POLICY STATEMENT.

 

The Division of Veterans Healthcare Services (DVHS) requires that each of the New Jersey Veterans Memorial Homes (VMH) provide, via resident assessment and care planning, as promulgated by the Centers for Medicare and Medicaid Services and the State of New Jersey Standards for Licensure of Long-Term Care Facilities, a Resident Assessment Instrument (RAI) User’s Manual (most current version) and ensure that each veterans home resident receives the care and services needed to enable the resident to achieve and maintain the highest practical level of functioning.

 

PURPOSE.

 

To ensure that veterans home residents are provided with all the care and services needed to enable them to achieve and maintain the highest practical level of functioning.

 

PROCEDURE.

 

A.     Resident Care Practice

 

          1.         The facility shall take preventive measures against the development of pressure sores including assessing the resident’s skin daily, and minimizing friction and pressure against clothing and bed linens.  When present, pressure sores shall be identified, documented, and treated.

 

          2.         The facility shall conduct a bladder and bowel retraining program for selected residents on a 24-hour per day basis, with results documented.

 

B.     Resident Personal Care Services

 

  1. Residents shall be weighed accurately every month.  Whenever there is a gain or loss of five percent or more, a note shall be entered into the medical record stating whether the care plan should be modified.  If the resident cannot be weighed, alternate measures shall be used to monitor weight change.

 

  1. Non-ambulatory residents shall be repositioned at least once every two hours.

 

  1. Effective and safe measures shall be taken to ensure that residents do not harbor parasitic insects.

 

  1. Effective and safe measures shall be taken to ensure that residents are not malodorous.

 

  1. Any dehydrated and/or malnourished resident shall be accurately evaluated and effectively treated.

 

  1. Oral hygiene care is offered to the resident by staff on a daily basis.

 

  1. The resident’s hair and nails shall be groomed.

 

  1. Each resident shall be kept clean and dry.

 

  1. Each resident shall receive at least one bath (tub or shower) per week unless contraindicated.

 

  1. Each resident’s bed shall be made daily.  Clean linen shall be provided for each resident at least once a week or whenever linens are soiled or wet.

 

  1. Each resident shall have access to fresh drinking water or juice at all times, unless contraindicated.  If a resident refuses to be weighed, this will be noted in their medical records.

 

  1. Non-bedfast residents shall be provided with the means for leaving and returning to their beds and rooms each morning and afternoon.

 

  1. Measures to prevent contractures shall be used, and contractures shall be identified, documented, and managed by rehabilitative nursing and physical therapy staff.

 

  1. Indwelling catheters shall not be used for the convenience of staff.

 

C.     General Resident Services

 

          1.         Residents shall be afforded the opportunity to eat in a group setting unless contraindicated, with the reasons noted in the resident’s medical record.  The need for feeding assistance shall not constitute an acceptable contraindication.

 

          2.         Residents shall be afforded an opportunity to go outdoors on a regular basis.

 

          3.         Clothing, including undergarments and footwear, shall be clean, comfortable, and personally assigned to each resident, and shall reflect personal preference and safety.  The facility shall promote the residents’ sense of personal control in acquiring clothing; for example, through the establishment of a clothing concession in the facility or clothing vendors’ periodic visits to the facility, the arrangement of shopping excursions, and/or the use of catalogue shopping by residents.

 

          4.         Residents shall be encouraged and helped to select the clothing they will wear each day.

 

D.     Post-Mortem Policies and Procedures

 

          1.         Deceased residents shall be removed in a timely fashion from rooms where other residents are staying, and shall be transported within the facility in a dignified manner.

 

          2.         The next of kin or guardian shall be notified at the time of the resident’s death.

 

          3.         Deceased residents shall receive post-mortem care, including cleaning and shrouding in conformance with each resident’s religious practices.

 

          4.         The deceased shall not be removed from the facility until pronounced dead, with the death documented in the resident’s medical record.  Any prostheses shall accompany the body out of the facility.

 

          5.         The body of a deceased resident who, at the time of death had a communicable disease as defined in N.J.A.C. 8:57-1.2, shall be tagged accordingly before being released from the facility.

 

          6.         Personal effects and financial accounts of deceased residents shall be safeguarded.

 

E.     Supplies and Equipment for Resident Care

 

          1.         Prostheses including eyeglasses, dentures and hearing aids, shall be functional and individualized, and shall be kept available to the resident, unless the resident specifically rejects their use.

 

          2.         Adaptive devices and equipment shall be functional and individualized, and shall be kept available to the resident unless the resident specifically rejects their use.

 

          3.         All drinking water containers shall be washed daily and sanitized weekly.  Containers that cannot be sanitized shall be discarded.

 

          4.         The facility shall maintain at least one bag-valve-mask resuscitator.

 

          5.         Bath thermometers or other temperature controls shall be used to monitor the temperatures of each bath or shower.

 

F.      Management of Inappropriate Behavior and Resident-to-Resident Abuse

 

          1.         The initial resident assessment should include a psychosocial behavior component with interventions, if appropriate, listed in the care plan. Reassessment should be done at least quarterly, or at any time when a resident’s pattern of behavior changes. Resident response to interventions should be recorded in the medical record.

 

          2.         Inappropriate behavior and/or actions should trigger an immediate reassessment with adjusted interventions, and notification of the physician, the resident’s next of kin and/or representative. The resident’s response should be recorded in the medical record.  The facility’s actions and/or interventions in response to behavior changes should also be part of the plan of care and should be appropriately recorded.  Prompt reassessment of behavior changes will, in most cases, avert the continued progression of inappropriate behavior.

 

          3.         Inappropriate behavior and/or actions involving other residents should be identified in the records of all involved residents including assessments, interventions and responses. Notifications of physician and/or designated resident representatives should be recorded in the medical records of all involved residents.

 

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

 

a.       Immediate assessments of the involved residents.

b.       Notification of the attending physicians or advanced practice nurses.

c.       Staff interventions and the responses of residents to those interventions.

d.       Notification of the residents’ designated representatives.

e.       Protection of the involved residents’ civil and constitutional rights.

f.        Determination by the administrator of the facility’s ability to assure the safety and security of all patients.

g.       Implementation of emergency or short-term precautions to assure safety, while working towards a resolution of the situation.

h.       Notification of the police, if necessary.

 

  1. In the event that it is determined that a resident must be removed from the facility, the transfer should be initiated in accordance with Appendix B of the N.J.A.C. 8:39, Standards for Licensure of Long-Term Care Facilities.

 

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

 

  1. In the event of an immediate 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 or advanced practice nurse.

 

b.       The return of the resident to the long-term care facility should be based on the physician’s or advanced practice nurse’s written notation of the appropriateness of returning the resident to the long-term care setting. 

 

c.       The administrator is responsible for the decision to accept or deny the return of the resident according to N.J.A.C. 8:39;

 

d.       A police complaint should be filed against the abuser, and the individual causing the disturbance should be removed from the facility.  The police complaint can be filed by the facility or by the abused party; and

 

e.       Notify all applicable agencies, including the New Jersey Department of Health and Senior Services (NJDOHSS).

 

  1. In the event all the guidelines have been followed and resolution has not taken place, assistance should be requested from the New Jersey DOHSS. Facility policies and procedures to address inappropriate resident behavior, including resident-to-resident abuse, include all of the above outlined actions.

 

 

 

 

Revised:  April 2007