1. Standard & Policies: Prevention of Resident Abuse Deb Geerlinks, Standards Educators REVISED MAY 2007

2. Session Overview ORCA Standard Policies & Procedures, Best Practices: – Recognizing Abuse – Definitions and Indicators – Prevention of Elder Abuse / Neglect Hiring Practices Staff Education – Reporting and Investigating Abuse / Neglect Person witnessing or suspecting abuse Investigation, Intervention Procedures by Designated Authority – Follow Up REFERENCE: ORCA Final – Guidelines for Prevention of Resident Abuse

3. ORCA Standard An Ad Hoc Committee developed a standard (and policies to support standard) that addresses resident abuse/neglect Standard in effect January 2005 (“New” Accreditation standard 4.03 – Staff Training section)

4. Standard 4.03 - Staff Training Section “There is a written policy and procedure in place for staff to deal with suspected or witnessed resident abuse and aggressive behaviour that includes: – Definitions and Indicators of psychological abuse, financial abuse, physical abuse, and neglect – Procedure for staff and management to report, document and investigate – Staff Training on resident abuse prevention at initial orientation and annually thereafter”

5. Philosophy – Resident Abuse A facility is committed to providing the highest level of quality care which encompasses the dignity, respect and rights of its residents A resident will be free from abuse or neglect by staff, volunteers, visitors and other residents Under no circumstances will abuse or neglect of a resident by a staff member be tolerated. If there is substantiated abuse or neglect to any resident by a staff member, employment will be terminated All staff are expected to fulfill their moral and legal obligation to report any incident or suspected incident of resident abuse or neglect

6. Definition of Elder Abuse Abuse and neglect of an older adult is “any action or inaction by any person or institution that causes physical or mental harm, neglect, or violates the older adult’s rights”.

7. Definitions & Possible Indicators Psychological Abuse Any action, verbal or non verbal, that diminishes a person’s sense of dignity and self worth Possible Indicators: Withdrawn, passive, reluctance to talk openly, embarrassment, depressed, hopeless, fearful interaction with a person, infantilization (eg. baby talk); not permitted to have friends visit

8. Financial Abuse Any act done without consent that results in the financial or personal gain of one person at the expense of another Possible Indicators: Forced to sign over assets, forced to sign Power of Attorney under duress, missing or lost possessions, no money for personal necessities / social activities

9. Physical Abuse Any act of violence or rough handling that may or may not result in physical injury Possible indicators: Abrasions, bruises, burns, bumps, pain, restricted movement, marks from restraint use, swelling, tenderness, ulcers, welts, pain, bruising, bleeding in genital area or around the breast area

10. Neglect Not meeting the needs of a resident who is unable to meet them for him or herself. Active Neglect: intentional failure of a staff member to fulfill their caregiving responsibilities Passive Neglect: unintentional failure of a staff member to fulfill their caregiving responsibilities because of lack of knowledge, skill or awareness Possible Indicators:Malnourished, emaciated, no dentures, mouth sores, rashes, unkept appearance, clothes in poor repair, signs of infrequent bathing, unttended, deserted, feet in bad shape

11. Prevention of Resident Abuse / Neglect The most effective ways to promote long-range prevention of abuse is: 1) Hiring Practices: Proper Employee Selection 2) Staff Education – on orientation and annually 3) Resident Education regularly 4) Appropriate Staffing Levels

12. Hiring Practices Policy: A facility will develop a comprehensive hiring policy, which includes recruitment and selection practices aimed at finding the best-suited and most qualified candidate for the job. Procedures/ Best Practices: Criminal Reference Checks Verify status and obtain proof of applicable licensing for any registered health professional

13. Hiring Practices … cont’d Pre-Employment Reference checks Develop a list of interview questions (consider using behavioral / situation model) (Sample list of questions in The Guidelines) Look for any behavioural indicators (eg. demeanour, attitude) during probationary period Conduct ongoing performance appraisals, review job tasks, coping skills and attitude of employee

14. Staff Education Policy: A facility is responsible for training staff, resident employees on prevention of resident abuse at orientation and annual inservices thereafter. Procedures & Best Practices: Staff Orientation Checklist – include : – ORCA Code of Ethics, Commitment to Residents, Complaints Procedure CRIS information (copies in kit) – What constitutes abuse and neglect – Identifying possible indicators of abuse neglect (copy in kit) – Duties and obligation of the employee / volunteer to monitor for resident abuse and to report any witnessed or suspected abuse – Identify who to report witnessed or suspected resident abuse

15. Staff Education …cont’d Ongoing Education and Annual In-Services for staff: An annual inservice should address : – Serious nature of abuse and associated legal implications – Monitoring for mistreatment of residents is an integral part of everyone’s job – What constitutes abuse and recognizing indicators – Duty to immediately disclose; must provide accurate information and explain suspicious circumstances – Procedure for reporting witnessed or suspected abuse to the appropriate authority* *( depending on situation this will either be – the designated facility authority, higher level of management or ORCA’s CRIS Service)

16. Annual inservices … cont’ – Discuss resident treatment approach/ understanding the rights of residents – Addressing potential barriers to staff recognition (See guidelines pg. 10) – Stress management Each facility should develop a community resource listing of key agencies and organizations that can provide assistance in responding to situations beyond their ability

17. Resident Education A facility will also develop education programs for residents to provide them with information on: – What constitute abuse/neglect – What their rights are (Commitment to Resources) – Code of Ethics – Complaints Procedure – Where the can get help should the require it (eg. ORCA’s CRIS line, local organizations that offer help

18. Appropriate Staff Levels A facility should ensure that there is a system in place to determine that staffing Patterns for each department are developed to meet the changing needs of the resident population

19. Reporting & Investigating Abuse/Neglect Policy: Facility to: – Train staff and volunteers to recognize possible abuse and how to properly report witnessed or suspected abuse – Develop a reporting mechanism and communicate to all staff/volunteers that any suspicion or resident abuse must be reported immediately and dealt with according to facility policy – Establish a designated authority within the facility to handle witnessed/suspected abuse. The designated authority can be Administrator, Director of Care, or the Owner/Operator – Inform staff that that if the witness or suspect abuse by the designated authority and/or facility management fails to respond to resident abuse report, staff are to contact ORCA CRIS for assistance

20. Procedure for Reporting Staff who witness abuse must immediately: 1. Report the incident to the designated authority; or 2. Report the incident if designated authority (eg. Administrator) to a higher level authority (eg. Owner/Operator); or 3. Call ORCA’s CRIS line (1-800-361-7254 if designated authority is owner/operator (eg. no higher level of facility management exists) and / or facility management fails to reasonably respond to resident abuse report

21. Staff who reasonably suspect abuse/neglect: – Should review the indicators to ascertain whether or not the action or inaction is abuse (see Possible Indicators) and must also report to the designated authority (or alternate authorities depending on circumstances as set out). – Note: Medical conditions (eg. dementia) should be considered as part of the indicator checklist

22. Investigation by Designated Facility Authority (DFA) Intake / Documentation: – DFA Responsible for implementing a closed door reporting policy to help maintain resident confidentiality, except in extenuating circumstances (see guidelines pg. 14) – For any report or witnessed or suspected abuse, the DFA must document the details of the situation in writing on an Occurrence Form (sample B-Guidelines). Information should be collected from the person reporting and/or alleged victim, the alleged abuser(s), supervisors and any witnesses – If the resident is physically abused, the facility must ensure they are examined by a physician without delay and a medical report prepared

23. Investigation by DFA Important that all evidence accumulated during an investigation process is documented. DFA must use investigation to determine validity of the alleged abuse: – Without delay, determine if a criminal or emergency situation exists, police must be notified; this may supersede documentation.

24. When to call police The police should be called if you: – Suspect a criminal offence has occurred / require direction on an incident that you feel may be criminal in nature (see Guidelines, pgs. 6-7) – Resident requests police be called – Require further investigative support (eg. surveillance)

25. Investigation by DFA … cont’d Inform the implicated employee(s) about allegation as quickly as possible while witnesses are readily available. If necessary remove the staff member from his or her duties or from dealing with the resident suspected of being abused Interview the resident first. Be sure the resident has sound mental capacity (has the ability to understand information and appreciate the decision that needs to be made). Be sensitive to their need for privacy and safety (see Guidelines pg. 13)

26. Investigation by DFA … cont’d Interview the suspected abuser next Provide a witness for any interviews conducted during the investigation Make collateral checks with appropriate others (eg. physician, other staff). Depending on type of information being sought, permission may need to be ascertained to allow you to discuss a resident’s situation with third parties (see sample __ of Disclosure form to be signed – guidelines)

27. Investigation by DFA … cont’d Repeated interviews and visits may be necessary Support may be required. Determine whether case should be referred to (eg. CON, Advocacy Centre for Elderly). Alleged abuser, regardless of who it is (eg. staff, volunteer, family member, visitor, other resident) shall not have any unsupervised contact with resident during investigation

28. Intervention / Action Consider each case individually – nature of abuse, its severity and implications – dictates degree of intervention (see guidelines pg. 16) If resident accepts assistance, identify and locate appropriate resources. Respect their confidentiality (see guidelines p. 13-14). Action may include a coordinated response from a variety of services/agencies. If resident refuses assistance, provide a list of local resources and emergency numbers and offer future support. Resident may wish to speak with authorities (eg. police) and work with them directly to make decision to pursue or not

29. Intervention / Action Alternate methods of intervention may be required if there is concern with resident’s ability to make decisions (mental capacity) or the alleged abuser is a designated substitute decision-maker (eg. Power of Attorney) for resident In either case, the Office of the Public Guardian and Trustee should be contacted (see guidelines, p. 15)

30. Follow Up Follow up will be appropriate to assessed needs of the situation and resident’s wishes. This may include future support and request for intervention, which was previously denied. – Depending on investigation outcome, it may be necessary to terminate an employee – If abuse of a resident by family member or visitor is substantiated, DFA must ensure supervised visits only – If resident abuse by staff member is suspected but cannot be proven, DFA will take proactive measures to prevent further resident abuse by providing education to employee, increasing supervisory needs with department, and/or reassign employee to alternate duties

31. Follow Up … cont’ Inform ORCA if a Coroner’s Inquest necessary, the situation is unsatisfactorily responded to by facility management, or outcome could negatively impact ORCA/industry (eg. media attention)

32. Related Resources & Information ORCA Prevention of Resident Abuse Kit – Staff Training Videos – Other Staff Training Resources – Resident Education – Information on Powers of Attorney – Facility Management Resources – Related Research Literature Forms: Sample Occurrence Form, Staff Orientation Checklist, Resident Disclosure Form (located at back of Guideline Document)