Page Two -To ask Clint a question just email us at askclint@ihnsolutions.com
Ask Clint it helps! Recently, there has been sensational news media about the abuse of nursing home residents. We have observed that the effect of these articles may create alarm from potential consumers, as well as health care workers commited to providing great care.
We've had several consumers and health care workers contact us asking about nursing home abuse. We believe their questions and our answers might prove useful to your organization as you work to reassure the community that your facility does not abuse elders.
To help us effectively answer these questions we drew from research gathered for "Creating 'The Zero Tolerance Program' to Address Community Concerns About Elder Abuse in Health Care Facilities." This step-by-step guide has been used by our clients to defend against the sensational charges of nursing home abuse in the media. The program can also assist in educating health care organizations and their constituent communities about the safeguards the health care profession uses to prevent abuse from occurring in their organizations as well as teaching about the very real problems of elders being abused in their own homes.
How big of a problem is abuse in health care facilities?
First, let us state that any form of abuse is totally unacceptable. ALL ABUSE IS BAD!
According to the American Psychological Association, "Most incidents of elder abuse don't happen in a nursing home... Most elder abuse and neglect takes place at home... When elder abuse occurs, family, other household members, and paid caregivers usually are the abusers."
Consistent with this, the National Elder Abuse Incidence Study reports that Adult Protection Services deals with approximately 550,000 cases of confirmed elder abuse a year. This report also estimates that another four to five times that amount of abuse goes unreported. That translates to 2 to 2.5 million elders being abused in their domestic settings annually.
Compare those numbers to the actual numbers that are being talked about in U.S. Representative Henry Waxman's July 2001 report "Abuse of Residents Is a Major Problem in U.S. Nursing Homes." This report documents 2861 instances of some form of actual institutional abuse concerning 1,500,000 nursing facility residents over the 2-year period studied. This translates to only .002% of the population in nursing homes.
Waxman's report also details another 6111 abuse violations; including failure to post abuse policies and procedures, failure to properly investigate and report allegations of resident abuse, neglect, or mistreatment or to ensure that nursing home staff do not have a documented history of abusing, neglecting, or mistreating residents. These items are officially classified as "abuse" but have little to do with actual physical, emotional, sexual, or financial abuse or neglect.
Even when we add the 2861 with 6111 we come up with a total of 8972 which, works out to be only .005 percent of the total 1.5 million people living in nursing homes at any given time.
The recent Congressional Hearings have created quite a stir in the press and the public has become concerned with the care delivered in long-term care facilities. Still, the headlines seem somewhat out of proportion when 2861 actual abuse citations in nursing homes is compared to 551,011 instances of domestic abuse documented annually by Adult Protection Services.
What protections should nursing homes have in place to protect residents from abuse?
Most States have legislatively mandated that physicians, nurses, and other health care professionals must report suspected institutional abuse to a designated State office.
Additionally, nursing homes are required to have policies and procedures in place to investigate, as well as report, any abuse occurrences in their facilities. These policies and procedures also establish the consequences when abuse has been found.
There are criminal background check requirements for employees and an effort underway to track health care worker's backgrounds nationally.
The Federal government contracts with states to conduct annual inspections and complaint investigations of nursing homes. During these team inspections, a sampling of residents is interviewed along with the nursing home staff, and family members. The inspection team also reviews a sample of clinical records. Violations of federal health and safety standards observed by the inspectors are cited by the inspection team and reported by the states to Centers for Medicare and Medicaid Services (formerly HCFA).
Violations can result in fines, sanctions and other serious penalties including the revocation of the right to admit residents to a facility. If actual abuse has occurred criminal charges can be brought against staff involved in the abuse as well as the supervisors responsible for overseeing the individuals charged. There have been instances where the administrator and nursing director have been charged with liability involving abuse allegations in their facilities.
The importance of protecting the elders in our care is a trust we cannot take lightly. We believe our responsibilities go beyond what the rules and regulations require. We support a "Zero Tolerance" approach to abuse of any kind. The best way to fight abuse is through education. When everyone in a health care facility understands what abuse is and is sensitized to be aware of abusive behavior, the possibility of abuse happening is greatly reduced.
What can we do, as health care professionals, to help people understand we are not abusers?
Most nursing facilities pride themselves as special, caring places for the people that live there. There are countless health care professionals who are special, as well. While it is true there are poor performers in the workplace, we believe the majority of health care professionals do good work and take special pride in the care they deliver.
It is difficult to know how to respond when issues like nursing home abuse makes the headlines. If your organization is involved in abuse investigations it needs to swiftly and directly deal with the allegations. If they turn out to be true, systems need to be put in effect that never allow abuse to happen again.
Even if your organization faces no issues involving abuse, just sitting back believing everything will blow over is like an ostrich burying its head in the sand. In the worst case, avoidance may give the impression that your organization has something to hide.
Therefore, we advise health care professionals to assume a leadership position and address their community's conversations on abuse. This provides the opportunity to explain the programs, policies and procedures your facility and staff use to combat abuse.
By making your stance against elder abuse public, you have taken the moral high ground and begun to establish yourselves as the abuse prevention experts. With a commitment on the part of your organization you position your facility as a valuable community resource for abuse prevention.
If you are a front-line worker, the most important response you can give when asked about elder abuse is, 'I work in a nursing home, I am proud of the work I do and I care about the people who live here. If there is any way to prevent it, I will never let one of 'my residents' be harmed.'
The media and politicians recognize that nursing homes are targets that provide them with a large public reaction. (Good for both ratings and votes.) We believe it is important to not allow your organization to be abused. So be proud, stand up and tell your story.
If you need help telling your story, IHN Solutions' Reaching the Public program development series, offers Creating 'The Zero Tolerance Program' to Address Community Concerns About Abuse in Health Care Facilities. This curriculum contains all the information necessary to create a Zero Tolerance Program for your facility and educate the public about the issues surrounding both domestic and institutional abuse. For more information click here.
The Zero Tolerance Program
The following question comes from Claudia Ress, MS, MBA, CNA, Administrator at Westmont Care Center in Logan, Iowa.
What is the best way to keep people from calling off when they have other commitments and don't want to come to work?
Your question can be easily broken into, "Time On" and "Time Off." As the employer you are rightly concerned with having enough staff to provide quality service to your residents. "Time On." And just as rightly, your staff's primary concern will be what they do away from work. "Time Off."
If you are like many health care organizations you probably have a centralized scheduling system with one coordinator responsible for pleasing everyone with their time on and time off needs.
With the appropriate setup, we advocate a system of team-based scheduling. We believe that when coworkers come together with a blank schedule and jointly, as a team, fill in as many of those blanks as they can before the scheduling coordinator gets involved, the team will have greater personal and group ownership of the schedule.
The next logical step is when someone needs time off they are responsible for finding their own replacement. If they find a coworker to pick up the shift there will be no consequences but if the scheduling coordinator has to track down a replacement it will go on the record. Based on the scheduling rules (i.e. overtime, differential pay, split shifts etc.) you establish, if the coordinator has to make too many replacements the employee's job could be in jeopardy.
At the same time if a worker finds their own replacements they could have 50 days a year off. (Although, this might make for some mighty thin paychecks.)
Tape one of "Proven Solutions," (click) our leadership techniques audiotape series, contains all the information needed to create a team-based scheduling program in your facility.
