Healthcare provider exceptions to confidentiality There are notable exceptions to confidentiality for the healthcare worker meeting the mental health needs of the older adult. The healthcare provider should refer all scope of practice questions to their state regulatory agency. State laws define the scope of practice. Understanding confidentiality, and when to breach it, is a necessary discussion when caring for older adults. Confidentiality is a client’s right for restricted information (Boyd, 2017). All healthcare workers play a role in maintaining client confidentiality. The HIPAA of 1996 is a federal guarantee of legal protection for privacy and confidentiality. Exceptions to confidentiality (when the need to inform outweighs confidentiality) include the following (Boyd, 2017): ● Client has an intent to harm self or others. ● Litigation if an attorney is involved. Informed consent and diminished capacity The American Bar Association (ABA) and APA created a working group to address the diminished capacity of the older adult in 2008. The framework is aimed at the psychologist who could be called to determine capacity in a legal, a medical, an ethical, or a civil situation for the older adult in medical, long-term care, or private practice settings. The healthcare provider should consult their scope of practice for their role in determining capacity. The ABA and APA outline six domains for capacity: medical consent, sexual consent, financial, testamentary, driving, and independent living capacities (American Bar Association & American Psychological Association, 2008). The ABA and APA working group highlights the importance of cultural and age considerations. Cultural intricacies such as immigration status, language, health perceptions, family member roles, and economics must be considered. The ABA and APA caution against ageism and the surrounding negative consequences. Clinical assessment and evaluation of older adult capacity is complex. Older adults have the right to informed consent for treatment. The healthcare provider must be aware of the importance of providing informed consent in conjunction with the client’s voluntary competency. The APA (2022f) defines informed consent as a person’s voluntary agreement to participate in a procedure on the basis of his or her understanding of its nature, its potential benefits and possible risks, and available alternatives. Informed consent is a fundamental requirement of research with humans and typically involves having participants sign documents, prior to the start of a study, that describes specifically what their involvement would entail and noting that they are free to decline participation or to withdraw from the research at any time. In therapeutic contexts, the principle of informed consent has provided a foundation Collateral reports Family, friends, and caregivers often play an important role in the mental healthcare of an older adult. The healthcare provider must obtain permission from the older adult client prior to discussing any medical or mental health information. Family, friends, and caregivers can help corroborate information (objective and subjective) gathered in the psychiatric interview of the older adult. Legal and ethical matters must be considered at all times. While caregivers can be beneficial to older adults and healthcare workers, they can also be sources of abuse and negative interactions in private for the older adult. Caregivers can experience overextension of self and inflict harm on older adults knowingly or unknowingly (NIA, 2017). The healthcare Assessment is a prerequisite for intervention and treatment. The healthcare worker needs to tailor the styles and techniques for obtaining the information needed to fully assess the older adult based on abilities and disabilities. The healthcare worker must enter each interaction with the older adult client with a willingness to embrace an objective perspective, the uniqueness of the encounter, and individualization of the assessment to maximize the quality of mental healthcare.
● Insurance company need to know for coverage and billing purposes. ● Sending information to answer a court order, subpoena, or summons. ● State requirement to report. ● Tarasoff principle—warn victim of imminent homicidal danger. ● Elder abuse suspected or involved (refer to state laws for proper channels). Knowing when and how to provide notification when exceptions of confidentiality are in question varies per state. The healthcare provider will need to follow policies subject to their practice and should take steps to familiarize themselves with the relevant policies and regulations. for do not resuscitate (DNR) orders and other advance directives and for the natural-death acts that have been passed into law throughout the United States. Along the lines of DNR and advanced directives for the older adult is the legal concept of undue influence: Undue influence is defined as a dynamic between an individual and another person. It describes the intentional use of social influence, deception, and/or manipulation to gain control of the decision making of another. For the healthcare worker, undue influence can be understood as a dynamic of a relationship when a person uses a role and power to exploit the trust, dependency, and/or fear of another. The role and power permit the person to gain control over the decision making of the victim. In cases of undue influence, a person may have full capacity. Alternatively, there may be a cognitive impairment that increases susceptibility and dependence. (ABA & APA, 2008, p. 14) Mental capacity can be questioned for the older adult. The healthcare provider must differentiate between capacity and competency. Competency is a legal (not a medical) concept. The APA (2022b) defines capacity as: ○ The maximum ability of an individual to receive or retain information and knowledge or to function in mental or physical tasks., ○ The potential of an individual for intellectual or creative development or accomplishment. ○ Inborn potential, as contrasted with developed potential provider is cautioned to consult all places of practice and state boards of practice for scope of practice questions or concerns. The healthcare worker has much to incorporate for the older adult assessment. Common developmental tasks can focus the healthcare worker’s assessment and note strengths and deficits. Legal documentation or intervention for healthcare directives, confidentiality, informed consent, and diminished capacity considerations should be included in older adult mental healthcare. If assistance is needed, consult your place of employment. Assessment considerations specific to the older adult are integral to addressing mental health concerns. The assessment of the older adult will include biological and psychosocial elements. The current presentation and history of the older adult will help define the assessment depth, highlight symptoms of diagnostic criteria, as well as maneuver toward or eliminate treatment options and interventions for stabilization and recovery. The biological considerations of the older adult can impact the psychiatric treatment options and necessitate the need to collaborate with primary care or initiate
ASSESSMENT OF THE OLDER ADULT: BIOLOGICAL AND PSYCHOSOCIAL
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Book Code: PYFL4024
EliteLearning.com/Psychology
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