Don’t get caught: Client requests can discriminate
By Elizabeth E. Hogue, Esq.
Burtonsville, MD
An RN recently sued a home health agency in Pittsburgh based upon case management practices. Specifically, the RN received copies of case management forms for a specific patient on two separate occasions. Both case management forms included a section in which the special needs of patients could be noted.
Both forms indicated in this section that "no black RNs" were to care for the patient. The nurse who received the forms and was asked to provide care to the patient is African-American. The RN made one visit to the patient but was never assigned to the patient again. She subsequently sued the provider for discrimination based upon race.
As many providers know, patient preferences for certain types of caregivers are common.
Experienced home health managers have been asked by patients not to provide caregivers who are foreign, for example. The question is whether such requests should be honored.
Generally, such requests should be rejected, especially when they involve discrimination based upon race, religion, or any other basis commonly used to treat groups of people differently. Legally and ethically, providers should not engage in such practices.
There is one exception to this general rule that occurs when patients ask for caregivers of the same sex as the patient based upon concerns about bodily privacy.
Then it is acceptable to assign only same-sex caregivers to patients who have made such requests.
Match skills to needs
In addition to concerns about discrimination, providers also must be concerned about risk management when they honor such requests. Especially in view of increasing shortages of staff, limitations on available caregivers may mean that patients’ needs cannot be met by staff members who are acceptable to patients.
In view of staffing shortages, the fewer caregivers who are permitted to care for certain patients, the more likely it is that patient needs will go unmet. Unmet patient needs are, in turn, likely to significantly enhance the risk associated with providing care to such patients.
Perhaps, the pressure to honor patients’ requests is at its greatest when patients receive home-care services. Patients who will accept any caregiver assigned to them in institutional settings somehow feel that they have the right to decide who may provide services in their homes.
On the contrary, with the exception noted above, assignments of staff should be made without regard to client preference in home care just as assignments are made in institutional settings.
So how should managers respond when patients tell them not to assign any foreign nurses to them? First, they should explain that the agency does not discriminate against its employees and that to avoid assignments based on cultural or ethnic background may constitute unlawful discrimination. Then staff should explain that if limitations on caregivers were acceptable, the provider might be unable to render services to the patient at all because they may not have enough staff.
The bottom line is that staff will be assigned without regard to patient preference in order to prevent discrimination and to help ensure quality of care.
Needless to say, patients’ requests and managers’ responses specifically must be documented in patients’ charts. Documentation that says patients expressed preferences for certain caregivers or rejected certain types of caregivers is too general. Specific requests and responses of staff must be documented.
After patients have expressed what may amount to prejudice against certain groups of caregivers, managers must follow up and monitor for inappropriate behavior by patients directed at caregivers who are not preferred.
Managers should be alert to the potential for this problem and should follow up with patients and caregivers to help ensure that caregivers are receiving the respect they deserve. Follow-up activities and ongoing monitoring also should be specifically documented.
Professional caregivers are becoming a scarce commodity. Agencies cannot afford to lose or alienate a single caregiver based upon discrimination or inappropriate behavior by patients.
[A complete list of Elizabeth Hogue’s publications is available by contacting: Elizabeth E. Hogue, Esq., 15118 Liberty Grove, Burtonsville, MD 20866. Telephone: (301) 421-0143. Fax: (301) 421-1699. E-mail: [email protected].]
An RN recently sued a home health agency in Pittsburgh based upon case management practices. Specifically, the RN received copies of case management forms for a specific patient on two separate occasions. Both case management forms included a section in which the special needs of patients could be noted.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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