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Guia Basica a Proveedores al Brindar Servicios de Salud a Beneficiarios LGBTT+

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Certificación de cumplimiento ASES 19-0305

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Guia Basica a Proveedores al Brindar Servicios de Salud a Beneficiarios LGBTT+

La Administración de Seguros de Salud del Gobierno de Puerto Rico (en adelante la ASES) fue creada en virtud de la Ley Numero 72 de 7 de septiembre de 1993, según enmendada (en adelante Ley 72), como "una corporación pública con plena capacidad para desarrollar las funciones que la ley le encomienda. Particularmente, se le delega "la responsabilidad de implantar, administrar y negociar, mediante contratos con aseguradores, y/u organizaciones de servicios de salud, [...] un sistema de seguros de salud que eventualmente le brinde a todos las residentes de la Isla acceso a cuidados medico hospitalarios de calidad, independientemente de la condición económica y capacidad de pago de quien las requiera."

Los poderes, deberes y funciones por las cuales queda investida la ASES en virtud de la Ley 72 incluyen, entre otros: implantar planes de servicios médico-hospitalarios basados en seguros de salud; negociar y contratar con aseguradores públicos y privados, y organizaciones de servicios de salud, cubiertas de seguros médico-hospitalarios, según se definen en la Ley 72; establecer en las contratos que suscriba con las aseguradoras o con los proveedores participantes, y organizaciones de servicios de salud asuntos tales coma la garantía del pago y la atención médico-hospitalaria que reciban sus beneficiarios, aunque la misma se preste fuera del área de salud donde las beneficiarios residan, par razón de emergencia o necesidad imperiosa y las mecanismos de evaluación y de cualquier otra naturaleza que garanticen todos las aspectos que afecten, directa o indirectamente, la accesibilidad, calidad, control de costos y de utilización de los servicios, así coma la protección de los derechos de los beneficiarios y proveedores participantes.

Además, el Plan de Reorganización Núm. 3 de 29 de julio de 2010 facultada y autoriza a la ASES para administrar, negociar, contratar y gestionar los beneficios de salud para los retirados y empleados públicos conforme a la Ley de Beneficios de Salud para Empleados Públicos (Ley Núm. 95 del 29 de junio de 1963, según enmendada; en adelante Ley 95) y su Reglamento.

El Boletín Administrativo Orden Ejecutiva-2017-037 (en adelante OE), emitido por el Gobernador de Puerto Rico, Honorable Ricardo Rosselló Nevares, reitera como política pública del Gobierno de Puerto Rico la prohibición al discrimen en todas sus manifestaciones, incluyendo el discrimen por identidad de género, expresión de genera u orientación sexual real o percibida. Por lo tanto, y siendo la ASES el organismo gubernamental designado por ley para negociar y contratar las cubiertas de servicios de salud del Plan de Salud del Gobierno Vital, Medicare Platino y el plan de Salud de los Empleados Públicos del Gobierno de Puerto Rico, así como la fiscalización en todos sus componentes para garantizar de servicios de salud de calidad, ASES reafirma la política pública establecida por el Gobierno.

Como parte de los esfuerzos anti-discrimen y en aras de que toda persona reciba servicios de salud de manera digna y sensible, la ASES emite esta Guía básica a proveedores para manejo sensible y adecuado al brindar servicios de salud a beneficiarios LGBTT+, como pautas mínimas a considerar y seguir al momento de proveer servicios de salud a nuestros beneficiarios de la población lésbica, gay, bisexual, transgénero, transexual (LGBTT+).

La orientación sexual, expresión de genera e identidad de género son conceptos muy distintos, pero en muchas ocasiones usados como sinónimos. El ser humano es la combinación de estos elementos: sexo biológico, identidad y expresión de género, y orientación sexual. Se trata de características independientes, que juntas, nos define. Reconocer la diferencia entre ellas y entender sus posibles combinaciones, es extremamente importante para poder construir una sociedad más tolerante y comprensiva, en la que todas las personas puedan desarrollarse y expresarse plenamente, redundando en una sana convivencia.

Uno de los obstáculos que las personas parte de la población LGBTT+ pueden enfrentar es que los servicios de salud que reciben pudieran estar marcados por discrimen, señalamientos o expresiones innecesarias hacia su persona, mancillando su integridad.

El propósito de este documento es que sirva como educación y protocolo de trabajo básico de provisión de servicios de salud sensibles y adecuados, dirigido a todos los proveedores de servicios de salud contratados por alguna aseguradora asociada a ASES, al momento de proporcionar sus servicios a nuestros beneficiarios que a su vez son parte de la población LGBTT+. Si su práctica o institución cuenta con un protocolo de trabajo a los efectos que se pretende satisfacer con este documento, no está en la obligación de usar el mismo. El recibo de este documento y educación sobre esta guía o el protocolo existente debe constar en el expediente de las personas que laboran en alguna oficina o entidad que se dedica a proveer de salud a beneficiarios de las líneas de salud contratadas por ASES. Aunque este documento detalla un protocolo de trabajo con guías mínimas, siéntase en la libertad de ampliarlo si las necesidades de la practica especifica así lo requieren, pero sin disminuir los parámetros aquí establecidos.

Asexual: Orientación sexual de una persona que no siente atracción erótica hacia otras personas. Puede relacionarse afectiva y románticamente. No implica necesariamente no tener libido, o no practicar sexo, o no poder sentir excitación.

Bifobia: Rechazo, discriminación, invisibilizacion, burlas y otras formas de violencia basadas en prejuicios y estigmas hacia las personas bisexuales o que parecen serlo. Puede derivar en otras formas de violencia como los crímenes de odio por bifobia, aun cuando cabe aclarar que ese hecho delictivo todavía no se encuentra legalmente tipificado. Supone, además, que todas las personas deben limitar su atracción afectiva y sexual a las mujeres o a los hombres exclusivamente, esto es, a uno solo de los géneros, y si no lo hacen así se les considera "en transición", como inestables o indecisas.

Binarismo de género: Concepción, prácticas y sistema de organización social que parte de la idea de que solamente existen dos géneros en las sociedades, femenino y masculino, asignados a las personas al nacer, como hombres (biológicamente: machos de la especie humana) y como mujeres (biológicamente: hembras de la especie humana), y sobre los cuales se ha sustentado la discriminación, exclusión y violencia en contra de cualquier identidad, expresión y experiencia de genero diversas.

Bisexualidad: Capacidad de una persona de sentir una atracción erótica afectiva por personas de un género diferente al suyo y de su mismo género, así como la capacidad de mantener relaciones íntimas y sexuales con ellas. Esto no implica que sea con la misma intensidad, al mismo tiempo, de la misma forma, ni que sienta atracción por todas las personas de su mismo género o del otro.

Características sexuales: Se refiere a las características físicas o biológicas, cromosómicas, gonadales, hormonales y anatómicas de una persona, que incluyen características innatas, tales como los órganos sexuales y genitales, y/o estructuras cromosómicas y hormonales, así como características secundarias, tales como la masa muscular, la distribución del pelo, los pechos o mamas.

Discriminación: Toda distinción, exclusión, restricción o preferencia que, por acción u omisión, con intención o sin ella, no sea objetiva, racional ni proporcional, y tenga por objeto o resultado obstaculizar, restringir, impedir, menoscabar o anular el reconocimiento, goce o ejercicio de los derechos humanos y libertades, cuando se base en uno o más de los siguientes motivos: el origen étnico o nacional, el color de piel, la cultura, el sexo, el género, la edad, las discapacidades, la condición social, económica, de salud o jurídica, la religión, la apariencia física, las características genéticas, la situación migratoria, el embarazo, la lengua, las opiniones, la orientación sexual, la identidad de género, la expresión de género, las características sexuales, la identidad o filiación política, el estado civil, la situación familiar, las responsabilidades familiares, el idioma, los antecedentes penales o cualquier otro motivo.

Diversidad sexual y de género: Hace referencia a todas las posibilidades que tienen las personas de asumir, expresar y vivir su sexualidad, así como de asumir expresiones, preferencias u orientaciones e identidades sexuales. Parte del reconocimiento de que todos los cuerpos, todas las sensaciones y todos los deseos tienen derecho a existir y manifestarse, sin más límites que el respeto a los derechos de las otras personas.

Equidad de género: se refiere a la imparcialidad y la justicia en la distribución de beneficios y responsabilidades entre hombres mujeres. El concepto reconoce que el hombre y la mujer tienen distintas necesidades y gozan de distinto poder, y que esas diferencias deben determinarse y abordarse con miras a corregir el desequilibrio entre los sexos.

Estereotipo: Son las preconcepciones, generalmente negativas y con frecuencia formuladas inconscientemente, acerca de los atributos, características o roles asignados a las personas, por el simple hecho de pertenecer a un grupo en particular, sin considerar sus habilidades, necesidades, deseos y circunstancias individuales.

Estigma: Es la desvalorización o desacreditación de las personas de ciertos grupos de población, atendiendo a un atributo, cualidad o identidad de las mismas, que se considera inferior, anormal o diferente, en un determinado contexto social y cultural, toda vez que no se ajusta a lo socialmente establecido.

Expresión de género: Es la manifestación del género de la persona. Puede incluir la forma de hablar, manierismos, modo de vestir, comportamiento personal, comportamiento o interacción social, modificaciones corporales, entre otros aspectos. Constituye las expresiones del género que vive cada persona, ya sea impuesto, aceptado o asumido.

Gay: Hombre que se siente atraído erótico afectivamente hacia otro hombre. Es una expresión alternativa a "homosexual" (de origen medico). Algunos hombres y mujeres, homosexuales o lesbianas, prefieren el termino gay, por su contenido político y uso popular.

Género: Se refiere a los atributos que social, histórica, cultural, económica, política y geográficamente, entre otros, han sido asignados a los hombres ya las mujeres. Se utiliza para referirse a las características que, social y culturalmente, han sido identificadas como "masculinas" y "femeninas", las cuales abarcan desde las funciones que históricamente se le han asignado a uno u otro sexo (proveer vs. cuidar), las actitudes que por lo general se les imputan (racionalidad, fortaleza, asertividad vs. emotividad, solidaridad, paciencia), hasta las formas de vestir, camina, hablar, pensar, sentir y relacionarse.

Heteronormatividad: Expectativa, creencia o estereotipo de que todas las personas son, o deben ser, heterosexuales, o de que esta condición es la única natural, normal o aceptable; esto es, que solamente la atracción erótica afectiva heterosexual y las personas heterosexuales, o que sean percibidas como tales, viven una sexualidad valida éticamente, o legitima, social y culturalmente.

Heterosexual: Capacidad de una persona de sentir atracción erótica afectiva por personas de un genera diferente al suyo, así como la capacidad de mantener relaciones íntimas y sexuales con ellas.

Homofobia: Rechazo, discriminación, invisibilización, burlas y otras formas de violencia basadas en prejuicios, estereotipos y estigmas hacia la homosexualidad o hacia las personas con orientación o preferencia homosexual, o que son percibidas como tales. Puede derivar en otras formas de violencia como la privación de la vida y el delito de homicidio, que puede ser tipificado como crimen de odio por homofobia. Su uso se ha extendido al rechazo hacia las orientaciones sexuales e identidades de genera no hegemónicas en general; sin embargo, esto ha contribuido a invisibilizar las distintas formas de violencia que viven lesbianas, personas trans, bisexuales e intersexuales.

Homosexualidad: Capacidad de cada persona de sentir una atracción erótica afectiva por personas de su mismo genera, así como la capacidad de mantener relaciones íntimas y sexuales con estas personas. El Comité para la Eliminación de Todas las Formas de Discriminación contra la Mujer (Comité CEDAW) observa una tendencia a reivindicar el uso y referencia a los términos lesbiana y lesbiandad, para hacer referencia a la homosexualidad femenina.

Identidad de género: Vivencia interna e individual del genera, tal coma cada persona la siente, misma que puede corresponder o no con el sexo asignado al nacer. Incluye la vivencia personal del cuerpo, que podría o no involucrar la modificación de la apariencia o funcionalidad corporal a través de tratamientos farmacológicos, quirúrgicos o de otra índole, siempre que la misma sea libremente escogida. También incluye otras expresiones de genera coma la vestimenta, el modo de hablar y los modales. Es un constructo social.

lgualdad de género: Es la ausencia de discriminación basada en las identidades de la persona en materia de oportunidades, asignación de recursos y beneficios o acceso a los servicios. Política Pública se fundamenta en la Ley.

Lesbiana: Mujer que se siente atraída erótica y afectivamente por mujeres. Es una expresión alternativa a "homosexual", que puede ser utilizada por las mujeres para enunciar o reivindicar su orientación sexual.

LGBTT+: Siglas para referirse a las personas lesbianas, gays, bisexuales, transgeneros, transexuales, queers, intersexuales y asexuales, entre otros. Aunque el termino no abarca todas las pequeñas comunidades de diversas sexualidades, igual están representadas y aceptan a sus integrantes.

Orientación sexual: Capacidad de cada persona de sentir una atracción erótica afectiva por personas de un genera diferente al suyo, o de su mismo genera, o de más de un genera o de una identidad de genera, así coma la capacidad de mantener relaciones íntimas y sexuales con estas personas.

Pansexual: Capacidad de una persona de sentir atracción erótica afectiva hacia otra persona, con independencia del sexo, genera, identidad de genera, orientación sexual o roles sexuales, así como la capacidad de mantener relaciones íntimas y/o sexuales con ella.

Prejuicios: Percepciones generalmente negativas, o predisposición irracional a adoptar un comportamiento negativo, hacia una persona en particular o un grupo poblacional, basadas en la ignorancia y generalizaciones erróneas acerca de tales personas o grupos, que se plasman en estereotipos.

Queers: Las personas queer, o quienes no se identifican con el binarismo de genera, son aquellas que además de no identificarse y rechazar el genera socialmente asignado a su sexo de nacimiento, tampoco se identifican con el otra genera o con alguno en particular. Dichas personas pueden manifestar, masque identidades fijas, expresiones y experiencias que: 1) se mueven entre un genera y otra alternativamente; 2) se producen por la articulación de los dos generas socialmente hegemónicos; 3) formulan nuevas alternativas. de identidades, por lo que no habría, en sentido estricto, una transición que partiera de un sitio y buscara llegar al polo opuesto, como en el caso de las personas transexuales. Las personas queer usualmente no aceptan que se les denomine con las palabras existentes que hacen alusión a hombres y mujeres, por ejemplo, en casos como "todos" o "todas", "nosotros" o "nosotras", o profesiones u oficios (doctoras o doctores), entre otras situaciones; sino que demandan en el caso del idioma español que en dichas palabras, la última vocal (que hace referencia al genera) se sustituya por las letras "e" o "x", por ejemplo, "todes" o "todxs", "nosotrxs", "doctorxs", etc.

Salud sexual: Estado de bienestar físico, mental y social en relación con la sexualidad. Requiere un enfoque positivo y respetuoso de la sexualidad y de las relaciones sexuales, así como la posibilidad de tener experiencias sexuales placenteras y seguras, libres de toda coacción, discriminación y violencia. Para que la salud sexual se logre, es necesario que los derechos sexuales de las personas se reconozcan y se garanticen. Requiere de un enfoque positivo y respetuoso de las distintas formas de expresión de la sexualidad y las relaciones sexuales, así como de la posibilidad de ejercer y disfrutar experiencias sexuales placenteras, seguras, dignas, libres de coerción, de discriminación y de violencia.

Sexo: Referencia a los cuerpos sexuados de las personas; esto es, a las características biológicas (genéticas, hormonales, anatómicas y fisiológicas) a partir de las cuales las personas son clasificadas como machos o hembras de la especie humana al nacer, a quienes se nombra como hombres o mujeres, respectivamente.

Transexuales: Las personas transexuales se sienten y se conciben a sí mismas como pertenecientes al género y al sexo opuestos a los que social y culturalmente se les asigna en función de su sexo de nacimiento, y que pueden optar por una intervención médica - hormonal, quirúrgica o ambas - para adecuar su apariencia física y corporalidad a su realidad psíquica, espiritual y social.

Transgeneros: Las personas transgéneros se sienten y se conciben a sí mismas como pertenecientes al género opuesto al que social y culturalmente se asigna a su sexo de nacimiento, y quienes, por lo general, solo optan por una reasignación hormonal - sin llegar a la intervención quirúrgica de los órganos pélvicos sexuales internos y externos para adecuar su apariencia física y corporalidad a su realidad psíquica, espiritual y social.

Travestis: Las personas travestis, en términos generales, son aquellas que presentan de manera transitoria o duradera una apariencia opuesta a la del género que socialmente se asigna a su sexo de nacimiento, mediante la utilización de prendas de vestir, actitudes y comportamientos.

Atributos del Buen Servicio

  1. Un buen servicio debe cumplir con ciertos atributos relacionados con la expectativa que la persona tiene sobre sí misma. Como mínimo, el servicio debe ser:
    1. Respetuoso: Los seres humanos esperan ser reconocidos y valorados sin que se desconozcan nuestras diferencias.
    2. Amable: Cortes pero también sincero.
    3. Confiable: Como está previsto en las normas y con resultados certeros.
    4. Empático: El proveedor de servicios de salud percibe lo que la persona siente y se pone en su lugar.
    5. Incluyente: De calidad para todas las personas sin distinciones, ni discriminaciones.
    6. Oportuno: En el momento adecuado, cumpliendo los términos acordados con la persona.
    7. Efectivo: Cumpliendo siempre con las leyes y normativas aplicables.

    El buen servicio va más allá de la simple respuesta a la solicitud de la persona: esto supone comprender sus necesidades, lo que a su vez exige escucharlo e interpretar bien sus necesidades.

  2. Las personas necesitan información y aprecian que esta les sea dada de manera oportuna, clara y completa. Respuestas como "No sé ...", o "Eso no me toca a mí ..." son vistas por la persona como un mal servicio. Los proveedores de servicios de salud y sus empleados, entonces, deben:
    • Informarse sobre los formatos, plantillas o guiones de atención definidos para el beneficiario y su situación particular.
    • Conocer los trámites inherentes y necesarios.
    • Seguir el procedimiento -el conducto regular- con aquellos temas que no pueda solucionar: ante alguna dificultad para responder por falta de información, información incompleta o errada, debe acudirse a su supervisor y/o aseguradora correspondiente.
    • Y siempre: Se debe atender a las personas como nos gustaría que nos atendieran a nosotros.

Actitud

Según la Real Academia Española de la Lengua, la actitud es la disposición de ánimo de una persona, expresada mediante diferentes formas como la postura corporal, el tono de voz o los gestos.

Los proveedores de servicios de salud deben mostrar una buena actitud de servicio, entendida como su disposición de escuchar al otro, ponerse en su lugar y entender sus necesidades y peticiones; no se trata tanto de pensar en la persona sino como la persona, ser conscientes de que cada persona tiene una visión y unas necesidades diferentes, que exigen un trato responsable. En este sentido, el proveedor de servicio y sus empleados deben:

  • Anticipar y entender las necesidades de la persona. Escucharlo y evitar interrumpirlo mientras habla.
  • Ir siempre un paso más allá de lo esperado en la atención. Comprometerse únicamente con lo que pueda cumplir.
  • Ser creativo para dar a la persona una experiencia de buen servicio.

La persona se llevara una buena impresión si el proveedor de servicios:

  • Entiende sus problemas.
  • Es respetuoso.
  • Lo orienta con claridad y precisión. Lo atiende con calidez y agilidad.

Por el contrario, se formara una impresión negativa cuando:

  • Lo trata de manera altiva, desinteresada o con falsa amabilidad.
  • Lo hace esperar innecesariamente o sin ofrecer una explicación por las demoras.
  • No tiene la información o el conocimiento necesario para atender su solicitud.

Lenguaje

Por medio del lenguaje los seres humanos expresan sus necesidades y experiencias. Estas son algunas recomendaciones para una comunicación efectiva:

  • El lenguaje para hablar con las personas debe ser respetuoso, claro y sencillo; frases amables como: "con mucho gusto, en que le puedo ayudar?" siempre son bien recibidas.
  • Evitar el uso de siglas, abreviaturas, extranjerismos, regionalismos o tecnicismos que puedan resultar incomprensibles. Si es imprescindible usarlos, hay que explicar su significado.
  • Evitar respuestas a la persona o utilizar términos confianzudos como " mi amor", "corazón", etc.
  • Para dirigirse a la persona encabezar la frase con "usted".
  • Evitar respuestas cortantes del tipo "Si", "No", ya que se pueden interpretar como frías y de afán. Dejar· hablar a la persona. El mejor interlocutor no es el que habla mucho, sino el que sabe escuchar.
  • Reconocer la identidad de la persona: "Como quiere que se llame?"

En la comunicación escrita se debe tener en cuenta:

  • La mejor estrategia para responder claramente a una persona es ponerse en su lugar. La persona no necesita un tratado filosófico, ni un inventario de normas, sino una respuesta clara, precisa y corta (4 o 5 párrafos es el ideal). Por lo tanto, en el primer párrafo se debe responder claramente la pregunta, y a continuación citar las normas que la sustenten, si es necesario.
  • Se debe escribir para comunicar, no para "impactar". El uso de palabras sencillas en una comunicación no reduce la calidad del escrito; por el contrario, se gana credibilidad y confianza en el lector.
  • No se deben utilizar siglas, abreviaturas, extranjerismos, regionalismos ni tecnicismos que puedan resultar incomprensibles. Si es imprescindible usarlos, hay que explicar su significado.
  • Lo ideal es poner en práctica aquella regla elemental del orden en la redacción: sujeto, verbo y complemento.
  • No se debe escribir todo en mayúsculas, pues complica la lectura y es agresivo para quien lee el texto. Lo ideal es combinar minúsculas y mayúsculas, en los casos que se requiera.
  • Es importante que el lector identifique la parte clave de la respuesta o las ideas más importantes. Por lo tanto, se aconseja resaltar estas ideas, subrayarlas o utilizar un tipo de letra distinto al resto del texto. Un escrito piano es monótono y dificulta la comprensión.
  • Revisar ortografía, puntuación y redacción. Esto también afecta la imagen no solo de quien escribe sino de la entidad que representa.

Atención a la persona

En muchas ocasiones al solicitar servicios de salud llegan personas inconformes, confundidas, ofuscadas o furiosas, a veces por desinformación. En estos casos, se recomienda:

  • Mantener una actitud amigable y mirar al interlocutor a los ojos; no mostrar agresividad verbalmente, ni con los gestos, ni con la postura corporal.
  • Dejar que la persona se desahogue, escucharle atentamente, no interrumpirle ni entablar una discusión con ella.
  • Evitar calificar su estado de ánimo.
  • No tomar la situación como algo personal: las personas se quejan de un servicio, no de quien la atiende.
  • No perder el control; si el proveedor de servicios de salud conserva la calma es probable que la persona también se calme.
  • Cuidar el tono de la voz: muchas veces no cuenta tanto que se dice, sino como se dice.
  • Usar frases como "lo comprendo", "que pena", "claro que sí". Estas demuestran que el proveedor de servicios es consciente del malestar de la persona.
  • Dar alternativas de solución, si es que las hay y comprometerse solo con lo que se pueda cumplir.
  • Si el mismo problema ocurre con otra persona, informar al supervisor o supervisora para dar una solución de fondo.

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Cultural Competency Training for Providers

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Purpose of Training

  • Cultural competency training programs are developed to increase cultural awareness, knowledge, and skills, leading to changes in staff behavior and member-staff interactions.
  • Training provides a way to redirect problems stemming from the cultural mismatches that result whenever members and staff do not share a common subculture and mutual understanding of each other’s health beliefs.

Provider Network

  • An Annual Population Assessment reviews Quality Improvement Referrals, Provider Satisfaction results, and Translator service request to identify any opportunities related to providing a sufficient provider network to support the linguistic, race, ethnicity, and gender needs of the patient/ beneficiary population.
  • The Organization does not discriminate against employees, patients / beneficiaries, or providers, based on age, race, sex, religion, sexual preference/orientation, or any protected status.

Culture

  • An integrated pattern of learned beliefs and behaviors that can be shared among groups.
  • It includes thoughts, style of communication, language, ways of interacting, views on roles and relationships, values, practices, and customs13

Cultural Competence in Health Care

The ability of systems to provide care to members with diverse values, beliefs, and behaviors, including tailoring delivery to meet the members social, cultural, and linguistic needs.13

Health Literacy

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions.

Members health literacy may be affected if they have:

  • Health care providers who use words that members don’t understand
  • Low educational skills
  • Cultural barriers to health care
  • Limited English Proficiency (LEP)17

National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care

  • In 2000, the U.S. Department of Health and Human Services, Office of Minority Health first published the National Standards for Culturally and Linguistically Appropriate Services in Health Care6
  • Principal Standard: Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs16
  • A significant number of states including Florida are actively implementing the National CLAS Standards by integrating the National CLAS Standards into their strategic plans6

Beliefs

How does culture impact the outcome of treatment?

  • How is the illness perceived
  • Community environment
  • Behavior / habits
  • A Members attitude about Providers & Health care can have an impact on compliance with treatment

Communication

Communication is vital for the patient to receive adequate care

  • Limited English Proficiency (LEP) - describes someone who has limited or inability to speak, read, write, or understand the English language

Communication (continued)

Patients with LEP may not understand health information concerning their care

  • A translation service will be used for patients unable to speak English, if the enrollee’s spoken language is outside of organizations in-house capabilities, which include: Spanish, Creole, and French.
  • The UM staff will notify providers and patients of the availability of oral interpretation services and inform them how to access oral interpretation services, regardless of whether an Enrollee speaks a language that meets the threshold of a prevalent non-English language. There will be no charge to the member for translation services
  • TTY/TDD services are available

Positive Communication

Patient: If they tell you they forgot their glasses, because they are ashamed they can’t read well.

Response from provider: Give clear instructions in different ways. Use “teach back” method.

Patient: I am more comfortable with a female doctor

Response from provider: Office staff should confirm preferences during appointment scheduling20

Emotional Intelligence

  • Emotional intelligence (EQ) is the ability to identify, use, understand, and manage your own emotions in positive ways to relieve stress, communicate effectively, empathize with others, overcome challenges and defuse conflict.18
  • By understanding your emotions and how to control them, you’re better able to express how you feel and understand how others are feeling.
  • This allows you to communicate more effectively and forge stronger relationships, with patients.18

Emotional Intelligence at work

You are a manager in an organization or practice owner that is trying to encourage respect for racial and ethnic diversity. You overhear someone telling a racist joke. What do you do?

Speak up on the spot, saying that such jokes are inappropriate and will not be tolerated in your organization.

The most effective way to create an atmosphere that welcomes diversity is to make clear in public that the social norms of your organization do not tolerate such expressions. Confronting the behavior privately lets the individual know the behavior is unacceptable, but does not communicate it to the team. Instead of trying to change prejudices (a much harder task), keep people from acting on them.

Tools

Teach back method is a way of confirming the patient understands by asking the patient to state in their own words what they need to know or do about their health, which:

  • Improves patient understanding and adherence
  • Decrease call backs & cancelled appointments
  • Improve outcomes and satisfaction
  • Use clear plain language when talking to patients19

Subcultures

  • A subculture is an ethnic, regional, economic, or social group
  • Cross-cultural health care teaches people in the health care industry how to relate to people of different sections of society

Cultural differences, it is important to understand and respect the values, beliefs, and customs, norms, and traditions of different people

  • Consider the person’s cultural views concerning
  • Eye contact
  • Personal space
  • Respect for authority

Seniors & People with Disabilities

Ask a person with a disability first before providing assistance like holding their arm to help them out of a chair. When dealing with seniors, consider the possible challenges and impairments:

  • Hearing
  • Visual
  • Cognitive
  • Physical
  • Taking multiple medications
  • Dependent on care givers

Possible Barriers to Cultural Competency

  • Lack of diversity in leadership
  • System not designed to meet the needs of a diverse population
  • Poor communication between providers and patients of different cultural backgrounds

Benefits of Cultural Competency

Healthcare experts identified a connection between cultural competence and quality improvement, and the elimination of racial and ethnic disparities.

LGBTT+ Cultural Competence training

Handling with sensibility the LGBTT population when requesting health care related services.

Objectives

  • To know the regulatory and legal basis that supports anti-discrimination efforts based on sexual orientation and gender identity
  • To distinguish among sexual orientation and gender identity
  • To know a basic guideline which provides tools to handle with sensibility the LBGTT+ population when requesting health care services.

Laws and Regulations

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. This Section prohibits health insurers to design a health coverage which includes benefits that can be discriminatory for transgender persons. The OCR (Office of Civil Rights)has been enforcing this provision since it was enacted.

Laws and Regulations

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. This Section prohibits health insurers to design a health coverage which includes benefits that can be discriminatory for transgender persons. The OCR (Office of Civil Rights)has been enforcing this provision since it was enacted.

Puerto Rico Plans

The Governor of Puerto Rico issued an Administrative Bulletin "Orden Ejecutiva 2017-037", indicating that Puerto Rico’s public policy prohibit any kind of discrimination including gender identity, gender expression or individual’s real or perceived sexual orientation.

Amended Normative Letter 19-0305

ASES reaffirms the public policy established by the Puerto Rico Government to ensure strict compliance with the anti-discrimination efforts, when beneficiaries of the Lesbian, Gay, Bisexual, Transgender and Transsexual population seeks for health care services.

Sexual Orientation and Gender Identity are two different concepts

Sexual Orientation: tells you how a person characterizes their sexual and emotional attraction to others.

Gender Identity: is a person’s internal sense of being a man, woman, both, neither, or another gender. Most people have a gender identity that is the same as the sex they were assigned at birth. However, some people have a gender identity that does not correspond to the sex they were assigned at birth. The term transgender is used to describe these individuals.

Common words to describe sexual orientation

  • Heterosexual: (straight) is a sexual orientation that describes women who are emotionally and sexually attracted to men, and men who are emotionally and sexually attracted to women.
  • Gay: Gay is a sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender. It is more commonly used to describe men.
  • Lesbian: Lesbian is a sexual orientation that describes a woman who is emotionally and sexually attracted to other women.
  • Bisexual: Bisexual is a sexual orientation that describes a person who is emotionally and sexually attracted to people of their own gender and people of other genders.

Gender Identity describes a wide range of people, including the following:

  • Transgender: A umbrella term describing the state of a person’s gender identity which does not necessarily match the gender they were assigned at birth. Transgender people may or may not decide to alter their bodies hormonally and/or surgically.
  • Transsexuals: They identify themselves with a gender which does not match the gender they were assigned at birth. Transsexual people decide to alter their bodies hormonally and surgically to match the gender they identify with.

Barriers when receiving health care services

  • There are different reasons why LGBTT+ people may have difficulty accessing health care services, among those are: Discrimination and/or unnecessary expressions toward them.
  • In some cases, health care services could be denied to them, which can cause serious and catastrophic consequences to their health.

Basic guidelines to handle with sensibility the LGBTT population when they request health care related services

Cultural Competence and Sensibility

  • Cultural Competence is about being respectful and receptive towards the beliefs, practices, and needs of the diverse groups of the population being able to interact effectively with the different groups that composed our society.
  • Diversity is what makes us unique. Which aspects are included on diversity?
  • Race, color, religion, age, socio-economic status, sexual orientation, gender, identity, nationality, disability among others.

Resource: Us Department of Health and Human Services

What can you do to render a service with sensibility?

  • Respect diversity. Make others feels safe in a comfortable and open environment.
  • Treat others with courtesy.
  • Be inclusive, give equal services to all people without distinctions or discriminatory attitudes.
  • Listen carefully to all client’s needs, when they call or visit the office.
  • Give the extra mile when attending the person.
  • Don’t promise what you can’t accomplish.
  • Be creative so you can be able to offer a good service, by making sure that you follow the established policies and procedures.
  • Do not make assumptions about people's gender identity or sexual orientation.
  • Be flexible and non judgmental
  • Familiarize with LGBTT+ concepts
  • Do not make unnecessary questions, ask yourself before asking any questions if the requested information is important to provide health care services.
  • Keep in mind that different gender identity or sexual orientation expressions exist.
  • Do not demonstrate surprise or disapproval to an affiliate’s sexual orientation or gender identity.

Cultural Competency's Mission

  • When we create an environment free of discrimination, everything around us becomes more sensible and inclusive by making people feel more comfortable when asking for health care related services without any fear of being judged or rejected by others.
  • Health System One, complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Reporting

If a person believes that Health System One has failed to provide these services or discriminated in another way on the basis of race, color national origin, age, disability, or sex, you can file a grievance:

  1. Organization Compliance Hotline: 866-321-5550 (Toll-Free)
  2. File an anonymous report
  3. You can mail your report to: Marjorie Dorcely 2001 S. Andrews Avenue Fort Lauderdale, Florida 33316
  4. You can fax your report attention: Marjorie Dorcely (866)276-3667 (This is a dedicated Compliance line)
  5. You can email your report to: Compliance@healthsystemone.com

Any person can also file a civil rights complaint with the US Department of Health and Human Services, Office of Civil Rights electronically through the Office of Civil Rights Complaint Portal, available at:

  • https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
  • U.S. Department of Health and Human Services
    200 Independence Avenue SW
    Room 509F-HHH Building
    Washington, DC 20201,
  • 1-800-368-1019
  • 1-800-537-7697 (TDD).

References

  • Weinick, R.M., Zuvekas, S.H., Cohen, J.W. (2000). Racial and ethnic differences in access and use of health care services, 1977-1996. Medical Care Research and Review, 57 (supplement 1), 36-54.
  • United States Department of Health and Human Services, Agency for Healthcare Research and Quality. 2004 National Healthcare Disparities Report. Available online at http://qualitytools.ahrq.gov/disparitiesreport/documents/nhdr2004.pdf.
  • Brach, C. & Fraserirector, I. (2000).Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57 (supplement 1), 181-217.
  • Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda. (1999). Part I: Recommendations for National Standards: Office of Minority Health.
  • Ross, H. (2001). Office of Minority Health publishes final standards for cultural and linguisticcompetence: Office of Minority Health.
  • National Standards for Culturally and Linguistically Appropriate Services in Health Care. (2001, March). Retrieved May 15, 2005, from ttp:// www.omhrc.gov/omh/programs/ 2pgprograms/finalreport.pdf
  • Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care (Vol. 1). Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.
  • Saha, S., Taggart, S. H., Komarony, M., & Bindman, A. B. (2000). Do patients choose physicians
  • of their own race? Health Affairs, 19(4), 76-83.
  • State of New Jersey 211th Legislature. Senate No. 144 and Senate Substitute for Assembly No 492. Adopted March 29 2004. http:// njleg. state.nj.us/2004/Bills/ S0500/144_R2.htm. Accessed 11/21/2005
  • Health Resources and Services Administration (HRSA), American Public Human Services Association (APHSA). Bridging Cultures and Enhancing: Approaches to Cultural and Linguistic Competency in Managed Care. May 30 2002:1-3 http://www.hrsa.gov/financeMC/ bridgingcultures/. Accessed 11/30/2005.
  • Gilbert MJ, ed. Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals-2003. Available online at: http://www.calendow.org/reference/publications/cultural_competence.stm. Accessed 10/13/05.
  • Doutrich, Dawn and Marni Storey. “Education and Practice: Dynamic Partners for Improving Cultural Competence in Public Health.” Family Community Health, Vol. 27, No. 4, 2004, pp. 298-307.
  • Joseph R. Betancourt, A. R. (2002). Cultural Competence In Health Care: Emerging Frameworks And Practical Approaches. Field Report, 1-24.
  • http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/healthlittoolkit2-tool5.html
  • http://www.floridahealth.gov/about-the-department-of-health/_documents/state-health-improvement-plan.pdf
  • https://www.thinkculturalhealth.hhs.gov/pdfs/enhancednationalclasstandards.pdf
  • http://www.hrsa.gov/publichealth/healthliteracy/
  • http://www.helpguide.org/articles/emotional-health/emotional-intelligence-eq.htm
  • http://www.teachbacktraining.com/
  • http://www.iceforhealth.org/library/documents/ICE_C_L_Cultural_Competency_Provider_Training_Final(1).pdf
  • https://www.psychologytoday.com/basics/emotional-intelligence
  • http://www.talentsmart.com/about/emotional-intelligence.php
  • Gulliford, R. (2003). CDHS Research Foundation of SUNY BSC. Retrieved July 2016, from Emotional Intelligence: How Your Emotions Influence Your Life at Work and at Home: www.bsc-cdhs.org
  • http://healthvermont.gov/family/toolkit/tools%5CF-6%20Cultural%20Differences%20in%20Nonverbal%20Communic.pdf
  • https://www.mindtools.com/pages/article/cross-cultural-mistakes.htm
  • Triple-S, Inc. LGBTT+ Cultural Competence training

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Health, Safety, Wellness, Financial Exploitation, Abuse, Neglect, and Human Trafficking Training

(This is a text version of the presentation. Click Here for the print version)

What is Financial Exploitation?

The fraudulent or otherwise illegal, unauthorized, or improper act , that uses the resources of an elder for monetary or personal benefit, profit, or gain, or that results in depriving an elder the rightful access to, or use of, benefits, resources, belongings, or assets.

https://elder.findlaw.com/elder-abuse/elder-financial-abuse-and-exploitation.html

What is abuse

  • Non-accidental infliction of physical and/or emotional harm.
  • Sexual abuse upon a disabled adult or an elderly person by a relative, caregiver, household member or any other person.
  • Active encouragement of any person by a relative, caregiver or household member to commit an act that inflicts or could reasonably be expected to result in physical or psychological/emotional injury to a disabled adult or an elderly person.

Physical abuse

Physical abuse Infliction of physical pain or injury to an older person.

Physical abuse of patient Non-accidental use of force that results in bodily injury, pain or impairment, including, but not limited to, being slapped, burned, cut, bruised or improperly physically restrained.

Signs and Symptoms of Physical Abuse

  • Sprains, dislocations, fractures or broken bones.
  • Bruises, welts or discolorations
  • Burns from cigarettes, appliances or hot water.
  • Abrasions on arms, legs or torso that resemble rope or strap marks.
  • Cuts, lacerations or puncture wounds.
  • Fractures of long bones and ribs.
  • Internal injuries evidenced by pain, difficulty with normal functioning of organs and bleeding from body orifices.
  • A history of similar injuries and/or numerous or suspicious hospitalizations.
  • Injuries healing through secondary intention indicating that the member did not receive appropriate treatment
  • A history of member being brought to different medical facilities for treatment to prevent medical practitioners from observing patterns.
  • Delays between the onset of injury and seeking of medical care.
  • Signs of confinement (e.g., member is locked in his or her room).

Sexual Abuse

  • Includes unwanted touching, fondling, sexual threats, sexually inappropriate remarks or other sexual activity with an adult with disabilities.
  • Touching, fondling, sexual threats, sexually inappropriate remarks or other sexual activity with an older person when the older person is unable to understand, unwilling to consent, threatened or physically forced to engage in sexual activity.

Signs and Symptoms of Sexual Abuse

  • Bruises on external genitalia, inner thighs, abdomen or pelvis.
  • Difficulty walking or sitting not explained by other physical conditions.
  • Stained or bloody underclothing.
  • Sexually transmitted diseases.
  • Urinary tract infections.
  • Inappropriate sex role relationships between victims and suspects.
  • Inappropriate, unusual or aggressive sexual behavior.
  • Signs of psychological trauma, including excessive sleep, depression or fearfulness.

verbal or Emotional Abuse

Verbal abuse Includes, but is not limited to, name calling, intimidation, yelling and swearing. May also include ridicule, coercion and threats.

Emotional abuse Verbal assaults, threats of maltreatment, harassment or intimidation intended to coerce the older person to engage in conduct that he or she wishes and has a right to abstain from, or to refrain from conduct the older person wants to do and has a right to do.

Psychological Abuse

  • Berating, ignoring, ridiculing or cursing.
  • Threats of punishment or deprivation.
  • Significant weight loss or gain that cannot be attributed to other causes.
  • Stress-related conditions including elevated blood pressure.

Isolation by perpetrator:

  • Berating, ignoring, ridiculing or cursing.
  • Threats of punishment or deprivation.
  • Significant weight loss or gain that cannot be attributed to other causes.
  • Stress-related conditions including elevated blood pressure.

Neglect

Neglect: Repeated conduct or a single incident of carelessness that results or could reasonably be expected to result in serious physical or psychological/emotional injury or substantial risk of death.

Neglect of customer: The failure of another individual to provide an adult with disabilities with, or the willful withholding from an adult with disabilities of the necessities of life including, but not limited to, food, clothing, shelter or medical care.

Self-neglect: Individual neglects to attend to his/her own basic needs, such as personal hygiene, appropriate clothing, feeding or tending appropriately to medical conditions.

Passive neglect: A caregiver’s failure to provide an eligible adult with the necessities of life including, but not limited to, food, clothing, shelter or medical care. This definition does not create a new affirmative duty to provide support to eligible adults; nor shall it be construed to mean that an eligible adult is a victim of neglect because of health care services provided or not provided by licensed health care professionals.

Signs and symptoms of neglect

  • Weight loss that cannot be explained by other causes.
  • Lack of toileting that causes incontinence.
  • Member sits in own urine and feces.
  • Increased falls and agitation.
  • Indignity and skin breakdown.
  • Uncommon pressure ulcers.
  • Evidence of inadequate or inappropriate use of medication.
  • Personal hygiene is neglected; emotionally withdrawn.
  • Lack of assistance with eating, drinking, walking, bathing and participating in activities.
  • Little or no response to requests for personal assistance.

Exploitation

Exploitation is the act of a person who stands in a position of trust and confidence with a disabled adult or an elderly person and knowingly by deception, intimidation or force:

  • Obtains control over the person’s funds, assets or property.
  • Deprives the person of the use, benefit or possession of funds, assets or property. This intentional action can be temporary or permanent.
  • Uses the person’s funds, assets or property for the benefit of someone other than the disabled adult or elderly person.

Types of Exploitation

Exploitation of customer: The illegal use of assets or resources of an adult with disabilities. It includes, but is not limited to, misappropriation of assets or resources of the alleged victim by undue influence, by breach of fiduciary relationship, by fraud, deception, extortion or in a manner contrary to law.

Financial exploitation: The misuse or withholding of an older person’s resources by another person to the disadvantage of the older person or the profit or advantage of a person other than the older person.

Indicators of exploitation

  • Visitors ask the member to sign documents the member does not understand.
  • Unpaid bills,  Despite adequate financial resources, bills remain unpaid by the caregiver or other party.
  • Lack of affordable amenities for the member, such as personal grooming items or appropriate clothing.
  • New "best friends" who take an interest in the member’s finances.
  • Legal documents, such as powers of attorney, which the member did not understand at the time he/she signed them.
  • Unusual activity in the member’s bank accounts. Includes large, unexplained withdrawals, frequent transfers between accounts or other activity that the member cannot explain.
  • Caregiver expresses excessive interest in the amount of money being spent on the member.
  • Belongings or property are missing.
  • Suspicious signatures on checks or other documents. Includes signatures not matching the member’s. Includes signatures and other writing by a member who cannot write.
  • Absence of documentation about financial arrangements.
  • Implausible explanations about the member’s finances are given by the member or the caregiver.
  • Member is unaware of or does not understand financial arrangements that have been made for him/her.

Family and caregivers:

  • Do not provide an opportunity for the member to speak for himself/herself.
  • See others who could impact a member’s situation without the presence of the member.
  • Have an attitude of indifference or anger toward the member.
  • Blame the member for the member’s condition. For example, accusation that incontinence is a deliberate act.
  • Show aggressive behavior toward the member, Threaten, Insult, or Harass

Abandonment

Abandonment is defined as the desertion of a person by an individual who has assumed responsibility for providing care or has custody.

Signs and symptoms of abandonment

  • The desertion of a person in a hospital, nursing facility or other similar institution
  • The desertion of a person at a shopping center or other public location
  • Report of being abandoned

Increased risk factors or traits of Abuse

Likelihood of abuse, neglect or exploitation occurring increases for members in the presence of one or more risk factors. These include:

  • Dependency on others for personal care.
  • Dependency on others for financial management.
  • Isolation from information about own rights and health.
  • Diminished mental capacity.
  • Serious health problems.
  • Taking medications that affect cognitive status.
  • Depression, anxiety or fearfulness.
  • Recent losses, including the loss of a spouse, home or friend.

Increased risk factors or traits of Abuse

Problems and contributing factors exhibited by caregivers who are at risk to abuse, neglect or exploit include:

  • Alcoholism
  • Mental illness
  • Stress
  • Chronic fatigue
  • Frequent medical consultation
  • History of marital violence and/or child abuse
  • Previous relationship difficulties
  • Conflicting demands of other family members
  • Problems with housing, finances and/or employment
  • Lack of support; lack of respite
  • The presence of a single risk factor or caregiver contributing factor does not by itself indicate that abuse or neglect is occurring or is likely to occur. It may, however, indicate the need for measures to be taken to reduce the potential for abuse or neglect in the future.
  • Plan care managers, providers (including participant direct employees) and other staff having contact with members or caregivers should be trained to recognize the risk factors for abuse and neglect, including how and when to contact Adult Protective Services.

Human sex trafficking

Human sex trafficking: The recruitment, harboring, transportation, provision or obtaining of a person for a commercial sex act in which a commercial sex act is induced by force, fraud or coercion, or in which the person induced to perform such an act has not attained 18 years of age.

Physical signs of adult sex trafficking

  • Multiple or recurrent STIs
  • Abnormally high number of sexual partners
  • Trauma to vagina and/or rectum
  • Signs of physical trauma
  • Somatization symptoms (recurring headaches, abdominal pain, etc.)
  • Suspicious tattoos or branding

Behavioral Signs of adult sex trafficking

  • Depressed mood/flat affect
  • Anxiety/hypervigilance/panic attacks
  • Affect dysregulation/irritability
  • Frequent emergency care visits
  • Unexplained/conflicting stories
  • Using language from "the life"
  • Signs of drug or alcohol abuse

Labor trafficking

The recruitment, harboring, transportation, provision or obtaining of a person for labor or services through the use of force, fraud or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage or slavery.

Physical signs of Labor trafficking

  • Musculoskeletal and ergonomic injuries
  • Malnutrition/dehydration
  • Lack of routine screening and preventive care
  • Poor dental hygiene
  • Untreated skin infections/inflammations
  • Injuries or illness from exposure to harmful chemicals/unsafe water
  • Ophthalmology issues or vision complaints
  • Somatization

Behavioral Signs of Labor trafficking

  • Anxiety/panic attacks (for example, shortness of breath, chest pain)
  • Unexplained/conflicting stories
  • Overly vigilant or paranoid behavior
  • Inability/aversion to make decisions independent of employer
  • Inability/aversion to speak with out an interpreter
  • Affect dysregulation/irritability

Reporting Human trafficking

Mandated reporting warranted or the patient wishes to report

  • Report to designated contacts and/or contact the NHTRC Hotline 1-888-373-7888

Reporting not warranted and the patient does not wish to report

  • Provide referrals and contact the NHTRC Hotline (1-888-373-7888)

Prevention Steps

  • When a provider suspects there is a risk of abuse, neglect or exploitation, he/she should work with the Health Plan
  • The health plan determines if a member is at-risk for abuse or neglect, if the patient does not display signs or symptoms, the health plan will include in the plan-of-care specific interventions to reduce the member’s risk.

Prevention Steps (Cont.)

Interventions may be tailored to the member’s particular risk factor(s) and may include, one or more of the following:

  • Increased frequency of care coordination face-to-face visits to monitor for potential abuse, neglect or exploitation.
  • Education of the member on the types, risks factors, associated traits and symptoms of abuse, neglect and exploitation, as well as options for reporting abuse and neglect, including through the care manager or through support agencies, such as Adult Protective Services.
  • Alert the member’s providers, including home and community-based services providers, of the need for heightened vigilance and surveillance, and review of the procedures for notifying the care manager of suspected abuse or neglect.
  • Seek arrangements for respite for unpaid caregivers, to be provided for in the plan-of-care.
  • Increase informal social support for member through use of community activities or resources, e.g., senior centers, support group or worship attendance.
  • Refer member, family or caregiver to mental health/substance abuse treatment.
  • Refer member to social service agency if family resources are severely limited.

When identifying abuse situations, utilize these handle with care measures

Recognize risk factors of abuse, neglect and exploitation.

  • Potential risk
  • Signs and symptoms

Assess each situation

  • Presence of possible problems or factors that might contribute to tendencies.
  • Observation and inquiry (subject to privacy rights and level of cooperation).

Prevention

  • If risk is determined, include specific plan-of-care interventions to reduce risk.
  • Intervention
  • Reporting

Report of abuse, neglect or exploitation

Although the law requires all persons to report suspected abuse, neglect and/or exploitation, certain professionals have a specific responsibility to report. These include, but are not limited to:

  • Physicians, osteopaths, medical examiners, chiropractors, nurses or hospital personnel engaged in the admission, examination or care and treatment of elderly or disabled adults.
  • Health and mental health professionals not listed above.
  • Nursing home staff, adult-living facility staff, adult day-care-center staff, social worker, or other professional adult-care, residential or institutional staff.
  • State, county or municipal criminal justice employees or law enforcement officers.
  • Human Rights Advocacy Committee (HRAC) and Long-Term-Care Ombudsman Council (LTCOC) members.
  • Banks, savings and loan or credit union officers, trustees or employees.

Mandated Reporter

A mandated reporter is an individual who is required by law to

  • report situations immediately in which he/she suspects an adult may have been abused, neglected or exploited or is at risk of being abused, neglected or exploited.

Rights of mandated reporters

Most states allow for:

  • Immunity from civil and criminal liability unless the report was made in bad faith or with malicious intent.
  • Identity protection; your consent must be given to reveal your identify.
  • The court may order the identity of the reporter revealed. The court can then release confidential information without penalty.

General reporting requirements (states may differ)

  • Can you identify the person being abused? If known, provide address and/or location.
  • What is the approximate age of the adult?
  • Does an emergency exist?
  • Can you describe the circumstances of the alleged abuse, neglect or exploitation?
  • What are the names and relationships of other members of the adult household, if applicable?
  • Is the adult incapacitated?
  • Do you know the name and address of the caregiver if applicable?
  • Do you know the name and relationship of the alleged perpetrators?
  • Are there other people who may have knowledge of the adult?
  • Do you know the name of the adult’s physicians?
  • What is your name, address, phone number? (You can report anonymously.)

Important reporting processes

  • Provider must report any suspected abuse, neglect or exploitation to the appropriate state agency. Provider must also report suspected abuse, neglect or exploitation to the Health Plan.
  • The Health Plan will also report the suspected abuse, neglect or exploitation to the appropriate state agency.

Reporting Requirements Florida

  • Briefly consult on the appropriateness of a referral.
  • If the member is in immediate danger, dial 911 or local police.
  • Immediately contact the appropriate agency: Telephone: 1-800-96-ABUSE (1-800-962-2873), Press 2 to report suspected abuse, neglect or exploitation of the elderly or a vulnerable adult. Florida Abuse Hotline toll-free number is available 24/7.
  • TTY (Telephone Device for the Deaf): 1-800-453-5145
  • Fax a detailed written report with your name and contact telephone to:1-800-914-0004
  • Website: https://reportabuse.dcf.state.fl.us

Reporting

If you suspect Abuse, Neglect, Financial Exploitation, or Human Trafficking, please contact your manager.

References

  • Prevention and Detection of Financial Exploitation Special Investigations Unit- MCS Training Presentation
  • Humana Health, Safety and Welfare Education Training
  • Simply Abuse, neglect, exploitation and human trafficking provider training

Attestation

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