Aides accepting gifts from patients and families: Where is the line?
Educate, document to avoid accusations of theft
Given the nature of private duty care, a natural tendency exists for personal relationships to develop between clients and their home health aides. Although agencies encourage this bond, most draw the line if the client tries to reward the aide with a gift of some sort. Eliminating the gift giving is not easy, however, especially if the gift is left in the form of an inheritance.
"We know gifts are going to be given," says Lucy Burkhardt, chief operating officer of private duty for the VNA Home Care in Oil City, PA. "But we discourage it by saying if [staff] do get gifts, they have to document it."
VNA Home Care keeps a statement regarding gifts in its personnel policy. The policy covers Medicare corporations as well as private duty and reads:
VNA discourages the acceptance of gifts from patients and families. If the family or patient insists on giving a gift, the gift shall be reported to the supervisor and put on the appropriate form.
The appropriate form is an errand slip, which is on NCR paper. One copy of the slip, which is signed by the patient saying he or she gave the aide the gift, goes to the patient. The other copy goes into the patient file. (See errand slip, at right.)
"If we get a call three months down the road from a family member saying that this item is missing, we can always pull that chart and say It appears your mother gave this as a gift she signed this piece of paper,’" says Burkhardt.
Attack the problem on the front end
"Preventive action is the best to take in terms of gifts," says Elizabeth E. Hogue, JD, a health care attorney specializing in home care in Burtonsville, MD. She and other providers recommend approaching aides and clients at the beginning of their associations with the agency.
"We encourage agencies to have a policy in the employee handbook that says employees may not solicit or accept gifts." Agencies can have employees sign an acknowledgement that they received the handbook. That acknowledgement also would cover the policy on gifts if it were included in the handbook, Hogue says.
In addition, a statement should be included in the admission materials that indicates that employees are not allowed to accept gifts, she adds. "Some agencies say, If it’s a small thing under $25 and sort of a token gift maybe staff can accept it.’ But staff need to disclose gifts immediately to the agency." For these cases, agencies should develop a policy for disclosure and a procedure for how to disclose and document gifts.
Several agencies approach the topic of gifts in employee orientation. "For several years, we have instilled in the employees that if someone gives them a gift, fill out an errand slip, get the patient to sign it, and report it [to the agency]," says Burkhardt. "When I do orientation, I give staff situational-type scenarios to explain the problem: Mrs. Smith gives you a sweater and then three months down the road her daughter comes from California and accuses you of stealing that sweater."
VNA Health Care of Hartford, CT, also uses employee orientation to emphasize the agency’s gift policy. "We have a written policy that says it is inappropriate to accept cash contributions from patients," says Karen Gadson, MBA, director of development. "As part of our orientation with private duty staff, we make the point that this is a professional relationship, and they are working on behalf of VNA Health Care. It is not personal.
"Coming from that approach from the beginning tends to then avoid some of these situations that may arise," she continues. "We certainly run into situations where patients do say to staff, I really like what you’re doing for me. I’d like to help you. Can I give you something extra?’ Staff know they are not to take that but instead advise patients that they might consider making a contribution to the agency in honor of that employee."
When a client dies and leaves an employee an inheritance, though, the agency loses some of its control.
"Anyone who has an estate can leave money to whomever or whatever they please. It’s their personal decision," Gadson says.
"The aide might not even have known they were named in the person’s will," adds Hogue. "I don’t really know how the agency can preclude that.
"Sometimes people are so genuinely grateful to their aides," she continues. "Given the investment that home care providers make to their patients, that’s a pretty reasonable thing to feel."
It can be difficult to thwart an inheritance because people in general don’t talk about their wills or who their beneficiaries might be. When wills are discussed, it is often in general terms.
"The whole thing with wills is that they tend to be private," says Gadson. "Oftentimes family members don’t know if or to what extent they are in a will. It’s not something people tend to feel comfortable about discussing."
The concern is that someone will claim that the aide exercised undue influence on the patient to make that gift.
"What we want to avoid in home care is the appearance of impropriety and the appearance that undue influence might have been exerted on this person. I think the only thing we can do is discourage [any kind of gifts] to the client up front, such as through the written and acknowledged gift policies."
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