This week’s Ftag of the Week is part of a regulatory group that is getting a lot of attention – Freedom from Abuse, Neglect and Exploitation. F602 Free from Misappropriation/Exploitation states that residents have the right to be free from misappropriation of their property and free from exploitation. The Interpretive Guidance (IG) for this regulation was greatly expanded when the Requirements of Participation (RoPs) were updated and include a detailed protocol for surveyors to follow when investigating allegations of misappropriation or exploitation.
Misappropriation
The State Operations Manual Appendix PP defines misappropriation as the deliberate misplacement/ exploitation or wrongful temporary/permanent use of a resident’s belongings or money without the resident’s consent. This includes, per the Interpretive Guidance, money, clothing, jewelry, electronics, and also the personal information of residents including credit card information, bank account information and Social Security cards. This has been cited on survey related to:
- Residents’ wallets/cash/gift cards going missing. In some cases, staff were identified on facility surveillance going into the rooms where items were reported missing, and in other cases even on the surveillance cameras of stores using the stolen items, such as ATM cards or gift cards.
- A CNA “traded” $20 bills with a resident because the one he/she had did not work in the vending machine. The resident gave the CNA a different $20 and it was later identified that the $20 the CNA had provided was a counterfeit bill (S/S: D)
Another area of resident property that should not be forgotten is resident medications, especially controlled substances, through diversion. Many of the citations reviewed for this post were related to controlled substance diversion, including:
- One facility reported it had identified diversion of controlled substances and was put into Immediate Jeopardy (S/S: K). Another facility in the same area employed the suspected RN who was a float nurse, and they received a visit from the local authorities who ultimately interviewed the RN and arrested her. That facility was also put into Immediate Jeopardy (S/S: K). Neither facility had conducted the necessary background checks on the employee.
- A facility was contacted by another nursing facility and was provided with social media messages showing that an LPN was selling controlled substances. Observation of the staff member showed that he/she spent most of the shift in the medication room and did not provide medications to residents as ordered. Checks of the controlled substances found missing medications (S/S: D)
Exploitation
Exploitation is defined in the SOM as taking advantage of a resident for personal gain through manipulation, intimidation, threatening the resident or through coercion. Residents may perceive staff as in a more powerful position than them, which may allow staff to unfairly manipulate the resident. This includes asking residents to borrow money or personal items or gaining access to resident’s personal holdings through persuasion, coercion or solicitation. Residents who consent due to intimidation, fear or coercion are not considered to have provided valid consent. Here are some examples of how facilities have been cited for exploitation:
- A resident loaned the Director of Social Services $1000 for personal use. The resident stated he felt uncomfortable saying no to the employee. The Social Services Director initially denied the allegation, but later admitted it. (S/S: D)
- One resident’s relative who managed her money withdrew nearly all of the money in the resident’s personal funds account and the facility did not intervene on her behalf to address the withholding of funds through exploitation of a vulnerable adult. (S/S: D)
Facilities need to have comprehensive policies and procedures in place to prevent misappropriation of resident property as well as exploitation. These topics need to be covered as part of the facility’s mandatory abuse training that should be in place as part of the Requirements of Participation.
When an allegation of exploitation or misappropriation of property is being investigate, do you think about and follow-up on identified changes in the victim’s mood and demeanor from the time the alleged exploitation/misappropriation was first noted? Are we looking for a change in the level of trust, fear of being touched/near others or is the person trembling or cowering (sure signs of fear), altered sleep patterns or new behaviors such as angry outbursts or agitation? Misappropriation and exploitation can have a profound negative affect on a resident, so we need to do our utmost to prevent misappropriation and exploitation through a strong prevention system that includes staff education and monitoring of the effectiveness of the system.
