I'm risk manager at LTC facility in KS.
We have a resident with advanced dementia and schizophrenia. She has a BIMS of 3 and is strong, violent, and resisting cares. We have attempted, without success, to have her transferred to a more appropriate facility and nobody will take her. At one point she attacked another resident and we had her hospitalized but we were forced to take her back.
She is completely incontinent of bowel and bladder and impossible to direct/redirect/distract.
We find ourselves in the position of having to choose between letting her remain in her soaked and soiled Depends indefinitely and risk severe skin breakdown, or change her Depends against her will.
Our CNAs have large, deep scratches on their arms from her fingernails, which are usually contaminated with feces. Many of them have bruises. One nurse has a black eye and a goose egg on her head. The only way to prevent the resident from injuring herself or others is to have 4-6 staff members assist with changing her.
Our staff members have been very careful not to injure her in any way and she has remained uninjured. She is never unsupervised.
I carefully documented that I have discussed the situation with the DON, the administrator, and the agency social worker and that we're working to get her placed in a more appropriate facility but that, in the meantime, we have decided we must use the minimum amount of physical force necessary to change her Depends and avoid skin breakdown.
Does anybody have any advice how we can handle this to avoid getting in trouble with the state? I am afraid we'll be accused of restraining her.