Patients keep their rights at home. Learn respect for the person and their things, choices and refusals, privacy, complaints and safety.
ForHome health, Hospice staff
TimeAbout 69–77 minutes
Lessons10, each with a quick check
FinishA quiz (80% to pass) and a printable certificate of completion
What you will learn
Explain that patients keep their rights at home, and the agency must protect them.
Treat each patient and their belongings with respect.
Explain that patients take part in planning their care.
Follow the written care instructions from your RN.
Keep patient information confidential.
Know that patients have the right to complain without reprisal.
Name the kinds of abuse, neglect and theft in your own words.
Explain that hospice patients have a right to good pain and symptom control.
Respect a hospice patient's choices, including their doctor.
Know patients must be told about costs and changes in care.
Written by Pact Compliance from federal rules and CDC, CMS, OSHA and NIH guidance (sources under each lesson), checked October 2026. Where your facility's policy is different, follow your facility's policy.
Lesson 1: Rights in the Patient's Home
In this lesson you will:
Explain that patients keep their rights at home, and the agency must protect them.
Know that rights are explained out loud and in writing, in a way the patient understands.
Know who may act for a patient, and when to ask your nurse.
Their home
You are a guest
In home health and hospice, you work in the patient's home. That changes things. It is their house, their rules, and their life. You are a guest there, even while you work. Federal rules say patients have the right to be told about their rights. The agency must protect those rights. It must also help patients use them. On every visit, that job is partly yours.
Why you train
Honor their rights
Aide training must cover respect for the patient, their privacy, and their things. In home health, the nurse who supervises you must check that you honor patient rights. In hospice, the nurse checks how you follow the care plan and how you get along with the patient and family. So rights are not just paperwork. They show up in how you act in the home.
Told out loud
And in writing
At the first visit, before care starts, the agency must give the patient a written notice of rights. Hospice must also explain the rights out loud. The notice must be in a language and a way the patient understands. The patient signs to show they got a copy. CMS says 'before care' means before any hands-on care. Usually the nurse does this visit, not the aide.
Show the answer
Thank him, and tell your nurse so the agency can get free language help. Home health language services must be free to the patient. A trained interpreter is the better choice.
Their language
Free help
In home health, language help and aids for people with disabilities must be free to the patient. That includes interpreters and written translations. CMS hospice guidance says to use a trained, fair interpreter. Family and friends should interpret only if no interpreter can be found, or if the patient asks. So do not make a child the interpreter for care talks. If a patient does not seem to understand, tell your nurse.
Who decides?
Ask your nurse
Some patients have someone who acts for them. If a court has found the patient cannot make health choices, the person the court named may act for them. Even then, the patient can still use their rights as far as the court order allows. CMS hospice guidance gives an example. A person may have power over money, but not over health care. So do not assume family decides everything. If you are not sure who decides, ask your nurse.
The rights folder
Help them find it
The patient keeps the rights notice in the home. In home health, the patient also gets the administrator's name, address, and phone, for complaints. CMS surveyors may look at these papers in the home. They may ask patients if they were told their rights. If a patient asks you about a right, you do not have to know every answer. Help them find the folder, or call your nurse. Do not guess.
On your shift
Guest manners
Here is a first visit. You knock and wait. Mrs. Owens opens the door. You say your name and your agency, and show your badge. You ask where she would like you to put your bag. You ask before you go into her bedroom. You ask how she likes things done. Nothing here is hard. But it tells her that her home and her person will be treated with respect.
Quick review
Rights at home
Let's review. You are a guest in the patient's home. The agency must protect patients' rights and help them use them. You are part of that. Rights are given in writing, and in hospice out loud too, in a way the patient understands. Language help is free in home health. Someone may act for a patient only as far as their authority goes. When a patient asks about rights, help them find their folder, or call your nurse.
Your facility's policy (ask your supervisor):
How staff request an interpreter or language line for a patient
Your steps when no one answers the door at a scheduled visit
Treat each patient and their belongings with respect.
Respect the patient's schedule and home customs.
Know what to do if something is lost or broken.
Person and property
A right
Home health and hospice patients have the right to have their property and their person treated with respect. Their person means them: their body, their feelings, their choices. Their property means their things: the house, the yard, the car, the furniture, the photos on the wall. In a home, almost everything you touch belongs to the patient or their family.
Their things
Inside and outside
CMS home health guidance says the agency must make sure staff do not steal, damage, or misplace a patient's things. That covers things inside and outside the home. So handle things with care. Ask before you move something. Put things back where you found them. Do not use the patient's phone, food, or car unless they offer and your agency allows it.
If it breaks
Be honest
Accidents happen. You may chip a cup or knock over a lamp. Tell the patient right away, and tell your agency. Be honest about what happened. If something goes missing, tell your agency too. Do not search the house or blame anyone. Missing money or things can be a sign of theft. That has its own reporting steps, in lesson 7 and in the abuse course.
Show the answer
Follow your agency's steps so the patient is told about the change quickly. CMS says patients should be told promptly when their visit schedule changes.
An active partner
Their schedule
CMS says the patient must be treated as an active partner in care. The agency should set the visit schedule to suit the patient, not the staff. It must tell the patient the schedule, and let them know quickly when it changes. So if you are running late or need to change a visit, follow your agency's steps to tell the patient. Do not just skip a visit or show up whenever.
Home customs
Ask and adjust
Every home has its own ways. One family takes shoes off at the door. Another has a prayer time, a pet, or a room no one enters. CMS says the agency must consider patient requests and meet them within the care plan. So ask, and adjust when it is safe. You might wear shoe covers. If a home rule would make care unsafe, do not argue. Tell your nurse so the team can find a plan.
Small things
Big respect
Respect is in small things. Call the patient by the name they like. Say what you are going to do before you touch them. Talk to the patient, not over them to a family member. Keep your phone away during care. Do not talk about your own problems. NIA says to never talk about a person with dementia as if they are not there. That is good advice for every patient.
On your shift
Two visits
Picture two aides. The first walks in, drops a bag on the table, and says, 'OK, let's get this bath done.' The second knocks, waits, and says, 'Good morning, Mr. Hall. Where would you like me to set my things? Is now a good time for your bath?' Both give a bath. Only one treats his home and his person with respect. Be the second aide, every time.
Quick review
Respect daily
Let's review. Patients have the right to respect for their person and their property. Do not damage, lose, or take their things, inside or outside the home. Put things back. If something breaks, be honest and tell your agency. If something goes missing, report it. Visits should suit the patient, and they should hear about changes quickly. Ask about home customs, and adjust when it is safe.
Explain that patients take part in planning their care.
Respect a patient's right to refuse care.
Report refusals to the nurse and chart what really happened.
Their care
Their say
Patients have the right to take part in their care. In home health, they take part in, and are told about, their plan of care, who will visit, how often, and what the goals are. They agree to or refuse care before it starts and while it goes on. In hospice, patients have the right to help make their plan of care. The hospice builds it with the patient and the main caregiver, if they want to take part.
Real choices
Bath or shower?
CMS explains what taking part means. The patient is given options about their care. One example is letting the patient choose a bath or a shower, unless there is a medical reason they cannot. Agreeing to care is not a one-time form. It goes on as care changes. You can offer choices too. Which shirt? Now or after breakfast? Bath first, or hair first?
Right to refuse
Even needed care
Patients have the right to refuse care or treatment. CMS home health guidance says refusing services is the patient's right. That can be hard when you think the care would help. But the choice is theirs. Never force care. Forcing care goes against the patient's right to refuse. CMS also lists threats of punishment as mental abuse.
Show the answer
Ask gently why, and offer another choice or time. The reason may be easy to fix. If he still says no, respect it and tell your nurse.
Ask why
Offer another way
A 'no' is a chance to learn. Ask gently, 'Can you tell me why?' Then listen. Maybe the water was cold last time. Maybe they are in pain, tired, or embarrassed. You might fix the reason. Offer a choice, like a sponge bath instead, or another time. NIA says bathing can feel scary or embarrassing for a person with dementia. For them, try again later. The answer may change.
Tell the RN
Every time
If the patient still says no, respect it. Do not argue. Then tell your nurse. Aides must report changes in the patient's condition or needs to the RN. A refusal can matter for health. The nurse may need to call the doctor or change the plan. CMS says it is the agency's job to explain the risks of refusing. That is the nurse's talk, not yours.
Chart the truth
Refused means refused
Write down what really happened. Home health records must be accurate. Hospice records must contain correct information. If the patient refused a bath, chart that they refused. Do not chart that care was done. Write what they said and what you offered. Follow your agency's steps. True notes help the team respect the patient's choice and keep them safe.
No pressure
No threats
Respecting a 'no' means no pressure. Do not say, 'If you don't eat, you'll end up in the hospital.' Do not keep coming back again and again to wear the person down. In hospice, this matters at mealtimes. NIA says not to force a dying person to eat. Losing appetite is a common, normal part of dying. Offer small amounts of favorite foods. Tell your nurse what you see.
Quick review
Respect the no
Let's review. Patients take part in their care plan and their daily care choices. They have the right to refuse care. Never force care, and never use threats or pressure. When a patient says no, ask why, offer another choice or time, and listen. If they still say no, respect it, tell your nurse, and chart what really happened. The nurse talks with the patient about risks.
Lesson 4: Your Care Plan: What You Can and Cannot Do
In this lesson you will:
Follow the written care instructions from your RN.
Know which tasks are part of an aide's job.
Send questions and new requests to your RN.
Written instructions
From your RN
In home health, a registered nurse or a therapist assigns you to each patient. They write care instructions for you. In hospice, an RN on the hospice team assigns you. The RN who supervises you writes your instructions. These instructions are your map for the visit. Read them before every visit. If something is not clear, ask before you start.
Only what's ordered
In the plan
An aide's services must meet four tests. They must be ordered. They must be in the plan of care. They must be allowed by your state's law. And they must fit the training you had as an aide. If a task does not meet all four, it is not yours to do. This protects the patient. It protects you too.
Your duties
Hands-on care
The rules list what aides do. Hands-on personal care, like bathing and dressing. Simple procedures that extend nursing or therapy care. Help with walking or exercises. And help with medicines the patient normally takes on their own, only if your plan says so. In hospice, aides may also do household tasks in the parts of the home the patient uses. That means things like changing bed linens, light cleaning, and laundry for the patient's comfort.
Show the answer
Say kindly it is not on your plan, and call your nurse about it. Aide tasks must be in the plan of care. The RN can decide if the plan should change.
All planned care
Every task
Home health patients have the right to receive all the services in their plan of care. In hospice, care must be given as the plan says. So do every task on your list, unless the patient refuses. If you cannot finish a task, maybe because supplies ran out or the patient said no, tell your nurse. Chart what you did and what you did not do.
Asked to do more?
Call your RN
Patients and families will ask for things that are not on your plan. Maybe they ask you to change a dressing, move him alone when the plan says two people, or clean the whole house. Be kind, and say, 'That's not on my plan, but I'll call my nurse.' CMS says the agency should meet patient requests within the plan of care. The RN can decide whether to change the plan.
Care questions
Send to the RN
Patients have the right to be told about their care. That includes how often visits happen, what the goals are, and any changes. Home health patients get written instructions. They include the visit schedule, the medicine schedule, treatments, and the name and phone of the clinical manager. If a patient asks, 'Why did my medicine change?' or 'How long will you keep coming?', do not guess. Tell them you will ask the nurse. Then do it.
Report changes
You're on the team
Home health aides are members of the care team. You must report changes in the patient's condition to the RN. Hospice aides must report changes in the patient's medical, nursing, therapy, and social needs. You must also complete your records the way your agency says. You see the patient often. What you notice and report helps the whole team keep the plan right.
Quick review
Know your plan
Let's review. Your RN gives you written care instructions. Read them every visit. Aide tasks must be ordered, in the plan, allowed by state law, and part of your training. Give all the care in the plan. If you cannot, tell your nurse and chart it. When asked to do more, or asked a care question you cannot answer, call your RN. Report changes, and keep your records complete.
Your facility's policy (ask your supervisor):
How aides reach the RN during a visit, and after hours
Where aides find the written care instructions (paper or app)
Lesson 5: Privacy and Confidential Records in the Home
In this lesson you will:
Keep patient information confidential.
Protect papers and devices that hold patient information.
Protect privacy during personal care in the home.
Confidential record
A right
Home health and hospice patients have the right to a confidential clinical record. Who can see it, and who can get information from it, is set by the federal privacy rules, often called HIPAA. CMS says these rules also give patients rights, like seeing and getting a copy of their records. Your part is simple. Keep what you know about the patient private.
Safe from loss
Safe from misuse
The rules say the record, and the information in it, must be kept safe from loss and from use by the wrong people. CMS hospice guidance says that covers paper records and electronic ones. They must be guarded from being shared without the patient's permission. So patient information is not yours to share, even in small ways.
Show the answer
Put it in a closed folder out of sight, and lock the car. Patient information must be kept safe from loss and from use by the wrong people.
On the road
Papers and phones
CMS says home health has special risks. Staff carry papers and devices with patient information from home to home. So keep papers in a closed folder, out of sight in your car. Lock your phone or tablet. Do not share your password. Do not leave one patient's papers at another patient's home. If a device or paper goes missing, tell your agency right away.
Neighbors ask
Keep it private
In a small town, people know your car. A neighbor may ask, 'How's Mr. Lee doing? Is he dying?' Do not share anything about the patient. You could say, 'I can't talk about that, but thanks for asking.' The same goes for your own family and friends. Talk about patients only with the care team, and only what they need for care.
Family and callers
Check first
Not every relative has the right to the patient's information. A cousin may call and ask about test results. A daughter may ask what her mother told you. Do not assume. Ask your nurse who the patient allows to get information. Then send the caller to the nurse. That keeps the patient in control of their own story.
No photos
No posts
Never take photos or videos of a patient or their home for yourself. Never post about a patient, even without a name. People can often tell who it is. CMS says abuse can include abuse done through technology. A photo or post that shames a patient can be abuse. If you see a coworker post about a patient, report it.
Private care
Close the door
Privacy also means the body. Homes can be busy, with family, visitors, and open doors. Before personal care, close the door or curtain. Ask the patient if they want others to step out. Keep the patient covered as much as you can. NIA suggests a towel over the body during a bath. Say what you are going to do before you do it.
Quick review
Keep it private
Let's review. Patients have the right to a confidential record. Keep patient information safe from loss and from the wrong people, on paper and on devices. Do not share patient news with neighbors, friends, or relatives. Send callers to the nurse. No photos and no posts. During care, close the door, keep the patient covered, and ask who they want in the room.
Your facility's policy (ask your supervisor):
Your agency's rules for carrying papers and devices, and who to call if one is lost
Know that patients have the right to complain without reprisal.
Pass on complaints made to you.
Know where patients can take complaints.
Right to complain
About any care
Patients have the right to complain about their care. That includes care that was given, and care that should have been given but was not. They can also complain about anyone from the agency who does not respect them or their things. In hospice, this is called voicing a grievance. A complaint is not an attack. It is a patient using a right.
No reprisal
Same good care
Patients must be free from reprisal for using their rights or for complaining. Reprisal means getting back at someone. CMS home health guidance says reprisal is treating a patient differently after a complaint, with no medical reason. Examples are cutting services, stopping services, or discharge. CMS hospice guidance says the hospice must not treat a patient or family differently, or retaliate, for using their rights.
Your part
No cold shoulder
Reprisal can be small. Coming late on purpose. Rushing care. Being cold. Saying, 'I heard you complained about me.' None of that is OK. After a complaint, give the same kind, on-time care as before. If a patient complains about you, stay calm. Tell your supervisor. Let the agency look into it. Do not bring it up with the patient.
Show the answer
Thank her, tell her she has the right to complain, and pass it on per your hospice's steps. A complaint made to any hospice worker counts, and she must be free from reprisal.
Told to you
It still counts
CMS hospice guidance says a grievance can be formal or informal, spoken or written. It counts when it is made to any hospice worker. That includes aides, volunteers, and contract staff. In home health, the agency must look into complaints from patients, their representatives, caregivers, and family. So when a patient complains to you, it counts. Listen. Thank them. Pass it on the way your agency says.
Where to go
Numbers they get
Patients get the information they need to complain. Home health patients get the administrator's name, address, and phone. They are also told about the state's free home health hotline, its hours, and that it takes complaints or questions about home health agencies. CMS hospice guidance says hospices should give patients and families clear steps for filing a complaint. If a patient asks how to complain, help them find this in their folder. Never talk them out of it.
The agency acts
Protects the patient
In home health, the agency must look into each complaint. It must write down the complaint and how it was solved. While it looks into a complaint, it must act to stop more harm, including reprisal. CMS says complaint reviews should feed into the agency's quality program. So complaints help. They show where care can get better.
Abuse is different
Report right away
Some complaints are more than a complaint. If a patient says someone hit them, yelled at them, touched them sexually, neglected them, or took their things, report it right away. The same goes for an injury no one can explain. Do not wait for a complaint process. Home health and hospice staff must report these immediately. Lesson 7 covers this. So does lesson 9 of the abuse course.
Quick review
Welcome complaints
Let's review. Patients have the right to complain about their care and how they are treated. There must be no reprisal. Give the same good care after a complaint. A complaint made to you counts. Listen, thank them, and pass it on. Help patients find their complaint contacts, including the state hotline in home health. If a complaint is about abuse, neglect, theft, or an unexplained injury, report it right away.
Your facility's policy (ask your supervisor):
Your agency's complaint (grievance) process and who staff pass complaints to
Home health: your state's toll-free home health hotline number and hours
Name the kinds of abuse, neglect and theft in your own words.
Know what 'immediately' means for your report.
Know your reporting duty is your own.
Free from abuse
Every patient
Home health and hospice patients have the right to be free from verbal, mental, sexual, and physical abuse. They also have the right to be free from neglect, from theft or misuse of their things, and from injuries of unknown source. Hospice rules add mistreatment. CMS home health guidance says this means abuse by agency staff and by others in the home. This lesson explains what each kind means.
Words can harm
Verbal and mental
CMS says verbal abuse is insulting, mean, or disrespectful words or gestures toward the patient. It can be spoken or written. Hospice guidance says it counts even if the patient cannot understand. Mental abuse includes shaming, harassing, and threats of punishment or of taking things away. CMS gives an example: living in fear in your own home. Abuse can also happen through technology, like a phone or social media.
Body harm
Sexual harm
Physical abuse means doing something to cause pain or harm. CMS lists hitting, slapping, punching, kicking, and pinching. It also includes physical punishment. Sexual abuse is any sexual act the patient did not agree to, or could not agree to because of their mental state. Hospice guidance says sexual abuse includes sexual harassment. No reason makes any of this OK.
Show the answer
An injury of unknown source, which you must report right away. No one saw it, she cannot explain it, and it is in an odd place. Report it immediately.
Neglect and theft
Unknown injuries
Neglect means not giving the goods or services a person needs to avoid harm or distress. Misappropriation means theft. Hospice guidance says it also covers using a patient's money or things without consent, or misplacing them on purpose. An injury of unknown source is one no one saw happen, and the patient cannot explain. Hospice guidance adds that it seems suspicious, like a bruise in an odd place, or many injuries.
Report immediately
Do not wait
If you see or learn of any of these, you must report it immediately. In home health, report to your agency, and to other authorities as your state's law says. CMS says immediately means without delay, as soon as you can. In hospice, report to the hospice administrator. CMS hospice guidance says no later than 24 hours, unless your state sets a shorter time. That is a limit, not a waiting period. Report now.
Your duty
Yours alone
CMS says many states have laws that make health workers report abuse and neglect. CMS also says that what your agency does, or does not do, does not stop you from making your own report. So if you told your supervisor and nothing happened, you can still report as state law allows. For step-by-step reporting, including 911 and adult protective services, see lessons 9 and 10 of the abuse course.
After you report
Patient protected
The agency must look into the report and act to stop more harm while it does. Hospice must do this right away. In home health, that includes stopping reprisal. CMS home health guidance says the agency should take a staff member off patient care right away if they are accused of abuse or theft. You may be asked what you saw. Tell the truth. Do not talk about the report with the person accused.
Quick review
Know it, report it
Let's review. Patients have the right to be free from verbal, mental, sexual, and physical abuse, neglect, theft, and unexplained injuries. Abuse can be words, threats, force, unwanted sexual contact, or posts online. Report immediately. In home health, that means without delay. In hospice, as soon as possible and never more than 24 hours. Your duty is your own. And after you report, tell the truth if asked.
Your facility's policy (ask your supervisor):
Who staff report to, with a 24/7 phone number (home health: agency; hospice: administrator or the designee in your policy)
Your state's mandatory reporting law and agency (for example, adult protective services)
Explain that hospice patients have a right to good pain and symptom control.
Notice signs of pain and other discomfort.
Report pain and symptoms to the RN right away.
Comfort is a right
Pain and symptoms
Hospice patients have the right to good pain control and symptom control for conditions related to their terminal illness. The hospice plan of care must include ways to manage pain and symptoms. Comfort is not an extra in hospice. It is the main goal. As an aide, you spend a lot of time with the patient. You are often the first to notice pain.
No long waits
Day and night
CMS hospice guidance says pain and symptoms must be managed in a timely way. Patients should not have to wait a long time for help, medicine, or care. The hospice must be able to control pain and other upsetting symptoms 24 hours a day, 7 days a week, wherever the patient lives. So when you see pain, do not wait for the nurse's next visit. Report it now.
Show the answer
Tell your nurse now about what you see. Moaning and poor sleep can be clues to pain. Hospice pain should be handled without long waits.
Watch for clues
Signs of pain
NIA says not everyone who is dying has pain. But knowing how much pain a person has can be hard. Watch for clues. Trouble sleeping. More restless or upset. Crying. Severe pain can also make a person angry or short-tempered. If a patient is grumpy, think about pain before you think about mood. Ask, 'Are you hurting?' Then tell your nurse.
Other symptoms
Notice and report
NIA lists other causes of discomfort near the end of life. Breathing problems. Itchy or dry skin. Nausea, vomiting, or constipation. Feeling too hot or too cold. Being very tired. Watch for dark or discolored spots on the skin, mainly on the heels, hips, lower back, and back of the head. Hospice aides must report changes in the patient's needs to the RN. Report what you see.
Comfort care
Follow the plan
NIA shares simple comfort ideas. Raise the head of the bed. Use a fan. Keep lips moist with lip balm. Wipe a dry mouth with a soft, damp cloth. Use lotion on dry skin. Add or remove a blanket. NIA also says to check with the health care team first. So do the comfort care on your plan. If you think something else might help, ask your nurse.
Medicine questions
Go to the RN
You do not decide about pain medicine. Your care plan says what, if anything, you may do with medicines. NIA says to tell the health care team if pain is not controlled, because medicines can be changed. A family member may be afraid to give pain medicine, or may want to give more. Do not give advice about doses. Tell your nurse, so the team can help the family.
Feelings matter
Be present
Comfort is not only about the body. NIA says a dying person may feel sad, scared, or afraid of being alone. Simple things help. Hold a hand, if they want. Use soft light and quiet music. Ask what they need. Say who you are when you come in. Talk to the person, not about them. If a patient seems very sad or wants spiritual support, tell your nurse.
Quick review
Comfort first
Let's review. Hospice patients have the right to good pain and symptom control, day and night, wherever they live. Watch for clues like poor sleep, restlessness, crying, or anger. Notice other symptoms, like trouble breathing, nausea, and skin changes. Do the comfort care on your plan. Do not advise on medicine. Report pain and symptoms to your nurse right away.
Your facility's policy (ask your supervisor):
How hospice aides reach the on-call nurse 24/7 about pain or symptoms
Your pain scale or tools for patients who cannot speak, if you use one
Respect a hospice patient's choices, including their doctor.
Know the basic services hospice covers.
Send questions about services and limits to the team.
Their hospice
Their choices
Hospice patients have rights about their care. They have the right to help make their plan of care. They have the right to refuse any care or treatment. And they have the right to choose their attending physician. These rights do not end as a patient gets weaker. They matter even more.
Their own doctor
Can stay involved
CMS hospice guidance says the attending physician is often a doctor the patient already knows. Most of the time, it is not someone on the hospice staff. That doctor can stay involved and work with the hospice team. If a patient says, 'I want my own doctor to keep seeing me,' or 'I want a new doctor,' that is their right. Tell your nurse so the team can help.
Show the answer
Not having an advance directive should not affect her hospice care. CMS says a patient's choice not to make an advance directive should not affect admission.
Advance directives
Their wishes
Hospices must give patients written information about their advance directive policies, including their state's law. CMS says the two most common kinds are a living will and a durable medical power of attorney for health care. Making one is the patient's right. Not having one should not affect admission. If a patient talks about their wishes, listen with respect. Tell your nurse, so the wishes can be recorded.
Covered services
What hospice gives
Patients have the right to be told about the services covered by the hospice benefit. Covered services include nursing, social work, doctor services, and counseling for the patient and family. They include short-term inpatient care for pain or symptoms, or to give the family a break. They include supplies, equipment, and drugs for pain and symptoms. Aide and homemaker services and therapy are covered too.
Scope and limits
Ask the team
Patients also have the right to know what the hospice will provide, and the limits on those services. Families may ask you, 'Can you stay all night?' or 'Will hospice pay for this?' Do not guess, and do not promise. Say, 'Good question. I'll ask the nurse or social worker to talk with you.' CMS says the hospice should fully inform patients about covered services. That is the team's job.
Family too
Part of the plan
In hospice, the plan of care is built with the patient or their representative, and the main caregiver, if they want to take part. The hospice must teach the patient and caregivers what they need to know for their part of the care. Counseling for the family is a covered service. If a caregiver seems worn out, scared, or unsure what to do, tell your nurse.
On your shift
A changed mind
Mrs. Patel tells you, 'I don't want the chaplain to come anymore. And I want my old doctor back.' Her daughter frowns and says, 'Mom, you don't mean that.' You stay calm. You do not take sides. You say, 'I hear you, Mrs. Patel. I'll let the nurse know today.' Then you tell your nurse exactly what she said.
Quick review
Her choices
Let's review. Hospice patients help make their plan, can refuse any care, and choose their attending physician. They get written information about advance directives. They have the right to know what hospice covers, what it will provide, and its limits. When patients or families ask about services or coverage, do not guess or promise. Send them to the team. And tell your nurse when a patient's wishes change.
Your facility's policy (ask your supervisor):
Who answers patient and family questions about covered services (nurse, social worker, admissions)
Lesson 10: Home Health: Charges, Notices and Discharge
For: Home health
In this lesson you will:
Know patients must be told about costs and changes in care.
Know the reasons a home health agency may discharge a patient.
Send money, coverage and discharge questions to the right person.
Money talk
Told up front
Home health patients have the right to be told, out loud and in writing, about payment. That means what Medicare, Medicaid, or other programs are expected to pay. It means charges for services that may not be covered. It means what the patient may have to pay before care starts. If any of this changes, the agency must tell them as soon as possible, before the next visit.
Not your job
Send it on
CMS tells its surveyors not to advise patients about money, coverage, or payment. That is a good rule for aides too. If a patient asks, 'Will Medicare pay for this?' or 'Why did I get this bill?', do not guess. Say, 'I'll have the office call you.' Then tell your nurse or the office. A wrong guess about money can upset or mislead a patient.
Written notice
Before changes
Patients have the right to proper written notice before they get a service the agency thinks may not be covered. They also get written notice before the agency cuts back or ends ongoing care. CMS says Medicare patients can use a fast appeal to dispute an end to covered services. If a patient is upset that visits are ending, listen, and tell your nurse.
Show the answer
Tell her you will have the office or nurse call her. Patients have the right to be told about payment. The office gives that information, not the aide.
Discharge rules
Only some reasons
Patients have the right to know the agency's transfer and discharge rules. An agency may transfer or discharge a patient only for certain reasons. The agency can no longer meet the patient's needs, and arranges a safe transfer. No one will pay. The goals are met. The patient refuses services or chooses to leave. There is also discharge for cause, after certain steps. And when the patient dies or the agency closes.
Refusals
Report patterns
CMS says a patient who now and then declines a service is different from one who refuses services all the time. Refusing is the patient's right. The agency explains the risks, and writes down what it did. The agency may think about discharge if refusals keep it from giving safe care. So report each refusal. Your reports help the nurse see the whole picture.
Feeling unsafe
Tell your agency
Discharge for cause is for behavior that seriously gets in the way of care. CMS says it can include threats, sexual harassment, or any incident where staff feel threatened or unsafe. This can be the patient's behavior, or someone else's in the home. Before this kind of discharge, the agency must tell the patient it is thinking about it, try to fix the problem, give contacts for other providers, and write it all down. So if you ever feel unsafe, tell your agency. If you are in danger, leave and call 911.
No threats
No payback
CMS says cutting or ending services after a complaint, with no medical reason, is reprisal. So never threaten a patient with discharge. Do not say, 'If you keep complaining, they'll drop you.' Threats of taking things away can also be mental abuse. Discharge decisions belong to the agency, following the rules. Your job is to report what you see.
Quick review
Route it right
Let's review. Patients must be told about costs out loud and in writing, and told quickly about changes. They get written notice before care that may not be covered, and before care is cut or ended. An agency may discharge only for certain reasons, and must take steps first for discharge for cause. Send money and discharge questions to the nurse or office. Report refusals and unsafe events. Never threaten discharge.
Your facility's policy (ask your supervisor):
Who answers billing, coverage and discharge questions (office name and phone)
Your agency's steps when staff feel unsafe in a home
Answer every question. You need 80% to pass. You can try again as many times as you like.
Your quiz covers the lessons for: Home health ( questions). Change your setting
Please read
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state.
Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse.
California: it does not count toward CNA or HHA renewal hours.
Your name and quiz answers stay in your browser and are never sent to Pact.
Pact Compliance LLC, Cordova, TN
Certificate of Completion
This certifies that
completed the online in-service course
Patient Rights in Home Health and Hospice
Setting
Completed
Seat time
Quiz score
Certificate ID
This free course gives you a certificate of completion from Pact Compliance. It is not continuing education (CE) credit and is not approved by any state. Your employer decides whether it counts toward required in-service hours. Home health and hospice aide training must be given or supervised by the agency's registered nurse. California: it does not count toward CNA or HHA renewal hours.
Part of this topic needs a hands-on check with your supervisor; this online course does not cover that part.
Pact does not keep a record of this certificate. Print it or save it as a PDF and give a copy to your supervisor. pactcompliance.com/free-training/patient-rights-home-health-hospice/
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