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If a home healthcare patient does not adhere to the treatment plan and nursing plan of care, can insurance make the patient liable for the hospital fees because of self-neglect?

Friday May 17, 2013
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Question:

Dear Nancy,

If a home healthcare patient does not adhere to the treatment plan and nursing plan of care, can insurance make the patient liable for the hospital fees because of self-neglect? My patient will not take showers or brush his teeth although he is capable. If he got an infection, and personal hygiene were the contributing factor, could he be made responsible for his own behavior?

Amanda



Nancy Brent replies:

Dear Amanda,

It is unclear what the health insurance company will do with a patient who is noncompliant with his plan of treatment. Only the health insurance company can provide you and the agency with this information.

It is important to note, though, if the patient ever were to allege the nursing care provided by you as the home healthcare nurse was not adequate, or that you never informed him about good personal hygiene and an injury resulted, the patient would be hard pressed to win that case because instructions were given and the documentation of those instructions and his noncompliance would stand to counter his verbal allegations. Obviously, your documentation regarding these matters is essential, as is all documentation concerning patient care and instructions.

If the patient continues to be noncompliant, the insurance company and the home health agency may decide to terminate treatment, doing so, of course, with adequate notice to the patient, where he can obtain emergency treatment if need be after services are terminated, and that any emergency treatment will be provided by your agency until the termination date, as examples. These conditions are to help the agency avoid any allegations of abandonment of care by the patient.

A consultation with your agency's legal counsel might be helpful in setting the stage for a termination of services in a manner that protects you, the agency and the patient.

Sincerely,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.