Qualilty Improvement for Senior Living Communities
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Confused Residents and Allegations of Staff Abuse

By Mark Wagner, CSP, ARM

All health care providers hope they are doing everything possible to prevent resident abuse in their facilities. However, if an outlandish claim of abuse is made by a mentally impaired resident, how would your facility respond?

Recently, a number of high profile sexual assault incidents have occurred throughout the country at senior living centers. One of the most notable and tragic situations occurred at a northern Minnesota senior living center, when an 89-year-old woman was raped in her bed by a nursing assistant, and then taken to the mental health unit of a hospital for nearly three days without treatment for her injuries.

While she was at the hospital, the nursing assistant confessed to raping the woman after he gave her narcotics that he knew would make her "mentally incapacitated." According to an article in the Star Tribune, the woman received no immediate treatment or counseling after she initially reported the rape to the police and facility staff. Instead, she was kept against her will in the mental health unit of a hospital for nearly 72 hours. Attorneys for the victim allege that the facility staff and medical professionals did not initially believe the woman's story because she was suffering from the early stages of dementia and memory loss.

The Health Department investigated the matter and concluded that the maltreatment had occurred, but that the employee, not the care facility, was responsible. However, the facility was cited for failing to immediately report an allegation of sexual abuse.

Risk Management Steps

Sexual abuse of residents by staff is a discovery that no provider wants to ever encounter, as there are few crimes more heinous than that. Initial reactions can be disbelief and a hope that there is something less sinister going on. If staff isn't careful, they can fall into the trap of explaining away the situation instead of accepting and acting upon the information at face value. You can minimize the risks of a similar situation happening in your facility by implementing the following risk management practices:

  1. Employee Background Checks – The first step is prevention by adopting written policies to do background checks on all prospective employees through national, state and local websites, according to state requirements. Routinely check sexual predator websites as well, including the FBI website that allows you to access the sexual offender registries for all states and territories (and Indian tribes) at http://www.fbi.gov/scams-safety/registry. Other checks include licensing boards and registries. Results should be verified, cleared and on file before allowing any new staff to have contact with residents.

  2. Abuse Prevention Policies – All employees should be informed of the facility's zero tolerance policy for any forms of abuse. View the following sample Sexual Abuse Policy for further information.

  3. Family Involvement – If an allegation or indication of abuse occurs, keep families informed of the incident and your ongoing investigation. As bad as the facts of the situation may be, it will be much worse for the facility if they prolong or withhold information from the family. This only leads to a perception of a cover up. Consult your legal representative for advice.

  4. Prepare in Advance to Deal with the Media – Whenever an allegation of abuse in a health care facility becomes public, the media will follow, so have a plan in place. Consider the following:

    • Appoint a Designated Media Spokesperson – All media inquiries should be referred to this individual. Usually this person is an administrator or other senior management person with some specific media relations training. Develop a policy and educate staff to defer to this individual if approached by media contacts.

    • Get Your Side of the Story Out – Generally "no comment" statements are perceived as guilty or a cover up. If the spokesperson cannot immediately respond, he or she should tell the media that they are investigating the alleged incident and will get back to them at a certain time. Then, make sure to follow through with a statement. Remember, the media have deadlines to meet and they are going to get the story out whether your facility cooperates or not. Don't miss the opportunity to state the positive things that were done, such as comprehensive background checks and abuse prevention training.

In summary, it is important to take all allegations and indications of abuse seriously, and provide immediate follow-up care and reporting. The preceding risk management steps will help to safeguard your residents and facility, now and into the future.

Serres, C. (2014). Woman, 89, raped by caregiver at Hermantown, Minn., senior facility. Star Tribune. Retrieved February, 18, 2014 from http://www.startribune.com.

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