Preventing Sexual Abuse or Misconduct in Health and Human Services Organizations

June 4, 2018

A quick scan of recent headlines – including the latest high-profile story about a nursing home that has been found 85 percent liable for the 2013 sexual assault of an 82-year-old resident – has left many health and human services providers wondering how to prevent these horrific events from happening in their own facilities.

This starts with the admissions vetting process. Should it be updated to include criminal background and sex offender registry checks? While it may sound prudent to simply add these checks, organizations must be prepared to create a policy that addresses key questions such as:

  1. Will we notify the resident or client that it is our policy to check the registry?
  2. What offenses would prevent the person from being served by our organization? Which offenses (e., less severe, non-violent or not in recent history) will be permitted? Will the resident’s or client’s functional status be considered (i.e., non-ambulatory, dependent for transfers)?
  3. Will offenses that do not prevent admission be disclosed to caregivers and nurses? Will staff’s knowledge of less severe, non-violent or old offenses affect the quality of care that the resident or client will receive?

Once your organization determines how it will approach background screening, you’ll now have to update your policy to reflect your answers to the above questions – and perhaps even further. Overall, there are many policies in place that protect residents or clients from sexual abuse or misconduct by workers. Conventional risk management approaches to preventing sexual abuse or misconduct in elder care facilities include screening of workers; staff education on signs of abuse, requirement to report and how to report; supervision of workers; and a thorough code of ethics and conduct. But protecting workers, residents or clients from sexual abuse or misconduct by another resident or client is more nuanced and may require revamping your current policy for Preventing Sexual Abuse and Misconduct.

The next set of challenges will involve evaluating residents’ and clients’ rights, as individuals in your care. Providers understand the resident’s or client’s rights right to dignity, choice and privacy. However, when it comes to sexual relations, concerns such as cognition, capacity, understanding and consent can blur the lines.

Most staff education modules on the prevention of sexual abuse or misconduct and residents’ or clients’ rights focuses on signs of abuse, requirement to report and how to report and supervision of workers. One recommended measure to prevent sexual abuse or misconduct of a staff member by a resident or between residents or clients is to monitor for conduct that crosses professional boundaries of the staff worker and client or resident relationship, or that infringe upon the rights of a fellow resident or client. Recognizing the signs of inappropriate or concerning interactions and understanding how to promptly report them is paramount in preventing sexual abuse or misconduct initiated by residents or clients.

On an annual basis – aligning with work performance evaluation and continuing education typically works well – employees should attest to their knowledge of signs to observe, their requirement to report and the proper procedure for reporting. They should also affirm that he or she did not fail to report as required any care or treatment concern. And finally, your organization must evaluate how responsive it is to staff concerns about inappropriate or concerning interactions. Reports of resident or client treatment and care must be welcomed, investigated fully and communicated appropriately with the care team. Sexual abuse is a serious matter, and should always be viewed as such and therefore never flippantly dismissed.

Bette McNee, RN, NHA
Senior Clinical Risk Management Consultant
The Graham Building
Philadelphia, PA, 19102




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