191. CCA Study Notes: Health Care Legislation and Client Rights

The Big Picture

People receiving health care have rights. Laws help protect those rights in facilities and community care.

These protections cover areas such as dignity, safety, privacy, consent, and personal choice. A person might have difficulty exercising these rights because of illness, injury, physical or mental challenges, confusion, frailty, or isolation.

Support workers need to respect client rights during everyday care. They also need to know the laws that apply where they work and follow employer policies about client rights.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Human Rights Laws

Each province and territory has its own Human Rights Act based on the Canadian Human Rights Act. The law applies within that province or territory.

These laws have two main purposes:

1. Prevent discrimination ⓘ.
2. Promote and advance human rights within the jurisdiction.

Issues addressed by provincial and territorial Human Rights Acts include:

• Indigenous rights
• Age discrimination
• Disability
• Employment
• Gender identity
• Hiring practices
• Housing
• Pregnancy and breastfeeding
• Racism
• Religious rights
• Sexual harassment
• Sexual orientation

Laws Protect People Receiving Health Services

Every province and territory has legislation dealing with the rights and freedoms of people who receive health care services.

The titles and details of these laws differ across Canada. Provincial and territorial governments also revise existing health care laws and introduce new ones.

Some clients have difficulty exercising their rights. Reasons identified in health care legislation include:

• Illness or injury
• Physical challenges
• Cognitive challenges ⓘ
• Mental challenges
• Frailty in old age
• Confusion
• Isolation

Acts, Regulations, and Standards

legislation is a body of laws governing the behaviour of a country’s residents.

An act is a specific law that has gone through the required legislative process.

regulations are detailed rules that put the requirements of an act into practice.

Health care acts often set broad requirements for health, safety, and well-being. Regulations then give more detailed rules for meeting those requirements.

For example, an act might set broad requirements for long-term care facilities. Its regulations then give detailed directions for areas covered by those requirements.

Areas Addressed by Complex-Care Legislation

Legislation in different provinces addresses issues such as:

• Bedroom space, furnishings, privacy, windows, and lighting
• Room and water temperatures
• Bathrooms and bathing facilities
• Fire safety, call systems, and other safety requirements
• Mobility and access
• Dining areas, lounges, recreation spaces, and outdoor activity areas
• Social activities and recreation programs
• Care, supervision, and care plans
• Confidentiality and privacy
• Neglect and abuse
• Restraint use
• Food preparation and service
• Medication safety, medication administration, and medication records
• Access to health services and oral health

Some provinces and territories use standards instead of detailed regulations. These standards expand on the legislation.

Live-in facilities must follow the rules that apply in their province or territory. Failure to follow them might result in the facility losing its licence.

Bills of Rights

A right is something a person is justly entitled to.

There is no single bill of rights covering every Canadian receiving care in a facility or community setting.

Some provinces have created bills of rights for clients. These bills summarize rights found in longer regulations and standards.

Some facilities and agencies also write their own bills of rights based on provincial or territorial laws. Clients must receive a written list of their rights.

Support workers must know the laws that apply in their province or territory and their employer’s policies about client rights.

An Example of Rights in Long-Term Care

British Columbia’s Residents’ Bill of Rights groups resident rights into several areas.

Individualized Care

An adult person in care has the right to a care plan developed specifically for that person.

The plan takes into account:

• Unique abilities
• Physical needs
• Social needs
• Emotional needs
• Cultural preferences
• Spiritual preferences

Health, Safety, and Dignity

An adult person in care has rights involving health, safety, and dignity.

These include the right:

• To receive care and live in an environment that promotes health, safety, and dignity
• To receive protection from abuse and neglect
• To have lifestyle choices respected and supported
• To pursue social, cultural, religious, spiritual, and other interests
• To have personal privacy respected
• To have privacy involving records, the bedroom, belongings, and storage spaces
• To receive visitors
• To communicate privately with visitors
• To keep and display personal belongings, pictures, and furnishings in the bedroom

Participation and Freedom of Expression

The person has the right to participate in their own care and express their views.

These rights include:

• Taking part in developing and putting the care plan into practice
• Establishing or participating in a resident or family council
• Having family members or representatives participate in a council
• Having access to a fair process for concerns, complaints, and disputes within the facility
• Receiving information about making a complaint to an authority outside the facility
• Having a family member or representative exercise these rights on the person’s behalf

Transparency and Accountability

The person also has rights involving information about the facility and its services.

These include ready access to:

• Laws, rules, and policies affecting services
• The most recent routine inspection record
• Information about charges and fees before payment
• Written refund terms and conditions when accommodation or services are prepaid

The person’s family or representative also has the right to receive information about these matters.

Scope of These Rights

The rights involving health, safety, dignity, participation, expression, transparency, and accountability are subject to:

• What is reasonably practical given the person’s physical, mental, and emotional circumstances
• The need to protect and promote the health or safety of the person or another person in care
• The rights of other people receiving care

A Pictographic Bill of Rights

The Aphasia Institute of Ontario introduced a pictographic ⓘ version of the Ontario Residents’ Bill of Rights in 2005.

In live-in facilities, the pictographic version must be posted near the written version. It supports communication with people who retain thinking and social abilities but have difficulty speaking, understanding speech, reading, or writing.

Five Major Client Rights

Client rights combine moral and legal rights.

Clients generally have the right:

1. To receive dignity and respect.
2. To receive protection from harassment, belittling, threats, and verbal or physical harm from workers, family members, or other clients.
3. To have privacy and confidentiality in verbal, written, and electronic information.
4. To give or withhold informed consent.
5. To have autonomy.

The Right to Dignity and Respect

Dignity is both an ethical principle and a legal obligation throughout Canada.

Dignity also forms part of DIPPS:

• Dignity
• Independence
• Individualized care
• Preferences
• Privacy
• Safety

Respecting dignity means treating clients respectfully and recognizing them as individuals.

Dignity and Independence Go Together

Supporting independence helps protect dignity.

Allow clients to do as much for themselves as possible. Doing a task for a person because it is faster might reduce an opportunity for independence.

A client who is able to put on their own shoes should have the opportunity to do so.

Do Not Assume What a Client Is Able to Do

A client who needs help in one area is not automatically dependent in every area.

Observe what the client is able to do and check the care plan.

For example:

• A person who needs help getting out of a chair might still feed themselves.
• A person who needs help shaving might still comb their hair and brush their teeth.
• A person might walk independently but need a secure environment because they wander.

Avoid assumptions about clients’ abilities, interests, and limitations. Assumptions might discourage a person from doing activities they are still able to perform.

Respectful Communication

How you relate to a client forms an important part of care.

To respect dignity:

• Make eye contact when culturally appropriate and listen attentively.
• Sit or stand close when appropriate.
• Use touch only when you are sure the client approves.
• Respect cultural differences involving touch and personal space.
• Be patient.
• Give kind and thoughtful care.
• Say please and thank you.
• Never yell at, scold, embarrass, laugh at, or use sarcasm toward a client.
• Keep hearing or vision limitations in mind when speaking with the person.
• Address an adult client by title and last name unless the client asks for another form of address.
• Never use names such as honey, sweetie, dear, grandma, or grandpa for a client.

Respect Belongings and Personal Property

Do not handle a client’s personal possessions without a reason and permission.

When you do handle an item, return it to where you found it.

Respect for property supports the client’s dignity and personal space.

Support Independence

Allow clients to do things for themselves when they are able. Avoid creating unnecessary dependence.

Give the client personal care and grooming help whenever it is needed. Make sure the client has:

• A neat and clean appearance
• A clean-shaven face or groomed beard
• Trimmed and clean nails
• Dentures, hearing aids, glasses, and other prostheses
• Clean, properly fitted, and fastened clothing
• Properly applied and fastened shoes, socks, or hose
• Extra clothing for warmth, such as a sweater or lap blanket

Report Client Concerns

Report: Tell your supervisor about a client’s complaints or concerns involving the agency, facility, or services.

The Right to Privacy and Confidentiality

People receiving health care have a right to personal privacy.

Care should take place privately without unnecessary exposure of the person’s body. Only staff members involved in the client’s care should see, handle, or examine the client’s body.

Information about a client’s care, treatment, and condition is confidential.

Privacy Laws and Confidential Information

Every province and territory has legislation protecting the privacy and confidentiality of health information.

These privacy laws provide guidance to facilities and agencies about collecting, using, and disclosing personal health information.

Most agencies require all staff members, and usually volunteers and students, to sign an oath of confidentiality. This oath is a promise to protect private information about clients, families, and the agency.

When unsure: Follow your employer’s policies before discussing something you saw involving a client.

Electronic Devices Used for Client Information

Some home care agencies use camera phones, tablets, or smartphones to document client information, such as changes in a wound or the presence of bruising.

Workers must follow agency policies involving:

• Client privacy
• Sending client information
• Disposing of the information after sending it
• Preventing unauthorized release of information

Most agencies provide their own camera smartphones for this work. These devices have social media access blocked and must be returned after the worker’s shift.

Protect Privacy During Care

Respect for privacy includes everyday actions.

• Knock on the client’s door and wait for permission before entering.
• Ask other people to leave the room before providing care unless the client gives them permission to stay.
• Close the door during care.
• Use curtains or screens during care or when the client requests them.
• Close drapes and window shades.
• Drape the client properly.
• Expose only the body part involved in the treatment or procedure.
• Keep the client covered while moving through corridors and elevators.
• Close the bathroom door while the client uses the bathroom.
• If the client needs help in the bathroom, remain with the client and keep the door closed.
• Do not open or read the client’s mail or personal documents.
• Do not touch or examine belongings without permission.
• Give clients privacy when visiting others or using the telephone.
• Do not pry into private matters.
• Do not ask for personal information that your work does not require.
• Keep personal and health information confidential.
• Never post client or agency information or images on social media.
• Discuss a client only with your supervisor and health care team members who need the information.
• Do not discuss clients with your family, friends, or the client’s family.

Electronic Privacy

electronic privacy means a person’s right to keep their image, words, character description, and comments about their reputation from being made public electronically.

Electronic communication does not remove a person’s right to privacy.

Posting pictures, names, or discussions about clients on social media is ethically wrong and legally wrong in most provinces, even when the worker believes the post is positive.

The Right to Give or Withhold Consent

consent means agreement or approval.

People have the right to decide whether they agree to:

• Medical treatment
• Health care
• Personal care services

Provincial and territorial legislation describes when and how consent is obtained.

What Makes Consent Informed?

Valid consent must be informed consent.

Informed consent means the person first receives complete, accurate, and relevant information so they understand the action or procedure and its possible implications.

The facility, agency, or physician provides the required information.

For consent to be informed, the client needs to understand:

1. Why the treatment or service is being proposed.
2. What will happen.
3. How it will happen.
4. Who will perform it.
5. The expected outcomes.
6. Potential risks and side effects.
7. Other treatment options.
8. The likely consequences of refusing the treatment.

General and Special Consent

When a client enters a facility or hires an agency, the client signs a form giving general consent to treatment.

Surgery and other complex or invasive procedures require special consent forms.

The physician is responsible for giving the client information about the surgery or procedure.

The Support Worker’s Role With Consent

Role limit: A support worker is never responsible for obtaining written consent or providing medical information.

Employer policy determines whether a support worker is permitted to witness a client’s signature on a consent form.

Know and follow your employer’s policy regarding consent forms.

Advance Directives

An advance directive, also called an advance care directive, is a legal document stating a person’s decisions about future health care, treatment, and personal care.

An advance directive is a legal document, but it is not legally enforceable.

It allows a person to communicate choices about end-of-life care while living at home or in a live-in facility.

The document is signed ahead of time. It is usually completed as part of advance care planning with the client, next of kin ⓘ, and the agency’s director of care or administrator. The next of kin is usually the substitute decision maker for health care. A substitute decision maker for personal care may, but does not have to, set out the person’s wishes about care and treatment.

Advance directive documents and the rules governing them differ between provinces.

What an Advance Directive Addresses

An advance directive gives clients a way to communicate their wishes to family, friends, and health care providers before a time when they are less cognitively aware of their surroundings.

A person has the option to state whether they wish to accept or refuse medical care under certain circumstances.

Topics addressed in an advance directive include:

• Dialysis and breathing machines
• Resuscitation ⓘ if breathing or heartbeat stops
• Tube feeding
• Organ or tissue donation

Living Wills

A living will describes a person’s preferences about care intended to sustain life and reflects the person’s wishes when the document was created and signed.

The term originated in the United States.

Sorrentino uses advance directive as the usual Canadian term. A living will has no legal status in Canada and is not legally enforceable.

A living will still gives family members information about the person’s wishes and encourages decisions that respect those wishes.

When Someone Else Gives Consent

Clients younger than the legal age, usually 18 years, and clients who are unable to make informed decisions need another person to give consent on their behalf.

The generally accepted Canadian term is substitute decision maker. Titles differ between provinces.

Substitute Decision Maker for Health Care

A substitute decision maker for health care is a person authorized to make health care decisions for a living person who is unable to make those decisions.

Depending on the province, this person might also be called:

• A proxy
• A power of attorney for personal care

People with certain mental illnesses, confusion, dementia, or intellectual disabilities might be unable to give informed consent. An unconscious client also cannot give consent for a procedure.

The substitute decision maker then makes health care decisions, including giving or withholding consent for treatment.

The substitute decision maker is often:

• A spouse
• A daughter
• A son
• A legal representative

Consent from a substitute decision maker must still be informed consent.

The substitute decision maker consults with the health care team when making decisions on the client’s behalf.

All provinces and territories have legislation addressing substitute decision making.

Substitute Decision Maker for Property

A substitute decision maker for property represents the interests of a person who is unable to make decisions about their belongings.

The client might have selected this person earlier. If no property substitute decision maker exists, a provincial or territorial court might appoint someone.

A court-appointed person is legally required to act in the client’s best interests.

A substitute decision maker for property does not have authority to make personal care decisions unless a separate document also identifies that person as the substitute decision maker for personal care.

Estate Trustees and Wills

A generally accepted Canadian term for a person acting on behalf of a client concerning property is estate trustee or guardian of property.

A will is a legal document stating a person’s wishes about where or to whom their property should go.

A will should be written while the person is cognitively intact ⓘ, witnessed by a lawyer, and kept in the lawyer’s office. Some people keep additional copies in secure, fireproof places.

Decisions After a Client Dies

After a client’s death, a substitute decision maker for health care or property does not automatically decide what happens to the person’s body.

Decisions involving release of the body for funeral preparations or burial fall to:

• The estate trustee named in the will
• The deceased person’s spouse
• The deceased person’s adult children
• A court-appointed administrator when conflicts exist

If a person dies without a will, the provincial or territorial court appoints an administrator to divide the person’s property.

In most provinces and territories, an estate trustee is also known as an executor when the person is a man or an executrix when the person is a woman.

The Right to Autonomy

Autonomy, also called self-determination, means having freedom and choice over decisions that affect one’s life.

People receiving health care have the right to make decisions involving their care and lifestyle.

Clients have the right to participate in matters involving:

• Admission to a facility
• Discharge from a facility
• Transfer to or from a facility
• Assessment of their care
• Planning their care and treatment

These participation rights apply to people receiving care in live-in facilities and at home.

Common Mix-Ups

Wrong Idea	Better Idea
An act and regulations mean the same thing.	An act is a law. regulations give detailed rules for carrying out the act.
Needing help in one area means the client is dependent in every area.	A client might need help with one task while remaining independent with another.
A living will has the same legal status as an advance directive in Canada.	An advance directive is a legal document. A living will has no legal status in Canada.
A property decision maker automatically makes health care decisions.	A substitute decision maker for property needs separate authority to make personal care decisions.
The support worker explains medical information and obtains written consent.	The support worker never obtains written consent or provides medical information.