident’s problems with another resident.

18. Informed Consent • Client has the right to decide what will and will not be done to his/her body and who can touch him/her. • Clients need to understand the reason for treatment, what will be done, and how and who will do it. • Clients need to understand the expected outcomes and treatment options.

19. Informed Consent (Cont’d) • All provinces and territories have legislation that describes when and how consent is to be obtained. • For consent to be valid, it must be informed consent.

20. Informed Consent (Cont’d) • Consent is informed when the person clearly understands: • The reason for a treatment, procedure, or care measure • What will be done • How it will be done • Who will do it • The expected outcomes • Other treatment, procedure, or care options • The effects of not having the treatment, procedure, or care measure

21. Decision Maker • Parent or legal guardian gives consent for client under the age of 18. • Responsible party gives consent for mentally incompetent, unconscious, sedated or confused client. • A consent form may be required – an RN or RPN obtains these. • Support worker is never responsible for obtaining written consent or giving medical information.

22. Advanced Care Directives • Advanced care directive • Legal document that allows clients to convey their decisions about their own end-of-life care. • Living will • A document that allows clients to convey their wishes to accept or refuse medical care to sustain their life. • Substitute decision maker/power of attorney • Allows one to make decisions for one who cannot give consent due to inability to understand.

23. Property • Will • Legal document that states one’s wishes about where or to whom his/her property should go. • Executor/executrix • Guardian of property; carries out instructions of the will. • Estate trustee • A person who acts on behalf of a client with regard to property.

24. Wills • Wills • You can ethically and legally witness the signing of a will, as long as your name is not on the will. • You can refuse to witness the signing of a will. • Wills should be written while the client is cognitively intact – usually a lawyer is present.

25. Autonomy • Clients have the right to participate in assessing and planning their own care and treatment. • Personal choice is important for quality of life, dignity, and self-respect. • You must allow the client to make choices whenever possible.

26. Legal Issues • Laws tell you what you can and cannot do. • A law is a rule of conduct made by a government body. • Criminal laws are concerned with offenses against the public and society in general. • Civil laws are concerned with relationships between people. • Torts are part of civil law. • Liability – if you break the law or violate someone’s rights, you are legally responsible.

27. Torts • A person who commits such an act can be sued by the injured person. • Torts may be intentional or unintentional. • An example of a tort is negligence. • Examples of intentional torts are assault, battery, false imprisonment, invasion of privacy, and defamation of character.

28. Negligence • Means the person did not mean or intend to cause harm • The negligent person failed to act in a reasonable and careful manner and thereby harmed the person or property. • The negligent person may have to pay damages to the injured person.

29. Negligence (Cont’d) • Not performing a task or procedure correctly • Performing a task or procedure that you are not qualified to do • Making a mistake • Box 11-7 (p. 150) lists examples of common negligent acts committed by support workers.

30. Negligence (Cont’d) • A client could be harmed even though you do your job competently. • Accurately record procedures. • Your record may protect you from charges of negligence. • You are responsible for your own actions. • Sometimes refusal to follow a nurse’s directions is your right and duty.

31. Intentional Torts • Acts that are meant to be harmful • Defamation is injuring the name and reputation of a person by making false statements to a third person. • Libel is making false statements in print, writing, pictures, or drawings. • Slander is making false statements orally. • Invasion of privacy

32. Assault • Intentionally attempting or threatening to touch a person’s body without the person’s consent • The person fears bodily harm. • Threatening to tie down an uncooperative client is an example of assault.

33. Battery • Is the actual touching of a person’s body without the person’s consent • Example: force-feeding a client • The client must consent to any procedure, treatment, or other act that involves touching the body. • The client has a right to withdraw any consent. • Consent can be verbal or gesture.

34. Awareness of Your Role • If a support worker performs duties beyond the scope of his/her practice, and these duties were never delegated and taught by the registered staff, the support worker is actually assaulting the client. • Support worker must understand the responsibilities within their role and safely act within these boundaries.

35. False Imprisonment • False imprisonment is unlawful restraint or restriction of a person’s freedom or movement. • Threat of restraint or actual physical restraint is false imprisonment.

36. Human Rights Legislation • Protects workers’ basic human rights • Must treat all workers equally • Must not discriminate on the basis of the workers’ race, colour, sex, sexual orientation, religion, age, or disability • Workers have the right to be free from harassment.

37. Occupational Health and Safety • Safety is a basic need. • In a safe setting, a person has little risk of illness or injury. • Person feels safe and secure. • Your employer is also responsible for providing a safe working environment for you.

38. Occupational Health and Safety (Cont’d) • Outlines the rights and responsibilities of workers, employers, and supervisors in creating and maintaining a safe environment. • Workers have the right to receive proper training, instruction, and supervision to ensure their safety. • Workers have the right to refuse duties if the work poses a danger to themselves or others.

39. Employment Standardsand Legislation • State minimum acceptable employment standards within the workplace • Covers basic rules about issues such as: • Minimum wage • How wages are paid • How many hours of work per day and per week are acceptable • Fair overtime • Holidays and vacation days • What situations qualify worker for a leave of absence

40. Labour Relations Legislation • Addresses how employers and employees can resolve workplace issues; ensures that employees have the right to form or join a union • Sets out rules for negotiation – collective bargaining • Identifies unfair labour and employee conduct

41. Workers’ Compensation Legislation • Addresses how workers are financially compensated for accidental injuries on the job • Discusses workers and employer rights when an injury occurs