VIOLENCE IN THE SENIOR LIVING COMMUNITY WORKPLACE Part One: Developing a Corporate Prevention Program

Transcription

1 VIOLENCE IN THE SENIOR LIVING COMMUNITY WORKPLACE Part One: Develping a Crprate Preventin Prgram Typically thught f as safe places, senir living cmmunities are increasingly facing a significant increase in acts f aggressin frm persnnel, residents, family members and visitrs. Cnsider the fllwing examples: VIOLENCE IN THE SENIOR LIVING COMMUNITY WORKPLACE Everyne at the assisted living cmplex in Frt Lauderdale, Fla. thught 72-year-ld Felix Freed had fund a best friend in his 90-year ld neighbr, as the tw were seen inseparably tgether at meals, during walks and sharing cnversatins thrughut the cmplex; until ne Thursday mrning, when Freed pulled a plastic bag ver his best friend s head and suffcated her. In Calif., a man facing evictin frm a lw-incme senir citizens cmplex sht and killed the building s tw managers and a tenant, then turned the gun n himself. In a rural Midwest nursing hme, plice surmised that it appeared that a 92-year-ld resident was the target f a murder attempt when an impster psing as a bld technician set his rm n fire. Als in the Midwest, tw nursing hme administratrs were gunned dwn as they left wrk, and plice arrested a fired nursing assistant described by c-wrkers as mentally unstable. In 2001, the Bureau f Labr Statistics released data shwing nursing and persnal care facilities had mre than duble the number f nn-fatal assaults and vilent acts than ther health services verall and had twelve times mre incidents than the private sectr. Unfrtunately, the incidents f vilence in nursing and persnal care facilities were likely underreprted, due in part t the perceptin within the industry that assaults are part f the jb. And indeed, as senir living cmmunities accept mre residents with dementia, psychiatric disrders and ther cnditins ften assciated with challenging behavirs, the number f residents that attack ther residents and staff is increasing. CM (10/11) Vilence in the Senir Living Cmmunity Wrkplace griskresurces.cm 1

2 Wrkplace vilence ranges frm ffensive r threatening language t hmicide. In this first f a tw part series, we ll discuss develping crprate wrkplace vilence preventin prgram guidelines, including plicy recmmendatins and practical crrective methds t help prevent and mitigate the effects f wrkplace vilence. The secnd part will deal mre specifically with training tips fr dealing with a vilent individual (e.g., resident, emplyee, family member, r visitr), including hw t respnd t gunfire in the wrkplace. Despite an increased in incidents f vilence in nursing and persnal care facilities, experts estimate that 80 percent f health care rganizatins have nt established frmal wrkplace vilence preventin prgrams. T address this prblem, the Occupatinal Safety and Health Administratin (OSHA) develped the Guidelines fr Preventing Wrkplace Vilence fr Health Care & Scial Service Wrkers at In their guidelines, OSHA ffers the fllwing recmmendatins. MANAGEMENT COMMITMENT AND EMPLOYEE INVOLVEMENT Management cmmitment and emplyee invlvement are cmplementary and essential elements f an effective safety and health prgram. Management cmmitment, including the endrsement and visible invlvement f tp management, prvides the mtivatin and resurces t deal effectively with wrkplace vilence, and shuld include: Demnstrated rganizatinal cncern fr emplyee emtinal and physical safety and health. Assigned respnsibility fr the varius aspects f the wrkplace vilence preventin prgram t ensure all managers, supervisrs, and emplyees understand their bligatin. Apprpriate allcatin f authrity and resurces t all respnsible parties. A system f accuntability fr invlved managers, supervisrs and emplyees. A cmprehensive emplyee assistance prgram f medical and psychlgical cunseling and debriefing fr emplyees experiencing r witnessing assaults and ther vilent incidents. Cmmitment t supprt and implement apprpriate recmmendatins frm safety and health cmmittee. Likewise, emplyee invlvement shuld include: Understanding and cmplying with the wrkplace vilence preventin prgram and ther safety and security measures. Prmpt and accurate reprting f vilent incidents. Participatin n safety and health cmmittees r teams that receive reprts f vilent incidents r security prblems, prvides scheduled and randm facility inspectins, and respnds with recmmendatins fr crrective strategies. Taking part in a cntinuing educatin prgram that cvers techniques t recgnize escalating agitatin, assaultive behavir, r criminal intent, and discusses apprpriate respnses. 2 griskresurces.cm Vilence in the Senir Living Cmmunity Wrkplace CM (10/11)

3 WRITTEN PROGRAM Develp a written prgram fr jb safety and security with clear gals and bjectives t prevent wrkplace vilence that is incrprated int the rganizatins verall safety and health prgram. The wrkplace vilence preventin prgram shuld: Create and disseminate a clear plicy f zer tlerance fr wrkplace vilence, verbal and nnverbal threats and related actins. Ensure managers, supervisrs, cwrkers, clients, residents and visitrs knw abut this plicy. Ensure n emplyee wh reprts r experiences wrkplace vilence faces reprisals. Encurage emplyees t prmptly reprt incidents and suggest ways t reduce r eliminate risks. Require recrds f incidents t assess risk and measure prgress. Outline a cmprehensive plan fr maintaining security in the wrkplace. This includes establishing a liaisn with law enfrcement representatives and thers wh can help identify ways t prevent and mitigate wrkplace vilence. Assign respnsibility and authrity fr the prgram t individuals r teams with apprpriate training and skills and ensure that adequate resurces t develp expertise are available. Affirm management cmmitment t a wrker-supprtive envirnment that places as much imprtance n emplyee safety and health as n serving the resident. Set up a cmpany briefing as part f the initial effrt t address such issues as preserving safety, supprting afflicted emplyees and facilitating recvery. WORKSITE ANALYSIS Wrksite analysis invlves a step-by-step, cmmnsense lk at the wrkplace t find existing r ptential hazards fr wrkplace vilence. This entails reviewing specific prcedures r peratins that cntribute t hazards and specific lcales where hazards may develp. When assembling the team t carry ut these tasks, cnsider representatives frm senir management, peratins, emplyee assistance, security, ccupatinal safety and health, legal and human resurces staff. Assign respnsibilities accrding t needs. The recmmended prgram fr a wrksite analysis includes, but is nt limited t: VIOLENCE IN THE SENIOR COMMUNITY WORKPLACE Recrds analysis and tracking This activity shuld include reviewing safety recrds, charts, incident reprts and lgs addressing near-incidents f assaultive behavirs t identify trends in assaults relative t particular: Departments; Units; Jb titles; Unit activities; Wrkstatins; and Time f day Tabulate these data t target the frequency and severity f incidents t establish a baseline fr measuring imprvement. Mnitr trends and analyze incidents f actual r ptential wrkplace vilence. Screening emplyee surveys An imprtant screening tl is an emplyee questinnaire r survey t get emplyees ideas n the ptential fr vilent incidents and t identify r cnfirm the need fr imprved security measures. Detailed baseline screening surveys can help pinpint tasks that put emplyees at risk. Peridic surveys cnducted at least annually r whenever peratins change r incidents f wrkplace vilence ccur help identify new r previusly unnticed risk factrs and deficiencies r CM (10/11) Vilence in the Senir Living Cmmunity Wrkplace griskresurces.cm 3

4 failures in wrk practices, prcedures r cntrls. Als, the surveys help assess the effects f changes in the wrk prcesses. The peridic review prcess shuld als include feed-back and fllw-up. Cnsider using independent reviewers, such as safety and health prfessinals r insurance cnsultants t ffer advice t strengthen prgrams. Cnducting a wrkplace security analysis The team r crdinatr shuld peridically inspect the wrkplace and evaluate tasks t identify hazards, cnditins, peratins and situatins that culd lead t vilence. T find areas requiring further evaluatin, the team r crdinatr shuld: Analyze incidents, including the characteristics f assailants and victims, an accunt f what happened befre and during the incident, and the relevant details f the situatin and its utcme. Identify jbs r lcatins with the greatest risk f vilence as well as prcesses and prcedures that put emplyees at risk f assault, including hw ften and when. Nte high-risk factrs such as types f residents (fr example, thse with dementia, psychiatric cnditins r a histry f alchl r drug abuse); physical risk factrs related t building layut r design; islated lcatins and jb activities; devices; areas f easy, unsecured access; and areas with previus security prblems. Evaluate the effectiveness f existing security measures, including engineering cntrls. Determine if risk factrs have been reduced r eliminated and take apprpriate actin. HAZARD PREVENTION AND CONTROL After hazards are identified thrugh the systematic wrksite analysis, the next step is t design measures thrugh engineering and administrative wrk practices t prevent r cntrl these hazards. If vilence des ccur, pst-incident respnse can be an imprtant tl in preventing future incidents. Engineering cntrls and wrkplace adaptatins t minimize risk Invlves remving the hazard frm the wrkplace r creating a barrier between the wrker and the hazard based n what was identified in the wrkplace security analysis. Examples include: Install and regularly maintain alarm systems and ther security devices. Use a clsed-circuit vide recrding fr high-risk areas n a 24-hur basis. Place curved mirrrs at hallway intersectins r cncealed areas. Lck all unused drs t limit access, in accrdance with lcal fire cdes. Install bright, effective lighting, bth indrs and utdrs. Administrative and wrk practice cntrls t minimize risk Affect the way staff perfrm jbs r tasks. Examples include: Require emplyees t reprt all assaults r threats t a supervisr r manager. Keep lg bks and reprts f such incidents t help determine any necessary actins t prevent recurrences. Advertise and encurage emplyees t seek cunseling thrugh emplyee assistance prgrams as needed. Cnduct exit interviews when emplyees retire, quit, transfer r are terminated t identify ptential vilence. 4 griskresurces.cm Vilence in the Senir Living Cmmunity Wrkplace CM (10/11)

5 Institute a sign-in prcedure fr visitrs. As needed, establish a list f restricted visitrs fr individuals with curt rdered restraints r histry f vilence r threats, disgruntled frmer emplyees, etc. Make cpies available at security checkpints, nurses statins, etc. Prvide staff with identificatin badges, preferably withut last names, t readily verify emplyment. Determine the behaviral histry f new and transferred residents t learn abut any past vilent r assaultive behavirs and develp plans f care. Encurage a buddy system, especially when persnal safety may be threatened. Prvide staff members with security escrts t parking areas in evening r late hurs. Ensure that parking areas are highly visible, well lit and safely accessible t the building. Advise staff t exercise extra care in elevatrs, stairwells and unfamiliar residences; leave the premises immediately if there is a hazardus situatin; r request plice escrt if needed. Develp plicies and prcedures cvering hme health care prviders, such as cntracts n hw visits will be cnducted, the presence f thers in the hme during the visits and the refusal t prvide services in a clearly hazardus situatin. VIOLENCE IN THE SENIOR COMMUNITY WORKPLACE Emplyer respnses t incidents f vilence Wrkplace vilence prgrams shuld prvide cmprehensive treatment fr emplyees wh are victimized persnally r may be traumatized by witnessing a wrkplace vilence incident. Injured staff shuld receive prmpt treatment and psychlgical evaluatin whenever an assault takes place, regardless f its severity. A strng fllw-up prgram fr emplyees will nt nly help them t deal with these prblems but als help prepare them t cnfrnt r prevent future incidents f vilence. SAFETY AND HEALTH TRAINING Emplyees shuld receive required vilence preventin prgram training during rientatin and annually thereafter. The training shuld cver tpics such as: Wrkplace vilence preventin prgram and related plicies cncerning illicit drugs and alchl and pssessin f weapns s emplyees knw exactly what is expected f them; Risk factrs that cause r cntribute t assaults; Early recgnitin f escalating behavir, warning signs r situatins that may lead t assaults; Ways t prevent r diffuse vlatile situatins, aggressive behavir, manage anger and apprpriately use medicatins as chemical restraints; A standard respnse actin plan fr vilent situatins, including the availability f assistance, respnse t alarm systems and cmmunicatin prcedures; Ways t deal with hstile peple ther than residents, such as relatives and visitrs; Plicies and prcedures fr reprting and recrdkeeping; and Plicies and prcedures fr btaining medical care, cunseling, wrker s cmpensatin r legal assistance after a vilent episde r injury. In additin, supervisrs and managers need training t anticipate, recgnize and respnd t cnflict and ptential vilence in the wrkplace. By learning t recgnize high-risk situatins, they can ensure emplyees are nt placed in assignments that cmprmise their safety. CM (10/11) Vilence in the Senir Living Cmmunity Wrkplace griskresurces.cm 5

6 RECORDKEEPING AND PROGRAM EVALUATION Recrdkeeping and evaluatin f the vilence preventin prgram are necessary t determine its verall effectiveness and identify deficiencies r changes that shuld be made. An effective wrkplace vilence preventin prgram will imprve mrale and prductivity and reduce wrkers cmpensatin csts. Emplyers wh wuld like help in implementing an apprpriate wrkplace vilence preventin prgram can cntact the Occupatinal Safety and Health Administratin Cnsultatin Service prvided in their state, public safety fficials, insurers, human resurce and emplyee assistance prfessinals. Please be sure t read the secnd part f this series n training tips fr dealing with a vilent individual, including hw t respnd t gunfire in the wrkplace in the next editin f Quality Imprvement fr Nursing Facilities. ( ) 2011 GuideOne Risk Resurces fr Health Care, a divisin f Lutheran Trust, Church Asset Management. All rights reserved. This material is fr infrmatinal purpses nly. It is nt intended t give specific legal r risk management advice, nr are any suggested checklists r actins plans intended t include r address all pssible risk management expsures r slutins. Yu are encuraged t cnsult with yur wn attrney r ther expert cnsultants fr a prfessinal pinin specific t yur situatin. 6 griskresurces.cm Vilence in the Senir Living Cmmunity Wrkplace CM (10/11) GuideOne Risk Resurces fr Health Care 1111 Ashwrth Rad West Des Mines, Iwa