The next “Ftag of the Week” on the CMSCG Blog is F600 Free from Abuse and Neglect, which is part of the Freedom from Abuse, Neglect and Exploitation regulatory group of the Requirements of Participation (RoPs) for nursing homes. Under the RoPs, the Interpretive Guidance (IG) for F600 has been expanded to such a length that we will be reviewing this Ftag over the next few posts.
The regulation at F600 states that residents have the right to be free from abuse, neglect, exploitation and misappropriation of resident property (F602). This includes the right to be free from corporal punishment, involuntary seclusion (F603) and from physical (F604) and/or chemical restraints (F605). The facility, per the regulation, is prohibited from using verbal, mental, sexual or physical abuse, corporal punishment or involuntary seclusion of a resident.
Abuse – Defined
F600 defines “abuse” as the willful infliction of injury, unreasonable confinement, intimidation, or punishment that results in physical harm, pain or mental anguish to the resident. Deprivation of good services by a caretaker that are necessary to maintain the resident’s well-being is also considered a form of abuse. The regulation clearly states that irrespective of any mental or physical condition, abuse of residents causes physical harm, pain or mental anguish. Forms of abuse include verbal abuse, sexual abuse, physical abuse and mental abuse – including abuse facilitated by technology (i.e. social media).
The IG notes that there are some facility characteristics that can increase the likelihood for abuse that administration needs to be on the lookout for:
- Chronic staffing issues, staff burnout and stressful working conditions
- Staff attitudes toward residents that are unsympathetic or negative
- Inadequate training/preparation to fulfill caregiving duties
- Deficiencies in providing a safe resident environment
- Policies that are not resident-centered and “operate in the interests of the institution”
- Lack of administrative oversight
Deprivation of Good and Services by Staff
If staff have the knowledge and ability to provide the necessary care and services to ensure a resident attains/maintains the highest well-being, but chooses not to, this is considered abuse. It is also considered abuse if a staff member does not acknowledge a request for assistance that results in a care deficit.
Physical abuse, per the IG, includes actions such as hitting, biting and slapping, as well as corporal punishment. Corporal punishment is meant to correct or control the behavior of a resident and involves someone taking an action such as pinching, flicking, slapping hands or hitting with an object.
Mental and Verbal Abuse
The IG notes that mental abuse includes both verbal and nonverbal actions which cause – or have the potential to cause – a resident to experience intimidation or fear, shame, humiliation, degradation or agitation. Verbal abuse, which includes oral, written or gestured communication or sounds, can also be considered mental abuse when used within hearing distance of residents.
Keeping or distributing photographs or recordings of a resident that demeans or humiliates the resident can be considered abuse. Even if the resident has provided consent, and regardless of whether he/she is cognitively intact, surveyors are instructed to investigate if there is non-compliance related to abuse at F600. Depending on the content of the documentation/materials reviewed, physical and/or sexual abuse may also be identified.
If a surveyor identifies mental abuse, he/she must cite F600 at a scope/severity level that considers any psychosocial harm that residents may have experienced as a result of the mental abuse. Staff should be familiar with the Psychosocial Harm Severity Scale.
Sexual abuse, per the IG, is any non-consensual sexual contact with a resident. Sexual contact is considered to be non-consensual under several circumstances, including if a resident appears to want the contact but is unable to consent, if the resident does not want the contact to occur, and if the resident is sedated/unconscious/in a coma.
Stay tuned for Part 2 of our review of F600 Free from Abuse and Neglect next week.