Freedom from Abuse Neglect Misappropriation and Exploitation for
Freedom from Abuse, Neglect, Misappropriation and Exploitation for Direct Caregivers
Objectives Participants will: • Understand the updated regulation that guides our practices regarding freedom from abuse, neglect and exploitation. • Identify the seven elements required for our process to protect residents from abuse, neglect and exploitation. • Be able to identify the role and responsibilities of direct care staff to identify and report potential abuse or neglect issues. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Introduction • The nursing home Requirements of Participation (Ro. P) are the regulations that set minimum standards for nursing homes. • The changes in regulations go into effect over the next three years, in phases. • There were changes made to the regulations for Freedom from Abuse, Neglect and Exploitation. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Overview of the Regulation The regulation states that: – Residents have the right to be free from abuse, neglect, misappropriation and exploitation. – Residents must be told about their rights. – The facility must promote the residents’ rights. – The facility must have policies and procedures and education for new and existing staff about freedom from abuse. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Overview of the Regulation The regulations also state: – The facility cannot employ individuals who have been found guilty of abuse or have an abuse violation against their professional license. – Facility staff must be able to identify potential abuse and know what to do to protect residents. – Facility staff must know how and when to report suspected abuse. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Updated Definitions • Abuse = the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. – Includes withholding goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. – Includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse caused through the use of technology. – Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. • Willful = the individual acted deliberately, not that the individual must have intended to inflict injury or harm. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Examples of abuse Group Discussion: Describe— • • Examples of physical abuse Examples of verbal abuse Examples of mental abuse Examples of sexual abuse This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Definitions • Exploitation. (NEW) Exploitation means taking advantage of a resident for personal gain through the use of manipulation, intimidation, threats, or coercion. • Group Discussion - Examples This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Definitions • “Involuntary seclusion” is separation of a resident from other residents or from her/his room or confinement to her/his room (with or without roommates) against the resident’s will, or the will of the resident’s legal representative. – Emergency or short term monitored separation – what does this mean? . Examples This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Definitions • Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident’s belongings or money without the resident’s consent. • Examples This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Definitions • Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. • Examples This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Definitions • Injury of unknown source – resident injury that is not the result of a known accident or event. • Example This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
First Things FIRST! *If you witness or are informed of abuse, you must first protect the resident, intervene and stop the abuse! This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 1 - Employee Screening The facility cannot employ or contract with anyone who: – Has been found guilty of abuse, neglect, exploitation, misappropriation or mistreatment. – Has a finding entered into the State nurse aide registry concerning abuse, neglect, exploitation, misappropriation or mistreatment. – Has a disciplinary action in effect against their professional license of finding of abuse, neglect, exploitation, misappropriation or mistreatment. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 2 – Policy and Procedure The facility policy must describe how the facility will: Prohibit and prevent abuse Investigate any allegations of abuse Provide training about abuse to staff Coordinate with the QAPI Committee Report suspected crimes in accordance with State laws Annually notify covered individuals about following reporting requirements – Participate in annual training as required – – – This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 3 – Report Suspected Abuse • All alleged abuse, neglect, exploitation, mistreatment, injuries of unknown source and misappropriated resident property must be reported IMMEDIATELY to the Administrator -- and State agency: – Within 2 hours – Within 24 hours – Excluding Saturdays, Sundays, and holidays • Some states or facilities may have more strict reporting rules. See the next slide. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Facility Reporting Requirements • Insert your facility/state specific reporting process NO other state specific language NOTED This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 3 – Reporting Suspected Crime • The federal regulations require that suspicion of a crime be reported to law enforcement officials against any resident: – No later than 2 hours after forming the suspicion if there is serious bodily injury to the resident. – No later than 24 hours after forming the suspicion if there is no serious bodily injury to the resident. • Your State or Facility may have more strict reporting rules. See the next slide for details. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Add State Specific Reporting Requirements Here This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 4 – Prohibit Retaliation Residents must be protected from retaliation if they report abuse – It is not allowed for anyone to mistreat or intimidate the resident after reporting potential abuse. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 5 - Investigation • Every allegation of abuse, neglect, exploitation, mistreatment, injuries of unknown source and misappropriated resident property must be thoroughly investigated. – Residents, employees, family members, visitors, and other may be interviewed about their knowledge of events. – All health care workers are “mandatory reporters” of abuse, so it is important to share all the information that you have about the event(s). This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 6 – Prevent Further Abuse The facility staff must protect the residents from further abuse while the investigation is being competed. – This may involve suspending staff or assigning staff to work in other areas of the facility during the investigation. – This is for the protection of residents and staff – Suspension during the investigation does not mean that you are guilty of anything. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Element 7 – Report Results • The results of the investigation must be reported to the Administrator and other officials, according to State law, and the State Survey Agency within 5 days of the incident. Each State has its own reporting rules and processes. See the next slide for more information about your State. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Facility Investigation Report This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Your Role and Responsibilities • Direct care givers are required to follow the nursing home regulations. • Healthcare workers are required to identify and report: – – – – suspected crimes toward residents and alleged abuse, neglect, misappropriation, exploitation, involuntary seclusion, use of restraints without a medical symptom. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Your Role and Responsibilities • Monitor your own level of frustration or anger and ask for assistance if levels get too high. • Step in to assist others who may be frustrated or angry. • Monitor and assist residents with behaviors that might disrupt or frustrate other residents or staff. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Your Role and Responsibilities • Be aware of changes in residents’ mood or level of interaction. Report changes to the supervisor for investigation. • Safeguard residents’ belongings. Report high value items to the supervisor for safe-keeping. • Report all skin changes and injuries right away to the supervisor. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
Your Role and Responsibilities • Understand the definitions of abuse related events that are reportable. • Know your facility’s abuse reporting policy and follow it. This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
In Summary • Know • Understand • Respond –Stop –Protect –Report This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
THANK YOU FOR PARTICIPATING IN THIS EDUCATION SESSION! This document is for general informational purposes only. It does not represent legal advice nor relied upon as supporting documentation or advice with CMS or other regulatory entities. © Pathway Health Services, Inc. – All Rights Reserved – Copy with Permission Only - 2017
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