On July 13, a resident of a Missouri nursing home was accused of seriously injuring another resident. According to charging documents, Resident 1 allegedly assaulted Resident 2 in a serious and violent manner using a toilet lid. Resident 1 has been charged with assault in the first degree.
According to a probable cause statement, Resident 1 reportedly struck Resident 2 multiple times in the head with the toilet lid until it broke. Resident 2 sustained serious head and neck injuries and was airlifted to a hospital in Arkansas. Police said there was a lot of blood all over Resident 2’s room.
Following the incident, Resident 1 was arrested and transported to the county jail. During transit, Resident 1 purportedly expressed a desire to be incarcerated, stating that Resident 2 had initiated the altercation by hitting him first.
Medical personnel at the jail examined Resident 1 and saw that he had sustained a hand injury when the toilet lid broke. He was then taken to the hospital for medical treatment.
Compliance Perspective
Issue
Failure to prevent a resident from attacking another resident and failure to perform a Preadmission Screening and Resident Review (PASARR) to accurately assess a resident’s risk for aggressive behavior or provide adequate monitoring and services, may result in citations for immediate jeopardy and provision of substandard quality of care, in violation of state and federal regulations. Staff should monitor for any behaviors that may provoke a reaction by residents or others, which include, but are not limited to:
- Verbally aggressive behavior, such as screaming, cursing, bossing around/demanding, insulting to race or ethnic group, intimidating;
- Physically aggressive behavior, such as hitting, kicking, grabbing, scratching, pushing/shoving, biting, spitting, threatening gestures, throwing objects;
- Sexually aggressive behavior such as saying sexual things, inappropriate touching/grabbing;
- Taking, touching, or rummaging through other’s property; and
- Wandering into other’s rooms/space.
Resident-to-resident abuse could also involve a resident who has had no prior history of aggressive behaviors, since a resident’s behavior could quickly escalate into an instance of abuse.
Discussion Points
- Review policies and procedures for accurately assessing residents before and after admission for the risk of aggressive behavior and for ensuring adequate supervision and appropriate room assignment are provided based on their history and current status.
- Train staff about the risk for aggressive behavior by any resident and their responsibility to monitor and note changes or patterns of behavior that may indicate increasing aggression. Also train staff on behavioral health protocols and the importance of reporting distressing behaviors immediately to a supervisor. Teach the reporting process, including how to access the Hotline if anonymous reporting is preferred. Document that these trainings occurred and file the signed documents in each employee’s education file.
- Periodically audit the behavior documentation of residents to determine if new behaviors are identified, or if behaviors have changed, and update the care plan immediately. Also audit to ensure that all staff are knowledgeable of behaviors that should be reported immediately to a supervisor, and the process for reporting.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
