Providers need to 'beef up' abuse documentation ahead of QAPI deadline, expert stresses

Training staff to recognize when to report abuse allegations is crucial, Seyfried says.
Training staff to recognize when to report abuse allegations is crucial, Seyfried says.

Long-term care providers should increase their focus on abuse documentation and reporting in order meet the recently-overhauled requirements of participation, one expert shared on Thursday.

The rule, released in September 2016, added new definitions and requirements for what constitutes abuse and exploitation of nursing home residents. Skilled nursing facilities will have to present a plan for coordinating their abuse response efforts with the QAPI program by Phase 2 of the rule, on Nov. 28, 2017. That QAPI plan will have to be implemented by Phase 3, which hits Nov. 28, 2019.

“Our focus on prevention and our documentation and policy procedure form has to be beefed up in accordance with what the new expectations are,” stressed Dorri Seyfried, vice president of IPMG Healthcare Risk Management. Seyfried spoke during LeadingAge Illinois' annual meeting Thursday.

In the new rule are changes to the definitions of abuse, including that an abuser must have acted “deliberately,” but not necessarily intended to inflict harm. The definition was also expanded to include “abuse facilitated or enabled through the use of technology,” along with the preexisting definitions of verbal, sexual and mental abuse.

That new addition is especially important at a time when a growing number of nursing home workers are being caught and penalized for taking unauthorized photos or videos of residents and posting them on social media. Those violations can have HIPAA and civil liberty implications for providers, Seyfried stressed.

But for all the training facilities offer on abuse, one critical piece of the puzzle is consistently lacking, she said: Helping staff understand what incidents should be reported.

“Facilities do a tremendous amount of inservicing on abuse, and yet we're still challenged by staff who don't recognize scenarios that they should be reporting,” Seyfried said. “When staff fail to report something timely it throws the whole train off the track. It becomes a systems issue within the facility when your surveyor comes to see you.”

Timely reporting matters, Seyfried said, since another update included in the rule requires incidents of abuse to be reported “not later than [two] hours after the allegation is made.”

“If your staff aren't recognizing the event that needs to be reported, you're never going to make the two hours,” Seyfried explained.

Seyfried's “to-do” lists for providers include updating abuse-related policies to cover the rule's new language; creating guidelines within the abuse policies regarding cell phones and social media posts; and evaluating who needs and has access to residents' information and belongings to avoid incidents of identity theft or misappropriation.

“Is the resident's information too available? Do you know what the resident brought in with them?” Seyfried asked. “If you don't specifically ask those questions and identify those belongings, how are you going to know and how are you going help keep the resident's personal information safe?”

LeadingAge Illinois' annual meeting continues through Friday at Chicago's Navy Pier.