June 1, 2010 |

Hidden cameras

At a glance…

Long-term care facilities that keep the lines of communication open between residents and families and that respect their rights will go far in preventing abuse and other inappropriate actions concerning residents.

Newspaper headlines shocked readers recently by declaring that 14 nursing home workers from one New York facility near Albany were arrested and charged with neglect. Eight others were arrested in a Western New York nursing home. These actions resulted from the use of hidden cameras installed with consent of residents’ family members. Attorney General Andrew Cuomo reported conducting a six-week investigation using all necessary tools to watch over the vulnerable who cannot advocate for themselves.

In the Albany area facility, hidden cameras revealed the following:

Staff often left residents in the same position for an entire shift, failing to turn and position an immobile resident.
Nurses failed to administer medication and treat bed sores.
Staff failed to check for incontinence or change undergarments for long periods of time.
Staff falsified medical records to conceal this neglect.
A physician’s assistant created a false record of an annual physical that was never performed.

In all, six licensed practical nurses (LPNs) and seven certified nurse aides (CNAs) were charged with felony first-degree multiple counts of falsifying business records and misdemeanor willful violation of public health law. The physician’s assistant was charged with one count.1

The Western New York investigation revealed similar findings:

Staff routinely failed to properly transfer a resident in and out of bed. Instead of using a mechanical lift with assist of two caregivers, they put the resident at risk of injury through other methods.
One aide failed to provide range of motion therapy.
Two LPNs failed to administer insulin, failed to provide skin and wound treatment, and failed to check vital signs.
The employees falsified medical records to conceal the neglect and mistreatment.1

Falsifying business records is a Class E felony punishable by up to four years in prison. The other charges are misdemeanors with varying maximum prison terms of up to one year.1

While this “sting” operation may catch many by surprise, use of hidden cameras and similar findings are not new. Consider these other cases:

In Texas, first-degree felony abuse charges were filed against a nurses’ aide captured by a hidden camera striking a woman to get her out of her wheelchair and then throwing her into bed. The resident, paralyzed from a stroke, also suffered from dementia. When the facility failed to act on complaints from her husband, stating the woman “could not identify her abuser,” he took action and installed the camera.2
In Ventura County, California, a family noticed unexplained bruises on their 70-year-old loved one admitted to the facility following a stroke. Family notified administrators, but there was no investigation. The family set up a hidden camera and captured what they could not believe. A CNA was seen slapping the resident, violently bending her fingers, wrists, and neck, and pulling her by her hair. An investigation showed the nursing home knew this was a problem employee. Other families had complained of suspected abuse, and one named the CNA in writing, but she was allowed to continue to work with residents. The family was awarded $7.75 million by a jury after facility owners refused to settle out of court for $500,000.3
In an Illinois nursing home, seven patients were admitted who had criminal backgrounds after the facility failed to conduct background checks. Two deaths resulted from neglect, and cameras showed mentally ill patients were out of control and elderly residents lived in fear. Two workers and three patients were arrested, and the administrator’s license was suspended.4

In our examples several key things happened:

Staff failed to provide care designed to meet the needs of residents.
Staff falsely documented that the care was provided.
Staff members intentionally abused or neglected residents.
Staff failed to report what they saw others do or fail to do.
Administration did not adequately investigate family concerns.

In each case, the installation of hidden cameras was the vehicle by which neglect and abuse was substantiated. In most of the examples, family members first tried to work with administration to gain resolution, but when they perceived they were not heard, they resorted to other means.

None of us want to believe that our staff could be involved in neglect or abuse, but we must remain vigilant in overseeing resident care. Attorneys and investigators are waiting to step in to right these wrongs, and the lesson for us is clear: As nurse leaders we must take all possible steps to prevent similar occurrences from happening in our settings, and we must make time to listen to our residents and their family members. Once they have shared their concerns, it is imperative that we follow up until they agree that they are satisfied with our response.

The Centers for Medicare & Medicaid Services (CMS) provides us with guidelines to help us organize our protocols and direct our staff. F-223 Abuse states, “The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.” This means residents are not subjected to abuse by anyone, whether they are staff, other residents, consultants, volunteers, agency personnel, family members, legal guardians, friends, or any other individuals. F-224 Treatment of Residents & their Property addresses mistreatment and neglect. The following definitions apply:

Abuse-The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish or the deprivation by an individual of goods or services necessary to attain or maintain physical, mental, and psychosocial well-being.
Neglect-failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.5

F-226 Policy & Procedure on Abuse instructs us to develop and implement written policies and procedures containing the following seven components:

Screening-Potential employees must be screened for a history of abuse, neglect, or mistreatment through attempts to obtain information from previous/current employers, appropriate licensing boards and registries, and law enforcement agencies who conduct criminal background checks.
Training-Employees must receive orientation and ongoing education on dealing with aggressive and/or catastrophic reactions of residents; reporting knowledge of allegations; and recognizing signs of burnout, frustration, and stress that could lead to abuse and explanation of what is considered abuse and neglect.
Prevention-Procedures should provide information to residents, families, and staff on how to report concerns, incidents, and grievances without fear of retribution; how to identify, correct, and intervene in situations where abuse or neglect are most likely to occur; and state the importance of giving feedback.
Identification-Procedures must instruct staff in identifying events needing investigation, such as suspicious bruising, patterns, or trends.
Protection-Procedures must explain how to immediately protect residents from harm while an investigation is conducted.
Reporting/response-Procedures should guide reporting of alleged or substantiated incidents to appropriate agencies, require corrective actions based on investigation results, and include reporting action by a court of law that indicates an employee is unfit for service to the appropriate agency, registry, or licensing authority. Also consider what changes to make to prevent future occurrences.5

Whether the individuals in our examples receive prison sentences or not, they will no longer work in nursing homes. Careers of many years were ended by bad choices and bad actions. In the long run, future residents will be protected from the substandard care delivered by these individuals.

Any facility without a policy on use of cameras in resident areas should develop one, with input from legal counsel. By following CMS guidelines for abuse and neglect prevention, nursing homes will establish a foundation for protecting residents from negative events. Reporting of inappropriate behavior must be the facility standard. Families should be listened to, even if they previously reported what administration deemed to be unsubstantiated complaints.

Administration in our examples, for whatever reason, failed to protect their residents. Nursing homes that establish open lines of communication and feedback with residents and families, and that respect their rights will go far in preventing inappropriate activity from happening. They may, in fact, avoid the arrival of hidden cameras in their own neighborhood.

Betty MacLaughlin Frandsen RN, NHA, MHA, CDONA/LTC, C-NE, has more than 30 years of experience in long-term care as a Director of Nursing, Administrator, and Regional Consultant. She is currently Vice President of Education and Regulatory Affairs for AANAC.

To send your comments to the editor, please e-mail mhrehocik@iadvanceseniorcare.com.