Q&A
Reporting Abuse and Neglect in AFHs
May 7, 2024 Webinar Questions
Q1. Webinar Offering
Any chance you can offer this class again?
The webinar is available on the Adult Family Home Council and Aging and Long-Term Support Administration Adult Family Home professional websites for viewing. Residential Care Services will consider future offerings. Thank you for your recommendation. Click here to watch the recording.
Q2. Hotlines
What is the difference between utilizing the Ombuds hotline vs. DSHS hotline?
The WA State Long-Term Care Ombuds advocates for residents residing in nursing homes, adult family homes, and assisted living facilities. Their purpose is to protect and promote Resident Rights guaranteed to residents under federal and state law and regulations. They are trained to receive complaints and resolve problems in situations involving quality of care, use of restraints, transfer and discharge, abuse, and other aspects of dignity and rights. The Ombuds does not conduct inspections, surveys, complaint investigations and any necessary follow up visits for state licensure and federal certification requirements. The Ombuds does not impose remedies.
Source: WA LTC Ombuds website, https://www.waombudsman.org
The Residential Care Services Division (RCS) hotline known as the Complaint Resolution Unit (CRU) receives calls and/or online reports from the public and homes/facilities/providers about nursing homes, adult family homes, assisted living facilities, enhanced service facilities, ICF/IID homes, and Supported Living. RCS investigates the public and facility reports to determine home/facility/provider compliance with state licensure, federal certification, or state certification requirements. RCS has the authority to impose remedies for noncompliance.
Q3. Abuse Reporting Rules
Do these rules also apply to assisted living settings?
RCW 74.34 Mandatory Reporting law applies to assisted living facilities as well as other RCS licensed and/or certified residential long-term care settings.
Q4. Resident to Staff Abuse
What do you do about a resident whose behavior borders on abuse of staff?
If a state client, work with the case manager for interventions to address the resident behavior. Consult Residential Care Services Behavioral Health Support Team for support how to address the resident behavior and train your staff how to interact with the resident. Involve resident physicians, family members if applicable and resident representatives as needed. Involve the resident in person-centered care. Access mental health support systems. Put preventive measures in place to prevent abuse and protect other residents and staff.
Q5. Preventing Residents to Leave
What if a resident has a tendency of running away and you prevent them going out is termed as abuse?
Abuse is defined per WAC 388-76:
WAC 388-76 defines abuse “Abuse” means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment of a vulnerable adult.
(1) In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish.
(2) Abuse includes sexual abuse, mental abuse, physical abuse, and personal exploitation of a vulnerable adult, and improper use of restraint against a vulnerable adult which have the following meanings:
Abuse can occur if the home never lets a resident go outside or leave the home, unreasonable confinement. If the home prevents the resident from leaving until a caregiver can be with them to go outside or take them somewhere or an outside party can be with them to take them somewhere, these actions are not abuse.
Q6. Unwitnessed Falls
Falling is part of the progression of the disease often as the demise of an end stage dementia patient. There is a lot of grey area in this when calling to report falls. Even with the best of fall precautions it can still happen and is not neglect. The key is educating the family on what is the road map of dementia and what to expect.
For residents receiving hospice, calling 911 first for falls is incorrect. Hospice should assess the fall first. Hospice will send a nurse out and discuss with the family what they want to do. Even with a fracture there is little intervention and the family often do not wish for their loved one to go through the agony of an emergency room visit where they do nothing and send them home again. In this case Hospice would focus on pain management and allow the patient to transition. The coroner is always informed by Hospice in the case of a fall leading to a death.
If the fall is unwitnessed and the resident cannot tell the home what happened, the home needs to make a report to the hotline because no one knows what happened. The fall may be related to a specific diagnosis, dementia, environmental hazards, being pushed, negotiated care plan not followed or other unknown causes. An investigation helps determine if the fall was a part of the disease progression and rule in or out abuse and neglect.
