The Texas Department of Aging and Disability Services (DADS) issued a provider letter to Licensed Nursing Facilities, Medicare/Medicaid-certified Nursing Facilities, and Skilled Nursing Facilities about guidelines for reporting incidents.

Superseding guidelines dated July 14, 2000, the revised guidelines require any facility staffer who believes a resident has been abused, neglected, or exploited by another staffer to report it, pursuant to Health and Safety Code §242.122 and 40 Texas Administrative Code (TAC) §19.602(a). You may download the letter here.

In a letter to Intermediate Care Facilities for Persons with Mental Retardation or a Related Condition and Provider Associations, DADS announced that the “Working Hand In Hand to Ensure Quality Services” – 2006 Provider and Surveyor Conference” will be held October 30 through November 1 at the Omni Austin Hotel South Park in Austin, Texas. Among the topics:

—Positive Outcomes, QMRP Guidance in Active Treatment and Individual Program Plans
—Rights Restrictions, House Rules; Meeting the Requirements for Protection during Investigations; Active Treatment for Seniors
—Self-administration of Medications
—Rulemaking Processes/New Rules - Restraint, Seclusion & Permanency Planning
—Top 10 ICF-MR Deficiencies
—Life Safety - Common Problems/Deficiencies
—Informed Consent
—DADS Guardianship Program

For more information, download the letter here.

Because of nightmarish stories like this one, long term care providers are doing more to prepare for disasters, natural and man-made. An organization called Mather LifeWays Institute created a program called PREPARE to train long term care providers in preparing for disasters and public health emergencies. (Senior Journal)

To learn more about PREPARE, see the press release.

More than 60 percent of Hurricane Katrina victims were elderly, according to the Louisiana Department of Health. A report by the Government Accountability Office called Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes (PDF) found that long term care facilities did not adequately prepare for a disaster like Hurricane Katrina. The report also found that long term care providers’ existing evacuation plans need to be improved.

As recently as May, the Senate’s Special Committee on Aging has been hearing testimony from people knowledgeable about what went wrong in the aftermath of Katrina and how to prevent similar problems during the next disaster.

Sounds like an ominous title for a documentary, doesn’t it? In many ways, it could be.

All providers must follow the prescribed reporting guidelines when reporting “unusual incidents” associated with Hurricane Rita to the Consumer Rights and Services Division by calling 1-800-458-9858 (see PDF copy of provider letter). The reasons go without saying, but just in case:

• Proper reporting will assist in studying the effects of the hurricane on long term care providers and patients.
• The information will be useful in creating more effective disaster management plans.

Long term care providers should report abuse, neglect, exploitation, deaths (even “natural causes” deaths and those “directly and indirectly attributed” to Rita-related events) in cases involving “unusual circumstances.” Specifically regarding deaths:

Providers should report all resident deaths (even those deemed to be due to “natural causes” and chronic or terminal medical conditions) which could be either directly or indirectly attributed to Hurricane Rita-related events, such as stressful environmental conditions, fatigue, anxiety, unavailability of needed medical care, insufficient medical history information, or insufficient water, food or medication.

Providers should also report missing residents and “drug diversions.”

On March 22, 2005, DADS issued Provider Letter #05-13–Joint Investigation of Nursing Home Abuse and Neglect Allegations. This letter notifes nursing homes that DADS will notify local law enforcement of abuse and neglect allegations of the nature that statutorily requires DADS to investigate within 24 hours:

A resident(’s):

• health or safety is in imminent danger, or
• has recently died because of alleged abuse or neglect or other complaint. or
• has been hospitalized or treated in E.R. because of alleged abuse or neglect…, or
• has been victim of a crime or
• suffered bodily injury

Local law enforcement will be given the opportunity to participate in the investigation within parameters of their discretion.

So will local law enforcement often participate? I think that it will depend on the seriousness of the allegations and injury. If complex medical questions are involved and no death is involved, local police may leave it to DADS. If it involves a death or instances like CNA’s dropping and injuring patients because a CNA attempts a transfer of a resident requiring a two people–they may participate.

We will have to see.

Lately, several people have asked me about the advisability of having employees write statements to accompany reports of incidents sent to DADS. It is my position that having your employees write such statements is neither advisable or required.

Thus, the next question is–how do you conduct your investigation if you don’t have your employees write statements? My answer is that your investigator actually investigates. That means interrogating employees who are witnesses to an incident or who may have material information.

What you are seeking in an investigation is facts. If you allow employees to write their own statements–you are most likely to get emotion and conjecture. When an incident occurs, it is natural for your staff to feel guilt and fear about it. It is your investigator’s job to cut through that and discover facts–not feelings.

The investigator (who should be a member of your Quality Assurance Committee acting as part of that committee) should sit down with each witness and ask pointed and specific questions about the incident, recording the relevant and material answers in detail. Use those answers to fill out the “investigation summary” section of the incident report form you must turn into DADS which is linked here.

I want you to look closely at this form. When it speaks of witness statements, it says attach them “if possible.” Do not make it possible! Understand that under the Rules of Civil Discovery in Texas, such statements are discoverable by plaintiff’s personal injury lawyers. Do you want to be party to a lawsuit that hinges on a statement written by a frightened nurse aide? Don’t do it. Furthermore, if you instruct your staff to write their own statements, they are possibly writing documents that will later end up in the hands of law enforcement. That nurse or nurse aide may end up signing a piece of paper that–perhaps unfairly–puts them in jail for abuse or criminal neglect.

If you think that it is absolutely necessary to obtain employee statements–have your attorney assist you in drafting them based on the information given to the investigator by the employee. Consider this–when members of law enforcement obtain written statements from witnesses–they don’t let the witnesses sit there and write their own statements. They interrogate–and from the results of their interrogation–they type up the factual parts and have the witnesses review the result for accuracy and sign it. If you absolutely think you have to have a statement and you don’t feel that the situation warrants hiring an attorney–the investigator should draft the statements based on the interrogation and the facts.