1. How does the Agency demonstrate it has informed the patient of their rights when the patient is cognitively impaired?


i. By keeping a copy of the Consent Form itemizing that the Patient Rights document was reviewed with the patient/caregiver at the time of admission prior to the provision of service,

ii. By providing the patient/caregiver with a written copy of the Patient Rights document to maintain in their home folder.

iii. By reviewing and/or asking questions of the patient/caregiver at each home visit of any questions they may have regarding their Patient’s Rights. For example does the patient know how to access the agency after hours, does the patient know where the ISDH home health hot line number is, and does the patient know what services they are receiving and when staff will be making visits?

2. The Agency must inform the patient of his or her rights. The Agency does not have to protect and promote the exercise of these rights
T or F

3. If in a particular situation the Agency determines that the patient despite the Agency’s best efforts, is unable to understand these rights, a notation describing the circumstances should be placed in the patient’s clinical record
T or F

4. It is not necessary to document the patient’s diagnosis, general state of physical or mental health, and/or other recorded clinical information, environmental information or observations to support why the patient is unable to understand his/her rights.
T or F

5. Does the Patient’s Rights document need to be provided to the patient in writing?
Y or N

6. When is the Agency supposed to inform the patients of their “rights”

a. ANSWER: Before care and service is initiated.

7. Where does the Agency maintain documentation attesting to compliance with CFR 484.10 (a)

a. ANSWER: In the consent section of the clinical record. The “Consent to Treat” document itemizes this documentation.

8. Can the family exercise the patient’s rights for the patient if the patient is impaired?
Yes or No

9. The Hha has provided the patient a sponge bath in the bathroom. The Hha leaves the dirty towels, bath equipment, dirty clothes scattered all over the bathroom. What patient right has the Hha violated? The Patient Right CFR 484.10 (b) (3).The patient has the right to his or her property treated with respect.

11. What patient right addresses question # 10?

CFR 484.10 (b)(4). The patient has the right to voice grievances regarding treatment or care that is (or fails to be) furnished, or regarding the lack of respect for property by anyone who is furnishing services on behalf of the Agency and must not be subjected to discrimination or reprisal for doing so.

12. Who is the individual at the Agency “ultimately” accountable for receiving and resolving any patient concerns or problems that cannot be resolved at the staff level? Administrator

13. The patient does not have to be informed of the visit frequency of the services he/she will be receiving.
T or F

14. The Agency must advise the patient in advance of any change in the plan of care before the change is made.
T or F

a. If the answer is true where is this documented in the clinical record? SNV note, Communication Note, or a Coordination of Care note.

15. It is a legal requirement to provide written information regarding Advance Directives.
T or F

16. The Agency has policies regarding Advance Directives. The Agency does not have to provide a copy of their policy on Advance Directives to the patient.
T or F

17. The plan of care is developed by the MD and the RN.
T or F

18. What questions will the surveyors ask the patients on home visits regarding their participation in the development of the plan of care? The surveyor will ask the patient the following questions on home visits:

a. What treatments are you receiving?

b. What does the aide do for you when she/he comes for a visit?

c. When is the aide scheduled to make a visit?

d. How frequently does the aide come to your home?

e. How often does the nurse come to your home?

f. How have the plans you’re your care changed since service has started?

g. Have there been any changes in your plan of care?

h. Does the patient have written instructions regarding the care he/she receives and the frequency of the visits?

i. Have you participated in developing the plan of care to be furnished by the Agency?

19. The MD writes an order mid-episode decreasing the visit frequency of the Hha visits for the patient. When should the patient be informed of the change in visit frequency?

The patient should be informed prior to the next home health visit.

20. What documentation in the clinical record indicates that the Agency informed the patient of the Agency’s policies and procedures concerning clinical record disclosure?

a. The Patient Rights document.
b. The Consent Form

21. It is acceptable to perform the Initial Comprehensive Assessment, set up the patient’s medication box and then inform him/her of the cost of the service before the clinician leaves the home
T or F

22. What are the patient’s rights regarding the liability for payment? What must the Agency do?

Before care is initiated, the Agency must inform the patient, orally and in writing of:

a. The extent to which payment may be expected from Medicare, Medicaid, or any other Federally funded or aided program known to the Agency,

b. The charges for services that will not be covered by Medicare;

c. The charges that the individual may have to pay.

23. When services are paid by 3rd party payers, changes may occur in the spend-down amount or the amount the 3rd party payer is willing to cover. The 3rd party payer sends a notice to the Agency informing the Agency of the change in coverage. By what date MUST the Agency inform the patient of the change in financial coverage for services received?

No later than 30 calendar days from the date that the Agency becomes aware of a change.

24. The patient has the right to be informed of the toll free Home Health hotline # used to notify the ISDH of any concerns or complaints the patient has with the Agency.
T or F

25. What is this number? 1-800-227-6334

26. The Agency must disclose the name and address of all persons with an ownership or control interest in the Agency. Persons who are officers, directors, or a managing employee must also be disclosed.
T or F

27. It is not necessary for the Agency to comply with acceptable professional standards that apply to professionals furnishing services in an Agency.
T or F

28. An example of a professional standard is “ complete and effective legible documentation”
T or F

29. The nurse makes a routine visit to pre-fill the patient’s medication box for a week. The patient asks the nurse a question about how often she is to take one of her pills. The nurse responds, “Look I am in a hurry, I have 5 more patients to see!”. “Just take the pills as I set them up for you”. Is this a violation of a Patient Right? Yes or No If you answer yes which right do you believe is violated?

The Patient Right to be treated with dignity and respect.

The Patient Right to Participate in the Plan of Care

The Patient Right to be free of verbal and physical abuse

30. What the required discharge notice timeframe is as defined in the State Rules for Home Health if this is a routine discharge and the patient has met his/her goals?

5 day discharge notice as documented in State Rule N0488.

31. As a nurse you arrive at the patient’s home for an unannounced Hha supervisory visit. You hear yelling and realize it is the Hha yelling at the patient to “Shut Up and do not bother me!” “If you keep up that yelling I am just going to let you lay in your soiled bed and I will not feed you any lunch”. What Patient Rights have been violated?

State Rule N512 The Right to be free from abuse and treated with dignity. Federal Regulation CFR 484,100(b)(4) The Right to voice grievances regarding care that fails to be furnished.