CLIENT ABUSE

Potential for client abuse is lower in facilities like Intermediate Care facilities (IFC).  I’m not saying that ICF’s never have client abuse issues,  but any facility that  has different shifts of staff and consultants in the facility every month, an RN that see the clients at least once a week, an MD every 60 days and a Regional Center caseworker visiting each resident quarterly, yearly Pap, mammograms, audiology, optometry plus their strict licensing requirements, Area board 10 Quality of Life assessments, regional center comprehensive reviews with a QIDP overseeing the coordination of services and monitoring their progress (or lack of) may not have the extent of potential abuse in this population as known in the past.  It has been my experience that many issues that lead to client abuse have so much more oversight.
Training in potential client abuse situations like frustration tolerance, the law and reporting procedures also help to reduce the occurrence of abuse.

Client Abuse

Client abuse is any denial of client rights. Some abusive situations are more obvious than others are. Examples include:
  1. Physical - hitting, punching, pinching, pushing, too hot, too cold, etc.
  2. Restraints - overmedication, locking wheelchair brakes for staff convenience, holding clients down or any part of their body like mittens straps or ties.
  3. Neglect - lack of 24-hour direct supervision, making clients stay alone in their room or out back against their will and with no supervision. Not assisting clients to the bathroom in a timely enough manner to avoid them urinating on themselves or not changing them immediately after they have urinated on themselves.
  4. Verbal - yelling at or around clients, using crude language, talking in a language other than English unless the client understands that language.
  5. Other - withholding of food or drink

Client Abuse Reporting

In any facility all the staff are also mandated reporters.  Suspected abuse must be reported immediately! If any staff has seen, heard of, or suspects any possible client abuse it must be reported to the QIDP or Director/ owner or the department of justice, licensing, or the ombudsmen or Department of children and family services right there and then.  Any delay can result in immediate termination of employment as well as possible accessory to prosecution if abuse is found to be substantiated. All reports of possible suspected abuse should be immediately investigated. QIDP will report all findings to the director/owner, Licensing, and the police if warranted.  During the investigation all information is expected to be confidential.  If suspected abuse is found not to be substantiated both staff (reporter and suspect) are to be treated confidentially. 
What is most important to remember is that our clients (many of them) are unable or unwilling to report problems with staff themselves.  Many are limited in verbal skills or non-verbal.  Many have no direct choice but to trust their care givers.  As much as most people want to trust the caregivers (myself included) there are those who should never work in this or any direct care field.   It is also important to remember that a person hiring staff may not be able to tell that another person has a problem with frustration tolerance, hidden anger or is just plain mean and enjoys hurting others.  And even with background checks, fingerprints, and all the training in the world it is still oversight that protects our clients the best.