5 tips for abuse and incident response in long-term care
Allow me to share a little long-term care humor to brighten your day. Did you hear the one about the long-term care resident who kept unplugging her roommate's ventilator?
Okay, clearly that isn't a joke. But in talking about that incident and others, attorney Matthew Murer of the Polsinelli law firm in Chicago had the audience laughing during a presentation at last week's LeadingAge Illinois conference.
It's safe to say no one found humor in residents being endangered or facilities being cited and fined. But Murer was sharp in describing some absurdly bad incident responses and, sometimes, all you can do is laugh — if only ruefully, cringingly. Take, for instance, when you hear that a facility allowed a resident to turn off another's ventilator numerous times before separating them.
Of course, Murer and his colleagues weren't using these cases to do a stand-up routine, but as examples to teach conference attendees about best practices in responding to incidents and accidents at facilities. Here are five important takeaways:
1. Take all allegations seriously. Some residents make accusations that seem so obviously untrue, no one reports or investigates them. This is a mistake, Murer emphasized. For one thing, the regulatory requirement is that facilities need to report all allegations of abuse. It's also a best practice for ensuring resident safety. Murer's example: A resident with dementia refuses to take a shower. Finally, the staff members get the resident's daughter on the phone. The resident starts yelling that her caregivers punched her in the stomach. The staff members know they haven't done this, and so they chalk up the resident's accusations as simply acting out and do not report it. “The problem with that is, maybe the resident was talking about yesterday, or maybe she was talking about a week ago and a different staff member,” Murer said. “We don't know, until we report and go through the full investigation process.”
2. Preserve evidence … and residents' dignity. While some alleged incidents seem far-fetched, in other instances the evidence that something went wrong is all too clear, and the police are called right away. “Police are going to want you to preserve the [involved] area, and this could pose dignity issues,” Murer said. For instance, this balance can be tricky when sexual abuse has occurred. Dressing the residents involved and getting them out of the room but not touching the bed linens might be the best course of action, Murer suggested. To the extent that a facility alters the scene, someone should document exactly what is done. Taking a photograph before touching anything might be smart.
3. Know what “immediately” means. Regulations might require a facility to “immediately” report all incidents, accidents and allegations. But what does that mean? Particular oversight bodies might have different expectations, but it does not mean that an administrator should call the department of health before seeing to residents' safety and well-being, Murer said. That should be step one. Next, a facility leader might have to call the police or other local authorities and see to it that they are on the scene and have what they need. But a leader at the facility should report the incident to the relevant oversight bodies as soon as possible — this does not mean you take your time to do it “within twenty-four hours,” Murer stressed. And the facility should document how soon contact with oversight organizations was made and what steps were taken prior. This should protect against charges that a facility did not meet the “immediate” reporting requirement.
4. Stick to the facts in an initial report. Providers can basically force surveyors to issue citations by including speculation about what caused an incident in an initial report, Murer's colleague Jason Lundy cautioned. One example of an unnecessarily damaging initial report: “Resident eloped from the facility, possible causes include malfunctioning door alarm or light staffing.” This report gives regulators two “great reasons” to issue citations, and they would probably cite the facility on both the broken alarm and insufficient staffing, even if only one were true, Lundy said. He advised that providers keep initial reports to a couple of paragraphs. They should include only concrete facts and state that further conclusions will be made based on investigations.
5. Send final reports to me. Well, the attorneys didn't literally tell facilities to send their final incident reports to me, but here's a rule of thumb from Polsinelli's Meredith Duncan: “Is it something you, your corporation, your decision-makers would be comfortable with if it was published in a newspaper or shown to a jury?” In other words, a final report should be scrupulously factual yet cast the organization in as favorable a light as possible. This was a theme throughout the talk — that long-term care providers should see the incident reporting process as an opportunity to be good advocates for themselves.
Since I didn't provide the humor I promised at the start of this blog, here's your reward for reading through to the end: a theft caught on video, no incident report needed.
Tim Mullaney is Senior Staff Writer at McKnight's. Follow him @TimMullaneyLTC.