It is critical for nursing centers and assisted living communities to address and mitigate resident-to-resident occurrences or potential incidents of resident-to-resident mistreatment. While mistreatment may or may not meet the definition of abuse, it would include negative and aggressive physical, sexual, or verbal interactions between long-term care residents that is unwelcome and have high potential to cause physical or psychological distress in the recipient.

Objectives:

1. Conduct a thorough investigation with proper documentation, follow up, and monitoring and care planning as needed.  
2. Create a structured self-assessment process to address the resident-to-resident occurrence and minimize or mitigate similar events for all residents. This includes a need to:
   • Document immediate interventions;
   • Conduct a root cause analysis process to identify the specific/source, root cause or causal factor of the problem; and 
   • Identify future actions to ensure sustained efforts to identify and prevent potential resident-to-resident mistreatment.
3. Identify existing AHCA/NCAL resources to support providers in addressing resident-to-resident mistreatment. 

Note: These tools were developed by members of AHCA/NCAL’s Survey/Regulatory Committee to assist centers and communities in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools.

© 2022 American Health Care Association. All rights reserved. 

All Provider Self-Assessment and Mitigation Tools for Resident to Resident Occurrences materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

Post-acute and long-term care facilities provide care and services to vulnerable populations who may become critically ill when steps are not taken to reduce the risk of waterborne diseases. Healthcare facilities are integral to the health and well-being of the communities and residents they serve. In order to maintain daily operations and care services, healthcare facilities need to develop an effective water management plan to prepare for, respond to, and recover from a total or partial interruption of the facility’s normal water supply. The water management course will provide post-acute and long-term care facilities with information on what a water management plan is, how to identify the elements of an effective water management program, and how to develop and maintain a comprehensive water management program in your facility. 

Audience: appropriate for both NF, as is required by regulation, and as best practices for AL.

Module Outcomes:

1. Describe what a water management plan is.
2. Identify elements of an effective water management program.
3. Discuss how to develop and maintain a comprehensive water management program for your facility.

© 2022 American Health Care Association. All rights reserved. 

All Water Management Training materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

The Centers of Medicare and Medicaid (CMS) require participating skilled nursing facilities to comply with the requirements of the National Fire Protection Association 101-2012 Edition, commonly referred to as the Life Safety Code (LSC) as well as the NFPA 99 – 2012 edition known as the Health Care Facilities Code.  These codes are a comprehensive set of requirements, which provide nursing home residents a high level of safety and security due to the nature of illness, impairment and the inability to self-evacuate in an emergency.

There are specific occupancy chapters of the LSC which apply to your center.  Facilities certified originally before July 5, 2016 are considered existing and Chapter 19 applies.  Facilities that have been certified after July 5, 2016 are addressed as new facilities and then Chapter 18 applies.  The Life Safety and Health Care Facilities Codes themselves are not all inclusive and often reference other editions of NFPA codes.

A number of issues have arisen based on the requirements of the NFPA 99, Health Care Facilities Code.  NFPA 99 establishes criteria for systems in nursing facilities such as gas and vacuum, electrical, etc. The requirements, however, generally are applied only to new construction and new equipment. Several chapters begin with specifying which criteria are applicable to existing facilities. Generally, existing facility systems are permitted to remain, even if they are not in strict compliance with the code, unless the authority having jurisdiction determines that their continued use constitutes a distinct hazard to life. If facilities are consider altering, modernizing or replacing equipment, the ‘new’ system or individual component are required to meet the installation and equipment requirements stated in NFPA 99.

The tips are for individual deficiencies which have been frequently cited across the U.S.  The tips provided are intended for reference only. If you have further questions, refer to the applicable NFPA Code manuals and/or please contact regulatory@ahca.org. 

© 2022 American Health Care Association. All rights reserved. 

All Life Safety Tips materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

How to Register in ahcancalED 

Easy as 1, 2, 3 !

click the  button found in the upper right corner of your screen or follow these three easy steps below! 

Step 1	Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner. Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.   Don’t have one or can’t remember? Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”. *Please note* you must add your member facility name to your login Once you are in and can see your name in the upper left hand corner, you are ready to go.
Step 2	From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays.  Under “upcoming webinars” go to a product in which you are interested. Click on the title. You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.
Step 3	Almost there! Click the green “register” button. Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard. FYI: after registering, you will be automatically notified when the recording of the webinar is ready. Need further help? Email us at educate@ahca.org We’ll walk you through it.

It is critical to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately.

Examples of adverse events/potential adverse events include:

• Falls (not following the care plan, use of gait belt, one vs. two-person transfers)
•  Falls with a mechanical lift
•  Elopement
•  Allegation of abuse or neglect
•  Water too hot
•  Smoking (supervised vs. unsupervised, with oxygen, defined smoking area, all about safety)
•  Bedrails (entrapment, assessment for use)
•  Significant medication errors such as cardiac medications, chemo, insulin, morphine, Coumadin
•  Infection Control – outbreaks (e.g. scabies, bedbugs, MRSA, C-Difficile, Noro Virus, Legionella)
•  Lack of timely or complete evaluation of a change in condition
•  Pressure ulcer – lack of prevention or following prevention measures
•  Grievances and resident/tenant council feedback

Objectives:

1. Identify adverse events that could potentially have a negative impact on residents/tenants as well as on a community’s regulatory compliance.   
2.  Establish a routine root cause analysis process to identify the specific/source, root cause or causal factor of the problem.  
3.  Create a structured process for developing a mitigation plan to address the adverse event/potential adverse event and minimize similar events for all residents/tenants:
   1. Complete the Initial Mitigation Action Plan 
   2. QAPI members complete the formal documentation of the Mitigation Action Plan
4.  Use information learned by sharing results and Plan with the QAPI committee for continued monitoring.

Note: These tools were initially developed by members of AHCA’s Survey/Regulatory Committee and adapted for assisted living communities to assist providers in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Communities may use different titles or terms than the action plans, such as Director of Health Services instead of Director of Nursing, or service plan instead of care plan. Please adapt the plans to reflect your AL community. 

Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools. 

© 2022 American Health Care Association. All rights reserved. 

All Assisted Living Action Plan Response for Adverse Events materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

You are also encouraged to register for the following free resource: 

Tools to Prevent and Address Resident to Resident Mistreatment

How to Register in ahcancalED 

Easy as 1, 2, 3 !

click the  button found in the upper right corner of your screen or follow these three easy steps below! 

Step 1	Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner. Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.   Don’t have one or can’t remember? Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”. *Please note* you must add your member facility name to your login Once you are in and can see your name in the upper left hand corner, you are ready to go.
Step 2	From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays.  Under “upcoming webinars” go to a product in which you are interested. Click on the title. You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.
Step 3	Almost there! Click the green “register” button. Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard. FYI: after registering, you will be automatically notified when the recording of the webinar is ready. Need further help? Email us at educate@ahca.org We’ll walk you through it.

It is critical for nursing centers and assisted living communities to address and mitigate adverse events and potential adverse events. An action plan, otherwise known as a mitigation plan, is a necessary response to adverse events and potential adverse events. For many such events, it is important to respond and start the mitigation process immediately.

Examples of adverse events/potential adverse events include:

• Falls (not following the care plan, use of gait belt, one vs. two-person transfers)
• Falls with a mechanical lift
• Elopement
• Allegation of abuse or neglect
• Water too hot
• Smoking (supervised vs. unsupervised, with oxygen, defined smoking area, all about safety)
• Bedrails (entrapment, assessment for use)
• Significant medication errors such as cardiac medications, chemo, insulin, morphine, Coumadin
• Served/consumed wrong consistency of food or liquids
• Infection Control – outbreaks (e.g. scabies, bedbugs, MRSA, C-Difficile, Noro Virus, Legionella)
• Fluid restriction not managed or monitored by facility, physician parameters not followed
• Lack of timely or complete assessment of a change in condition
• Pressure ulcer – lack of prevention or following prevention measures
• Grievances and resident council feedback

Objectives:

1.  Identify adverse events that could potentially have a negative impact on residents as well as on a center’s regulatory compliance.   
2.  Establish a routine root cause analysis process to identify the specific/source, root cause or causal factor of the problem.  
3.  Create a structured process for developing a mitigation plan to address the adverse event/potential adverse event and minimize similar events for all residents:
   •  Review the guidance for determination of avoidable versus unavoidable event
   • Complete the Initial Mitigation Action Plan
   • QAPI members complete the formal documentation of the Mitigation Action Plan
4. Use information learned by sharing results and Plan with the QAPI committee for continued monitoring.

Note: These tools were developed by members of AHCA’s Survey/Regulatory Committee to assist centers and communities in addressing adverse events and potential adverse events, documenting and tracking the steps they have taken, and identifying best practices for ongoing improvement. Use of these tools does not guarantee regulatory compliance nor mitigate potential liability. Providers should adapt their tools, policies, and processes as needed to ensure compliance with current federal and state requirements and use both professional judgement and the advice of legal counsel in determining whether or how to share these mitigation tools. 

© 2022 American Health Care Association. All rights reserved. 

All Nursing Centers Action Plan Response for Adverse Events materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.

You are also encouraged to register for the following free resource: 

Tools to Prevent and Address Resident to Resident Mistreatment

This course is free and was designed to meet the critical staff shortages occurring as a result of COVID-19. You will need to register and create an account using your name and e-mail. Once you have created your account, you may complete the course on your own time, stopping as needed, and then rejoining the class wherever you left off. 

Completion of this training is intended to prepare you to develop, manage and maintain a surge plan. 

Key Takeaways 

• Types of Surge (Begins at 9-minute mark) 
• Components of a Surge Plan (Begins at ~10:48 minute mark) 
  • Space – Structure  
  • Staff – Identifying staff requirements 
  • Stuff – Equipment and Supplies Needed 
  • Systems – Policies and Procedures to keep residents and staff safe 
  • Safety – Providing a safe environment for residents, staff and visitors 
• How to Develop your Surge Plan (Begins at ~16:55 minute mark)  
  • Understand the lifecycle of a surge event 
  • Include Infectious Disease Expert when developing plans, team effort to develop 

Presented by RPA, a Jensen Hughes Company

Main Office, 500 CrossKeys Office Park

Fairport, NY 14450

© 2022 American Health Care Association. All rights reserved. 

All How to Prepare your Facility for Surge materials subject to this copyright may be photocopied or distributed for the purpose of nonprofit or educational advancement. The use, photocopying, and distribution for commercial purposes of any of these materials is expressly prohibited without the prior written permission of American Health Care Association.