In Part 1 of our review of F600 Free from Abuse and Neglect, we provided an overview of the types of abuse. We are continuing our review of F600 in this “Ftag of the Week” post by looking at some different types of abuse situations outlined in the regulation.
Staff to Resident Abuse (Any Type)
The Interpretive Guidance (IG) very clearly spells out some important information related to these situations, so even if you plan to skim the rest of the post, read these bullets:
- When a facility accepts a resident, it assumes responsibility for ensuring the safety and well-being of the resident. Thus, it is the facility’s responsibility to ensure that staff are appropriately trained and understand how to respond to a resident’s exhibited behavior. The Facility Assessment provides a guide to the variety of resident conditions that a facility states it is capable of caring for. Remember, there should be related staff competencies to validate that the staff is competent in managing behaviors and ensuring that the resident population remains free of abuse.
- Staff are expected to control their own behavior and the Centers for Medicare & Medicaid Services (CMS) does not consider striking a resident who is being combative to be acceptable under any circumstances. The Agency also does not accept that a staff member’s action was unintentional or reflexive and not intended to cause harm.
- Any retaliation by a staff member towards a resident is considered abuse and will be cited as such.
- A nursing facility cannot disown the acts of its staff members since the facility relies on its staff to provide care in a safe environment.
Visitor to Resident Abuse (Any Type)
Facilities also need to ensure they have procedures in place to ensure residents are safe when they are with visitors, whether they are family members or otherwise. Surveyors are instructed to look at a resident’s social history to the extent possible, to see if there are issues or concerns that have been identified related to the resident’s relationship with a spouse, family members or visitors who are not part of the resident’s immediate family to see if the facility identified and implemented interventions to keep the resident free from abuse. Facilities need to have P&Ps in place related to visitor access, including safety restrictions if issues have been identified related to a visitor.
Resident to Resident Abuse (Any Type)
The regulatory guidance at F600 states that resident-resident incidents should be investigated as potential abuse, even if one or both residents have a cognitive impairment/mental disorder. The definition of abuse, as we mentioned in our last post, includes the concept of “willful” which means that the person acted deliberately. The IG notes that just the fact that a resident may have a cognitive impairment or mental disorder does not mean that he/she is unable to take deliberate actions. If the surveyor determines that an action was not willful, then the surveyor needs to investigate whether the facility is in compliance with the requirement for adequate supervision at F689. The facility is responsible for ensuring that it has effective interventions in place to prevent resident-resident incidents and if needed, provide immediate interventions to ensure the residents are safe from abuse. This includes monitoring for any aggressive behaviors by one resident that may provoke another. These interventions need to be included in the care plan and updated based on effectiveness. Those residents who are at risk to harm others as well as those who are at risk to be victimized need to be on the radar screen not only of the caregivers but Administration as well. There is an administrative responsibility to have sound systems in place to prevent abuse as well as a mechanism to monitor compliance with established protocols.