Working Effectively With Home Care Patients Who Are Physically Disabled

One of the most common situations you’ll face as a home health care aide is working with people who are physically disabled. This means dealing with people who have disabilities which prevent them from engaging in the full range of motion possible for a non disabled person. Disabilities can range from mild disabilities to major ones. The important point here however is that these people will need help in managing their day to day lives. Here’s what you need to know:

Causes of Physical Disability

While the cause of a disability doesn’t necessarily change the kind of help the home health care patient needs, it does change the way they feel about it and as such, it changes the way that you need to handle emotional issues related to your clients.

Developmental (At or Near Birth)

The first kind of disability which you may be dealing with as a home health care professional is a developmental disability. This means that the person requiring home health care has been disabled for most or all of his or her life. This is important because someone who has experienced disabilities all of her life will be more likely to have come to accept the situation, given that they’ve never known anything else.

Injury/Disease Related

The second possibility is injury or disease related disabilities. In this case, your home care patients who are physically disabled have been that way for varying lengths of time and likely experienced life without this disability prior to their accident or illness. In this case, it’s possible that you may be dealing with emotional trauma in addition to dealing with physical disabilities since the person is mourning the loss of what they once had.

Emotional Trauma and Frustration

In both cases however, it is possible that the person will experience emotional trauma and frustration related to their disabilities for the simple reason that they know they are unable to do everything they might otherwise be able to do. Therefore, it’s important for you as a home health care aide working with the physically disabled to be sensitive to this and to deal with these issues appropriately.

Temporary Vs. Permanent

Another important consideration when working with home health care patients who are physically disabled is that you need to consider whether their disability is expected to be permanent or temporary. This is important because those who have a disability which is expected to be temporary should be encouraged to work toward the day when they are able to overcome the disability. By contrast, home health care patients with permanent disabilities should be encouraged to work toward the day when they can accept their disabilities as part of their lives and realize that being disabled doesn’t mean that they are worth anything less than those who are not disabled.

Your Daily Work

As a home health care aide working with those who are physically disabled, your work will include many of the same kinds of jobs that most other home health care aides must perform. These include basic needs, such as helping the person with bathing, dressing and eating as well as more complex tasks, including arranging transportation.

Getting family and Social Support

It is also important that you recruit family and friends to help support your patient so that he or she doesn’t feel as if they have been abandoned. This includes making sure that the family understands that the disabled person is not someone to be pitied but should instead be treated in as normal a fashion as possible, allowing the person to feel as if they are able to move past their initial experiences and to integrate into society.

Dealing with Society

It’s also important to help your home health care patients with physical disabilities to integrate into society as much as possible. Often, those with physical disabilities find it difficult to integrate into society as non disabled persons shun them. While you obviously cannot change the world, it’s important to help your client to maintain a feeling of self worth and independence in whatever way possible so as to ensure that they are able to overcome these problems in whatever way they can.

How You Can Help

There are a number of specific things that you can do as a home health care worker with the physically disabled which will allow them to feel as if they are able to continue with their lives. Some examples include:

Maintaining Dignity

It’s important for the disabled person to maintain their own dignity and self worth. This means that wherever possible, you need to allow the person to take care of their own needs rather than relying on someone else. For example, while you may have to help the person in a wheelchair into and out of the bathtub, there is often no reason that he cannot take care of his own physical needs once inside the tub, assuming he is paralyzed only from the waist down.

Preserving a Normal Lifestyle

Another thing which is extremely important for the physically disabled home health care patient is maintaining a normal routine. This means being able to help the person to accept life while at the same time helping them to keep up with all the things they always did in the past. This is especially important when working with physically disabled patients who were disabled later in life as opposed to those who grew up with it – they need to adjust while at the same time maintaining as normal a routine as is possible given their new circumstances.

Of course, those who were born with disabilities may also experience problems where they need help in maintaining a normal life. This is especially true when working with children who are physically disabled as their peers may not be as sensitive to the needs of the disabled person as adults in general society.

Bottom Line

The bottom line is that working with those who are physically disabled as home health care patients can be a challenging experience. However ultimately, it really boils down to making sure that they are able to maintain a life which is as normal and routine as possible in much the same way as others who are not disabled.

Terminating Patient Relationships

Earlier this year, I read an article about a doctor in Canada who literally “fired” 500 patients. After many years of practice, the doctor found himself with 2,100 patients and a 14-hour-a-day workload. Exhausted from trying to keep up with the demands of his practice, even with an assistant, the doctor held a lottery. The 500 names that were selected received a letter explaining that they would have to find medical care elsewhere.

That story prompted thoughts about why, when and how a physician might need to terminate a relationship with a patient. After all, a patient can leave a physician at any time for any or no reasons. A doctor, however, must follow ethical protocols in order to end a physician/patient relationship without incurring potential litigation.

Guidelines issued by the American Medical Association cite that a doctor is ethically obligated to provide for the patient’s continuity of care. According to those guidelines, a doctor my end the relationship if the patient, patient’s family or responsible parties are notified with enough advance notice for the patient to secure another doctor. A physician can also, under these guidelines, decline to treat a patient who requests a treatment protocol that is scientifically invalid or is incompatible with the personal, religious or moral beliefs of the physician.

Many physicians also believe that, no matter how frustrating it may be, a patient’s noncompliance with treatment may not be reason for terminating the relationship. Although when such noncompliance cannot be overcome and the doctor is unable to make any headway in bringing such patients around, it may be in the patient’s best interests to terminate the relationship.

Some reasons that doctors may need to fire a patient include:

  • Patients who are abusive to the doctor and staff.
  • Deadbeat patients who will not pay for their care.
  • Patients demanding unacceptable treatments.
  • Patients that create problems with other patients or staff.
  • Patients who chronically miss appointments.
  • Improper sexual advances by the patient.

Regardless of the specific reason or situation, experts advise that a doctor discuss the situation with a peer or clinical risk manager before taking any termination action. Such an objective outside view can often provide some balance. Sometimes the patient may not be at fault. It is possible that, for whatever the reason, the doctor has an adverse emotional reaction to a patient. That may be a valid reason to request the patient seek help elsewhere, but the doctor should understand the situation beforehand.

Expanding on the listed items, patients with poor hygiene (odoriferous and unkempt) can disrupt other patients in your waiting room. Patients with a history of drug and alcohol abuse may demand opiate medications that are not in their best interests. A patient may continually scream abusively at your receptionist, nurse or yourself.

Each case needs to be thoroughly reviewed individually. Have steps been taken to change the patient’s behavior or belief? Have they been successful? Have you sought out assistance from family, friends or other professionals for the patient (without violating HIPAA)? After a thorough review, the decision to terminate the relationship must be handled ethically and appropriately to avoid potential claims of abandonment. Therefore I would recommend that you seek advice on the termination action with your attorney or insurance representative.

Key factors in the termination process include:

  1. Allowing the patient adequate time to locate another caregiver. Most experts feel that a month is a suitable time period, but that may vary due to the availability of medical care providers in your community.
  2. Draft a letter advising the patient of your decision. Be specific as to the date you will terminate services and resources directing them to other physicians. The letter should also reference the fact that you will need their written authorization to transfer patient records to a new physician.
  3. There is some debate as to including the specific reasons for termination in the letter. Some experts advise avoiding any reference to the reasons behind your decision. Other experts advise full disclosure, but recommend keeping the reasons brief and factual. Each physician should follow the recommendations of their attorney or other professional on this matter.
  4. You are still required to treat the patient during the period prior to the termination date and in cases of emergency.

However you write the termination letter, it should be written in such a way that the patient who reads it will feel that the discharge is for the benefit of the patient, not the practice. The patient should feel that whatever happened has damaged the physician/patient relationship to the extent that it has become ineffective, which does not serve the best interests of the patient. Therefore the patient can seek a doctor with whom a good relationship can be created. Emotionally you may want to “fire and blame the patient”, but that could actually increase your potential exposure for claims of abandonment or unprofessional conduct.

And, as always, document, document, document every step of the termination process.