Hiring the right personnel and maintaining appropriate staffing levels both play an important role in ensuring patient safety. Rigorous hiring procedures can be used to ensure that staff members meet the standards of care required for the elderly. Background checks on all employees, even part-time service personnel and volunteers, should be mandatory — no exceptions.

Long-term care facilities require formal elopement prevention policies that are closely followed by all staff members. Training staff on how to better supervise patients with dementia, confusion, and a history of wandering will help integrate prevention policies into the daily activities of medical personnel and facility staff. For example, regular resident counts can be used to quickly determine if patients are missing.

If employees are the first line of defense for protecting patients, security systems provide the next level of support. A facility's security plan should address everything from the roles and responsibilities of staff members to physical security support, such as cameras and alarms. If a patient wanders from the facility, alarms should sound and staff members should be notified immediately so the patient can be escorted back into the building.

Electronic surveillance systems (bracelets/proximity readers), locked dementia units, and electronic lockdown capabilities are considered best practices in long-term care facilities, whether stand alone or within a hospital. Access control is essential — who is in the facility is as important as who leaves.

In the face of facility-wide emergencies, such as a fire or blackout, the entire staff needs to be trained in the right procedures. In case of an evacuation, demands on elder care require that patient holding and staging stations are both staffed and secured appropriately. Maintaining tight controls over ambulatory as well as those patients who require assistance (for example, residents who cannot walk on their own or are easily confused) is critical to patient safety.

The Health Insurance Portability and Accountability Act (HIPAA) placed additional requirements on long-term care facilities. HIPAA includes specific business continuity planning, emergency management, and information security compliance requirements. Failure of the facility to meet these requirements will have significant effects on providers — from both a funding and legal standpoint.



"[One] facility could face fines of up to $2,000 per violation once the probe was complete. Among the violations cited were failure to conduct a search of the home when door alarms first sound, failure to account for all residents at risk of leaving the building and failure to train staff to supervise patients with dementia, confusion and a history of wandering."
The Associated Press, 2/12/2004

There are a variety of resources that healthcare executives can use to protect patients and staff and help ensure a quick response to an emergency. These include:

• Has the building been appropriately secured?
• Is my staff trained in patient security and safety issues?
• Do I have the right response plans in place to protect patients?
• Do I have an emergency response plan that adequately addresses all major risks?
• Has my plan been coordinated with local fire, law enforcement, and emergency medical service organizations?
• If a building evacuation is required, is patient safety monitored through each stage of the evacuation process?
• Do I have the in-house expertise to conduct regular staff training?
• How should I communicate with employees, patients, and the general public during and after an emergency?
• Are we compliant with all applicable regulations, including HIPAA?

"Wandering is one of the most frightening and potentially life-threatening behaviors that may accompany Alzheimer’s disease, and often, one of the first warning signs of the disease. As many as 60 percent of the four million Americans with Alzheimer's disease will wander at some point, often leaving home and unable to find their way back."
Alzheimer's Association Press Release, 3/30/2003

There are a variety of resources that healthcare executives can use to protect patients and staff and help ensure a quick response to an emergency. These include:

Critical Incident Prevention and Planning — Deals with compromises of company security, threats of violence, and critical incidents. This service includes proactive and reactive methods and protocols for loss identification, prevention, and resolution.

Business Continuity Planning — Helps ensure compliance with HIPAA regulations by identifying those processes and functions that are impacted by regulations and ensuring that appropriate controls and procedures are in place.

Emergency Response Planning — Helps organizations effectively respond to potential threats including fires and explosions, natural hazards, and utility outages.

Workforce Strategies — Help organizations establish safety and health programs, train employees, and audit compliance with program requirements.

Information Technology Risk and Security Services — Provides a solid framework of information technology policies, standards, and guidelines in order to mitigate the threats to an organization's information systems and the business processes it supports.

Property Risk Consulting — Provide property protection solutions through proven assessment and evaluation services, and address a wide range of risk issues, including security, fires, natural hazards, and explosions.

Risk Technologies — Use auditing software, such as Marsh's TrendTracker®, for management and facility evaluations to define risk and to assess compliance with health and safety regulatory standards.

Strategic Risk Communications — Provide timely and appropriate information to reassure different audiences — including employees, patients, family members, the media, vendors, and the public — that the organization is effectively managing related challenges.

For more information on Marsh's healthcare and consulting experience, please contact us.