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Survey Survival

September 1, 2005
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Good Reasons to Take Elder Abuse Seriously by Reta A. Underwood
SURVEY survival

Good reasons to take elder abuse seriously As an industry that will forever experience the fallout from abuse citations and the ever-increasing demands and expectations of its consumers to prevent abuse, it is necessary to understand and comply with F223 483.13(b), the abuse regulation. As statistically proven by the National Association of Adult Protective Services Administrators (NAAPSA) for the National Center on Elder Abuse (NCEA) (, in a 2000 study that included responses from all 50 states plus the District of Columbia and Guam, elder abuse has reached epidemic proportions, with more than 166,000 cases substantiated for that year (of 472,813 reports).

Remember, for starters, that consumers have at their fingertips a treasure trove of knowledge about your facility, including past survey records and measured levels of performance during the past several years. Examples are the Web sites and, both of which are dedicated to highlighting facilities that have received citations and demonstrated serious resident care issues.

Remember, too, these keys to compliance:

Key 1. Does your facility conduct regular consumer education regarding abuse and neglect? Many people will associate your willingness to discuss such issues with a sense that you have nothing to hide. Providing such information as part of your marketing packet is therefore well advised. Moreover, if you are a drug-free workplace and/or conduct criminal background checks on every prospective employee, highlight those facts. Consumers take comfort in knowing that their loved ones are being cared for by people who are not using drugs and/or do not have a history of criminal activity.

Key 2. The regulation clearly outlines what a facility's policy and procedure must contain to be considered complete and comprehensive. Review your policies and procedures to ensure that the following eight items are addressed:

1. The definition of abuse. Include definitions of verbal, sexual, physical, mental, and involuntary seclusion abuse, as well as of neglect and misappropriation of resident property.

2. Your facility screening procedure. Recent years have seen this becoming more broadly employed. For example, the Illinois Department of Public Health filed in July an emergency rule that would require a police background check on every potential nursing home resident prior to admission. This could be the start of a trend in which background checks continue to broaden their scope to include volunteers, attending physicians, and other people who enter the facility on a regular basis.

3. Types of education offered. There should be an educational track for the resident and one for the employee. For the resident, this would include: review of the definitions of abuse for residents and/or responsible parties at the time of admission and annually, and a review of how to and to whom to report their concerns or situations of suspected abuse, assurance that there is no need for fear of retribution (for example, offering a private, toll-free hot line for making reports), and reassurance that they will be provided with feedback regarding their concerns, both in terms of solutions and information about other agencies where they might obtain assistance. For the employee, training would include orientation and ongoing in-services addressing abuse-prevention practices. Again, review the "without fear of reprisal" stance of your facility and provide education on recognizing signs of caregiver burnout, frustration, and stress, as well as your facility's working definitions of abuse and neglect.

4. Prevention. Keeping a good grievance/complaint report form in a well-advertised location readily available to residents, family, and staff is encouraged. For those submitting such a form, anonymity should be offered. Enhance visibility of the anti-abuse policy by having the local police department conduct staff education on various relevant topics, such as investigative protocols. Also, administrative personnel should conduct regular and unannounced rounds. Residents might be provided a safe in which to keep small prized possessions. Conspicuously located security cameras can be strategically located inside and outside of the facility; hallways, common areas, courtyards, exit and entrance doors, parking lots, and smoking areas are basic starting points for such monitoring.

5. Identification of abuse. Make sure it is understood that, because many residents cannot always make their needs clearly known, identifying possible abuse is the responsibility of all who work within the facility. Suspicious bruising, particularly on the face, arms, abdomen, and shins, should be assessed by nursing and an investigation conducted. Staff should be on alert for patterns, occurrences, and trends that might constitute abuse.