A hospice registered nurse (RN) was assigned as the case manager of a hospice patient living in a California assisted living. The RN allegedly failed to record the discovery of open pressure injuries in the resident’s medical record. In addition, she failed to notify a doctor and the family of the resident’s deteriorating condition. As a consequence of her lack of care, the resident’s condition worsened, which ultimately resulted in the resident’s death.
The RN was arraigned on one count of felony elder abuse. The California Board of Registered Nursing (the Board) opened an administrative investigation into the RN’s lack of care following the compliant. The Board’s investigation concluded that the RN failed to properly assess a pressure injury that she discovered on the resident’s right heel. As a result, a Plan of Care was never developed and the pressure injury worsened into a wound that required emergency surgery to the resident’s right foot, which had become septic and gangrenous. After the surgery, the resident’s health declined, and eventually she passed away. The RN was charged with a felony complaint with one count of felony elder abuse and allegations that as a result of the abuse, the resident suffered great bodily harm.
An attorney for the California Department of Justice stated, “Elder abuse does not always come in the form of a physical attack. It can result from utter neglect and lack of proper care.” The charges stem from a criminal investigation conducted by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA). Through the DMFEA, the Attorney General’s office works to protect Californians by investigating and prosecuting those who perpetuate fraud on the Medi-Cal program. DMFEA also investigates and prosecutes those responsible for abuse, neglect, and fraud committed against elderly and dependent adults in the state.
Issue:
Elder abuse and neglect can occur in a multitude of ways. It is critical that all leaders of a nursing facility can recognize elder abuse and neglect and know the steps that should be taken when it is suspected. If elder abuse is not reported in an appropriate time frame, it can be seen as immediate jeopardy with harm, and be considered provision of substandard quality of care.
Discussion Points:
- Review your policies and procedures on elder abuse, neglect, and exploitation. Update as necessary.
- Train all staff on what is considered elder abuse and neglect, and the steps that should be taken when it is suspected. Offer the training during new employee orientation and repeat at least annually, and more often if needed. Document that the training occurred, and record in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of the steps that should be taken if they suspect elder abuse, neglect, or exploitation, and their reporting options, including accessing the anonymous hotline if necessary. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 7 Resident Rights, Policy RR 1.1 Freedom from Abuse, Neglect, and Exploitation.
