Whether or not the termination of employment after reporting substandard quality of care could be viewed as unlawful retaliation?
Compliance Perspective – Neglect and Abuse:
The Compliance and Ethics Officer will review with the DON and the Administrator the policies and procedures regarding prohibited retaliation, quality of care, wound care and care plans. Staff will receive education and training on the facility’s no tolerance policy regarding retaliation for reporting compliance violations, including the procedure to follow to report a violation and how to use the anonymous Hotline. Staff will also receive training on Abuse and Neglect, Quality of Care and Following Residents’ Care Plans. Multiple audits will be developed and implemented to determine residents’ need for increased and improved quality of care in these areas: untreated/undiscovered pressure ulcers/bed sores, daily hygienic care (bathing, shaving, hair, clean clothing, etc.), evaluation of care plans to determine if they are being followed or need revision, e.g., 2-person care, ability to feed themselves and residents will have their medications evaluated to determine if they are being over- or under-medicated. An audit will be conducted to determine if staff are responding to residents’ call bells in a timely manner and that residents’ rooms are being cleaned daily and their linens changed. Results from the completed audits will be summarized and submitted to the QAA/QAPI Committee for review and recommendations.
A nurse’s aide providing care for a resident in a Massachusetts VA nursing home, heard what seemed to be a disturbance with another resident being cared for by another aide behind the privacy curtain. She heard the 94-year-old resident shout, “Ow, Ow, Ow!” Then, because it sounded like fighting, the aide went to see what was happening. As she watched, she saw the male aide trying to lift the resident out of his wheelchair and onto the bed—something that was supposed to be a two-person job. Finally, not asking for any help, the aide just tossed the elderly resident who had dementia onto the bed.
Two days later, the aide wrote to her supervisor about how “brutal that guy (aide) was with the veteran.” She said that right after the incident the resident was wet and needed to be changed.
The aide who rough-handled the resident quietly resigned and the aide who reported the incident was fired two weeks later supposedly because she had attendance problems. However, those attendance problems had not been documented.
An investigation by The Boston Globe and USA Today discovered that the VA nursing home was one of 11 that the Veterans Administration had given its lowest rating. Documents obtained in the investigation indicated the poor rating was due to problems in providing care for the facility’s 200 veterans and included: bed sores, high rates of medication and a general decline in the veterans’ health.
The poor rating was also attributed to what inspectors from The Long-Term Care Institute 
found in their 2017 surprise inspections. They found instances of neglect like a veteran lying naked on a urine and feces-stained sheet, and another man trying unsuccessfully to feed himself with a spoon while staff nearby ignored him.
Another reported incident was of resident who died while the aide who was supposed to monitor him played video games.
Others reported that residents would wait as much as two hours before their call bells would be responded to.
The facility has had four directors in the last four years.
