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Difference between revisions of "Health Care Consent in Residential Care"
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Health Care Consent in Residential Care (view source)
Revision as of 18:30, 26 June 2014
, 18:30, 26 June 2014no edit summary
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;Major health care: which includes matters such as surgery, risky or complex tests, any treatment involving a general anesthetic, radiation, chemotherapy, and kidney dialysis. | ;Major health care: which includes matters such as surgery, risky or complex tests, any treatment involving a general anesthetic, radiation, chemotherapy, and kidney dialysis. | ||
The public might assume that almost anything done in a health care setting such as a private hospital, extended care unit of a hospital or residential care facility would be “health care”. Similarly they may assume anything involving technology or medical equipment; prescribed by a physician; done by a nurse, nurse practitioner, or care worker was “health care “ or “treatment “; and anything physically intrusive in a care setting is “treatment”. | |||
The public might assume that almost anything done in a health care setting such as a private hospital, extended care unit of a hospital or residential care facility would be “health care”. Similarly they may assume anything involving technology or medical equipment; prescribed by a physician; done by a nurse, nurse practitioner, or care worker was “health care “ or “treatment “; and anything physically intrusive in a care setting is “treatment”. However a recent British Columbia case (Bentley v. Maplewood Seniors Care Society, a case involving spoon feeding a woman in care with advance dementia) suggests that health care is more narrow than commonly assumed. | |||
As the traditional nursing tasks have increasingly become delegated or transferred to care workers, the lines between “health care “ tasks involving informed consent and other kinds of care that residents might receive, have become increasingly blurred. The matter of health care is sometimes becoming less about what is being done, than who is doing it. | |||
==Areas of Confusion around Health Care Consent in Residential Care== | |||
As noted, the Health Care (Consent) and Care Facility (Admission) Act sets out the requirements for health care providers to follow to ensure that a capable resident (or their substitute decisionmaker when the resident is incapable) provides consent before health care is given. However family members of residents with dementia often find a resident has been given an antipsychotic or other medication without the resident’s or substitute decisionmakers’ knowledge or informed consent. This is in spite of the fact that the family may be the legally recognized health care decisionmaker for the mentally incapable resident. | |||
About one half of all residents in British Columbia care facilities are prescribed psychoactive medications. The medications are often used in response to anxiety, wandering, verbal and restless behaviours. Many commonly used psychoactive medications prescribed in care facilities have been shown to have serious side effects on people who are frail and elderly. These effects include sedation, higher risks of falls and hip fractures, Parkinson's disease-type symptoms, cardiovascular events (stroke and heart attack), and a greater risk of death. | |||
In June 2005, Health Canada issued an advisory notice about the use of atypical antipsychotic medication in the treatment of behavioural disorders in elderly patients. Health Canada specifically pointed out these medications are not approved for use in elderly patients with dementia. In some instances, operators (many of whom may not have training in health care, particularly geriatric health care) are unaware that some of these medications are not suitable for older people, and can have serious side effects. | |||
The use of these medications is a health care intervention; as such it comes under the Health Care (Consent) and Care Facility (Admission) Act consent requirements. However the use of the medication also potentially becomes a form of chemical restraint, also bringing it under the Residential Care Regulations rules on restraints. Depending on the circumstances, the misuse of restraints may also fall under the Adult Guardianship Act abuse definition. | |||
The safeguards, such as consent, for chemical or other restraints are not covered by the laws governing some facilities. As the Ombudsperson Report has noted “There are no legislated requirements in the Hospital Act that limit the use of restraints in private hospitals or extended care facilities”. | |||
Recent best practice guidelines for dementia care from the Ministry of Health have been beneficial in raising awareness of the responsibility of health care providers to seek consent for use of the medication or other intervention before treatment. The guidelines stress: | |||
:''“With few exceptions it is paramount that the resident’s closest family or friend (of whom one of is likely the resident’s authorized substitute decision maker) should be included in the consent seeking process.'' | |||
