Abuse Allegations

pixie120 · Sep 12, 2011

Our agency does have a compliance hotline. I will voice my concerns to them. I have never used the compliance hotline but the last person in management who did was terminated for "other" reasons. The DON found out who the person was based on inside knowledge of the evidents that occurred. It was evident who the person was based on the information provided. Our facility has 5 G tags and 1 IJ. I agree that things are very wrong with this facility and not sure how to proceed. I realize what I'm saying is serious, that's why I need advice on what to do. I understand that investigations are confidential however when the DON is given an allegation of abuse concern and it's automatically dismissed before the investigation something is not right. When an allegation of abuse is given to the DON the response often is: Really? I find that hard to believe, yeah right?, If that really happened I think I would have been the first to know about it, high fiving CNA's when things are unsubstantiated, the list goes on and on.
I did not mean to infer my administrator was covering up incidents. My administrator truly believes that falls resulting in fractures are not reportable if the origin is known and doesn't involve neglect or abuse - such as resident was ambulating, lost balance and fell. The administrator said as long as it wasn't abuse or neglect of any kind then the incident is not considered a reportable to state. Do states vary when it comes to reportables. All reported occurances are tracked on our states CMS website. Only 1 out the 15 allegiations that I'm aware of is listed as of 6/12/11. The CMS website is updated daily.

I know this post is old but can I jump in here with a comment? In this state, the specific wordings and items that must be reported are in a purple book and the number of the state hotline clearly posted all over the building. You can make anoymous reports, you dont' have to say you are an employee. That having been said, you are also a mandated reporter, so if YOU suspect abuse, YOU must call it to the hotline. (AND usually you have 24 hours to dothis, so do an initial investigation, then proceed, so you have more data).Protocals are generally guidance that IF you feel there is a reportable offense (and now, a crime, new in this state, we have to report all suspected crimes) you call the DON and Administrator, voice concerns, or fill out incident report, and then call in your complaint. As a DON I agree, I would be furious if you DIDN'T tell me, nothing worse than the state calling back for "more information on this allegation" and I have no incident report and haven't a clue that the "abuse" occurred. None of this should be a "secret" your facility should be doing regular inservices on abuse and neglect and the state laws are easily viewed on Nursing Home complaince laws, on whatever state you reside.

The other concern is your DNS may NOT be able to substantiate. I have done many an investigation and the patient simply cannot tell me WHO the person was and it could have been one of 5 CNA's that did this to her/him, and without collaborating evidence (ie bruises, roommate or family concerns, or peripheral investigations of surrounding patients regarding care in general) I cannot proceed. I call it into the state, but then call it back in unable to substantiate. Resident too confused to interview, and shows no signs of abuse, fall,neglect etc.

I do think the line staff sometimes "gossip" it into a bigger issue, (I have had that happen where it was this, and then, I interview the person(s) and they say, "Oh, no... I didn't see that, I was told that in report by that nurse" Interview that nurse "NO, I didn't see it, but the friend of the roommate told me..." and then the whole investigation fizzles cuz there was no true witness and no one has the same story. Plus by the time I am made aware, sometimes it is 5 days later, or it happened over the weekend, but no nurses notifying, charted, told family or MD, and there is no bruise, no fall, or the resident discharges home....or it's a whole other patient all together". I can only teach the staff to report everything via incident report so it's a clear record that can be investigated.

We always have to remember that the abuse/neglect has to be systematically substantiated, in order to proceed with termination and reporting on to that person's license. I would certainly ASK the DNS to tell me how or why she wasn't able to substantiate whichever particulars you are concerned about. If one of my staff asked me, I would gladly show them the process and the incident report. Also, another really big concern, staff will verbally tell me and the world about stuff, but I have to chase them down to get a witness statement, or incident report.

CathRN · Jan 21, 2012

Per CMS guidelines, a copy of the last survey must be posted in a open area in the facility so that it may be viewed by residents, visitors, families and staff. Look at you last survey and see what the reporting agency is for your state. Texas is the Department of Aging and Disability Services (DADS). Also the 800 number for reporting incidents must be posted so that anyone (resident, visitors, staff, families, etc) can see it and read the number. Also, you can go to nursing home compare online and that should have a responsible reporting agency for your state as well.

I hope this helps.

Aem1215 · Jan 26, 2012

We report all allegations of abuse confirmed or not, even the ridiculous. I do investigate each case, and make sure the resident is interviewed. What I don't do is talk about an ongoing or concluded investigation with employees not directly involved in the event. Many employees show up in my office looking to find out what is going on, and my response is always the same, thanks for your concern, but I can't discuss it with you.

Aem1215 · Jan 26, 2012

Let me just ask, not to offend you, but are you sure about that? Do you have access to the investigations to know for 100% guarantee they are not completed? Do you have access to your corporate database? Or is it an assumption that she is not doing her job?

silverbat · Jan 26, 2012

My first instinct is that the DON is playing with her license and may involve those above her as well. I would RUN RUN to another job.. She is falsifying nformation and doing other ILLEGAL things! Does the Administrator know this? are you a DON or ADON in her building?

Aem1215 · Jan 28, 2012

I haven't seen a website where our reportables are public, just the ERS system which is a secure website. I was under the impression that if you have an IJ, the surveyors can't leave your facility until the IJ is cleared. Also, your administrator hangs his or her license on the wall as being responsible for everything that occurs in your building. It's a scary thought that he/ she is unfamiliar with reporting requirements, or is complacent with what your DON is not doing. Whistleblowing is an option for you, but even with whistleblower laws, it may cost you your job. You are obligated to make sure your residents are safe in their environment, so don't wait too long to act!

CathRN · Jan 28, 2012

True, the surveyors can't leave the building until the immediacy of an IJ is lifted.

CathRN · May 9, 2012

Oops. Surveys can leave the building. But cannot exit the investigation or survey until the immediacy is lifted. Often we will inform the Administrator, DON, and whatever other department heads they may want to know. Then we leave the building for lunch or whatever to give them a cool off period.

I commend the Administrators and DONs that jump on these. I work very hard to build good relationships with the facilities. The people who benefit from it are the residents. The residents are the reason any of us are there. My normal "speech" runs along the lines of.......many times we (surveyor/investigators) are the last voice a lot of the residents have. That is a responsibility that I take very seriously. I'm not saying you don't. But please look at this as a learning experience, as painful as it may be, we still need to work together for the residents.

tclemens36 · Sep 29, 2012

What do you mean by systematically substantiated?

CapeCodMermaid, RN · Sep 29, 2012

I investigate evefy allegation of abuse. I sometimes interview everyone, I sometimes just gather and read their statements. It all depends on the allegation. I always speak to the resident even if they are demented. The worst cases are he said she said without any evidence....not so much when a confused, paranoid resident accuses a staff member of something, but when one staff member accuses another. This is the part of my job I hate the most. I do not have a crystal ball to determine the truth. I can only go on what little evidence I have and my gut.

sickofthegame · Oct 26, 2013

Early in 2012 a physically debilitated Alzheimer's resident supposedly fell out of bed and sustained SEVERE injuries. The nurse on the unit was told by someone in higher authority that she was not to send the resident to the hospital. All parties involved admitted that the unit nurse did notify the higher authority and the higher authority admitted that the unit nurse was told not to send the resident to the hospital. Needless to say the resident died just past the time to be considered a sentinel event. The higher authority was then either suspended or fired because they were no longer at work. The remaining authority then held an investigation and during the investigation was noted to say that the absent higher authority would be coming back to work. Corporate staff produced a letter from the unit nurse stating that she never told the higher authority about the residents fall or injuries. Corporate staff then deemed that the higher nursing authority did not "neglect" the resident she just used "poor judgement" and was allowed to return to work. While this was being sorted out another resident became ill and the unit nurse asked another nurse to check in on the resident. This other nurse had every authority to check in on the resident. The concern was the resident was not eating or drinking and was complaining of severe pain and the treatment for these symptoms was enemas. Enemas for 2-3 weeks for severe pain, anorexia and dehydration. The nurse that was asked to check on the resident attempted to call the family but no number was available. She decided to call the State appointed guardian but that number was also not available. The Ombudsman was called and when she arrived she wanted to see the resident she had received several phone calls about. The resident was sent to the hospital and was sent back to the facility the same day. The Administrator suspended the nurse for stepping on the toes of the unit nurse and unprofessional conduct. Or in other words for calling the Ombudsman. The nurse was allowed to return to work after a few days and after the death of the resident that had screamed and begged to go to the hospital for 3 weeks. Then the State came in and there were some serious tags. I believe there were some IJ tags and the Administrator had to be removed as well as the higher nursing authority. They were both sent to continue their work at other facilities. The nurse that attempted to get the family involved and notified the Ombudsman was fired. The nurse called several attorneys about the situation and was told she has no rights. She feels she has been blacklisted and I believe has given up on nursing.

CapeCodMermaid, RN · Oct 26, 2013

Sounds like pure fiction.