Under HIPAA, a healthcare organization may share patient information for these purposes:

• To carry out treatment
• To receive payment from the patient’s health insurance plan
• To carry out programs necessary for quality control
• To comply with legally mandated reporting to public health agencies
• Patients can sign a separate consent for any other information sharing that they want, such as between family members or with an advocate.
• There are both civil and criminal penalties for not following the HIPAA guidelines. These penalties vary. They depend on the intention of the violation and the type of information released. Penalties and fines may be up to $250,000 and ten years imprisonment.
• Protected Health Information
• You will hear the term Protected Health Information (PHI) more and more in your job. It refers to personal information about patients that can be used to identify them. It is the right of patients to decide when, why, and to whom PHI may be released.
• The information that is protected includes the patient’s name, address, telephone number, age, diagnosis, surgery, date of procedure, and medications. It also includes the medical history, results of physical examinations, laboratory and other diagnostic tests, billing records, and claim forms. In short – ANY information that could be used to identify a patient is protected under HIPAA. It is important for you to know this means information in any form, be it written, electronic, or verbal.

Discussions about Patients with Other Employees

• Most likely, all the personal information you use and share in your daily duties is covered under HIPAA. You obviously must discuss assignments with other team members in order to coordinate care and report information.

• Although there are people with whom you need to talk to about specific patients, ask yourself:
• Does this person need to know the information about the patient? Is there a medical need to discuss the patient? Also, how much does this person need to know? For example, the person delivering meals does not need to know the details of the patient’s illness unless it affects where the meal tray is placed.
• Are you talking about the patient out of the hearing range of others?
• Even without using a patient’s name, are you still talking in a way that allows others to guess who you are talking about?
• Patients Needing Maximum Confidentiality
• Some patients need a greater level of confidentiality. These patients include those receiving care for substance abuse, psychiatric disorder, HIV (Human Immunodeficiency Virus), pregnancy, sexual abuse, or rape. This means it is illegal for you to say that the patient is being treated or seeking treatment. Your organization should give you the exact wording to use in this situation. Additionally, this applies to any patient who requests NOT to be in the patient directory.
• Maximum confidentiality rights are a critical feature of HIPAA. Your organization has specific standards to follow.

Unauthorized Disclosures

Ensuring the security of patient information relies on you. Unauthorized disclosures of protected information can occur if:

• You fail to make sure that the information you are giving is going to a person authorized to receive it
• You neglect to find out what restrictions on information are in the patient’s record
• You hear discussions about patients in non-secure locations, within hearing range of people not authorized to know the patient’s personal information
• If you are aware of a HIPAA violation, report it immediately. Your organization has a method to report this violation without revealing you as the reporter. Remember we are all in this together!!

ELDER ABUSE

• Elder abuse is a common and frightening social problem, which unfortunately seldom seems to attract the attention they need. The victims very often do not report their abusers, and the cycle of violence and injury continues.
• Home care aides are very often the health team members who have the most constant contact with members of society who are victims of elder abuse. Because an aide will see patients frequently and for long periods of time, he/she is in a unique position to detect the signs and evidence of elder abuse. All healthcare workers function as patient advocates and need to be prepared to know the signs of elder abuse. 
• They also need to know when it may be appropriate to inquire further. When concerns are based on objective information that can be observed, documented, and verified, healthcare workers have a duty to report domestic violence or elder abuse to the proper persons or authorities, if required by law or the healthcare agency.

• Physical abuse is one aspect of the problem but elder abuse can take many forms, it may also include physical, sexual or emotional abuse.

Sexual Abuse

• Actual sexual contact does not have to happen for sexual abuse to occur. The victim may be forced to undress, watch pornography, listen to sexually explicit or suggestive language, or be subjected to unwanted sexual situations.

Neglect

• Neglect is perhaps the most common form of elder abuse. In these cases, relatives or caretakers ignore the elder and deliberately neglect to provide for the basic emotional, comfort, safety, health care, or nutritional needs of the victim.

Emotional Abuse

• Emotional abuse involves behavior that causes psychological pain and trauma but does not involve physical injury. This can include threats, ridicule, insults, embarrassment, intimidating or manipulative behavior, non-verbal threats, deliberately withholding attention, or forced isolation.

Financial Abuse

• An elderly person may find that people close to them are exploiting them financially. The abuser may be stealing money or valuables, forging signatures, or improperly accessing personal financial records.

Physical Abuse

• The elderly person might be struck, shoved, or restrained. A caregiver may also force an elderly person to take extra doses of his/her medication or take illicit drugs or alcohol. The elderly person may be deprived of medications or medical care, or chronic health problems may be ignored or neglected.

Abandonment

• Deserting an elderly person by someone who has the responsibility of providing for the physical care of that person is abandonment.

Signs of elder abuse or domestic violence may be observed. The most sensible approach would be to follow the guidelines that have been developed by an employer or in the workplace. If required to ask a client about abuse, it should be done in a way that is non- confrontational, non-judgmental, and supportive.