New Regulations and Renewed Risks in Senior Care

In the wake of upcoming regulation shifts such as the Patient Driven Payment Model (PDPM), the Patient Driven Groupings Model (PDGM), and Phase 3 of the Requirements of Participation (ROP), it is and will continue to be crucial to take purposeful steps to protect some of the most vulnerable individuals in your care.

Changes in the complexity of your organization’s resident or case mix can lead to a much higher risk for those you care for to experience abuse and neglect. Unfortunately, staff can easily commit abuse and neglect due to burnout, inadequate training on policies and procedures, or to ease caregiving burdens in challenging scenarios.

To review the Center for Medicare and Medicaid Services’ (CMS) definitions of abuse & neglect:

• Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment that results in physical or mental harm, whether or not the abuser intended to cause harm. Abuse can be physical, mental, sexual, or verbal.
• Neglect is the failure provide necessities such as good, water, clothing, shelter, personal hygiene, healthcare, comfort, and personal safety. Neglect also includes lack of basic emotional support, respect, and caring.

There may be some scenarios in which abuse has obviously occurred, but most of the time, abuse is not easily identified. Abuse and neglect can be committed anywhere, at any time, by anyone – at a facility, in a community, and in the home.

How Regulation Changes Could Put Those in Your Care at Risk

Older adults with higher complexity of medical and personal needs are particularly vulnerable to abuse and neglect. Those who are especially susceptible include:

• Those who experience mental and/or physical impairments
• Persons with dementia
• Those over the age of 65

As regulatory changes such as PDPM, PDGM, and ROP come into play, you will likely see a more complex case mix, including individuals who may have diverse medical needs or who experience co-occurring mental and physical illnesses. When your case mix becomes more complex, staff without appropriate training may commit abuse and/or neglect, even without meaning to.

For example, a more clinically-compromised individual who has less autonomy also increases the risk of your staff neglecting the personhood of the individual, thus leading to abuse and neglect. Even if the individual does not know or is unable to react to abuse that is being committed, such as a staff member taking a picture of the individual receiving personal care, this remains an act of abuse.

There are many scenarios in which a person in your care does not have full autonomy can become a victim of abuse and neglect. Another common example involves involuntary seclusion, which can occur when a caregiver places an individual in an isolated area or restricts their ability to communicate with others – whether it be in the home or at a facility. If an individual is exhibiting challenging or disruptive behaviors that the caregiver does not have the training to appropriately manage, they may try to alleviate the situation by secluding the individual – but this is an act of abuse.

The Importance of Person-Centered Care

Using a person-centered approach to care can help caregivers better understand and respect those they serve – and can reduce the likelihood of staff committing abuse and neglect. Person-centered care respects each individual as unique with their own values, preferences, and beliefs, and recognizes that even if the caregiver has distinct differences from the individual in their care, they must put those differences aside and remain committed to providing the highest quality services.

Educating caregivers on this method encourages them to keep person, not the disease, at the forefront of care. This will benefit not only the resident or client, but also the post-acute organization as it is shown to improve satisfaction, which can have a direct impact on an organization’s bottom line.

Upcoming regulation shifts will require you to demonstrate a commitment to person-centered care by:

• Documenting personal preferences in care plans
• Showing awareness of emotional challenges and trauma
• Displaying evidence of person-centered approach in caregivers’ attitudes and behaviors

Taking purposeful steps to train your staff on person-centered care will not only prevent abuse and neglect, but it will also position your organization for success as upcoming regulation changes begin to take effect.