By Jim Burke
With abuse and/or neglect of residents with cognitive and physical impairments a persistent problem in long term care facilities, having a comprehensive, written elder abuse policy to guard against occurrences is in everyone’s best interests. It’s a necessary complement to federal and state regulations that aim to protect the safety of those who are unable to protect themselves.
Your elder abuse policy should be reviewed at least annually and integrated into your Quality Assurance and Performance Improvement (QAPI) program. Its seven key components, and their related policies and procedures, are:
- Employee Screening
Policy: Conduct and verify criminal background checks for all prospective employees, as well as relevant board registrations and certifications. Check nurse’s aides and licensed professionals for any history of abusive treatment of residents or related legal actions indicating unfitness for service, and related disciplinary actions by state licensure bodies. Also check and verify volunteer references and backgrounds if direct contact with residents is involved. - Training
Policy: Train all new employees at orientation and host annual sessions. Training covers dealing with aggressive or challenging resident behaviors, reporting abuse, defining abuse and neglect, establishing a Resident Bill of Rights and identifying at-risk residents.
Policy: Monitor staff for burnout, a potential cause of resident maltreatment. Establish intervention procedures and resources. - Prevention
Policy: Prevent abuse by establishing a reprisal-free reporting structure for concerns, incidents or grievances, and a process for providing feedback on status of investigations. Publicly post contact information for reporting abuse.
Policy: Assess residents for risk of abuse based on health, behavior or cognitive concerns. Screen prior to admission and periodically thereafter. Identify vulnerabilities and interventions in the resident’s care plan. Inform residents and their representatives about the abuse policy and resident rights.
Policy: Tailor preventative procedures (per state laws/statutory requirements) for risks in the facility’s physical environment, the resident population; or should a predatory offender gain admission to the facility. - Identification
Policy: Monitor residents to recognize such signs and symptom of abuse as: unexplained bruising; unnecessary fear; abnormal bodily discharge; inconsistent explanations/details about incidents; and unusual resident behaviors towards staff, other residents, family or visitors. - Investigation
Policy: Designated facility personnel investigate reports of abuse promptly and thoroughly.
Policy: Tailor investigatory procedures to specific state laws and statutory requirements, following distinct protocols for the type of incident/suspected incident, including who is interviewed, how circumstances are evaluated, how findings are communicated, corrective actions taken, and law enforcement notification. - Protection
Policy: Protect residents from alleged offender(s). Deliver medical and/or psychological care immediately for the safety and well-being of residents. Maintain contact with social services for resident and/or resident’s representative.
Policy: Other safety policies and procedures for the facility will also guide measures on reporting protocols (internally and to state authorities); disciplinary actions, when warranted; resident and/or family notifications; education; and provision, if needed, of counseling resources. - Reporting and Response
Policy: Report all abuse allegations as required by federal and state law. Provide reports to facility administrators, state officials (survey agency and adult protective services) and local law enforcement. Reports include detailed information about the victim, type of abuse, injuries and information about alleged staffers involved, and detailed investigative components.
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