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Unit 2
Resident Rights
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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
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Nursing assistant is responsible for knowing regulations providing for resident rights & assisting residents to exercise those rights.
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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
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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
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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
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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
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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
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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
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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
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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
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Freedom from abuse (cont)
Psychological – ridiculing, ignoring, manipulating
Involuntary seclusion – isolation Abandonment – leaving someone
unattended Neglect – not answering call light
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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
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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
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Title 42 – Quality of Life (cont)
Accommodation of needs Activities Social Services Home environment
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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
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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
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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
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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
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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
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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
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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.
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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
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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)
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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
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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
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Signs of elder abuse
Living conditions unsafe, dirty, or inadequate
Poor personal hygiene Weight loss Frequent injuries Old bruises Quiet/withdrawn attitude
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Signs of elder abuse (cont)
Anxious to please caregiver Private conversations not allowed Meds not taken properly Frequent visits to ER Dr. hop
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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.
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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
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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.
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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.
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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.
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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
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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
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Nursing Assistant responsibility
Not always easy or possible Discuss observations with licensed
nurse!!!!!!! Licensed nurse then contacts
appropriate members of the health care team.
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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
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Maslow’s Hierarchy of Needs
Physiological – – Food– Water– Oxygen– Sleep– Sex – Temperature extremes
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Maslow (cont)
Safety & Security– Freedom from fear/anxiety– Stability & consistency in routine– Asepsis– Knowledge of resident’s needs
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Maslow (cont)
Belonging – Love & Affection– Sense of belonging– Acceptance & love– Receive family, friends, visitors in a
homelike environment
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Maslow (cont)
Self-Esteem– Feeling competent– Gaining respect, approval, recognition– Ask opinions– Really listen
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Maslow (cont)
Self-actualization– Attain full learning– Creative potential– Spiritual potential– Pride in accomplishment– Opportunity to do their best