Ask the Nursing Expert about ... behavioral difficulties

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Judi Kulus, MSN, MAT, RN, NHA, RAC-MT, DNS-CT, Curriculum Development Specialist for AADNS
Judi Kulus, MSN, MAT, RN, NHA, RAC-MT, DNS-CT, Curriculum Development Specialist for AADNS

I heard that nursing homes can get cited for causing residents to have behavioral difficulties. Can you explain?

While other regulations related to Post Traumatic Stress Disorder take effect in 2019, starting this November, surveyors will check that facility staff are treating residents for trauma and PTSD, not causing these conditions. This initiative originates with the new F-Tag 743, “No Pattern of Behavioral Difficulties Unless Unavoidable,” which states that a resident who admits with no mental or psychosocial adjustment difficulty or documented history of trauma or PTSD should not develop these behavioral symptoms.

F743 is intended to protect all residents, not just war veterans and victims of, for example, recent abuse. Even residents with a recent stroke or CVA can develop trauma-related behavioral symptoms. It also includes residents who may have suffered potentially debilitating “transfer trauma” from being provided no individualized support to adjust to new surroundings. 

In addition to expanding the definition of at-risk residents, F743 underscores the nursing staff's leadership responsibility in the effort to help residents adjust to and thrive in the facility.

Immediately after admission, residents should be assessed for trauma or PTSD. If they don't have these diagnoses, the nursing staff should monitor to ensure that they don't develop behaviors such as decreased social interaction or becoming increasingly withdrawn, angry, or depressed. If these behaviors develop, the nursing staff should assess carefully to determine whether they were unavoidable.

In its guidance to §483.40(b)(2), the Centers for Medicare & Medicaid Services lists steps facility staff must take to comply with the new regulation.