Investigating and Reporting Allegations of

Misconduct in Nursing Homes

presented by:University of Wisconsin Oshkosh CCDETWI Department of Health Services DQA

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Welcome

• Project Background/Staff Introductions

• Reminder: Silence Electronic Devices

• Agenda

• CEUs

• Evaluation

• Certificate of Attendance

• Participant Introductions

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Learning Points

• Misconduct Definitions

• Developing an Investigation Protocol

• Conducting an Internal Investigation

• Interviewing Skills

• Reporting Requirements

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A Word about Prevention

• Background checks are good but not enough

• Key thoughts on preventing caregiver misconduct

• Adapting keys to prevention in your facility

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Legal Definitions

Misconduct

Abuse Neglect Misappropriation

Injury of Unknown Source

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Developing a Process and Protocol

• Develop a process

• Review protocol steps 1 – 5

• Activity: checking your process

A Protocol = A Plan of Action

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Investigating the Allegation

• An investigation is a fact-finding mission

• Internal investigations should be written reports

• Employment actions are internal entity decisions while the investigation is pending

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Elements of an Investigation

• Who, What, Where, When, Why, How• Contact Law Enforcement• Preserve Evidence• Document the Effect on the Victim• Document the Caregiver’s Duty• Diagram the Scene• Develop a List of Interviewees• Write your Report

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Incident-Specific Elements

• Physical Abuse

• Verbal/Psychological Abuse

• Sexual Abuse

• Neglect

• Misappropriation

• Resident-to-Resident Altercations

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Activity: Case Studies

• Note some elements that are important to your investigation

• Use your training materials to help remember/apply the elements

• Assume that:– You have taken steps to protect the resident– You have taken action re: the accused

caregiver

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Top 10 Interviewing Tips

1. Ensure privacy 6. Clarify

2. Prepare 7. Ask open questions

3. Relaxed demeanor 8. Stay on the subject

4. Informal seating 9. Show empathy

5. Be clear & concise 10. Listen well!

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Activity: Interviewing Skills

• Video interview between a facility administrator and a witness

Interview Video

• Compare the video conversation with the interview tips

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Signs of Deception

• No single telltale sign for a lie

• Liars “might” have some things in common

• Behavior during an interview vs. behavior under more normal circumstances

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Reporting Misconduct in Nursing Homes

Develop and operationalize written policies and procedures:– Written procedures contain specific elements– Everyone knows about the procedures– Staff trained to immediately report any

incident to the NH Administrator

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Nursing Home Reporting Requirements

Allegation of Misconduct

Immediately report to NH Administrator

and DQA(initial eval)

Report reasonablesuspicion of a crime

to DQA &law enforcement

Report investigationresults to DQA within 5 days

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More Reporting Info

• Report Allegations Immediately Here – Initial Evaluation Permitted w/Conditions

• Report Suspicion of a Crime to Law Enforcement

• Report Investigation Results– Reports on Credentialed Staff– Unreported Incidents

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More Reporting Info

• Reporting Requirement Penalties

• Reporting on Behalf of Adults-at-Risk

• Caregiver Misconduct Registry

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Resources

• Wisconsin Caregiver Program Manual http://dhs.wisconsin.gov/caregiver/publications/CgvrProgMan.htm

• Caregiver Abuse and Neglect Prevention Project Trainingwww.uwosh.edu/ccdet/caregiver

• Caregiver Misconduct Training Videohttp://www.dhs.wisconsin.gov/caregiver/training/intInvstTrng.htm

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Wrap-Up

• Questions?

• Evaluation

• CEU Application

• Attendance Certificates