MDS Alert

Training staff to recognize signs of abuse is key to resident safety.

Sexual abuse and its victims have been invisible for a long time. The elderly are a less visible population than other age demographics, and so it's unsurprising that seniors suffer sexual abuse, often repeatedly and silently, as well as the trauma of not being able to pursue justice for themselves.

Though domestic news cycles are saturated with coverage of the waves of sexual abuse and assault survivors breaking their silences, a similar reckoning has not yet occurred in the long-term care industry. Everyone knows abuse sometimes happens, and facilities and regulatory agencies are doing everything to try to prevent and uncover sexual abuse of residents.

Train Staff

In fact, abuse prevention is one of the mandatory training requirements that became effective in Phase 1 of the Requirements of Participation," says Linda Elizaitis, president of CMSCompliance Group in Melville, New York.

"When thinking about preventing sexual abuse in nursing homes, one of the most important things is a well-trained staff. The facility has a responsibility to ensure that staff have been screened appropriately before hiring and trained on abuse prevention," she adds.

Base your training on your facility's own policies and procedures, and make sure to emphasize identifying signs of potential abuse and staff's responsibility to report any signs. Staff should also know the process and procedures for investigating abuse allegations, as well as protecting residents from further harm during the ongoing investigation, Elizaitis says.

These Signs May Indicate Abuse

Signs of abuse may include both physical signs as symptoms, as well as changes in behavior, and should be incorporated into staff education and training.

"Some examples of behavior changes or physical signs that require follow-up to ensure sexual abuse is not occurring include: bruising or bleeding of the genital area, bruises on a female resident's breasts, pain when seated or walking, depression, a fear of being touched or something as simple as changes in sleep pattern or a new onset of nightmares," Elizaitis says.

"Any of these signs being identified warrant an investigation," she adds. "Facility staff all must understand their individual responsibility related to prevent of any type of abuse."

Conduct Behavioral Assessments

Use assessments as a chance to establish a baseline, flag aggressive behaviors, and identify residents who may be especially susceptible to victimization.

"The importance of behavioral assessments and the associated care plan development cannot be understated," Elizaitis says. "Identifying residents who exhibit sexually aggressive behaviors towards others is essential for preventing abuse; however, it is also critical to identify any resident who is likely to be victimized and care plan for the resident's risk to be abused."

Incorporate this information into your residents' care plans as well. "Care plans need to be individualized and include interventions that are monitored, periodically evaluated, and adjusted based on success or failure of the team-developed interventions for any resident who is at risk to abuse or be abused," Elizaitis says.

Surveyors will be on the lookout to make sure facilities are ensuring the safety of all residents, and that facilities and staff actively mitigate the risks of residents who may try to take advantage of others.

"For example, a citation was issued to a nursing home that did not take proper precautions to move a sexually aggressive male from a unit where he was surrounded by women, several of whom had cognitive issues," Elizaitis says. "We have also seen situations where a facility has been cited for failing to protect a resident who did not have a capacity to consent from engaging in sexual activity with a cognitively intact resident."

Don't forget to keep visitors in mind when establishing or reevaluating your facility's policies and procedures for sexual abuse, or when training staff on what signs of abuse to look for, she adds.

Understand Consent Between Residents

Staff and facilities know that long-term care residents are adults, and there has to be recognition that, as adults, residents can engage in consensual sexual activity. However, facilities should have policies and procedures in place for conducting capacity evaluations, including how and when staff conducts such evaluations.

Don't forget to monitor and reevaluate residents' mental status. "A resident's capacity to consent may change over time," Elizaitis says.

Monitoring and reevaluating residents' capacity to consent helps with preventing abuse from occurring in the event that a person is no longer capable of consenting, she adds.