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Client Abandonment and Potential Ethical Concerns

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

July 23, 2019

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Question

Can you explain client abandonment and any potential ethical concerns regarding changing employment?  

Answer

For a variety of reasons, such as leaving a practice to pursue other career opportunities or relocating for family reasons, clinicians may decide to end their relationships with clients. There is nothing unethical about such departures. Maintain their focus on the welfare of the client, even when, as clinicians, they decide to end their relationships with employers or patients is key. Adequate notice is necessary to prevent treatment disruptions, but even when given adequate notice, employers may be tempted to pressure or threaten departing clinicians to stay or give unreasonable amounts of notice.  Caution managers of care-giving facilities that it is unethical to try to exert moral pressure on clinicians to continue once they have indicated their plans to leave. However, professionals must be mindful of the fact that such departures may result in former clients being left without the appropriate care. When clinicians leave a caseload without coverage by an appropriately qualified professional, it is called client abandonment. Prior to departing, a professional must make effective efforts to provide for the patient's continuing care. The more seamless the transition for the patient, the better.

Examples of misconduct may include the following:

  • failing to give sufficient notice to employers when leaving a position
  • failing to provide an interim plan for each client
  • failing to complete all remaining reports, billing slips, and other required paperwork
  • withholding paperwork so that the clinician's successor does not have access to the client's entire record
  • removing materials, records, protocols, and other administrative materials without the consent of the administrator of the facility or organization
  • maligning, in the presence of clients, the facility or organization the professional is leaving
  • recruiting clients for the new employment setting

A professional who is leaving a facility should, if requested, assist the organization with the recruitment of a replacement and should offer to participate in the orientation of replacement personnel as necessary.  Therapists who leave an organization or facility should attempt to sever ties with the employer amicably. Employers should cooperate in every way with departing clinicians in order to safeguard the well-being of clients. When the therapist’s departure has been precipitated by difficulties in workplace relationships or what the clinician regards as deficiencies in working conditions, there may be increased potential for behavior that violates the principles and rules of the Code of Ethics. Professionals in such situations should avoid engaging in behaviors that might be viewed as retaliatory or slanderous. Angry and spiteful words, obstructive actions, and uncooperative or aggressive behavior are potentially very harmful to clients and reflect badly on the profession. If a clinician is dismissed for cause, the employee's responsibility to clients terminates with the dismissal, and the facility assumes all responsibility for seeing that no clients suffer harm as a result of the departure.

 


kathleen d weissberg

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

Kathleen Weissberg, OTD, OTR/L, in her 25 years of practice, has worked in adult rehabilitation, primarily in long-term care as a clinician, manager, researcher, and most recently as Education Director with Select Rehabilitation where she oversees continued competency and education for close to 12,000 therapists. In her role, she conducts audits and provides denials management and quality improvement planning training for more than 700 LTC sites nationwide. She also conducts compliance, ethics, and jurisprudence training to therapists.  Kathleen has authored several publications that focus on patient wellness, fall prevention, dementia management, therapy documentation, and coding/billing compliance.  

 


Related Courses

Health Literacy: Effective Client Communication and Education
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

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Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3177Level: Intermediate1 Hour
  'Very relevant information!! So many brochures I see at doctors offices are written at a level much higher than 6th grade'   Read Reviews
This session will review techniques for clear and effective communication, verbal and written communication with those from other cultures, writing and selecting easy-to-read health materials, and assessment tools to use to ensure that clients understand the therapy services provided and have the skills needed to access, understand, and use health information.

Preventing Sexual Harassment in the Workplace
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Harassment, and more specifically, sexual harassment, is illegal. This course reviews the definition of sexual harassment, ways to prevent harassment, and what to do should harassment occur in the workplace. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Supporting the LGBTQ Senior in Healthcare
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Course: #3454Level: Intermediate2 Hours
  'Very well presented, explanations were clear, and above all, information all of us can benefit from'   Read Reviews
This training describes the required elements for responding to the emerging needs of long term care communities to provide sensitive and respectful services to LGBT elders. The training reviews definitions related to sexual orientation and gender identity challenges experienced by LGBT older adults, and strategies for communication and policies that honor residents' rights. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Current and Future Status of Medicare Part A: A Review of the Prospective Payment System and the Patient Driven Payment Model
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

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Course: #3216Level: Advanced2 Hours
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This course provides a detailed overview of current Prospective Payment System for Medicare Part A as well as details about the Patient Driven Payment Model set to begin October 1, 2019. Concepts such as Other Medicare Required Assessments (OMRA), coding therapy minutes, student service under Part A, and case mix groups for PDPM will be reviewed.

Medicare Part B Coding and Billing: For Therapy Services in Long-Term Care
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
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Course: #2962Level: Intermediate2 Hours
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This seminar offers an in-depth review of Medicare Part B coding and billing, including CPT coding, unit to minute conversion, appropriate use of evaluation codes, modifiers, and G codes is offered. Using multiple examples, therapists will learn how to be compliant with coding, thorough in documentation to support skilled interventions, and detailed to avoid common errors. A review of elements known to trigger medical review including coding and documentation to support the plan of care is offered and tips and strategies for successfully managing medical review will be explored. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.