A quick review of CNA related Facebook pages will show that no group of people get more upset over media reports of court cases involving caregiver abuse of nursing home residents than other caregivers. After expressing their shock and disgust, caregivers will often add that they have no problem reporting other staff members who mistreat residents. There is nothing in these comments to suggest that both the strong emotion and the claim are anything but genuine.
Not all forms of abuse are equally severe. When determining charges and sentencing, the legal system itself takes into consideration such things as the intent of the accused, the severity of a crime and – important for our purposes here – how the victim experienced it. Obviously, some acts are particularly heinous and deserve harsher sentences.
Caregivers are obligated both morally and legally not only to report incidents of abuse that they’ve witness, but to intervene on behalf of the victim. Silence and inaction are forms of collusion and zero tolerance is the standard policy. Zero tolerance means that the relative severity of mistreatment cannot be used to relieve long-term care staff of the responsibility to intervene and report.
How a resident experiences our interactions with them is a primary consideration. As caregivers we may not intend to mistreat, but if we fail to give reasonable and adequate attention to how a resident perceives any given interaction, we could be guilty of a form neglect or abuse. Perhaps not a severe or overt form, but under zero tolerance it is a violation and we are required to intervene and report.
The quality of life for residents in a long-term care setting depends on much more than how they experience their interactions with their direct caregivers. While the factors that determine their quality of life are diverse and complex, there is at least one universal standard that should be applied in all situations: how does the resident experience it?
No one is more aware of how residents experience life in a nursing home than their caregivers. Direct care workers accompany residents through that experience on a daily basis. They see and feel the impact of when the system is working – and when it fails. They are familiar with the flaws of long-term care in a way no one else can be: in intimate detail and within the context of the lives of the people in their care. No quality assessment tool or inspection protocol can adequately replace that unique perspective.
This is a perspective that informs the worker of how things such as inadequate staffing levels, an unstable work force and insufficient or inappropriate regulation negatively affect residents. Because of the way residents experience that impact, it is nothing less than a systemic form of abuse and neglect.
While systemic forms of mistreatment are not intentional or overt, under zero tolerance do we not as witnesses have a moral obligation to report them like any other form of abuse?
If so, the question then becomes how do we respond to this obligation? How and to whom do we report?