1. Unit 2 Resident Rights

2. Purpose of a LTC Facility Provide physical care Provide team approach to care & services Prevent illness/injury & loss of function Promote recovery & health in a residence facility Assist resident to reach max potential

3. Nursing assistant is responsible for knowing regulations providing for resident rights & assisting residents to exercise those rights.

4. Title 42, Code of Federal Regs – Resident Rights Residents have THE SAME rights as those held by all U.S. citizens Right to be free of interference, coercion, discrimination, or reprisal from the facility Resident may file complains Notice of rights, rules, & services given at admission & posted in facility

5. Title 42 (cont) Resident Rights Protection of resident’s funds Free choice of physician, informed consent, participation in development of care plan Privacy & confidentiality Treatment & care, prompt resolution of grievances Examination of survey results

6. Title 42 (cont) Resident Rights Not required to work unless part of care plan Privacy to send & receive unopened mail Ability to receive family, relatives, & visitors during visiting hours Telephone provided for use Retain & use personal possessions

7. Title 42 (cont) – Resident Rights Right of married couples to share room Self-administer personal medications Refuse transfer without medical justification Participate in social/religious activities Make personal choices to accommodate needs Assistance in participating in activities

8. Title 42 Admission/Transfer/Discharge Policies related to admission must be based on ability to provide adequate care. Policies for transfer & discharge must be based on resident’s needs & welfare, concern for safety & welfare of other residents, or as a result of nonpayment for services

9. Title 42- Admission,Transfer, Discharge (cont) Transfer & discharge requirements Notice of bed-hold policy & readmission requirements Equal access to quality care regardless of payment Admission policy Resident care policies

10. Title 42 – Resident Behavior Resident has the right to be free from any physical restraints or psychoactive drugs that are administered for disciplinary purposes, convenience, & are not required for treatment of the resident’s medical symptoms

11. Title 42 – Resident Behavior Restraints – physical vs. chemical Freedom from abuse –Financial – Stealing, borrowing, gifts –Verbal – Teasing, profanity, racial slanders, threats –Sexual – Overtures, innuendo, gestures, inappropriate touching –Physical – Battery, kicking, biting, hitting, shoving, pulling hair, rough handling

12. Freedom from abuse (cont) Psychological – ridiculing, ignoring, manipulating Involuntary seclusion – isolation Abandonment – leaving someone unattended Neglect – not answering call light

13. Role of the CNA with Title 42 Self-care – –Personal stress management –Take breaks/lunch, proper nutrition –Exercise, sleep, support network –Seek out professional help if needed Communication with supervisors Identify resident abuse – suspected, verbal, witnessed, known Mandated reporter – SOC341(reporting form), aiding/abetting, ombudsman, DHS

14. Title 42-Quality of Life Resident must be cared for in a manner & environment that promotes maintenance or enhancement of each resident’s quality of life –Dignity –Self-determination & participation –Participation in resident & family groups –Participation in activities

15. Title 42 – Quality of Life (cont) Accommodation of needs Activities Social Services Home environment

16. California Code of Regulations Resident is encouraged/assisted to exercise rights as a patient & citizen. Written rights must be established & available. –Patient must be informed of rights, rules, & regs regarding pt. conduct –Patient must be informed of services & charges

17. CCR (cont) Pt. must be informed of condition by dr. & have opportunity to participate in planning therapy Informed consent, can refuse treatment Transferred/Discharged only for medical reasons, welfare, other pts’ welfare, or nonpayment

18. CCR (cont) Pt assisted to exercise rights, voice grievances, recommend changes, have outside representation, & freedom from restraint, interference, coercion, discrimination, & reprisal Pt. allowed to manage finances Free from mental/physical abuse & chemical/physical restraints

19. CCR (cont) Confidential treatment of records –HIPAA – Health Insurance Portability Accountability Act – standards & safeguards for documentation & transmission of health records to assure privacy & security of this data Treated with consideration, respect, dignity, individuality, including privacy

20. CCR (cont) Pt. has right to not be required to work Right to communicate privately & send & receive mail Right to be allowed participation in social & religious activities Right to retain & use personal clothing & possessions Right to share a room with spouse & have privacy

21. CCR (cont) Right to daily visiting hours Right to have clergy visit at any time Right to have relatives or responsible person visit anytime if critically ill Right to privacy for visits Right of access to telephone & confidential calls Right to vote

22. CCR (cont) Pt. rights may only be denied or limited for good cause evidenced by dr’s order & may be denied or limited only if allowed by law.

23. CCR – Skilled Nursing/Intermediate Care Written policies about rights available to pt., family, sponsor, public, etc. Adequate/qualified staff Assure personal hygiene (incontinence & prevent decubiti) Provide nutritious diet to meet needs Activities & promote self care Clean, sanitary, & in good repair

24. CCR – Skilled Nursing/Intermediate Care Facility requirements written (Title 22 & Health & Safety codes) Violations result in civil/criminal proceedings against facility &/or staff Pts have right to voice grievances free of reprisal & submit complaints to DHS Rights of incompetent pts or those with communication barriers are carried out & protected by guardian, next of kin, conservator, or sponsoring agency (ADVANCED DIRECTIVES)

25. ABUSE IS A CRIME! One or more of the following elements –Willful causing of injury –Unreasonable confinement –Intimidation – making someone afraid –Punishment –Refusal of goods/services needed for physical/mental/psychological well-being

26. Abuse (cont) ALL states required reporting of elderly or child abuse (SOC341 form), mandated reporter Forms of elder abuse –Physical abuse – corporal punishment –Verbal abuse –Involuntary seclusion –Financial abuse –Mental abuse –Sexual abuse

27. Signs of elder abuse Living conditions unsafe, dirty, or inadequate Poor personal hygiene Weight loss Frequent injuries Old bruises Quiet/withdrawn attitude

28. Signs of elder abuse (cont) Anxious to please caregiver Private conversations not allowed Meds not taken properly Frequent visits to ER Dr. hop

29. Examples of Physical Abuse A resident spits at a caregiver as she feeds the resident breakfast. The caregiver retaliates by spitting back and shouting,”Don’t ever do that again!” A resident refuses to get out of bed. The nurse forcibly pulls him out of bed, into the chair, pushes him out of his room, while he cries to be left alone.

30. Physical Abuse (cont) A male employee kisses an Alzheimer’s resident on her lips while fondling her breasts. A nursing assistant slaps a resident’s hands when he refuses to let go of his shirt. A nursing assistant sprays cold water on a struggling resident with dementia while in the shower being cleaned up after incontinence

31. Examples of Neglect Resident left in the bathroom, turns on call light. No one comes so she transfers herself & falls. Nursing assistant unplugs the call light after repeated use by resident seeking attention. Nursing assistant feeds a resident a peanut butter & jelly sandwich while he is on a pureed diet Resident wanders away from facility & is hit by a car.

32. Neglect (cont) Resident has difficulty eating because dentures were lost. Resident is not taken to the dentist. Resident being care for by intoxicated nursing assistant Resident left covered in feces or soaked in urine overnight. Nursing assistant postpones peri-care until after her break.

33. Example of Abandonment Group of residents go to the park for the afternoon. One wanders away and the group returns to the facility, leaving resident unattended. Nursing assistants do not report to duty during an emergency (flood, earthquake, hurricane), leaving residents unattended.

34. Example of Financial Abuse Staff asks resident if they would like pizza. Order is placed & pizza is purchased from resident’s personal account. Pizza is given to staff. Resident’s cell phone kept at nurses station & used by staff member Resident no longer watches t.v. so staff member takes the t.v. home

35. Examples of Isolation Nursing assistant tells family that resident doesn’t want to speak to them. You are aware that they do indeed wish for family visits. Nursing assistant restrains resident in bed & tells family that resident is too ill to have visitors

36. Nursing Assistant responsibility Not always easy or possible Discuss observations with licensed nurse!!!!!!! Licensed nurse then contacts appropriate members of the health care team.

37. Ombudsman Role Patient advocate & member of health care team. Impartial person who investigates complaints Acts as an advocate for residents/families to resolve conflict Training/assignment Legal responsibility – follow facility protocol

38. Maslow’s Hierarchy of Needs Physiological – –Food –Water –Oxygen –Sleep –Sex –Temperature extremes

39. Maslow (cont) Safety & Security –Freedom from fear/anxiety –Stability & consistency in routine –Asepsis –Knowledge of resident’s needs

40. Maslow (cont) Belonging – Love & Affection –Sense of belonging –Acceptance & love –Receive family, friends, visitors in a homelike environment

41. Maslow (cont) Self-Esteem –Feeling competent –Gaining respect, approval, recognition –Ask opinions –Really listen

42. Maslow (cont) Self-actualization –Attain full learning –Creative potential –Spiritual potential –Pride in accomplishment –Opportunity to do their best