Avoiding Safety Pitfalls in Senior Care: Resident Vetting, Visitor Monitoring, and Staff Training
Susan Lucot, MSN, RN, MLT (ASCP), CPHRM
Senior care organizations (e.g., nursing homes, long-term care facilities, and assisted-living communities) strive to provide a welcoming and safe environment for their residents. Doing so allows residents to seek enjoyment through group activities and build relationships with others who have similar interests. Yet, safety remains a preeminent concern, and organizations must consider the various individuals traversing the environment to ensure a safe setting.
This article offers guidance and risk strategies related to resident vetting, visitor monitoring, and staff training. Each of these areas represents a potential risk, and senior care organizations should ensure due diligence to protect residents and minimize the potential for state deficiency citations and malpractice claims.
Resident Vetting
Vetting starts with evaluating prospective residents and determining whether they are a good fit for your facility. Reviewing previous medical records and conducting in-person preadmission assessments — particularly in the prospective resident’s home — is a helpful first step.
The following strategies provide additional aspects to consider in protecting your existing and future residents and staff. Incorporating a checklist of admission and discharge criteria to assist in the process can mitigate some of the risk exposures related to resident evaluation.
Risk strategy: Conduct criminal (state and federal) and sex offender background checks on all prospective residents.
Rationale: People come from a variety of experiences, some of which can be harmful. Without conducting thorough criminal and sex offender investigations into each prospective resident, the organization may compromise the safety of residents and staff members and incur undue risk.
Countless cases have happened in which residents have harmed other residents in aggressive, violent, or sexual assaults. If an assault occurs, your organization might be held liable for failing to ensure a safe environment. Even if your state does not require background checks, your organization is not absolved from liability.
Several states have enacted legislation requiring criminal and sex offender background checks for all residents in senior living and nursing care communities. Other states don’t allow for discrimination of resident admission based on previous felony charges or incarceration. Be aware of the laws in your state and contact knowledgeable legal counsel regarding these matters.
Beyond any legal obligations, it is still crucial for organizational staff to know who is in the building and to be trained and prepared for any altercations that may arise.
Risk strategy: Assess all prospective residents for current and previous formal behavioral health diagnoses, including conditions that are associated with aggressive or violent behaviors.
Rationale: Senior care organizations typically have a limited scope of services that they provide. Each organization is unique, and variations exist in staffing, resources, and external support among facilities. Some potential residents may not thrive in certain environments, particularly if they have specific medical conditions or needs. Therefore, determining admission and discharge criteria — and strictly adhering to these criteria with every prospective and existing resident — is crucial. Admitting or retaining residents whose needs supersede the services the organization can provide increases the risk of medical malpractice claims.
Risk strategy: Implement and strictly observe well-defined care procedures and resident agreements if your organization admits residents who have active substance abuse issues.
Rationale: Caring for residents who have ongoing substance abuse issues is quite challenging. The actions of these residents and their visitors often times can negate many of the safety measures the organization has put in place. For example, residents have eloped from facilities to access illegal substances, and visitors have delivered illegal substances to residents.
These situations can result in behavioral health crises and, in turn, lead residents to harm themselves, staff members, and other residents. Senior care organizations can be held liable for injuries that are sustained as a result of these circumstances.
Developing specific protocols for managing patients who have substance abuse issues can help guide staff members in these difficult situations. Further, using resident agreements may help improve residents’ adherence to organizational policies and address problematic behaviors.
Visitor Monitoring
Aside from residents, many other individuals move throughout senior care organizations, such as external vendors, delivery personnel, and repair staff. Vetting and monitoring these individuals is vital for safety. Organizations should determine who will perform these functions (internal or external staff/vendors) and the appropriate evaluation criteria.
Risk strategy: Ensure that all business visitors (delivery personnel, repair staff, vendors, contractors, etc.) are escorted at all times while inside residential buildings.
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Rationale: The senior care population is particularly vulnerable to falling prey to bad actors. Just as organizations implement processes to screen potential employees, they also must ensure proper screening of nonemployees.
The companies that employ senior care vendors and contractors should have evaluation processes as part of hiring. However, these companies may have different and less rigorous employment criteria than senior care organizations. To address this potential risk, your organization should ensure that business visitors are properly escorted in residential areas and never left alone with residents. Any harm inflicted on residents may result in legal liability for the organization.
Risk strategy: Closely monitor family members and friends, especially those who are permitted to stay overnight with residents, and limit their access to other residents.
Rationale: Even though your organization conducts thorough background checks on residents, what is known about their family members and friends, especially those who want to stay overnight with their loved ones? Vetting family members and friends is not an easy task, nor is it practical. However, this does not eliminate your organization’s risk exposure if a visiting family member or friend harms a resident.
In some situations, family members or friends may request to stay overnight with a resident to provide comfort and care (e.g., if the resident is gravely ill or nearing the end of their life). Your organization can approve the family member’s or friend’s request, but maintaining safety for all residents and staff is imperative.
Staff members should, at minimum, frequently monitor the visiting family member or friend and limit their access to travel throughout the building. Additionally, the organization should notify all staff members working during night-shift hours about the presence of the visiting family member or friend and where they are permitted within the building.
Staff Training
Most, if not all, senior care organizations conduct criminal (state and federal) and sex offender background checks on prospective new hires. Yet, the process should not end with those activities. Another critical aspect of resident safety is providing training to help staff members understand and maintain professional boundaries.
Risk strategy: Ensure that staff education and training programs include ample information and guidance related to professionalism, ethics, and appropriate behavior when interacting with residents and their family members.
Rationale: Although senior care organizations want to create a home-like atmosphere, they are still businesses and can be held responsible when adverse events or other violations occur. As such, maintaining professional boundaries between staff members and residents/families at all times is essential. Although staff members may have friendly relationships with residents and their families, they should avoid:
Complaining about coworkers, leaders, and the organization
Making statements that could potentially harm the organization from a legal standpoint (e.g., “we’re shorthanded in staffing,” “my coworkers aren’t doing their job,” or “our leaders aren’t doing anything about that issue”)
Providing staff members with ongoing training opportunities that highlight these issues can help them avoid risky situations and reinforce organizational expectations for ethical behavior and professionalism.
In Summary
Creating a safe environment in senior care organizations is complex and multidimensional. One important factor is having processes and strategies for managing the people who work in, live in, or come in contact with the organization, including staff members, residents, family members, friends, business vendors, etc. Ensuring thorough resident vetting, visitor monitoring, and staff education and training will help reduce the risk of state deficiency citations and liability exposure.
Disclaimer
This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.
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