Download Unit 2

Unit 2
Resident Rights
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

Nursing assistant is responsible
for knowing regulations
providing for resident rights &
assisting residents to exercise
those rights.
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

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

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

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

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
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

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
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
Freedom from abuse (cont)
Psychological – ridiculing, ignoring,
manipulating
 Involuntary seclusion – isolation
 Abandonment – leaving someone
unattended
 Neglect – not answering call light

Role of the CNA with Title 42

Self-care –
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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
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
Title 42 – Quality of Life (cont)
Accommodation of needs
 Activities
 Social Services
 Home environment

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
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

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

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
CCR (cont)
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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
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

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.
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

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)
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
Abuse (cont)

ALL states required reporting of elderly or
child abuse (SOC341 form), mandated
reporter
 Forms of elder abuse
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Physical abuse – corporal punishment
Verbal abuse
Involuntary seclusion
Financial abuse
Mental abuse
Sexual abuse
Signs of elder abuse
Living conditions unsafe, dirty, or
inadequate
 Poor personal hygiene
 Weight loss
 Frequent injuries
 Old bruises
 Quiet/withdrawn attitude

Signs of elder abuse (cont)
Anxious to please caregiver
 Private conversations not allowed
 Meds not taken properly
 Frequent visits to ER
 Dr. hop

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.

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

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.
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.
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.

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

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

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
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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
Maslow’s Hierarchy of Needs

Physiological –
– Food
– Water
– Oxygen
– Sleep
– Sex
– Temperature extremes
Maslow (cont)

Safety & Security
– Freedom from fear/anxiety
– Stability & consistency in routine
– Asepsis
– Knowledge of resident’s needs
Maslow (cont)

Belonging – Love & Affection
– Sense of belonging
– Acceptance & love
– Receive family, friends, visitors in a
homelike environment
Maslow (cont)

Self-Esteem
– Feeling competent
– Gaining respect, approval, recognition
– Ask opinions
– Really listen
Maslow (cont)

Self-actualization
– Attain full learning
– Creative potential
– Spiritual potential
– Pride in accomplishment
– Opportunity to do their best