Your child is now 18, how does this impact their healthcare?

Spoiler Alert!

The tradition for most informative written pieces is that the information given is presented in logical order, building ideas upon each other in a forward movement and expansion of knowledge.  HA!

Well, that’s the beauty of a blog!  There are few rules for the author, so while I have your attention I’d like to start at the end….that is to say the end of “childhood” and the beginning of adulthood, which is the legal age of 18 years old.

For all parents of 18-year-olds, LISTEN UP!  Your child, the one who’s room is a disaster, the one who still looks to you for food, shelter, heat and clothing, the one for whom you pay health insurance, dental insurance, car insurance and now tuition insurance is a LEGAL ADULT.  Overnight, they have become in charge and control of decisions regarding their lives and you, as the parent, are technically and legally no longer in the position to ask about their health or make decisions regarding their health without their written consent to do so.   All medical and dental decisions from this day forward are now the sole ownership of your “adult” child, and you as the parent legally no longer have an opinion on health decisions, nor are you advised of treatment needs.

Well, that’s a fine How do you do? Isn’t it?

Due to HIPAA laws, dental practices and medical facilities, including hospitals and COLLEGE/UNIVERSITY CAMPUS HEALTH FACILITIES CAN NOT share information regarding your child’s health condition, good or bad; UNLESS SIGNED PERMISSION is given by your child to the health office.

All these types capitalizations make me feel like I’m shouting!  And I am!  It can become quite an anxiety filled scramble if an unplanned incident happens to your “adult college student ” while they are away at school and you, trying to get the right help and assistance, are handcuffed by this unforeseen legal shackle and can’t render immediate attention.   Now before anyone gets too riled up here, remember, the best decisions for the safety of your children will be made to deliver the best care and keep them safe.  That is the nature of health care so no extreme worries.  And in extreme cases I’m sure these rules do not apply, so being annoyed over a much smaller crisis isn’t such a bad thing, as long as you are prepared.

When my son started college, he was not yet 18 years old (September birthday).  Neither one of us thought about the so-called “changing of the guards” regarding his health care responsibilities and decisions and off to school he went.  Well, as luck would have it while playing a pick-up game of basketball indoors on a cold December afternoon, my son, untouched and unprovoked, tore his ACL.  Of course all he knew at the time was that he hit the ground after hearing a pop in his knee and feeling a good amount of pain.  He immediately went to the on-campus infirmary.  Because he was expected to play baseball as well as receive an education, he did not rush to tell his father or me about his current snafu.  He was able to see the doctor, make transportation arrangements to the nearest hospital, obtain an MRI, receive a definitive diagnosis and obtain treatment counseling ALL without my knowledge.

Huh.

That was a lot of medicine given to an 18-year-old, and I had no idea.  You know, I had always forbidden him from being on a basketball court while he was in high school and while I was paying those exorbitant club baseball fees.  He would always say he was surprised I didn’t wrap him in bubble wrap since I “was so paranoid”… But I digress.

Of course, he finally had to come clean to us, his parents, after all, he needed the resources to find the best orthopedist,  surgeons, transportation, food, bedside care, and love!  Ahhh…that’s Where we come in!  Got it!    However, trying to transfer his information from any of these facilities, including the college health services, was truly an impossible task without his WRITTEN consent to do so.  So back HE had to go (on crutches mind you) to the imaging center, to the hospital, and to his college doctor to either obtain himself or leave written permission for me to collect his chart notes and x-rays for the orthopedist.  It’s exhausting reliving it all over again!

Solution?    Simple…have your child complete a signed permission form that will allow you access to their records if necessary.  And this includes dental records as well.

HIPAA-Hip-Hooray!

So what is HIPAA?   The Health Insurance Portability and Accountability Act is a Federal law that was established in 1996.  The purpose of this law, among many, is to provide the patient the right to access medical records and decide who else may have access to those records, including family members.  This Privacy Rule gives patients the power over who can see their medical and dental records.  The information contained in these records may include insurance information, lab reports, radiographs, medical notes and billing information.  Officially going into effect in 2003 (ehow.com), the law is designed to protect privacy and prevent discrimination to patients with “pre-existing” health conditions.  It also helps to reduce fraud and higher charges to patients and insurances based on medical histories.

So to bring this all back around to the dental practice, your child has the decision-making authority to give their dental team permission to take x-rays, place fluoride, complete a filling, crown, root canal and even an extraction without parental knowledge if they are at least 18 years old. This young individual may still be in high school!  This young man or woman may find out he has a cavity and choose to have it fixed that day, pay cash and the parent will not be advised or alerted by the dental practice because it is against the law.  Of course, when possible, our team will ask your child’s permission, most occasions, if we can speak openly in front of their parent or while we are all standing together make sure the “adult” child is open to his or her treatment needs and recommendations before speaking freely in front of a parent.  It can be tricky, but it’s not complicated.

  If they want you to have permission, as parents, get permission.

Recently one of our hygienist (And NOT me for once!) ran into a common situation whereby the 18-year-old adult came in alone for their dental examination, cleaning, and radiographic evaluation.  It had been over a year since their last visit and will be heading off to college in the coming months.  The hygienist, in discussion with the patient, recommended check-up x-rays (four in total) to ensure the absence of decay in between the teeth before heading off to school, with no access to his dental providers, for the next eight to ten months.   It was an extremely reasonable and responsible recommendation and a decision made by both the patient and the hygienist, especially based on the potential increase in college-age patient decay rates, poor eating habits and the proverbial decline in personal hygiene habits).  Also, the dental history had always shown an acceptance of this treatment throughout their adolescence.  Unfortunately, upon discussion with their parent after the appointment while at home, the parent was very upset that this treatment was not cleared with them before completion.  Typically if a parent is not present in the office, or even outside in their car waiting, we will make every effort to gain permission for any treatment before it begins, either by calling the parent or caregiver or even running out to the car for verbal approval.  This patient, however, was an “adult” patient in complete authority of their dental treatment decisions.  That being said, health professionals understand this hazy area between childhood and adulthood and I am certain any extensive treatment needs would prompt encouragement for the young adult patient to discuss them with their parent if they felt more comfortable doing so before the treatment is completed.

For the new parents of “adult” children, I feel your pain!  Fortunately, most of the time our children want us involved, as they are often no more capable of making these health decisions as they are making their bed, making a sandwich, or making this very appointment!

So what do WE do?    We (parents and health providers) remind them and discuss with them whether or not they want you involved in their healthcare decisions. We have them sign a consent form allowing us to contact you or whoever is on the list regarding their personal information, and we educate them on what treatment you as the parent may want them to have or refuse until you are included in the discussion.  Do you want them to have x-rays or not, fluoride or not, fillings or not, and so on at which time they can request those desires at the beginning of the appointment.

So, with enthusiasm, I say good luck to all the young adults ready to embark on all the new responsibilities that await you in these coming years.  On behalf of your parents, however, I firmly request that you just stay healthy, safe, smart, brush and floss regularly and don’t eat too much candy or drink too much soda during those late night study sessions!!  (But study!)

by Julia Guerra, RDH, BA