PRACTICE PERSPECTIVES


When Patients Can’t Navigate Care Alone Practical Guidance for Treating Elderly and Nursing Home Patients


D


ental offices increasingly en- counter a challenging scenario: long-time patients who are now in advanced age or living in


nursing facilities arrive unaccompanied, may have cognitive impairment, and leave with treatment plans or referrals they may not fully understand—or be able to act upon.


This situation raises two important ques- tions: How do we ensure appropriate patient care? And what is permissible under HIPAA? Drawing from member experience, guid- ance from another state dental association, and established best practices, the following framework can help offices navigate these situations with confidence.


Start with the Right Mindset – HIPAA Allows Care Coordination: A common mis- conception is that HIPAA prevents commu- nication with anyone beyond the patient. In reality, HIPAA permits information sharing for treatment purposes, including coordina- tion with other providers and caregivers, when done in the patient’s best interest and with only the minimum necessary informa- tion. In these situations, the more relevant issue is often decision-making capacity, not privacy restrictions.


Assess and Document Capacity at Every Visit: For elderly patients, especially those ar- riving alone, providers should make a simple, informal assessment of whether the patient can: • Understand their diagnosis • Comprehend the proposed treatment or referral


• Explain next steps • Make a reasoned decision


If there is doubt, documentation is essential. For example: “Patient demonstrates limited understanding of diagnosis and referral instruc- tions due to cognitive impairment.” Informed


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consent is not valid if a patient cannot fully understand the information presented, mak- ing this step both a clinical and risk manage- ment priority.


Engage the Care Team: Nursing Homes and Facilities: If a patient resides in a nursing home or assisted living facility, those staff members are part of the patient’s care team. It is appropriate—and often necessary—to communicate with: • Nursing staff • Case managers or social workers • Facility administrators (as needed)


This type of communication supports treat- ment coordination and is permissible under HIPAA. When possible, ask the patient: “Is it okay if we speak with your nurse about today’s visit?” Even if the patient cannot clearly con- sent, providers may share information if it is in the patient’s best interest. Importantly, limit information shared to what is neces- sary—such as diagnosis, treatment plan, referral needs, and any urgency or risks.


Close the Loop on Referrals: Referrals represent one of the highest-risk breakdown points in these scenarios. If a patient has cognitive impairment, arrives alone, and requires follow-up care, simply handing them a referral is not enough. Instead: • Send referral information directly to the facility


• Contact the nurse or case manager to help coordinate next steps


• Clearly communicate urgency and risks if care is delayed


• Equally important is documentation— note who was contacted, what was shared, and when.


As one Missouri dentist shared, practices may need to set expectations with facili- ties that patients should not be sent alone without appropriate support, and that clear


communication channels must be in place for follow-up care.


Identify a Decision-Maker: Offices should routinely ask: • Does the patient have a healthcare power of attorney (POA)?


• Who helps make medical decisions? • Is there a family member or guardian to contact?


If a POA exists: • Obtain and retain documentation • Confirm it applies to healthcare deci- sions


• Clearly document the decision-maker in the chart


If no decision-maker is identified and capac- ity is in question, this should be flagged, and facility social work staff may need to be involved.


Use Emergency Contacts When Appropriate: When a patient is unable to manage their own care, HIPAA allows providers to contact an emergency contact if it is in the patient’s best interest. This is


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