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Lesson 1, Topic 1
In Progress

Legal Protections

Clients have legal options and access to organizations that protect their rights. Home Care Aides must be familiar with and understand these resources.

Advance Directives

Advance directives are legal documents that protect a client’s right to make their own decisions. There are several types of advance directives in Washington state, and each has a different function:

  • Living wills or healthcare directives explain a client’s healthcare decisions in case they become incapacitated.
  • Powers of attorney authorize another person to make decisions or act on behalf of the client.
  • Anatomical gifts express the client’s wish to donate all or part of their body for transplantation, therapy, research, or education upon their death. These documents represent the client’s wishes and can only be made or canceled by the client.

Living Wills

A living will outlines a client’s desire to receive or withhold life-sustaining procedures. If a client becomes incapacitated, their living will tell health care providers which procedure they do and do not agree to. For example, a living will tell a healthcare provider that the client refuses life support or artificial ventilation. Living wills are sometimes called Health Care Directives.

Powers of Attorney

A POA document gives another person legal permission to make decisions or act on the client’s behalf. The client controls everything about their POA, and the document gives very specific permission. The client chooses what the authorized person can do and when the POA’s decisions can be made. Usually, healthcare POAs and financial POAs are separate documents.

Durable Power of Attorney

A simple POA is only active when the client is able to make their own decisions. It ends when the
client becomes incapacitated. A durable power of attorney becomes (or remains) active when the client becomes unable to make decisions.

Durable Power of Attorney for Health Care

A durable power of attorney for health care authorizes another person to make a client’s medical decisions. These decisions might include choosing treatments, medication, or end-of-life care. Clients usually choose a family member or close friend for this important role. The DPOA for health care may include instructions to help the authorized person follow the client’s wishes.

Guardians

If an adult client is incapacitated, a legal guardian can take responsibility for their interests. A relative, friend, care facility, or case manager may ask the court to appoint a legal guardian. After a detailed process and review, the judge signs papers appointing a guardian. Guardians are responsible to act in the best interest of the client. They follow the client’s wishes and make the choices that the client would have made themselves. A guardian may also have authority beyond health care decisions, including the client’s property, income, and/or finances. You may need to know how and when to contact a client’s guardian. This will depend on the type of guardianship and the care setting where you work.

Portable Orders for Life-Sustaining Treatment (POLST) Form

A POLST form is not an advance directive. It is a summary of the client’s wishes regarding life-sustaining treatment identified in their advance directives. Clients who have one or more chronic illnesses, or who are in the last stages of a life-threatening illness might prepare a POLST form. The client (or their legal representative) works with a medical provider to complete and sign it.

The signed POLST form represents the client’s wishes and physician’s orders. It gives instructions to doctors and emergency medical staff in the event of a medical emergency. It explains what treatments the client wants, and whether or not to start Cardiopulmonary Resuscitation (CPR). In Washington state, this form is usually printed on bright green paper, although other colors are acceptable. Photocopies and faxes of signed POLST forms are also legal and valid. See POLST Form in the Resource Directory on page 278 for an example.

Do Not Attempt Resuscitation (DNAR)

A DNAR is a client’s request to refuse CPR if their heart or breathing stops. This may be written as a doctor’s order or in section A of a signed POLST form. Home Care Aides can honor a client’s documented wishes regarding CPR. Make sure you know and follow your facility/company’s policies and procedures on what to do if you find a client not breathing/without a heartbeat.

Why might a person not want to have CPR?

Responding to Medical Emergencies

In general, if there is an emergency situation, you must call 911. However, your care setting might have additional emergency procedures. You must understand the emergency policies and procedures in the care setting where you work. Some clients receive hospice care. Their hospice plan of care should include who to call in an emergency. Make sure you know how to respond to emergencies for each individual client before they happen. Learn the policies about advance directives and emergency response for your care setting. You may need to give a client’s documents to emergency medical services (EMS) staff when they arrive. In this case, make sure you know where to find a client’s POLST form and advance directives if they have these documents. See Module 12, Lesson 2: Surviving Loss and Grief on page 267 for more information about working with hospice.

Washinton State Long-Term Care Ombuds Program

The Washington State Long-Term Care Ombuds Program protects the rights, dignity and well-being of individuals in long-term care facilities. The Long-Term Care Ombuds Program is required by the federal Older Americans Act. It has three primary responsibilities:

  • working to resolve resident complaints;
  • monitoring state oversight agencies; and
  • commenting on proposed state laws and
    regulations.

There is a network of 13 local offices across Washington state. Volunteer and staff ombuds visit
thousands of facilities to ensure that resident’s rights are being upheld. These services are free and confidential.

Ombuds Duties

Ombuds advocate for the rights of individuals in long-term care facilities (RCW 70.129). Ombuds:

  • works with residents, families, and facility staff to meet the needs and concerns of the people
    living there;
  • hears and helps to resolve complaints and concerns;
  • monitors laws, regulations, and policies that affect residents;
  • provides public education to promote a better understanding of laws, regulations, and standards governing long-term care facilities; and
  • helps to establish a resident or family council.

Accessing the Ombuds Program

People who may access the Ombuds Program include:

  • residents of nursing homes, assisted living facilities, adult family homes, enhanced services facilities, and veterans homes;
  • relatives and friends of residents in long-term care facilities;
  • administrators and employees of nursing homes, assisted living facilities, adult family homes, enhanced services facilities, and veterans homes;
  • any group or individual concerned about the welfare of residents of long-term care facilities;
    and
  • the community-at-large.

For more information or to find your local ombuds office, visit waombudsman.org or call 1-800-562-6028.
For information about the Office of the Developmental Disabilities Ombuds, visit www.ddombuds.org.