N.J. Admin. Code § Tit. 5, ch. 27A, app A

Current through Register Vol. 56, No. 23, December 2, 2024

Appendix A

RESIDENTIAL HEALTH CARE FACILITIES GUIDELINES FOR INAPPROPRIATE BEHAVIOR AND RESIDENT TO RESIDENT ABUSE

I. Upon admission, the initial resident assessment, MDS 2.0 or approved equivalent, should include a psycho-social behavior component. If interventions to address identified behavior issues are appropriate, these should be incorporated into the care plan. A reassessment should be completed at least annually, or at any time when a resident's pattern of behavior changes. The resident's response to interventions should be recorded in documentation established by the health maintenance and monitoring service.

II. Inappropriate behavior and/or actions should trigger an immediate reassessment with adjusted interventions. The facility should notify the physician, advanced practice nurse or physician assistant and the designated resident representative of the incidents or behaviors. The resident's response should be documented. The facility's actions and/or interventions in response to behavior changes should also be part of the plan of care and should be documented to ensure implementation. Prompt reassessment of behavioral changes will in most cases avert the continued progression of inappropriate behavior.

III. Inappropriate behavior and/or actions involving other residents must be identified in the records of all involved residents, including their assessments, any interventions, and the resident's responses. If the physician, advanced practice nurse or physician assistant and designated resident representatives were notified, this must be documented in the records of all involved residents.

IV. Incidents of inappropriate behavior or actions of abuse between residents should result in the following actions, as applicable:

A. Notification of the health maintenance and monitoring nurse or the physician, advanced practice nurse or physician assistant who will determine if the resident should be transferred or whether an immediate assessment will be done.

B. Documentation of interventions and responses of residents.

C. Notification of residents' designated representatives.

D. Protection of involved residents' civil and constitutional rights.

E. Determination by the administrator of the facility's ability to assure safety while working toward resolution.

F. Implementation of emergency or short-term precautions to assure safety while working toward resolution.

G. Notification of police, if necessary.

V. Transfer from the facility should be based on the appropriate evaluation and transfer order of the attending physician, advanced practice nurse or physician assistant, facility medical director and/or consultant psychiatrist.

VI. In the event of an emergency situation only:

A. Have the resident removed to the emergency room of the local hospital for medical and/or psychiatric evaluation and consultation by a physician. Return of the resident should be based on the physician, advanced practice nurse or physician assistant's written notation of the appropriateness of returning the resident to a residential health care setting. The administrator is responsible for the decision to accept or deny the return of the resident.

B. File a police complaint against the abuser and have the individual removed. The complaint can be filed by the facility or the abused party.

C. Notify all agencies (i.e., Medicaid if applicable; Ombudsman for the Institutionalized Elderly, if the resident is over 60 years of age; and the Department of Community Affairs). In the event that all guidelines have been followed and resolution has not taken place, request assistance from the Department of Community Affairs, Residential Health Care Evaluation Program (609-633-6251).

VII. Facility policies and procedures to address inappropriate resident behavior, including resident to resident abuse, should include all of the above outlined actions.

N.J. Admin. Code Tit. 5, ch. 27A, app A