This CNA committed exploitation of an elder. Exploitation is defined in the new federal regulatory requirements for skilled nursing facilities as “Taking advantage of a resident for personal gain through the use of manipulation, intimidation, threats, or coercion.” In the above case study, the CNA received payment for services she did not and should not perform as an employee of the facility. The facility leadership should review their abuse policies to ensure exploitation is addressed, and that it is adequately explained to all staff during new hire orientation and at least annually thereafter. Training should be provided to all current staff members, highlighting the recent occurrence and reinforcing the disciplinary action that will be taken should an employee exploit a resident.
Risk Exposure: An alert resident, with a diagnosis of COPD and a BIM score of 12, required hospitalization. While she was hospitalized, she told her daughter that she wanted to go home instead of returning to the facility. The daughter, who is the DPOA, told her mother that she could not provide care for her at her home, and then the resident told her daughter that she had hired a staff member to care for her. The daughter checked the resident’s bank account and found that two checks had been written to one of the CNAs working at the facility. One check was for $500 and the other was for $700.
Potential Reason/Root Cause: A staff member inappropriately took money from a resident.
Quality Assurance Mitigation Strategy (QA): An investigation was begun, and the CNA was suspended pending the outcome of the investigation. The facility attempted to interview the CNA, but she failed to show up for the interview; however, she did tell the administrator by phone that she had taken the money from the resident to be a housekeeper. The daughter brought in copies of the two checks for the investigation, and it was noted that the word “loan” had been written on them. The police were notified and a report was filed with the state. The abuse allegation will be substantiated, and the CNA will be terminated. The resident’s physician is aware of the situation along with the resident’s family. All residents with a BIM score of 10 or above will be interviewed to rule out abuse and exploitation, and all staff will be interviewed as well. The resident is still hospitalized, but will be returning to the facility.
F224 Prohibit Mistreatment/Neglect/Misappropriation
F225 Investigate/Report Allegations/Individuals
Performance Improvement/Education (PI): Abuse and neglect prevention training will be provided to staff.
