Definition of neglect

Wanted to pass along one of the many definitions of neglect. As professional nurses in long term care settings if you assess that a resident needs medical attention then get them to the hospital. Do not allow an administrator or family member to decline the services of an ambulance because they do not want the resident to go to the hospital. As a professional you can be held responsible for neglect when you do not advocate for the resident, especially when the facility's policies direct what action is to be taken. As a professional you are held to the regulations that operate in your state governing the operation of the facility and your nurse practice act including resident rights, and reporting requirements. Not knowing what the requirements are will not excuse you from legal and professional action when allegations of neglect are reported. You also can be held responsible if you fail to provide supervision to caregivers under your leadership and do not provide adequate training. Your best protection is knowing what your job description states, the facilities policies, your nurse practice act, regulations governing the type of facility for which you work and what must be reported to the state board of nursing.

Assessments of residents in Assisted Living Centers

The position of the licensed nurse in an Assisted Living Center comes with a lot of autonomy and requires the discipline of a self starter. How to integrate assessment skills with the requirements of an assisted living is challenging for nurses who enter the field without the experience of well developed critical thinking. Assessment of a resident needs to include information from family members, the resident, the resident's physician, case manager and the licensed nurse. The assessment is pivoted around what makes up the resident's life, not just a head to toe physical assessment. The question that needs to be answered is "Can the facility meet the needs of the resident in a manner that provides the highest quality of life for that resident?" Combining all the information regarding a resident and developing a service plan that identifies what services the resident needs and wants, at the time he or she wants, in the manner he or she wants, determines if the resident's needs will just be met or if the needs will be met in an atmosphere that validates the person and supports their rights.

Taking belongings away violation of resident rights

An incident that I became aware of recently where caregivers had decided to remove a resident's belongings because he would make a mess of his room was disturbing. To take and with hold a person's belongings is a violation of their right to property. The caregivers needed to explore options that protected and ensured the resident's rights. Options possible could have included increased supervision, providing activities that interested the client, request a family member to visit during that particular time or exploration of why the resident was agitated and remove the cause. Did the agitation occur frequently or at the same time during the day or night? Did the resident need to be toileted, was the resident in pain, did the resident have gastric upset or was ill or possibly hunger? Putting residents in front of a television without monitoring what is being viewed could possibly be the problem. Residents with dementia lose the ability to process stimuli in the same manner that individuals who do not have dementia. Providing care to individuals with dementia is challenging because often they are unable to verbalize what is bothering them. Providing a safe environment with a high quality of life requires all the skills of observation, reasoning and critical thinking of the caregivers.

Resident Rights

Some of the examples I have seen of resident right violations include; Residents being called sweetie, honey, babe, love. Residents have names and should be addressed by what they prefer to be called. Usually Mr. or Mrs. followed by their last name is appropriate. Residents should only be addressed by their first names if one is given permission to do so. Asking an individual how they prefer to be addressed establishes respect and provides dignity to the person. So many times residents have come to live in an assisted living because they have lost the ability to perform activities of daily living independently. Demonstrating kindness and respect only requires a bit of effort and time yet validates the individuals self worth and sense of dignity.

Resident Rights

I am simply baffled at some of the things I see. Last week I came across an incident that I would think automatically would be viewed as a violation of resident rights and yet the situation was not handled with that level of urgency. In no situation would it be acceptable to refuse a resident breakfast for being 5 minutes late of the appointed meal time. An assisted living center is home to vulnerable adults and no one should be allowed the power to decide if a resident will or will not be served a meal because they are 5 minutes late. Hopefully the ombudsman will be in that facility next week to help establish a resident council and do some teaching on resident rights. Facilities that have active resident councils are better informed of resident rights and are more likely to engage the services of an appointed ombudsman.

For anyone who is not aware of what an ombudsman does, they are volunteers that go into facilities to assist residents in exercising their rights. They often will lend a voice to the resident's concern, or assist a resident in obtaining a service they need, or negotiate when there is a dispute. The ombudsman program for Washington State provides training for ombudsman and we are so fortunate to have as many as we do.

Care Giver Training

This past week I was privileged to observe a training in a facility that the nurse was presenting to caregivers. Training was on resident rights. The question being discussed was how to balance resident rights with resident safety. A resident had a recliner lift chair and wished to have use of the controller. The staff were concerned she would accidentally flip herself out of the chair. One caregiver stated she had placed the controller beside the resident's leg and requested she call for assistance when she wanted to get out of the chair. Another caregiver stated that perhaps they could check on her hourly. Another caregiver volunteered and said "we need to include this on the service plan". Another caregiver suggested "lets ask the resident what she would like". By the end of the training almost everyone present had contributed something about the care for this resident.

Observing interaction between care giving staff and trainers is a another means to evaluate a facility and how they provide for residents. When the caregivers are engaged in the decisions about the care they provide and feel they are being listened to then it is a good probability you will see the care givers listening to what residents are saying.

Thirteen Thursday #2 Issues of dignity

My 13 idea of respecting another's dignity when living in an assisted living center.
1. Address an older individual by their title Mr. Mrs. Miss, Mame, or only if given permission, by their first name.
2. Refrain from addressing an older person as "honey, sweetie, sweetheart or any other term that denotes an intimate relationship. You wouldn't address an employer with these terms.
3. Be considerate of the individual's personal space.
4. Knock before entering an individual's quarters.
5. Wait, after knocking, for an invitation to enter or at least wait an appropriate amount of time before entering to allow the individual to respond.
6. Request to speak to an individual quietly in private. Do not holler across a dining room the individual's name. No one else needs to know the resident's business or that you need to talk to them. Demonstrate that respect.
7. Do not holler across a dining room and ask the resident how their meal is, that is demonstrating a lack of respect. Go over to the individual and address them in a respectful manner to inquire if their meal is satisfactory.
8. Go about your duties in the dining room in a quiet manner. Meal time is one of socialization for residents. Be respectful of their environment it should not remind one of a junior high cafeteria. There should not be banging of dishes, wait staff hollering across the dining room shouting orders or staff visiting with one another. This is time for the residents and should be a pleasant experience; for some this is the highlight of their day.
9. If a resident needs assistance to the bathroom do not announce it to the whole dining room how embarrassing! If you need to let a coworker know you are leaving the area because a resident needs assistance to the bathroom develop specific statements such as "Mrs. Brown requires assistance" meaning its a bathroom run and may take a while or "Mr. Moon requests assistance" meaning you will be taking him back to his room to change cloths because of an accident or whatever might work for your situation. Remember the residents were once fully functioning adults with pride and dignity. They have lost so much independence, control over bodily functions, ability to care for themselves as they once did; we need to make the effort to preserve their dignity and demonstrate respect.
10. When providing personal care for residents make the environment as private as possible. Provide adequate covering. Do not allow coworkers to walk in and carry on a conversation while you are providing care.
11. Try to carry on polite conversation while providing intimate personal care to decrease embarrassment for the individual. Provide the resident modesty whenever possible.
12. Explain what you wish to do before you execute and ask the resident's preference and permission.
13. Refrain from discussing resident information in public areas such as the dining room, elevators, common bathrooms (it is amazing how voices carry out of a bathroom), hallways or any where the information could be overheard.
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Resident Rights Source

Resident Rights published on the Thirteen Thursday (#1) came from the RCW (Revised Code of Washington) Chapter 70.129. The 70.129.005 RCW states ...the intent of the legislature includes that long-term care facility residents have the opportunity to exercise reasonable control over life decisions. The legislature finds that choice, participation, privacy, and the opportunity to engage in religious, political, civic, recreational, and other social activities foster a sense of self-worth and enhance the quality of life for long-term care residents.
The first resident right identified was the right to a dignified existence. Fellow bloggers would you share with me? What would a dignified existence be for you? What would be a dignified existence for your parents?

Thirteen Thursday

Thirteen Resident Rights
1. A resident has the right to a dignified existence, self-determination and communication.
2. A resident has the right to exercise his or her rights as a resident of a facility, as a citizen or resident of the United States and the state of Washington.
3. A resident has the right to be free of interference, coercion, discrimination and reprisal in exercising his or her rights.
4. A resident has the right to manage his or her financial affairs.
5. A resident has the right to personal privacy and confidentiality of his or her personal and clinical records.
6. A resident has the right to voice grievances.
7. A resident has the right to prompt efforts by a facility to resolve grievances.
8. A resident has the right to examine the results of the most recent survey or inspection of a facility conducted by federal or state surveyors.
9. A resident has the right to privacy in communications, including sending and prompt receiving of mail that is unopened.
10. A resident has the right to have reasonable access to the use of a telephone where calls can be made without being overheard.
11. A resident has the right to retain and use personal possessions.
12. A resident has the right to be free from physical restraint or chemical restraint.
13. A resident has the right to be free from verbal, sexual, or physical abuse including corporal punishment or involuntary seclusion.
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