Committing to protecting a vulnerable population
Their dependence on others leaves nursing home residents at greater risk of abuse or exploitation. For every case of abuse reported, many more cases go unreported. According to the National Center on Elder Abuse, elders who suffer even modest abuse have a 300% greater chance of death in the three years following the abuse.
Any incident of abuse is unacceptable, especially in a setting where the vulnerable among us are presumed to be safe. We must balance caring with caution to provide and maintain an environment that keeps residents safe and doesn't unintentionally invite abusers in.
Starting with screening – including volunteers
Unfortunately, “gut feeling” isn't a reliable screening tool, especially when it's estimated that 8% to 10% of the population has a criminal conviction. And while nearly all state laws require background checks for nursing home employees, this requirement often doesn't extend to volunteers. We know volunteers fundamentally enhance the quality of life for residents and their families, and nursing homes increasingly rely on their support, yet inconsistent vetting of these individuals can expose you to unintended risk.
The issues that hinder the effectiveness of employee screening also plague volunteer background checks, including inadequate screening methods and insufficient information resources.
Ideally, all volunteers should be screened even if they are working on a temporary basis. While screening may not need to rise to the same level as that required of the professional healthcare staff, volunteer background checks must still be comprehensive enough to ensure the physical and emotional safety of residents, staff and other volunteers.
For more thorough screening for all, we advise healthcare organizations to:
- Use the most comprehensive sex offender search. The only comprehensive search available in the country, the Dru Sjodin National Sex Offender Public Website, contains real-time, national sex offender data from sources such as the U.S. Department of Justice and state, territorial and tribal governments.
- Conduct multiple searches. No single database contains every criminal record, not even the FBI's National Crime Information Center. Using multiple searches provides a more thorough look into an individual's criminal past and fills in as many gaps as possible since criminal records reside within multiple data sources. Background checks should search the primary source of information (the county or state courthouse), current addresses and address history, and alias and maiden names. Depending on an individual's role, they may also include motor vehicle record checks, credit checks and reference checks.
- Don't over-rely on fingerprint checks. Fingerprint checks may be required in certain situations; however, the idea that they are the most reliable way to conduct criminal record checks is a fallacy. Fingerprint checks query the FBI's National Crime Information Center, which is based on voluntary submission of records by each state. The records are often flawed, inaccurate and missing critical information.
- Identify other areas that are vulnerable. Your residents' safety is clearly paramount, yet it may not be your only vulnerability. Background checks also protect other visitors, staff and volunteers as well as your facility's assets and reputation. Any individual who handles finances, personally identifiable information or technology, should be screened.
- Rescreen regularly. Once you have screened staff or volunteers, you should not assume that means they are clear of criminal history forever. Rescreening ensures you have the latest information about potential criminal history.
Going beyond screening – Implementing a comprehensive standard of protection
Screening represents one crucial element of the standard of protection, but it is certainly not the only one. Organizations should also have:
- A statement of policy. This written policy, formally approved, implemented and periodically reviewed under the direction of executive leadership, should confirm your commitment to providing a safe environment and declaring zero tolerance for abuse, harassment or neglect. The declared purpose of the policy should be clearly expressed, that is, preventing harm to the adults in your care and protecting your staff and volunteers from false or wrongful allegations.
- A definition of abuse. Define abuse and related issues so that all of your employees and volunteers will clearly understand and be able to identify unacceptable behavior including physical, sexual and emotional abuse, harassment and neglect.
- Operational procedures written out and distributed to all workers. Operational procedures should include, but are not limited to, guidelines for communication, appropriate touch, personal care, emergency response and health and safety guidelines.
- Premise modifications or alterations of your facilities, which can assist in preventing and discouraging abuse incidents. This may include having security and hall monitors doing frequent checks of rooms.
- Training (orientation and annual refreshers) for all staff members and volunteers who regularly work with residents to assist in the prevention of abuse.
- A protocol for reporting and responding to all allegations or complaints of abuse in an appropriate manner that adheres to legal requirements.
Even with the standard in place, we still see many organizations with gaps in their policies and practices. You should plan to conduct a policy audit every year to be sure your policies are actually being followed and that your practices are adequate. For instance, are you certain that your reporting guidelines are not in conflict with what is required of you by law? Older policies are also often missing important operational procedures regarding reporting, incident reports and transportation.
Protecting your residents as well as those around them from harm, and safeguarding your facility itself, must be a strategic initiative.
Through proper screening and adherence to the standard of protection, we believe you can significantly minimize negative incidents and ensure that when they do occur, they do not go unnoticed and unreported. You also demonstrate your duty of care to everyone who enters your premises. Not least, by taking the appropriate measures, you help maintain and preserve the integrity of your institution as one that prioritizes the safety and well-being of its residents and the caring individuals who serve them.
Katie Zwetzig is executive director of Verified Volunteers and Melodie Bissell is president of Plan to Protect. The organizations recently announced a partnership that aims to provide the highest level of protection for nonprofits serving vulnerable populations.