LTC 328 Week 4 DQ 1 (Case Study)

“Case Study #3” in Part V of Effective Management of Long-Term Care Facilities.

answer #1: Should the latest incident in July be regarded as patient abuse or not? See Exhibit CS3–1.

answer #2: How would you go about investigating and documenting the incident? See Exhibits CS3–2 and CS3–3.

answer #3: Suppose this is patient abuse, what further action would you take?

answer #1: Should the latest incident in July be regarded as patient abuse or not? See Exhibit CS3–1.

Mrs. Hollister/Hollinger previously had an incident in January where she was observed trying to pry her husbands mouth open then ultimately slapped him. This resulted in her being barred from the center and a report was made to police as a registered complaint of domestic violence as well as a notification was made to the state Department of Health.
Apparently Mrs. H felt she had a right to continues visiting her husband after this incident and after meeting with the Social Worker, she was granted the opportunity to visit with supervision and monitoring by the facility.
In July, it was witnessed and reported to the new Administrator that Mrs. H slapped her husband in the face during breakfast that morning.
Regardless of the reason Mrs. H used to justify her action, it should also be considered a case of abuse. Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. (Robinson, de Benedictis, & Segal, 2012)
The main reason is that a similar incident occured before which led to reports being made to the police. She was also allowed to continue visiting her husband with the understanding that she was being monitored. Since an earlier incident was documented and reported to the state DoH, any further complaint on this issue could become discoverable, therefore, in order to cover the facility obligation to comply with one of the basic rights for a person residing in a care facility.:Residents have the right to dignity, respect, and freedom. Residents have the right to be treated with consideration, respect and dignity, to be free from abuse, both mental and physical, corporal punishment, involuntary seclusion, and physical and chemical restraints. Residents have the right to self-determination. (Nursing Home Abuse, 2010)

Robinson, L., de Benedictis, T., & Segal, J. (2012, April).Elder Abuse and Neglect. Retrieved from www.helpguide.org/mental/elder_abuse_physical_emotional_sexual_neglect.htm

            Nursing Home Abuse.(2010, April).Laws Protecting Nursing Home Residents. Retrieved from http://wwwhttp://www.elderly-abuse.com/nursing_home_laws/

Response 2

For me personally, this is a tough one to answer. For some the answer may seem so simple and i’m pretty sure that the first answer that would pop into someone’s mind is that yes this is patient abuse. Could it have been patient abuse? Perhaps. I think a lot of it may have to do with perception, an awful lot can be misconstrued by what one may have thought that they saw and then in turn how they interpreted it. I would like to think that one’s spouse would only want the best for their better half and would by no means want to harm them but, we don’t live in a perfect world and reality is that stuff like this happens. I don’t think there is a clear-cut answer because it very well could have possibly been exactly like she put it that he had clamped his teeth down and that was how she in turn reacted and tried to get him to stop. Was it an abusive slap? A playful slap in order to get him to stop that others took the wrong way or did she in fact abuse him? I think at one point or another family members may try to force their loved ones to eat because they may think that it’s best for them and they hate to see them deteriorate and just try to get them to eat a little something. Again, I think it all stems from perception.

answer #2: How would you go about investigating and documenting the incident? See Exhibits CS3–2 and CS3–3.

The initial investigation in a case of suspected abuse has to occur within 24-hours of the witnessed or suspected abuse.  This case was reported within the required amount of time.  In this case, it was determined upon examination of the resident that no bodily harm was incurred; therefore, it is not necessary to report the incident to the police, but it should be documented in the resident’s medical record.  The initial phase of the investigation would involve fact gathering followed by examination of the information obtained.  The fact gathering process would include interviewing the witness, the nurse who completed the physical examination, Mr. Hollister, and Mrs. Hollister.  Based on the information, obtained further fact gathering would then occur and the DON at this point would examine all information in an attempt to determine if this was a case of abuse.  In some instances, a determination cannot be made and in that case, measures to prevent a future incident must still be put into place in an effort to protect the resident (Singh, 2010).  Because a previous incident of abuse by Mrs. Hollister was documented, and the approach to preventing further incidence was to provide supervised visits an investigation into why Mrs. Hollister was left alone with Mr. Hollister in his room should also occur.  A staff meeting should be held to inform staff that Mr. Hollister’s visits with his wife must be supervised at all times.   This would also be an appropriate time to re-educate regarding the abuse policy and procedure.

According to Exhibit CS3–1 Definition Diagram (Singh, 2010), the next step after reporting the incident investigating is to complete the following: reassessment as needed, revise the plan of care, provide necessary staff training, and make necessary modifications to assure resident safety.  Even if the outcome of the case is undetermined it would be appropriate to have a meeting with Mrs. Hollister to discuss the situation and encourage individual counseling or a family support group for Parkinson’s.  Mrs. Hollister could also be educated regarding the appropriate approach to use when feeding her husband.  It may also be best to encourage Mrs. Hollister to visit at a time that is less stressful for her and allow the staff to feed her husband as these individuals are trained on what approach to use with an individual like Mr. Hollister.  Staff could explain to Mrs. Hollister that because accurate intakes are needed to ensure he is receiving the appropriate level of nutrition staff must feed Mr. Hollister.  Social Service would need to be involved during these meetings with Mrs. Hollister, and it would also need to be explained to her that she is only allowed to visit with supervision.  It would also be appropriate to explain to her that if she refuses supervised visits she will be asked to leave as it is the responsibility of the staff to protect Mr. Hollister, and remind her that staff is mandatory reporters. 

Everything must be documented.  The facilities policy and procedure for abuse would include required forms to fill out, for example an incident report.  Information would be recorded in the resident’s chart including the physical assessment that followed the report of abuse.  Every interview would be documented and included with the investigation form that would then be logged with the state within five days per regulations. 

Singh, D. A., (2010). Effective management of long-term care facilities (2nd ed.). Sudbury, MA:Jones and Bartlett Publishers. 

answer #3: Suppose this is patient abuse, what further action would you take?

Suppose this is patient abuse, What further action would you take?

            The nursing home’s first obligation is to the patient and their safely, which in this case is Mr. Hollinger. The staff member observed Mrs. Hollinger forcing Mr. Hollinger’s mouth open and slapping his left cheek. The nurse did the right thing by removing Mrs. Hollinger from the patient’s room, reporting the incident to the DON, and the DON reporting to the police. There are steps that the nursing home has to follow if they observe domestic violence or any type of abuse. Protect, investigate, report, and put the Prevention and Corrective plan in action.  Abuse is defined as the “willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish” (Singh, p.117). After reporting the incident to the police, the facility also has to complete an incident report for their records and send a copy of the incident report to their state’s Department of Health. At that point, Mrs. Hollinger’s visits with her husband may be curtailed to supervised visits, until the allegations are dismissed or charges made against her.

Reference:

Singh, D. (2010). Effective management of long-term care facilities. Sudbury, MA: Jones and Bartlett.