This document discusses behavioral health disorders common in older adults. It notes that depression and dementia are particularly prevalent, with around 15% of adults over 50 having a mental disorder. Depression in older adults can present with physical symptoms rather than mood changes. Dementia causes cognitive decline that impacts daily functioning. Early signs include memory loss, impaired judgment, and changes in mood or behavior. The document emphasizes that behavioral health screening and treatment are important for older adult well-being and quality of life.

1. Abuse & Neglect
Required Vendor Training
Disclaimer: Unless otherwise stated, the content in this course is sourced from Appendix PP Guidance to Long Term Care
Surveyors published by the Centers for Medicare & Medicaid Services, or CMS (2017).

2. About this course
 Recognize situations that indicate abuse
 Recall how to report suspected abuse
 And be able to explain your role in
preventing abuse

3. Overview
 90,000 confirmed cases of elder abuse in 2004
 1 in 6 cases of abuse actually get reported to proper agencies
 Why
 Fearful
 Embarrassed
 Isolated
 Dependent
 Incapable

4. Recognition
Risk Factors
 Physical impairment
 Dependence on others
 History of abuse
 Age
 Mental impairment
 Gender
 Lack of social support
At Risk Behaviors
 Verbally aggressive
 Physically aggressive
 Sexually aggressive
 Lack of respect
 Wandering
 Resistance to care
 Communication barriers
 Extensive nursing requirements

5. What is abuse The Centers for Medicare & Medicaid Services defines abuse as the willful
infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental
anguish. Willful, as used in this definition, means the individual must have acted deliberately, not that the individual
intended to cause injury or harm. Abuse also includes:
 Deprivation
 Exploitation
 Verbal
 Sexual
 Physical
 mental
 Physical and Chemical restraints
used inappropriately

6. Physical Abuse
Physical abuse is the use of or threat of physical force to
cause injury, pain, or impairment. Examples of physical
abuse include pinching, slapping, pushing, pulling,
shoving, burning, shaking, or hitting.
Less obvious actions that constitute physical abuse
include the inappropriate use of physical and chemical
restraints and force-feeding. Handling a person roughly
during care can also be physical abuse.
Corporal punishment is a type of physical abuse. Corporal
punishment is the intentional punishment of a person in
order to change a behavior. For example, slapping Mr.
O’Hare’s mouth for cursing is an example of corporal
punishment.

7. Sexual Abuse
Sexual abuse is non-consensual sexual contact, harassment, or coercion. Sexual abuse
includes unwanted touching, inappropriate comments, requests of a sexual nature, and
sexual assault and battery. Sexual assault and battery includes rape, sodomy, coerced
nudity, and sexually explicit photography. Sexual coercion involves persuading a person to
perform sexual acts by the use of physical force or verbal threats including observation of
masturbation and/or pornography.
Sexual abuse includes consideration of whether the activity was consensual or non-
consensual. Sexual activity that occurs against an individual’s will or occurs despite an
individual’s inability to give consent because of physical or mental limitations is non-
consensual. This means that consent from individuals to engage in sexual activity is not
valid if that individual lacks the capacity to consent.
Sexual activity is also considered non-consensual if it is gained by intimidation, coercion,
or fear as expressed by the individual or suspected by staff. Any forced, coerced, or
extorted sexual activity with an individual, regardless of the existence of a preexisting or
current sexual relationship, is considered to be sexual abuse.

8. Mental Abuse
Mental abuse is the use of verbal or nonverbal acts which cause the
individual to be humiliated or experience intimidation, fear, shame,
agitation, or degradation. You may hear mental abuse referred to as
emotional or psychological abuse.
Mental abuse includes humiliation, intimidation, harassment, taking away
privileges, or threats of harm or punishment. It also includes acts
intended to frighten a person, such as telling a vulnerable adult that they
will never see their family members again. Mental abuse also includes an
employee taking or using photographs or recordings of an individual in
any manner that would demean or humiliate the individual. Mental abuse
can be very subtle and difficult to recognize.

9. Technology
CMS now defines mental abuse as including abuse that is enabled through the use of technology,
including smartphones, computers, or other electronic devices. Using social media or electronic
messaging to share or store humiliating or degrading photographs or videos is mental abuse. This
includes photos or videos that:
• Contain nudity
• Show sexual or intimate relations
• Show the individual receiving personal care such as bathing, showering, toileting, or perineal care
• Show an employee, or any other person, agitating an individual to evoke a response
• Contain derogatory or insulting statements
• Show body parts without the face
• Show an individual in inappropriate positions
• Show an employee, or any other person, instructing an individual to use inappropriate language
These acts are considered mental abuse even if:
• The individual does not have the ability to understand or relate to what has occurred.
• The individual is unable to express distress related to the act.
• The picture or video is not shared, such as on social media.

10. Verbal Abuse
A type of mental abuse is verbal abuse, which is the use of oral, written, or
gestured language or sounds directed toward another person or within hearing
distance of that person. Verbal abuse includes communication made about an
individual regardless of their age, ability to comprehend what has been
communicated, or their disability. It includes:
• Harassing
• Mocking or ridiculing
• Yelling
• Intimation such as hovering over the person
• Threatening to withhold contact from others
• Talking disrespectfully
• Scolding

11. Involuntary Seclusion
Involuntary seclusion is another type of mental abuse involving the intentional separation of a person
from other people or certain places against that person’s will or the will of their legal guardian. It
includes separating an individual from their room and confinement to their room.
Here are some examples of involuntary seclusion:
• An individual repeatedly blocks the television so that others cannot see the screen. The individual is
placed in another room with the door closed without addressing the individual’s behavior.
• In an effort to keep an individual in a specific area, the doorway is blocked with furniture such
as chairs and a table.
• To keep an individual from leaving a room, a chair is placed behind a door to shut that individual
in the room.
• An individual is placed in a dark room for punishment or to ease caregiving burdens.
• An individual is secluded in an area without a means of communicating with other or ability to
call for help.

12. Misappropriation of Propery
One of the most common types of misappropriation is using a vulnerable adult’s
money for something other than their expenses. Other examples of
misappropriation include:
• Stealing or “borrowing” money or property
• Identity theft
• Forcing someone to change legal documents
• Charging for services not rendered or not needed
• Convincing someone to give you access to financial accounts.
• Unauthorized or coerced purchases on an individual’s credit card or with their
funds
• Gifts given to staff to make sure that care continues
• Individuals providing monetary assistance to staff to help with staff’s financial
situation

13. Neglect
Neglect is the failure to provide the goods and services
necessary to avoid physical harm, pain, emotional
distress, or mental anguish. Neglect is a failure to act, an
omission, or something not done. It occurs when a person
or their environment does not get the proper attention,
resulting in the endangerment of that person’s physical or
mental health.

14. Can you Recognize Abuse
 Mr. Black has a dx of Alzheimer’s
disease, unable to communicate
and does not understand. You
overhear his daughter saying (Look
at me having to feed you just like a
baby has to be fed
 Is there a suspicion or allegation of
abuse here?
 You notice Mr. Hernandez has a
new tablet sitting on his bedside
table. You comment you have been
thinking about purchasing one. Mr.
Hernandez tells you to take it
home overnight to see if you like
it. You do.
 Is there a suspicion or allegation of
abuse here?

15. Can you Recognize Abuse Cont….
 Ms. Flannigan has dementia and
wandering behaviors. Every
evening she makes repeated
attempts to go outside. Staff tell
her “you’ll be hit by a car if you go
out that door”
 Is there a suspicion or allegation of
abuse here?
 Mr. Connor wanders around in his
wheelchair, makes a mess of
anything he encounters. To keep a
better eye on him, you decide to
put him in front of the TV with his
wheelchair locked
 Is there a suspicion or allegation of
abuse here?

16. Can you Recognize Abuse Cont….
 After taking Ms. Walters to the
bathroom about 1 hour ago, she is
asking to go again. You tell her you
are too busy right now, so she will
have to wait a few minutes. Thirty
minutes later you find Ms. Walters
on the floor in the bathroom. She
fell trying to transfer herself to the
toilet.
 Is there a suspicion or allegation of
abuse here?
 You’re sitting on the couch at
home one evening scrolling the Fb
and see a post from Rachel, a co-
worker. The post is a video of an
older adult screaming and crying
about having to take a shower with
the comment “This is too funny not
to share”. It hits you the person in
the video is Mrs. Tubers, a
resident.
 Is there a suspicion or allegation of
abuse here?

17. Signs of Abuse
 Fear of a person or place, being
left alone, in the dark, and/or
disturbed sleep with nightmares
 Extreme changes in behavior
toward a specific person
 Running away, withdrawal,
isolating self, feeling of guilt and
shame, depression, crying, talks of
suicide or attemtps

18. Where, When, and Who
Abuse can be committed anywhere at any time by anyone. It can occur in the
person’s home, in a family member’s home, at a day center, at a hospital, at a
residential community, or anywhere else that a vulnerable adult may frequent.
Caregivers, family members, friends, and even strangers are all capable of
abusing vulnerable adults. If the person lives in a residential community, even
another resident can be the abuser.

19. Reporting and Preventing Abuse
 Responding
 Ensure the person’s safety FIRST
 It IS NOT your responsibility to determine whether abuse has occurred, but it IS
your responsibility to report your suspensions
 Better to report and find out your were wrong than not to report and find out your
suspicion was right
 Remember, you must make an IMMEDIATE REPORT, no later than 2 HOURS after
you suspect abuse has occurred.
 DO NOT wait until the end of your shift.
 DO NOT wait until you see your supervisor again.
 If your supervisor is not immediately available you must report to the next person
in charge

20. Elder Justice Act
The Elder Justice Act requires
covered individuals of long-term
care facilities to report any
reasonable suspicion of a crime that
occurs against a resident of the
facility.

21. More about the Elder Justice Act
 What does the Elder Justice Act have to do with Abuse?
 I’m not sure how long I have to make my report under the Elder Justice Act.
I’ve heard 2 hours, then I heard something about 24 hours. What is the time
frame?
 Instead of making a report to the state survey agency and the local law
enforcement agency, can I just report my suspicions to my Administrator?

22. Abuse Prevention
 Identify situations that may foster abuse
 Identify situations that increase caregiver’s stress levels
 Recognize the signs of burnout
 Feeling tired or drained most of the time
 A change in appetite or sleep habits
 Feeling lonely or helpless
 A lack of emotion
 A pessimistic, distrustful attitude
 A decrease in job satisfaction
 Taking frustrations out on others
 Attendance problems
 Using food, drugs, or alcohol to cope

23. What can you do?
 Know the signs of burnout
 If you see burnout or experience it yourself get help, talk to a supervisor, or
reach out to your employee assistance program
 Get enough sleep, exercise and eat a healthy well-balanced diet
 Take your breaks!!!
 Avoid working excessive number of hours in one day or in one week
 If you feel anger or frustration building up make sure you remove yourself
from the situation, tell a supervisor, and take time to calm yourself.
Remember the vulnerable adult is not intentionally trying to aggravate you

24. Consequences of Abusive Behavior
 If an individual has an allegation of abuse brought against them, your
organization will take needed steps to ensure the safety of those it cares for.
This will vary depending on the specific circumstances, but the important
thing to remember is that preventing further incidences of abuse is crucial. If
you have been found guilty of abuse, neglect, exploitation, misappropriation
of property, or mistreatment, there are serious consequences. Those found
guilty may have their name entered into their state’s registry, lose their
license or certificate to practice, and even face criminal charges.
Organizations must not employ those who have been found guilty of abuse or
had disciplinary action taken against them by their state licensure board for
abuse.

25. Congratulations! Congratulations! Now that you’ve
finished reviewing the course content, you should have learned the
following:
Many healthcare workers think that abuse is not their business, but think again.
Abuse is your business. You are the first line of defense for vulnerable adults and
it is your job to help protect the health and well-being of these individuals.
Abuse is never acceptable, so make sure you are able to recognize and report
situations that indicate potential abuse. Remember, it’s better to report your
suspicions and be wrong than to not report and be right! As a healthcare worker
who has day-to-day contact with vulnerable adults, you are the most important
element in preventing abuse and maintaining the individual’s safety and security.

26. BEHAVIORAL HEALTH
AND OLDER ADULTS

27. ABOUT THIS COURSE
Many older adults manage the transitions that frequently come with aging, such as
physical decline and increased loss of loved ones, without experiencing behavioral
health disorders. However, when they do have problems, older adults are less likely
to seek and receive services to treat them effectively (Sewell, 2016). Knowing what to
look for, how to do an initial assessment, and what resources are available are all
critical skills needed by those who frequently work with older adults. This course
discusses how common behavioral disorders present in older adults, the components
of behavioral health screening and assessment for older adults, the levels of care
and available community support, and steps you can take to promote behavioral
health.
The content in this course is applicable to general staff and nursing professionals in
all settings.

28. LEARNING OBJECTIVES
 Recognize the symptoms of depression, including the difference in
presentation in older adults.
Identify other behavioral health disorders common in older adults.
Describe appropriate tools for behavioral health screening.
Explain appropriate community service referrals based on levels of
care.
Promote services that support the behavioral health functioning of older
adults.

29. DEPRESSION AND DEMENTIA IN OLDER
ADULTS
• Approximately 15% of adults over 50 have a mental disorder
• Adults in long-term care facilities are more likely to have a behavioral health disorder
• Behavioral health refers to
• Mental health
• Psychiatric care
• Counseling
• Substance abuse disorders and treatment
• Common behavioral health disorders in older adults include
Depression Anxiety
substance use Bipolar
Dementia Eating disorders
Any combination of the above

30. DEPRESSION
• Not a normal part of aging
Older adults at higher risk
• Symptoms often overlooked and undertreated
• Symptoms
Inability to experience pleasure Fatigue/Weakness
Personality changes Persistent pain
Feeling negative/worthless Changes in appetite
Hopelessness Sleep disturbances
Irratible/restless loss of interest in anything
Memory lapse/loss desire to stay alone
Difficulty concentrating and making decisions suicidal thoughts/feelings/actions

31. DEMENTIA
• Symptoms that interfere with thought and social function
• It affects behavior
• More difficult to perform daily tasks
• May cause personality changes or alter behavior
• Result of brain damage that control
• Memory Impulse control
• Speech Language
• Learning Planning
• Reasoning Decision Making
• Alzheimer’s Disease most common cause of dementia

32. DEMENTIA CONTINUED
Dementia related behaviors include:
Aggression Agitation
Confusion Depression
Suspicion Hallucinations
Sleep disorders Repetition
Wandering

33. ALZHEIMER’S DISEASE
Most common diagnosis in older adults
Represents 60-80% of all dementia diagnosis
Suicide
Never assume an older adult is incapable of s

34. ANXIETY
Leads to health problems and interfere with daily life in older adults
Includes:
Generalized anxiety Phobias
Panic disorders PTSD
obsessive-compulsive disorder
Symptoms include:
chronic worry Avoidance of perceived threats
extreme fatigue tension
headache nausea
sleeplessness rapid heart/respiratory rate
restlessness difficulty concentrating
irritability trembling

35. SUBSTANCE USE DISORDERS
Over 1 million older adults in 2014 had substance use disorder
Expected to rise to 5.7 million by 2020
Criteria for diagnosis
Larger amounts over a longer period of time
Persistent desire or unsuccessful effort to cut down/control use
Great amounts of time spent in activities necessary to get the substance
Craving
Using to the point that role responsibilities are not met
Regular use despite continued social problems
Fewer or no role or rectreational activities
Use in dangerous situations
Tolerance
Withdrawal

36. CONSEQUENCES OF SUBSTANCE ABUSE
Acute injure Increased tolerance to prescribed medications
Confused thinking Blackouts
Sleep disturbances Emotional extremes
Legal and financial problems Relationship problems

37. BIPOLAR DISORDER
A mood condition involving at least 1 manic episode and often depressive symptoms
Swings from manic to depression within several days or weeks
Older adults may display slower thinking and difficulty concentrating
Manic phase – 1 week of symptoms such as grandiose ideas, inflated self-esteem, increased
energy, drive, distractibility, goal-directed activity, and decreased sleep
May speak rapidly, race from one thought to the next, show poor judgement,
risky behaviors, excessive shopping/spending, drug/alcohol use, sexual promiscuity
Depressed phase – loss of pleasure in favorite activities, constant/near constant feelings of sadness
or hopelessness, inappropriate guilt, suicidal thoughts, excessive worry, weight loss/gain, sleep
problems, psychomotor agitation or slowing, fatigue,

38. EATING DISORDERS
Anorexia –poor appetite, ill fitting dentures, damaged/painful teeth, swallowing issues, loss of smell
taste, medication side effects, substance use, GI issues, hormones that regulate hunger, inflamma
acute/chronic illness, low caloric need due to inactivity, depression, anxiety, or other psychologic
concerns, impairments in function
Signs to watch for
Unexplained weight loss Inappropriate use of laxatives
Rejection of food Preference to eat alone
Muscle wasting Weakness and dizziness
Falls Difficulty with thinking
Slow healing Increased sensitivity to cold
Significant hair loss/ oral disease, unexplained heart or GI problems

39. SCHIZOPHRENIA
Schizophrenia is a complex, disabling mental illness that is usually diagnosed in late teenage
years through mid 30’s
Characterized by persistent, sever, disabling psychotic symptoms that include:
Delusions Hallucinations
Disordered thoughts Problems with memory/decision making
Incoherent/derailed speech Diminished/absent emotional expression
Absent motivation Difficulty managing social relationships/interactions
Motor impairment or agitated movement

40. WHY DO I NEED TO KNOW ALL THIS
Each resident living in the facility has a different set of needs, just like you and I.
Some are grumpy in the morning, some get more confused in the later evening or
if their routine is changed.
The Doctors and Nurses assess and plan the care specific to each resident. It is
important to rely on the clinical staff for information about the residents you will
be around
Example – you are assigned to remove the trash on the 100 unit each
morning. Mr. Smith stays
up until 2 or 3 AM every night and likes to sleep in at least until 10
AM. You enter
room at 7:45 to get his trash and he begins to cuss at you. It would
be better if you
knew before hand about this and could either pick up his trash later
in the shift or
know to be very quiet when in his room
Example - Mrs. Rose asks you to open the door so she can go outside and

41. • Assure you are familiar in the areas you work
• Do not assist residents with care
• You can answer a call light and find out what they need but always let
them know you will tell the staff caring for them what their need is
• DO NOT turn off the call light
• Do not refill or provide water or drinks. Relay request to clinical staff
• Do not let residents outside without the specific direction or permission of
clinical staff
• Alert staff immediately of any concerns (resident found on floor, residents
hitting or yelling at other residents, anything that concerns you)
• Be courteous, kind, and respectful.
• THERE IS NEVER A STUPID QUESTION!

42. Communication
Communicating with People with Dementia

43. Overview
Dementia gradually destroys the areas of the brain responsible for sending and receiving
messages, making communication difficult. There are guidelines, however, that you can
follow to ensure effective communication with persons with dementia, even those who
have severe cognitive impairments.
In this course, you will learn how to understand the person with dementia by knowing them
as an individual and recognizing common speech patterns, how persons with dementia use
behaviors for communicating discomfort, and the communication strategies you can
employ to ensure the person receives your message clearly.

44. Understanding the Person with
Dementia
• Know the Person as an Individual
• Not a disease
• Not an attitude
• Not a paycheck
• Know their story
• Know their routine
• Know what they value

45. Stages
 Early Stage Patterns
 Tongue-tied
 Difficulty with short term memory
 Middle Stage Patterns
 Neologisms (can’t come up with word, make up words)
 Word Salad (string words that do not make sense)
 First in, Last Out (reverting to a native language)
 Past Reality (Forget people, forget someone died, mix up relationships)
 Time travel (May be living in the past then suddenly think it is another time in his/her lifetime.
 Verbal security Blankets: Holding something or holding on to someone provides comfort
during communication.

46. Stages continued
 Late Stages
 Very little talk or no talking at all
 My surprise you
 Visual and hearing impairments
 Need more light
 Misunderstanding frequently

47. Behavior is communication
 The meaning of some behaviors may be very obscure, especially if the person with
dementia has difficulty with speech, hearing or seeing.
 Example: I want to go home – is the resident uncomfortable in the current surroundings
or is something else causing discomfort?
 Example: A resident is always taking another resident’s red sweater. Is it because she likes
red or remembers having a red sweater?
 Example: A man who walks away from an activity may be restless or hungry.

48. Environments roll
 Create a warm and loving supportive environment
 Routines and rituals that breed familiarity
 Reduce background noise
 Temperature
 Maneuverability
 Number of people

49. Internal factors
Fatigue
Frustration
Fear and Confusion

50. Other causes
 Pain
 Medication side effects
 Impaired vision
 Impaired hearing
 Acute illness
 Dehydration
 Depression

51. Tips
 Never argue with a person with dementia
 Slow down and be patient
 Don’t over explain
 State things in a positive manner
 Issue an invitation/have a conversation
 Use concrete terms
 Don’t take insults personally and be aware of your own frustration levels
 Avoid open-ended questions/substitute statements for questions
 Use multisensory clues

52. Summary
To communicate effectively with a person with dementia, they have to be able to
understand what you are saying. This is often difficult for these individuals because of
their impaired cognitive abilities. You can utilize certain guidelines to help ensure the
person with dementia understands the message you are conveying. It first begins with
common courtesy. One of the most important things you can do in communicating
with a person with dementia is to slow down and be patient. Several other critical
techniques include issuing an invitation and stating things in a positive manner. You
can also nurture the communication skills of a person with dementia by building their
confidence. That comes, in part, by asking for their help, their opinions, and their
advice.

53. COMPLIANCE & ETHICS

54. OVERVIEW
Did you know that in 2014 the United States collected $2.3 billion in healthcare fraud
judgments and settlements and convicted 734 people of healthcare fraud (Department
of Justice [DOJ] & Department of Health and Human Services [HHS], 2015)? Did you
know that the Office of Inspector General excluded over 4000 individuals from
participating in Medicare, Medicaid, and other federal healthcare programs (DOJ &
HHS, 2015)?
These numbers emphasize the importance of compliance programs in the healthcare
industry. Compliance is one word that you will hear frequently in healthcare. All
healthcare organizations have laws, rules, and regulations that they must follow.
Additionally, there is an expectation that persons working in healthcare will act in an
ethical manner. Corporate compliance programs help healthcare organization prevent,
detect, and correct unlawful and unethical behavior.

55. LEARNING OBJECTIVES
• Describe the requirements of the False Claims
Act and Deficit Reduction Act
• Recognize fraudulent and other types of
improper conduct
• Describe common high-risk areas for
fraudulent conduct

56. COMPLIANCE PROGRAMS
THE FALSE CLAIMS ACT
• Knowingly submitting or causing the submission
of false claims for payment by the government
• Knowingly making, using, or causing to be made
or used a false record or statement material to a
false claim

57. WHISTLEBLOWERS
The False Claims Act contains provisions that encourage people to expose fraudulent
activity or poor quality of care to the federal government. It does this by allowing a
person, commonly referred to as a whistleblower, to sue a person or organization
that has violated the False Claims Act on behalf of the government.
If the government decides to pursue the suit brought by the whistleblower, the
whistleblower can be entitled to anywhere between 15 and 25% of the award or
settlement. If the government declines to pursue the matter, the whistleblower can
still move forward with the suit in which case they are entitled to between 25 and
30% of the award or settlement (FCA, 2012).

58. DEFICIT REDUCTION ACT
The federal False Claim Act
The administrative remedies for false claims
Any state laws pertaining to civil or criminal penalties
for false claims
Whistleblower protections under these federal and
state laws
The roles of these laws in preventing and detecting
fraud, waste, and abuse

59. BENEFITS OF A COMPLIANCE PROGRAM
Providing concrete demonstration that your organization is committed to
ethical corporate conduct
Increasing the likelihood of identifying and preventing unethical or
unlawful conduct
Prompting you and other employees to be vigilant for compliance
violations
Providing a mechanism to encourage employees to report potential
problems and allow for appropriate internal inquiry and corrective actions
Improving the quality, efficacy, and consistency of care and services
Helping to reduce you and your organization’s exposure to civil damages,
penalties, and criminal sanctions

60. ELEMENTS OF A COMPLIANCE PROGRAM
1) Developing compliance policies and procedures including standards of conduct
2) Designating a compliance officer and committee
3) Developing open lines of communication
4) Conducting effective training and education
5) Developing internal auditing and monitoring systems
6) Enforcing standards through disciplinary guidelines
7) Responding to detected offenses through the development of a plan of correction
(OIG Supplemental Compliance Program Guidance, 2008)

61. FRAUD, WASTE, AND ABUSE
Waste – At the beginning of the continuum is waste. Waste is an unintentional
overutilization, underutilization, or misuse of resources. Waste also includes
incurring unnecessary costs because of inefficient or ineffective practices, systems,
or controls.
Abuse – Further down the continuum of improper acts is abuse. Abuse covers
practices that are inconsistent with sound fiscal, business, or medical practices
resulting in unnecessary costs, improper payment, or payment for services that fail
to meet professional standards of care or that are medically unnecessary.
Fraud – At the far end of the continuum is fraud. Fraud is the intentional deception
or
misrepresentation made by a person with the knowledge that the deception or
misrepresentation could result in benefit to said person or another person. It
includes violations of the False Claims Act.

62. ANTI-KICKBACK STATUTE
• Prohibits healthcare organizations from giving or
accepting kickbacks, bribes, rebates, or any other
kind of payment made to arrange a deal that involves
federal dollars
• Forbids not just cash payments, but discounted
products, bundled services, compensation in kind and
other reciprocal arrangements
• Includes both giving and receiving parties
• May lead to civil or criminal penalties, including fines
and imprisonment.

63. ETHICAL CONDUCT
The term compliance refers to what is mandatory under the law. In other words, “Can I
do this?” However, compliance programs should extend not only to lawful conduct, but
also to ethical conduct.
Ethics are the standards of conduct that define what is morally right and wrong. In other
words, “Should I do this?” These standards will help you make the right decision in
tough situations you may face when working in healthcare.
You can use ethics to help you determine how you should act in relationships and
toward other people. Many of the decisions you make involve other people. When you
act with honesty, integrity, and compassion, the people around you will trust you and
your decision-making abilities.
Ethics are important because sometimes it is not easy to decide what is right and what
is wrong. Many of the choices you will have to make in your workplace will be unclear
and/or complicated. The good news is that using ethics will help you make good
choices in all types of situations.

64. REPORTING COMPLIANCE ISSUES
• Every employee is responsible for reporting ANY
potential violations
• Failure to report potential violation can lead to
disciplinary action
• Compliance hotline
• No retaliation
• You must know who your compliance office is

65. RISK AREAS
• Quality of Care
• Billing
• Documentation
• Kickbacks
• Gifts

66. CONCLUSION
Now that you have finished reviewing the course content, you should have learned the
following:
Your organization’s compliance program is designed to prevent, detect, and correct
unlawful and unethical conduct specifically fraudulent conduct. You play a vital role in
ensuring the effectiveness of your organization’s compliance efforts. Your day-to-day
responsibilities must include compliance with legal and ethical principles. Always be
on the lookout for potential non-compliance. If you see something that is not right,
report it! Make sure that you are familiar with your organization’s policies and
procedures regarding legal and ethical conduct. Recognize your responsibility in
making sure your compliance program is successful.

67. INFECTION CONTROL
AND PREVENTION

68. Learning Objectives
• Describe the basic concepts of infection control and why
it is important
• Identify various infectious illnesses and diseases and
how they are transmitted from one person to another
• Apply standard and transmission-based precautions to
prevent the transmission of various infectious illnesses
and diseases

69. Chain of
Infection
In long-term care, the most common infections are urinary tract,
respiratory, and skin and pressure injury infections (Centers for
Medicare & Medicaid, 2017). The chain of infection is a sequence of
events that allows infections to be transmitted. Breaking any of the
links in this chain will help stop the spread of infection. If you know
how to break the chain of infection, you can help save lives!
It is important to be familiar with some terms associated with the
chain of infection for better understanding. Each term can be
thought of as a link in the chain of infection, according to the CDC
(2012)
Infectious agents are microorganisms capable of causing illness or
disease
Infectious Agent:
• Bacteria
• Viruses
• Fungi
• Parasites

70. Chain of Infection
• Reservoir
• Portal of Exit
• Method of Transmission
• Portal of Entry
• Susceptible Host

71. Types of Transmission
• Contact transmission is spread through
contact with the infectious agent.
• MRSA and VRE
• Herpes simplex virus
• Scabies
• C. Diff
• Rotavirus
• Contact precautions are used to prevent the
transmission of illnesses easily spread
through contact with residents or
contaminated items in their environment
• Direct Transmission is transmitted from
person to person through direct contact.
• MRSA
• VRE
• Infectious Mononucleosis
• Gonorrhea
• Direct contact occurs when performing
resident care activites when your hands come
into contact with a residents’ non-intact skin,
mucous membranes, or body fluids.
• Droplet transmission is also considered direct
transmission and includes coughing,
sneezing, or even talking

72. Indirect Tranmission
• Occurs when an infection is transmitted
through a contaminated object or person.
• Thermometers
• Telephones
• Light switches
• Television remotes
• Toilet handles
• Airborne Transmission occurs through tiny
droplets or particles floating in the air
which are inhaled by another person.
• Checken pox
• Tuberculosis
• Measles

73. Bloodborne
Pathogens
• Every day, people encounter any number of harmful pathogens
such as bacteria, viruses, fungi, and parasites, which, given the right
circumstances, can result in an infection or illness. Certain types of
harmful pathogens are called bloodborne pathogens.
• Bloodborne pathogens are transmitted via contact with blood or
other potentially infectious fluids, such as semen, saliva, and other
body fluids. Exposure to a bloodborne pathogen occurs when
blood or other potentially infectious materials come into contact
with non-intact skin or mucous membranes, such as the eyes, nose,
or mouth.
• HIV/AIDS
• Hepatitis B
• Hepatitis C

74. Exposure to bloodborne pathogens is of critical concern for healthcare workers. As such,
the Occupational Safety and Health Administration (OSHA) requires all healthcare
organizations to have a plan in place to prevent their employees from exposure to these
pathogens. This is called an Exposure Control Plan. This plan will outline:
An employee’s risk for exposure
Methods taken to reduce this risk
Response if an exposure occurs
As a healthcare worker, it is vital that you know about your organization’s Exposure
Control Plan. Plans can and do differ between organizations. Take a moment to locate
your organization’s Exposure Control Plan. Can’t find it? Don’t be shy – the Plan is for
YOUR protection. Ask your supervisor about this plan and any elements of it about which
you are unsure.

75. Infection
Prevention
•Standard Precautions
•Transmission Based Precautions
•Contact
•Droplet
•Airborne

76. NOW THAT YOU HAVE FINISHED REVIEWING THE COURSE CONTENT, YOU SHOULD HAVE
LEARNED THE FOLLOWING:
HEALTHCARE-ASSOCIATED INFECTIONS CAN HAVE A SIGNIFICANT IMPACT ON AN
INDIVIDUAL’S HEALTH, SAFETY, AND OVERALL WELL-BEING. AS A HEALTHCARE WORKER,
ARE RESPONSIBLE FOR ENSURING THAT YOU USE THE APPROPRIATE STRATEGIES TO
THE SPREAD OF INFECTIONS FROM ONE PERSON TO ANOTHER. NOW THAT YOU KNOW
CHAIN OF INFECTION AND THE INFECTION CONTROL STRATEGIES THAT BREAK THE CHAIN,
YOU’RE IN A BETTER POSITION TO PREVENT THE TRANSMISSION OF INFECTIOUS
AND POTENTIALLY PREVENT ILLNESS, DISEASE, AND EVEN DEATH.
Conclusion

77. QAPI
Quality Assurance Performance Improvement

78. Learning
Objectives
After taking this course, you should be able to:
 Explain the basic concepts and principles ofQAPI.
 Describe each of the four elements of QAPI.
 Utilize QAPI principles to address problems and opportunities with
your facility.

79. Understanding
QAPI
• Quality Healthcare
• Improve individual care including quality and
satisfaction
• Improve the health of populations
• Reduce per capita costs of healthcare
• Defining QAPI
• Goals
• Quality measures
• Staff, Resident, and family input
• Identify problems and opportunities for
improvement
• Root cause to identify underlying cause

80. QA vs PI
Quality Assurance
 Meet minimum standards of
care
 Reactive strategy
 Focus on individuals
 Improvements usually end
once focus is off problem
Performance Improvement
 Aim to improve processes
even if problem not identified
 Proactive strategy
 Focus on process or system
 Sustained improvement

81. WrittenQAPI
Plan
Because your QAPI program must be a sustained, systematic approach to
quality improvement, your facility must develop and maintain a written
QAPI plan that includes policies and procedures outlining the approach you
will take to improvement through your program.Your written QAPI plan is a
living, breathing document that will continuously change as your facility
changes. It is not some mythical creature that lives in the administrator’s
office that staff have heard of but never seen. All those involved in QAPI
activities should reference it frequently. It will evolve as the needs of your
residents, staff, and facility evolve. It details exactly how your facility
utilizes QAPI and directs all QAPI activities.

82. Guiding
Principles
• Vision Statement
• Mission Statement
• Purpose Statement
• Guiding Principles
• Scope

83. QAPI
Involvement
• Identifying opportunities for
improvements
• Addressing gaps in systems or processes
• Developing and implementing
improvement or corrective plans
• Continuously monitoring the effectiveness
of interventions

84. QAPI
Elements
• Design and scope
• Governance and leadership
• Feedback, data systems, and monitoring
• Systematic analysis and systemic action

85. • Leadership Rounding
• Feedback, Data Systems, and Monitoring
• Adverse Events
• SystematicAnalysis and SystemicAction
• SelfAssessment

86. Conclusion
Now that you have finished reviewing the course content, you should
have learned the following:QAPI is the pairing of two complementary
approaches to create a proactive, systematic, comprehensive
approach to quality improvement and management. In order for QAPI
to be effective, your facility must have created a culture that
promotes quality improvement, which starts at the top. It must look at
system breakdowns to correct the root cause of problems rather than
looking to place individual blame. Effective QAPI programs value the
input of staff, residents, and families and include these individuals in
PIP teams. QAPI is more than meeting the regulatory requirements. It
is continuously aiming to improve the quality of care and life of the
residents in your facility

87. Facility Policies
 Abuse and Neglect
 Resident Rights
 QAPI
 Behavior and Dementia
 Communications
 Infection Control
 Compliance and Ethics

88. 4
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R e s i d e n t R i g h t s

89. 4
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Ms. Rose, Resident

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Questions
• Residents have the right to be
treated with dignity?
• True
• False
• If you answered true you are
CORRECT.
• Residents can choose to wear
what they would like to wear
each day?
• True
• False
• If you answered true you are
CORRECT.

91. 4
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Questions
• If a resident is not allowed a
private visitation with his/her
spouse or family it is a
violation of their rights?
• True
• False
• If you answered true you are
CORRECT.
• Residents do not have a right to
personal belongings?
• True
• False
• If you answered false you are
CORRECT.

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RIGHTS FOR EVERYONE

93. 4
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Rights for Everyone – Key Provisions

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Nursing Home
Reform Act
• Abuse
• Neglect
• Inadequate care

95. 4
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F
F
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E

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Nursing Home
Reform Act
• Fully informed
• Participate in care
• Independent
choices

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Nursing Home
Reform Act
• Visits
• Privacy and
confidentiality
• Security of
possessions

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Nursing Home
Reform Act
• Grievances
• Manage Finances

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“I have the right to be treated with dignity and respect”
“I have the right to be free from verbal, sexual, physical, and mental
abuse”
“I have the right to manage my own money or to choose someone I
trust to do this for me”
“I have the right to be informed, make my own decisions, and have
my personal information kept private”
Resident Rights in Summary