Running head: RISK ASSESSMENT IN ASSITED LIVING FACILITIES

Risk Assessment in Assisted Living Facilities

Joanina Gazcon, CHES

Department of Health Science and Human Ecology

California State University, San Bernardino

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Risk Assessment in Assisted Living Facilities

As a family member of an aging adult life can be unpredictable when it comes to the care

of an aging adult. The hope is that they will maintain as much independence in their life for as

long as possible. When an unexpected change occurs such as diagnoses of illness, a loss of

companion, or an unexpected fall; assisted living can be very particle solution. Assisted living is

becoming a necessity in today’s aging society. With baby boomers growing older and life

expectancy getting longer there is a growing population that is needing the services provided in

an assisted living facility. Many individuals move into assisted living facilities because living

alone is no longer the safest option for an aging adult. In these facilities individuals can receive

assistance with activities of daily living, medication management, and even socializing

assistance. Activities of daily living include hygiene care, laundry, cleaning, eating, and any

other activity that is done on a day to day basis. Assistance can range from supervision which is

keeping a close eye to prevent injury to full assistance which would be dressing someone to

prevent personal harm.

Assisted living can be seen a solution as it is comforting knowing there is 24-hour care

available, services offered like mental health or dietary, and even piece of mind that a live ine is

not completely alone. Although it may appear that assisted living is a solution to issues listed

above it can also lead to many risks. There are risks for neglect, medication errors, wrongful

death, and much more. From personal experience as an employee of an assisted living facility

there is more risk for a resident than what it displayed to family or residents. This paper will

discuss what risk assessment is, how risk assessment is relevant to assisted living facilities, how

it is applied, current policies and procedures, and finally, some gaps and suggestions.
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Risk Assessment

Risk is defined as the expected frequency and magnitude of undesirable effects arising

from exposure to pollutant (Vandyke, n.d.). Risk assessment is accomplished by identifying the

hazard, conducting a dose response assessment, exposure assessment, and risk characterization.

In simple terms risk assessment is identifying a threat, assess the likelihood of that threat, and

then understand how devastating or undesirable that threat will be. Threats that exist in assisted

living can come from neglectful of abusive staff, other residents who are mentally compromised,

and environment.

An example of how this is used in assisted living facilities in assessing fall risks. The

identified threat would be falling. The likelihood of that would take multiple factors into

consideration. First, would be the persons physical abilities are they able to ambulate without a

walker? Second, would be to look at the environment, Is the poor lighting? Is the area cluttered?

Finally, by understanding that falls can cause physical harm and can possibly be fatal will show

the intensity of the threat or hazard of falling.

Falls can also pose a threat or a hazard not only to the individual but to an organization.

Lawsuits can arise if a proper protocol is not followed when a resident fall. This can be avoided

when the proper risk assessment is implemented. This is why there is a need for incident reports

and communication. Incident reports document the incident and ensure what actually occurred

cannot be altered.

Relevancy

As mentioned before today’s society is growing older and living longer. With living

longer comes with a need of greater assistance. Aging adults are facing many changes as the get

older. The are biological or internal changes, behavioral changes, and environmental changes
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(Mildner, n.d.). Biological changes include muscle weakness, vision loss, balance issues, chronic

conditions, and the need for medications. All of the biological changes increase risk for fall along

with other risks. Medications are a huge risk as the can change an individual’s ability to function

or affect their activities of daily living. Behavioral changes include but are not limited to fear,

inactivity, risky behaviors, alcohol use, and depression. These behavioral change raise risks are

they require some form of attention. The attention provided should be care that best fits the

resident’s needs to live the best quality of life.

Applying Risk Assessment

Risks typically leads to lawsuits. Common lawsuits are associated with falls, abuse,

elopement/wandering, failure to supervise, wrongful death, changes in condition, medication

errors, and wound issues (Heicklen, n.d.). Such law suits come to be because of lack of

communication between transfers of facilities, failure to document communication or results and

orders, and failure to implement doctor’s orders correctly. Risk assessment is applied to avoid

such law suits by looking at multiple aspects such as services, environment, consumer

protections, contracts and agreements, shared or negotiated risk, and staffing.

Services

Services are an applied use of risk assessment as a facility is taking the time to

understand a resident wants and needs. It is important to reach this understanding to develop a

care plan to best meet wants and needs in the safest and most efficient way possible.

“Resident screening should occur before move-in. In additional, each resident must

undergo assessments for health, psychosocial, and cognitive status. This ensures that the

facility is able to meet the resident's needs and serves as a basis for the development of a

comprehensive service plan…The plan should include the scope, frequency, and duration
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of services and monitoring, and it must be responsive to the resident's needs and

preferences.” (“Developing Risk-Management Protocols in Assisted Living | I Advance

Senior Care,” n.d.)

By applying these services from the very beginning lawsuits can be avoided as an early

understanding is created.

Environment

An assisted living facility is a home. This safe and homelike environment should be

provided to everyone at all times. This can be accomplished by supporting resident choices,

independence, privacy, and individuality. An example of supporting resident choices and

individuality would be allowing them to dress how they want and make their own decisions as

long as it is appropriate and the individual is mentally sound. Independence and privacy can be

supported by knocking before entering a room, allowing a resident to dress themselves as long it

is still safe for them to do so.

Consumer Protections

Residents even though they are older adults the still have a reason to maintain their rights.

Older adults belong to a population that is vulnerable to a world that is ready to take advantage

of them at any moment.

“Residents should not be physically or chemically restrained, except when expressly

ordered by a physician to treat a medical condition. Residents' records should be kept

confidential and released only with consent. In addition, providers should ensure

residents' choices and the right to autonomy for as long as possible, even if that means

taking some risks. Residents should share responsibility for decisions affecting their lives

and be fully informed of their rights and responsibilities.”

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This is an important consideration when assessing the risk of neglect or abuse. Abuse comes in

many forms and should not be inflicted on anyone especially vulnerable populations that cannot

protect themselves. Restraining and individual is physical abuse and should only be used when

ordered by their physician. This is an application of risk assessment as all staff of assisted living

facilities are to have a mutual understanding of the consumer protections.

Contracts and Agreements

Resident contracts contain all the facility's policies and procedures, including the criteria

and procedures for admission which should discuss all services offered and available, on-site

transfers, and discharge. Payment information should include: a breakdown of all services

included, what it costs for what is not included, and the facility's policy for residents who can no

longer pay for services. It is most important to address what happens when a resident can no

longer pays for services as there are ways to avoid this issue. Contracts and agreements are put in

place so that residents can understand what is available for their benefit.

Shared or Negotiated Risk

When a resident wants to engage in potentially risky behavior, such as service refusal, a

risk agreement should be negotiated. Residents have every right to make their own decisions as

long as they are in their right mind to do so. A resident should be made aware of all

consequences both positive and negative to make the most conscious decision possible. Family

should also be included as they may not always agree with decisions being made. Open

discussion makes all parties aware and prevents further risks. An example where this comes to

use is when a resident decides to no longer continue living. This most frequently occurs with a

diagnosis of cancer or a change in condition. This decision can be difficult on the individual and
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on the family. Applying a shared or negotiated risk prevents that facility from being liable and

provides a course of action that best suits the resident.

Staffing

The facility should maintain sufficient qualified staff members capable of meeting needs

at all times. The facility should have ongoing trainings for staff on how to monitor changes in

residents' physical, cognitive, and psychosocial conditions. Information for the best practice is

always changing or improving so it is best to stay updates. In facilities serving residents with

dementia, direct-care staff should receive dementia-specific training each year. Memory care

requires that staff have all the knowledge necessary to approach the vast amount of situation that

will occur. Staff, especially caregivers are what keeps facilities afloat. They provide the direct

care to residents and should be equipped with the most updated information and proper tools to

be the best at their jobs.

Current Policy and Procedures

Ombudsman

The most current and important policy or procedure is the use of the ombudsman. “Long-

term care ombudsmen are advocates for residents of nursing homes, board and care homes and

assisted living facilities”(“National Consumer Voice,” n.d.). Ombudsman are great resources to

find a facility, resolve issues when living in a facility, educate on rights, and to serve as

advocates. This is accomplished by proving information regarding long term care, visiting

facilities for quality assurance and to respond to complaints submitted and provide trainings to

staff.

Who has access to an ombudsman? Any resident of any nursing home, a family member

of a resident, and any administrator or employee of a long-term care facility. Ombudsman

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provide their services through visitation and anyone can contribute by volunteering as an

ombudsman and visitng residents.

Documentation

Current policy states that any qualified staff must document on any change in condition,

incident, or physician order. Change in condition can be reported in progress notes, shift reports,

and communication logs with family members. Incidents have a sperate report, report must be

filed within 24 hours of an incident occurring, and also are reported with the same protocols of a

change in condition. Finally, physician orders are orders on how an individual’s care must be

done and what exactly needs to be done. Many times, physician orders are used to carry=out

prescriptions and methods of care for wounds or illnesses.

Staffing

Staffing is a large part of risk assessment as they play a role in identifying risks and

hazards. Staff must be trained in identification of hazards and the also be trained as to how to

combat those hazards. An example for this would be knowing how to identify when a resident is

a fall risk. Risks for falling could include the need for assistive devices such as walkers and

canes, inebriation, certain medications and much more. A way to avoid to fall risk is assuring

residents have their assistive devices as close as possible, monitoring a resident when they have

an altered state of mind, and finally picking the right time to dispense medications that will least

affect residents physical and cognitive function.

Communication

Communication while is not directly associated with risks, it can be used to manage risks.

Risk management is the result of a well-executed risk assessment. Communication manages risk

as it makes all parties aware of a situation and allows for action to be taken if necessary.
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Gaps and Suggestions

Ombudsman

Staff for the ombudsman consists mainly of volunteers. Volunteers when there for the

right purposes can be purposeful to benefiting to the elder community. Volunteers can also be

lacking and can make it difficult to reach out to everyone is in need. A second issue, is that the

ombudsman mainly conducts their services through visitations. Visitations can be difficult to

arrange because of conflicting schedules. Some solutions could be to provide incentives for

volunteers to maintain a consistent team or to hire actual staff to conduct services.

Documentation

One of the most challenging parts of documentation is that it can create extra work for the

following reasons:

1. Some facilities are continuing to hand write all documents which can be time consuming.

2. Hand writing can be difficult to read and can be misinterpreted.

3. When multiple incidents occur, it can cause confusion and create false reports.

Although it may not be financially possible, transitioning to a computerized system for

documentation will allow for easy storage and clear and concise information. Providing extra

staffing that can split the work load could also eliminate confusion and stress experienced by

employees doing the documentation.

Staffing

As mentioned before staffing plays an important role in risk assessment. Ensuring that

staff is full trained and qualified will result in the best risk management possible. Staff is

responsible for monitoring residents' physical, cognitive, and psychosocial conditions. With that

being said it is an immense amount of responsibility to place on staff. This can lead to stress and
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possible burnout for employees. Implementing stress management techniques in the work place

and providing an advocate could reduce the possibility of these issues occurring.

Communication

Communication can be difficult when there is lack of consensus among residents and

their family members. As mentioned earlier one of the bigger issues is when a resident wishes to

no longer continue living. Family members can remain in denial and refuse to receive any

communication or it can be difficult to be able to communicate such changes in condition. A

solution to these communication barriers is to attempt to maintain an open-door policy so rapport

can be built between family and administrators of facilities. A second solution could be to

provide advocates for residents and they can a good support and communication channel.

Conclusion

Risk assessment is a necessity in every day life. This is because in everyday life there are

risk and hazards to face in everything. From getting up off the bed we face the risk of falling.

When we get up and get dressed we face the risk of falling as well. When we go and have a meal

we run the risk of consuming harmful agents that can damage our health. This is only heightened

to greater extents when an individual gets older. As people age their balance goes away, vison

can deteriorate, swallowing can become difficult, and many more bodily functions slow down

making an elderly person susceptible to risks or hazards. Assisted living can be solution to

combatting those risks; but it is only a solution when there is risk assessment conducted within

the facilities. Risk assessment prevents lawsuits, falls, errors, and wrongful death which helps

assisted living achieving facilities main goal: provide the best quality of life for their residents.
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References

Developing Risk-Management Protocols in Assisted Living | I Advance Senior Care. (n.d.).

Retrieved April 22, 2019, from https://www.iadvanceseniorcare.com/article/developing-

risk-management-protocols-assisted-living

Heicklen, E. D. (n.d.). Risk Management for Assisted Living Nurses and Facilities. 6.

Mildner, W. (n.d.). Fall Prevention and Reduction in Assisted Living and Personal Care. 14.

National Consumer Voice. (n.d.). Retrieved April 23, 2019, from

https://ltcombudsman.org/about/about-ombudsman#Ombudsman

Vandyke, W. (n.d.) Environmental and Occupational Health