Allegation of Abuse

A surveyor observed a nurse had an abrasive tone that increased a resident’s agitation. The resident had requested that someone take him to the office in order to withdraw $40. The nurse told him that she was busy, but would take him in 10 minutes. In 8 minutes, the resident again requested to be assisted to the office, and the nurse used a forceful tone of voice in responding. The resident then raised his fist to the nurse, and a nurse aide intervened. The resident was then assisted to the office to withdraw his money. The same surveyor heard an unidentified aide state that “If he didn’t give his money away, he would not be broke.” The fact that this was reported by a surveyor and not a staff member indicates that the culture may allow for verbally abusive behaviors by the staff towards residents.

The facility, according to regulation, is required to have policies and procedures that prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property. Guidance states the facility policies and procedures must include the following seven components: screening, training, prevention, identification, investigation, protection, and reporting/response.

The facility leadership should review the policy related to verbal abuse and training that has been provided during orientation, annually, and as needed, to ensure all components of abuse prevention are addressed. Additionally, it is important that facility leadership monitor the culture of interaction between staff and residents to prevent further occurrences. An easy way to monitor staff and resident interactions is to conduct daily purposeful rounding by facility leadership. The leaders should have a clear understanding of expected interactions from staff to residents, including respectful language and appropriate tone, dependent on resident need. A consistent review of the findings should be completed and follow up action defined by the leadership team, and implemented in a timely manner.