Every nursing facility in which you might work is required to have policies and procedures regarding abuse, neglect and exploitation.  Those polices must address many elements required to provide residents a home in which they are free from Abuse, Neglect or Exploitation (ANE).


What is Abuse?


Abuse, is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This  includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology (possessing and/or distributing photos, videos, opinions or private health information out on social media sites for example).  Willful means that the person acted deliberately and not that the individual must have intended to inflict injury or harm.


What is Neglect?


Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress.


What is Exploitation?


Exploitation is “taking advantage of a resident for personal gain, through the use of manipulation, intimidation, threats, or coercion.  One type of exploitation is Misappropriation.

Misappropriation of resident property is the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident’s belongings or money without the resident’s consent.


Who commits Abuse?

  • Employees—CMS expects ALL staff to be in control of their own behavior, to act professionally, and understand how to work with every resident in the facility.CMS does not consider striking a resident an appropriate response in any situation.Abuse by employees is never a “reflexive” or “knee-jerk” reaction.Striking a resident in response to a resident behavior is abuse.

  • Visitors—typically a family member (a child or spouse) who has a dysfunctional relationship with the resident

  • Other residents—resident-to-resident abuse occurs when a resident, regardless of cognition, deliberately abuses another resident. Again, the intent is not to cause harm.The intent is to strike, bite, etc.


How do facilities prevent ANE?


Federal regulations require all facilities to have ANE prevention plans.  While they will differ slightly between facilities, common features of ANE Prevention plans include:

  • Conduct Criminal Background Checks on all persons who will be employed and decline offers of employment to anyone with a finding of ANE in a court, administrative hearing,

  • Conduct a Sexual Predator check on all prospective residents

  • Develop policies and procedures that govern prevention, investigating and reporting suspected ANE

  • Providing training on ANE prevention, investigating and reporting suspected ANE and on stress management, working with verbally or physically aggressive residents

  • Posting information on reporting requirements and the State Hotline for reporting

  • Providing staff with opportunities to express challenges related to their job and work environment

  • Instructing staff on appropriate ways to address interpersonal conflicts

  • Providing training to further staff understanding of cultural, religious and ethnic differences that can lead to conflict

  • Protecting residents during an investigation by suspending employees suspected of ANE and restricting the visits of non-staff individuals suspected of ANE


What must be reported?

  • Any incident or suspected incident of a crime or ANE which you saw or heard

  • Any incident or suspected incident of a crime or ANE which you heard about from someone else

  • Any unauthorized posting of phots, videos, opinions, comments or information on social media

  • Any injury of unknown origin or which is a greater injury than attributable to incident from which the injury allegedly arises


What are physical signs of abuse?

  • Welts or bruises

  • Abrasions or lacerations

  • Fractures, dislocations or sprains of questionable origin

  • Black eyes or broken teeth

  • Sexual exploitation

  • Rape

  • Involuntary seclusion

  • Multiple burns or bite marks


What are signs of neglect?

  • Malnutrition or dehydration

  • Poor hygiene

  • Inappropriate clothing

  • Decayed teeth

  • Improper administration of medications

  • Inadequate provision of care

  • Caregiver indifference to resident’s personal care needs

  • Failure to provide privacy

  • Leaving someone unattended who needs supervision


What are the signs of psychological abuse/neglect?

  • Resident clings to abuser or caregiver

  • Paranoia

  • Depression

  • New or increasing confusion or disorientation

  • Withdrawal

  • Inconsistent injury explanation

  • Anger

  • Suicidal ideations


When must an incident/suspected incident of ANE be reported?

  • Caregivers, support staff and volunteers report situations immediately to the charge nurse or other management staff

  • Charge nurse or other management staff report immediately to the Administrator

  • If a suspected instance of ANE involves a possible crime or serious bodily injury, report situation to local law enforcement within 2 hours of notification

  • In all situations, report within 24-hours to KDADS Complaint Hotline if no crime or serious bodily injury

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