All residents’ complaints, no matter how trivial, should be investigated and documented. A log should be maintained containing information about complaints such as the nature of the complaint,date, time, persons involved, witnesses, interventions and outcomes. During the compliance survey process, a state or federal surveyor may request to see the complaint log for the previous year.
When investigating a complaint, the resident’s version of the incident should be given as much credence as the staff member’s. Residents with numerous complaints may require social service intervention to help identify reasons for any discontent/dissatisfaction. Good communication is vital and problem solving should be proactive not reactive.
The Elder Justice Act is a preventative law that protects the elderly from abuse, neglect and exploitation. It is part of the Patient Protection Affordable Care Act (PPACA) passed in 2010. Elder abuse refers to actions or lack of actions that can harm or place in harm’s way any elderly person. Nursing home personnel should acknowledge that abuse could happen in their facility and they should always be on the alert for prevention, intervention and treatment of elder abuse.
The law mandates reporting requirements. Federal regulations require all alleged violations involving mistreatment, neglect or abuse are reported immediately to the administrator of the facility. A hotline for reporting should be available 24/7 and an abuse coordinator is usually the administrator or a designee if the administrator is unavailable.
If serious bodily injury occurs, a report must be made to the state survey agency (such as the Department of Public Health) and the local law enforcement agency within 2 hours. When a staff member is involved, he/she is immediately suspended and must leave the facility until the investigation is completed. Less serious issues are reported to the state agency within 1 day and a final report including investigation, findings and interventions are reported in 5 days. Mistreatment, neglect and all forms of abuse, including verbal, mental, sexual and physical, injuries of unknown origin,and misappropriation of resident’s property are all reportable offences.
To assist in the prevention of abuse, the facility should post a list of residents’ rights and should provide mandatory training on Abuse prevention and reporting. Appropriate staff screening and signs and symptoms of staff burnout should be monitored. Awareness of staff attitudes and actions regarding abuse reporting is important. Staff members should feel they can report problems without fear of reprisals or retaliation.
Clinicians should also monitor problems of aggression between residents and appropriate interventions for separation should be put in place.
Outcomes of visitation should always be positive. On one occasion a resident complained to me she had overheard a visitor verbally abusive to the other resident in the room. When the visitor left, the resident cried for long periods. An investigation determined that she was correct. The daughter of a resident was attempting to get money from the resident. The daughter was forbidden to visit except with supervision. The resident was brought to the dayroom during visitation, where staff could observe for any negative interactions.
As I have stated earlier the physician and family members should be notified timely and the necessary documentation should be completed.
