Residents Rights Abuse

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Residents RightsAbuse Neglect
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Residents Rights for residents in Kentucky
Long-Term Care Facilities

• Upon admission, each resident is given a booklet
  explaining their rights as a resident in a
  long-term care facility

• Every resident in a long-term care facility shall
  have at least the following rights

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• Residents have the Right to
• be fully informed (in a language they can
  understand)
• exercise rights as a citizen of the US
• freedom from discrimination or reprisal from the
  facility
• have family notified of changes in condition
• have written copies of the facilities rules and
  regulations and examine OIG Survey Reports
• be informed of contact information for advocacy
  groups (State LTC Ombudsman, CHFS, OIG)
• notified in advance of any plans for change in
  room or roommate

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• assistance if they have a sensory impairment
• participate in their own care
• refuse medication, treatment, services
• refuse chemical and physical restraints
• review and secure copies of their medical record
• make independent choices (clothing, activities)
• choose their own physician
• participate in Resident Council
• privacy and confidentiality regarding their
  medical, personal, or financial affairs

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• dignity, respect, and freedom
• free from abuse and misappropriation of property
• exercise legal rights
• security of possessions, managing personal funds
• complain without fear of reprisal
• remain in the nursing facility, be discharged, or
  transferred
• visits (physicians, advocates, spouse, relatives,
  friends)

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Visitation Rights

• Patients have the rights to consent to receive
  the visitors he/she designates, including, but
  not limited to, a spouse, a domestic partner
  (including a same sex partner), another family
  member or a friend.
• Patient can visit with whom ever they wish.
• Patients have the rights to withdraw or deny
  consent to a visit at any time.
• The organization must ensure that ALL VISITORS
  designated by the patient enjoy visitation
  privileges consistent with patient preferences.

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Clinically Necessary Restrictions

• Visitation interferes with necessary Medical Care
• Visitation is disruptive to the therapuetic
  setting for the patient or other patients
• Restricting visitation is necessary for the
  physical protection of the patient or others.

• When the patient is undergoing a clinical
  intervention or procedure and the healthcare
  professional believes it is in the best interest
  of the patient, and or is otherwise clinically
  contraindicated.
• The patient/support person must be informed of
  the reasons for the restrictions or limitations
  of visitation.

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IMPORTANT

• Patients have rights to visit with whom they
  wish.
• Important that we make every effort to allow
  visitation to occur.
• Restrictions in visitation will include
  documentation of rationale for restrictions with
  patient notes.
• Make every effort to accommodate request.
• Patient Centered care.

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RCC Visitation

• Normal visiting hours are 9am-9pm.
• Special accommodations occur for visits after 9pm
  to prevent disruption to roommate.

• Restrictions for RCC also include
• Deny or limiting access related to abuse
• Deny or limited visitors found to be committing
  criminal acts
• Deny access to visitors who are enebriated or
  disruptive.

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When in doubt about visitation?

• Contact Charge Nurse, House Supervisor, Unit
  Coordinator or Senior Manager on call

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ETHICAL DECISIONS

• Residents and families may be faced with making
  difficult treatment choices
• The organization will respect their right to make
  decisions based on their personal beliefs and
  values
• Residents and families will be personally
  involved in the consideration of all ethical
  issues involving their care
• Any ethical issues will be addressed by the
  organizations Ethics Committee

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Employees who have concerns about safety, ethical
issues, or the quality of care provided

• May report these concerns to the Joint Commission
  or Administration.
• The organization will not take any disciplinary
  action because an employee reports concerns.

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ABUSE NEGLECT

• Definitions/Types
• Identifying Abuse/Neglect
• Causes/Prevention
• Obligations/Reporting

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Definitions

• Abuse - the willful infliction of injury,
  unreasonable confinement, intimidation, or
  punishment with resulting physical harm, pain, or
  mental anguish
• Physical Abuse - hitting, slapping, pinching,
  grabbing, kicking, poking, twisting, handling
  roughly
• Verbal Abuse - any use of oral, written, or
  gestured language that uses derogatory terms to
  describe residents or their families
• Sexual Abuse - sexual harassment, sexual
  coercion, sexual assault
• Neglect - the failure to provide good and
  services necessary to avoid physical harm, mental
  anguish, or mental illness

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More Definitions...

• Involuntary Seclusion - separation of a resident
  from other residents or their room, or
  confinement to their room against their will or
  the will of their legal guardian or
  representative
• Mental Abuse - humiliation, harassment, threats
  of punishment, withholding of treatment or
  services
• Misappropriation of resident property - a pattern
  or deliberate misplacement, exploitation, or
  wrongful (temporary or permanent) use of a
  residents belongings - with or without their
  consent

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Why does abuse and neglect occur in facilities?

• Working in the healthcare field is challenging.
• We work with some exceptionally difficult
  behaviors.
• The hours are long and we do not always feel
  emotionally rewarded.
• We see chronically debilitating conditions and
  some of our patients do not get any better or
  respond well to medical treatment.

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RESPONSIBILITIES

• STAFF OBLIGATIONS
• It is the responsibility of all employees to
  ensure that resident rights are not being
  violated and that abuse and neglect does not
  occur
• If you are aware of any type of abuse or neglect,
  it is your responsibility to report it
  IMMEDIATELY to your SUPERVISOR

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...RESPONSIBILITIES...

• FACILITY OBLIGATIONS
• pre-employment screenings
• orientation and training
• establish a resident-sensitive environment
• internal reporting and identification of all
  allegations
• external reporting per state and federal law

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After an Allegation...

• An RN will assess the patient for suspected abuse
• Nursing supervisor and Administration are
  contacted
• Facility Social Services is notified
• Identify the possible source of abuse
• If a staff member is identified as the possible
  source of abuse, they are removed from patient
  care until the investigation is complete
• Physician is notified

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• Contact is made with the following agencies
• Rockcastle County Dept. of Social Services
• Law Enforcement Agency
• Office of the Inspector General
• Contact patients family or legal guardian
• Complete all documentation and incident report
• Investigation must be completed within 5 days
• All phases of the investigation will be kept
  confidential!

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If any employee is found to be guilty of any form
of abuse or neglect...

• They will be terminated immediately and banned
  from the premises

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IDENTIFYING INDICATORS OF PHYSICAL/MENTAL, SEXUAL
ABUSE OR NEGLECT - ADULT

• Caretaker denies the patient the chance to
  interact privately with the physician.
• Caretaker displays an attitude or anger toward
  patient.
• Discrepancy between injury and history.
  Untreated old injuries, fractures in non
  ambulatory patients
• Malnutrition and/or dehydration without illness
  related causes
• Poor personal hygiene, frequent or multiple
  pressure ulcers
• Lack of necessary equipment, which includes
  walkers, canes, and bedside commodes
• Unsafe conditions in home, absence of assistance
  from the caretaker. Lack of necessities such as
  heat, food, and water.
• Depression, hesitation to talk openly. Fearful,
  prefers to stay in hospital
• Cuts, lacerations, puncture wounds, burns,
  bruises, welts or discoloration

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Identifying Indicators of Physical/Mental/Sexual
Abuse or Neglect - Infant / Child

• Failure to thrive, signs of malnutrition, begging
  or stealing food
• Poor personal hygiene
• Frequent injuries from lack of supervision
• Bruises, welts, burns, bites
• Regular patterns descriptive of objects used,
  such as belt, buckle, hand, wire, hanger, chain,
  wooden spoon, squeeze or pinch marks.
• Fracture and dislocations, skull nose or facial
  structure, lacerations or abrasions
• Spiral fracture or dislocation from twisting of
  an extremity or whiplash from shaking the child
• Painful urination-recurrent urinary tract
  infections
• Self stimulating behaviors, such as finger
  sucking or rocking. Regressive behavior, such as
  bed wetting or thumb sucking
• Absenteeism from school, running away from home
• Pregnancy in young adolescent

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PHYSICAL INDICATORS OF DOMESTIC VIOLENCE

• Unexplained bruises, lacerations, fractures, or
  multiple injuries in various stages of healing -
  presence of injuries to head, neck, chest,
  breast, abdomen, and genital area
• Extent or type of injury is inconsistent
  explanation given
• A history of prior physical abuse
• Minimizing statements, anger, defensiveness
• Patient describes in a hesitant, embarrassed or
  evasive manner surrounding the allegedaccident
• Depression regarding family situation, i.e., not
  wanting to return home, fear of safety
  ofchildren, flat affect
• Previous suicide gestures or attempts
• The presence of an overly controlling or
  solicitous partner, who may insist on joining the
  victim while being examined. The partner may
  even answer questions for the victim. The
  partner should not be allowed in or near the area
  where the victim is being examined or questioned.

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• Crisis
• Aggression
• Communication
• Grief
• Staff Burn-Out

Understanding can help prevent Abuse and
Neglect...
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Stages of CrisisAnxiety, Resistance, and
Threatening

• Stage 1 - Anxiety
• Staff Response
• Communicate
• Provide Assurance
• Remove the source of anxiety
• Stage 2 - Resistance
• Staff Response
• Answer any reasonable questions they may have
• Provide re-direction
• Offer choices (but set limits)

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• Stage 3 - Threatening
• Staff Response
• Remain calm
• Use non-threatening body language
• Allow an escape route
• Seek assistance

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What causes AGGRESSION?

• Aggression is an instinct, a response to anything
  that they perceive to be a threat, a loss, or a
  challenge
• Most triggers to aggression in a health care
  setting are related to being in a hospital
  environment
• Internal Triggers to Aggression - Pain, Disease,
  Intoxication, Fatigue, Hunger

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External Triggers to Aggression

• Any threat, loss, or challenge to someones
• Freedom, Autonomy
• Success, Failure
• Privacy
• Economic Well-Being
• Family, Relationships
• Self-Image
• Desired Goals

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Communicating with Agitated Individuals

• Agitated individuals cannot listen to reason, so
  staff need to use their NON-VERBAL skills to deal
  with agitation
• BODY LANGUAGE - allow personal space, make eye
  contact, use appropriate facial expressions,
  watch you hand and body stance
• TONE OF VOICE - Volume, Rate of Speech, Affect
  you have on your words

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VERBAL DOs

• Address the patient by name
• Speak clearly and distinctly
• State what you want the patient to do and what
  choices they can make
• Explain what you are prepared to do to help
• Use positive reinforcement, focus on the future
• Let the patient know you are listening

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VERBAL DONTS

• Dont
• give multiple instructions
• threaten or lie
• dwell on negative behavior
• bring up any unrelated past
• interrupt when the patient is talking
• fake attention
• embarrass or belittle the patient
• be rigid or authoritarian
• argue
• needlessly confront the patient in front of
  others

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Infant-Abandonment Act of 2002

• Any infant that is less than 72 hours
  old can be placed with a hospital,
  police station, or fire department
  if the parents are
  unable to care for the infant.
• No retaliation will be taken against the parent,
  unless there are signs of abuse or neglect.

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Death Dying The Facts

• In the US, 43 of people who reach age 65 can
  expect to spend time in a Long Term Care Facility
• The mortality rate for Long Term Care residents
  is approximately 25 per year
• 66-80 of residents die in Long Term Care
  Facilities

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Families will grieve for a loved one, Resident
may grieve for roommate/friend, Staff may grieve
for loss of resident The Stages of Grief

• 1. SHOCK immediately following the death of a
  loved one feeling of being out of touch
  occurs
• 2. EMOTIONAL RELEASE the awareness of just how
  dreadful the loss is, accompanied by the
  intense pangs of grief (sleep badly and cry
  uncontrollably)
• 3. PANIC the grieving person feels mentally
  unstable and has physical symptoms heaviness
  in chest, tightness in throat, empty feeling
  in stomach
• 4. GUILT individual begins to feel guilty
  about failure to do enough for the deceased
• 5. HOSTILITY some individuals feel anger at
  what caused the death
• 6. Inability to resume Business as Usual
  Activities the ability to concentrate,
  entire being is focused on the loss
• 7. RECONCILIATION OF GRIEF balance in life
  returns little by little
• 8. HOPE the sharp, ever present pain of grief
  will lessen and hope for a continued,
  different life emerges

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GRIEF - How Staff Can Help

• Provide support and comfort to the grieving
  family members
• always offer to contact family members, spiritual
  advisors, friends, etc.
• provide a quiet, solemn environment for them to
  grieve
• offer additional amenities to provide comfort to
  the family (snacks, drinks, pillows, blankets,
  chairs)
• go above and beyond your usual duties - always
  strive to meet ALL of their needs

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Prevention of Staff Burn-Out

• Burn-out is the reaction of our body and mind to
  job stress.

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What Makes a Person Susceptible to Burn-Out?

• Life Stressors (good or bad)
• Financial Issues
• Relationship Problems
• Poor Physical or Emotional Health
• Isolation
• Lack of Outside Interests or Hobbies
• Inability to Express Feelings
• Unrealistic Expectations of Your Job, Others, and
  Your Life

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Signs of Burn-Out

• Easily irritated/annoyed
• Substance abuse problems
• Recurrent illness
• Anxiety
• Overuse of caffeine/sweets
• Take your work home
• Increased absence from work/lowered productivity
  at work
• Treat people with less respect
• Feelings of guilt
• Feel numb
• Loss of sense of humor

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Preventing Burn-Out

• Know about burn-out, know it can happen to you
• Monitor yourself
• Stay healthy, exercise, and eat well
• Balance your life
• Be sure your job is right for you
• Avoid feeling victimized
• Take responsibility for yourself

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What to do if you think you are experiencing
Burn-Out

• Seek support from family/co-workers
• Get reality checks from co-workers
• Re-balance your life between work and home
• Find a person/place to vent your feelings
• Employ relaxation techniques
• Take small time outs daily
• Use your breaks in different ways
• Dont rush lunch
• Talk to your supervisor honestly about your
  situation

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Remember..Working in Long Term Care is a TEAM
EFFORT!