3,181 Comments Posted by Lynne

As a matter of fact, the procedures for HIPAA (U.S. health privacy act) were modeled closely after the British privacy procedures.

[He's . . . . . . . he's a vampire. =8-o ]

Or that could be him in the mirror alongside the door using a tripod - hard to say - mebbe with a very tall spider.

[Caution: Rant ahead - please feel free to fast-forward to the next post.]

Joseph,

There is a lot of abuse everywhere. As a person whose job it is to prevent abuse in residential facilities and who has worked in 5 different residential facilities over the past 22 years, I am betting you there is a much smaller possibility of abuse in these places at the current time than there is almost anywhere else in the world.

I can personally vouch for that being the case at the facility where I currently work, or I wouldn't be there. Our staff have to examine everyone daily who lives in our facility when they assist them with their bathing routines (the people who live at the facility where I work have severe and profound intellectual & developmental disabilities and need a lot of assistance for bathing and other self-help activities). On a daily basis I personally see every report on every injury or accident that occurs to our 500+ people and if one shift misses reporting an injury (including inflamed hair follicles, pinpoint bruises, shaving nicks, mosquito bites, etc.), the next shift will almost always pick it up. And if they miss it and it is found later (yellow, aged bruise found that had not previously been reported) there is often hell to pay because whoever was responsible for the care of that person missed reporting an obvious injury. There can be no chance of on-going abuse such as occurs in many private homes because when one shift leaves there is another fresh set of eyes coming on, and every week the staff have days off so that a different person has a chance to work with and examine our folks on each shift on each of our 43 living areas.

Those of us in risk management each have an assigned section of campus to walk through at random times weekly on all three shifts (this includes weekends and holidays - I worked 6 days in a row this past week and filled in as a direct care staff for two 3-hour stretches because our staffing was low), and every shift of campus has an assigned shift supervisor who must walk through every living unit on their assigned sections every day on their shift. That means they do 1095 checks yearly. Every living area has registered nurses whose offices are on the living areas. It is not like the old days where they had glassed in nursing stations. The nurses have one of the living area bedrooms assigned to them that they have converted into an office, so they are right there when needed. Staff are not allowed to hide in offices, but must work "on the floor" alongside the folks who live there. Many of the professionals also have their offices on the same living area where their assigned folks live so we encourage interaction as much as possible.

I know 250 of the folks who live where I work by first name (and, more importantly, they know me) and I am familiar with the other 250 by case record or by face, and I have only been in my current position for 2 1/2 years. I read every nursing log on campus daily, I see every injury report on campus each day, and I assist my supervisor in deciding which ones need investigation, which ones need follow-up, which ones need immediate (and I mean immediate) response, and which ones may just be medical issues that medical staff will handle. We even require that people report incidents that occur in which an injury does not happen at the time but might show up later, like a fall. I do constant walkthroughs on campus and observe how our folks react to the different staff with whom they work (we have 700 or 800 direct care staff and nurses) and if any of the other risk management staff or I feel at all uneasy about how they interact with our people or how our people react to them nonverbally, we ask for a review or investigation. If we have the slightest suspicion that anyone may have acted without the best intent of the person served, we move them that minute either off work entirely or to a place where they cannot be in contact with the people who live here.

I am betting there are few places in the entire world where you have a better on-going safety assessment and proactive protection of anyone, especially given that a number of these people also have some degree of loss of behavioral control that can make them dangerous to self or others. Some of them need specially prepared meals because they can't chew or swallow well, many of them cannot walk on their own or need individually adapted equipment to help them ambulate, many of them do not have control over their bowel or bladder, over half have of them have seizures that are (sometimes - if we are lucky) controlled with anticonvulsant medication(s), and the majority of folks take a variety of medications because of their various complicated health problems. On top of that, the folks where I work are aging and almost all of them have lived far longer than anyone with such serious disabilities would have lived even 25 years ago.

When someone who does not work at or live in a psychiatric or developmental facility starts to take potshots at the care we provide, I get a little testy. I would challenge anyone to show me that they know of a similar group of people (with or without handicapping conditions of any sort) anywhere in the world who have such a system of checks and balances. Our paperwork is set up such that our system is "transparent" - anyone walking in can see exactly what we do, where our flaws are, and how we have handled anything that has occurred. This includes reviews of where we have messed up and what we are doing to try to make sure it doesn't happen again. The teams I work with are sometimes sick of the "endless" meetings I ask them to have to show how they are protecting our people and how they are setting up systems to prevent similar things from happening again. We put as much effort into preventing sunburns and mosquito bites as we do in preventing fractures and lacerations.

Many of the individuals where I work have osteoporosis due to years of anticonvulsant medication use or minimal ambulation, they can't eat foods that the rest of us eat daily without having the texture changed or they will choke to death or aspirate, many of them have poor ambulation skills and some have no protective reflexes when they fall, many of them will eat anything that they put their hands on because they don't know any better, some will bite or scratch themselves or hit their heads until they are covered with blood, some will rock for hour upon hour and not respond when you try to get them interested in something, and yet every single person out there has at least a handful of staff who will tirelessly stand up for them and champion them and make sure that if they think something is not happening right, they will make noise until someone does something about it. You can't pay anyone enough money to do that - that is shameless, selfless love for one's fellow man, and sometimes at great personal cost.

Do we have abuse and neglect? Yes. It happens everywhere. It always will. Sorry to say that is human nature. But it has a much better chance of being detected and stopped because of all the eyes available and because we know that 95% of all abuse occurs because of systems issues - NOT because of bad people. If you can improve the system you can make assure that there is a lesser chance of abuse/neglect occurring.

No, it's certainly not a perfect system and if the people of the world would get off their butts and vote for money so that these people could stay at home or in the community, we wouldn't have institutional settings. But the truth is that most people in the world don't care about these folks until something bad happens and they see it splashed across their newspapers. And then they are interested for exactly one week until something more exciting happens and their attention is diverted elsewhere.

I will put ALL my money on the odds that my 500+ folks are safer on an on-going basis where they currently live than almost any other place they could be in the world. And you can take that one to the bank.

Did someone call my name? ;-)

Highly unlikely, but it is made out of polished metal, so cannot crack and be used to hurt oneself or others. The edges of the mirror are sealed with smoothed plastic for a similar reason.

~A~

Now THAT'S funny! :`-)

So . . . no pix of you in the blue one, then?

Felyne,

Or a towel . . .

J-131274,

Ha! Makes me think of when the U.S. tried to force some dictator out of his hiding place by playing loud rock music. 8`-)

There are some crazy laws in different states about disposing of state-owned equipment/supplies. In the state-run facility where I currently work if we receive certain types of supplies and then no longer need them, we can't give them away, sell them, or donate them - they have to go to the trash dump and we can't even tell people when we are going to the dump. Three years ago I watched them empty all the unwanted supplies out of a 4 x 6 room that was 8 feet high, and had to watch them throw all this marvelous stuff in a dumpster. If we took anything out of it (other than to use for the folks on grounds) we would have been "stealing." If we gave it away it would have been "misappropriation of state materials." It was gruesome. I filled a small room with some of these supplies for folks on my caseload, but a large portion of the materials were "age-inappropriate" (I work almost exclusively with adults currently, and many of the supplies would have been perfect for a pre-school or kindergarden).

However, that's how many of us in state facilities get our supplies initially - they are rejects from other state facilities. You just have to hope you are high on the "donor list." Too bad no one votes for increased taxes so we can have decent supplies and have to live on donated ones, and too bad state bureaucracies are so dense that you have to trash unused goods. :-(

So men don't get to have uvulas anymore?

I just noticed the nice padding in the room as well. :-)

Exactly, Bill. That one is built to specs too. You can see what is happening in the room so if someone tries to hurt themself or they stop breathing or whatever, you can go right in and assist them.

Now, that's just plain nasty.

So, did you try them on? Was Yaggy there to model? ;-)