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Preventing, Monitoring and Identifying Abusive Behavior by Your Staff


Updated June 30, 2014

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The long-term care industry is vastly misunderstood and usually lumped together as one entity. Most suffer from the image that not only is your facility the place people go to die but that it is also a place where elders are abused. Actual statistics do not support the perception of rampant abuse; however, no abuse can be tolerated. In this article find out how to monitor and identify abusive behavior by your staff

When it comes to the treatment of residents, nursing homes face the highest standards set by the federal government. F tags (nursing home standards used by CMS) specify that "the facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property."

This article uses federal standards as benchmarks to strive for by any organization caring for the elderly and disabled.

Understand What Abuse Is

Abuse takes many forms not just physical. There is verbal abuse, sexual abuse, physical abuse, mental abuse and financial abuse among others. And beyond that there are certain conditions that arise in facilities that might be construed as abuse.

Falls - A resident's fall may be unavoidable though sometimes staff's inattention could cause it.

Improper Medication or Incorrect Dosage - The consequences of improper medication are sometimes fatal. Medication errors do occur. Most are mistakes but outside parties might skew it as abuse.

Neglect - A person enters a facility because he or she is incapable of performing at least some of the tasks necessary for daily living. If you fail to meet those needs, it can be construed as neglect.

So start with understanding what is obvious abuse and what could be construed as such.

Hire Right

Preventing abuse starts at the hiring process. Minimize the chance of hiring an abusive worker by following these steps.

  • Have written applications.
  • Conduct personal interviews.
  • Check references.
  • Conduct background checks of criminal records.
  • Check dependent adult abuse registries with your state Department of Health and Human Services.
  • Check motor vehicle records, sex offender registries and professional disciplinary board records.
  • Conduct alcohol and drug testing.

There are intangible parts of hiring that can help you understand how a prospect would fit from a cultural perspective - their compassion, values. You can start to understand these attributes by asking the right questions.

Care Plans and Environment
  • Fix features of the physical environment that may make abuse and/or neglect more likely to occur, such as secluded areas of the facility.
  • Assess and develop care plans for residents with behaviors, which might lead to conflict or neglect, such as residents with a history of aggressive behaviors; residents who enter other residents' rooms.
Identifying Abusive Behavior

Here are some things that could signal elder abuse in a facility.

  • Unexplained signs of injury such as bruises, welts, scars, bedsores, abrasions, burns
  • Unexplained weight change
  • Poor personal grooming
  • Threatening, belittling, or controlling caregiver behavior
  • Withdrawal from activities
  • Unusual behavioral changes
  • Staff preventing family from being alone with loved one
  • Bruises around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Sudden change in finances and accounts
  • Altered wills and trusts
  • Unusual bank withdrawals
  • Items or cash missing
Monitoring Behavior - Communication with Family / Ombudsman Key

Employees cannot be monitored 24-7. Other staff, families and visitors, the president of the resident's council and a facilities ombudsman all play a role in monitoring. (While the ombudsman and resident council president are typical positions encountered in skilled nursing and assisted living facilities, independent living facilities may not have these in place. At the very least a resident council should be established. The president of that council is often the first place residents go when they have a concern.)

Savvy families are also demanding technology solutions such as webcams in the resident's room. Be aware of these but be careful how far you go so as to avoid a perception that "big brother" is always watching.

  • Establish an ongoing relationship with the audiences above and encourage open and transparent communication. Provide residents, families and staff information on how and to whom they may report grievances without the fear of retribution; and provide feedback regarding the concerns that have been expressed.
  • Supervise staff to identify inappropriate behaviors, such as using derogatory language, rough handling, ignoring residents while giving care, directing residents who need toileting assistance to urinate or defecate in their beds.
  • There are numerous technology solutions to facilitate communication with client contacts. Consider ways to consistently communicate with families.
  • Visit your residents on an ongoing basis. Have other members of your team do the same.
Preventing Abuse

Assuming you have hired the right staff and have on-going monitoring in place, it is important to establish a culture that promotes client respect and dignity and one that has zero tolerance for abuse.

  • Empower your employees (think Neiman Marcus) to be able to make and act on decisions for the well being of the resident. That does not mean having a checklist of what good customer service means. It does mean setting the context for employees (how would you like your mother to be treated for example) and let them figure it out.
  • Develop ongoing training programs for employees. In addition to enlisting workers' support in identifying abuse by others, training can further reduce the likelihood that workers, themselves, will engage in abusive or negligent conduct. Training can further raise workers' morale and help to eliminate negative public perceptions and stigma that have been created by media attention to abuse by helpers.
  • Burnout, frustration and stress of your employees can lead to abusive behaviors. Be alert and mindful of staffing patterns, workload as well as personal issues that may affect employee behaviors.
Abuse is a serious issue. If you hire right, monitor and cultivate a culture that does not tolerate abuse you will be well on your way to growing your business and debunking many of the myths associated with elder care facilities.

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