Written Assignment: Difficult Problems

The following are common responses we hear when we ask this question. Following each paragraph is the degree to which the course content speaks to the issue raised.

1. Knowing the difference between abuse and behaviors which are not abusive, or in other words, the definition of abuse.

Although to begin an investigation staff must know what behaviors are considered abusive or neglectful, the definitions of these terms are beyond the scope of this course.  These are policy issues which begin with federal and state regulation of health care delivery systems and end with facility and unit policy statements on those subjects.  If participants are in doubt about what constitutes abuse, facility management and staff should begin an educational program which would remedy that deficiency.

2. It takes too much time to do an investigation, particularly with all of the other administrative duties which management must fulfill.

Admittedly, it takes longer to do a good investigation than a poor investigation.  The course assumes this proposition as a given and makes no apologies.

3. Staff and clients or patients are often afraid to cooperate during an investigation.

This is true and is a circumstance that will not disappear even if the investigation is conducted properly.  On the other hand, the course will deal with this issue in a number of ways, particularly with respect to the interviewing process.

4. It is difficult to remain objective during an investigation.

It is indeed difficult to remain objective.  The course will show at various points how our lack of objectivity can affect the outcome of an investigation.

5. Interviewing without asking leading questions is difficult.

We will spend considerable time during the sessions on interviewing identifying and then eliminating leading questions from interviews.

6. Often clients or patients lack credibility and therefore it is sometimes useless to do the investigation because it is their word against someone who appears more credible.

Credibility is always an issue if an investigation results in a hearing.  Sometimes clients are truly not credible and ought not be believed.  But we have to acknowledge a widespread prejudice among many who will review investigations about clients’ credibility.  The course will focus on how to find as much evidence as possible during the course of an investigation. In many cases, it would be possible to have additional evidence to bolster the testimony of someone who otherwise faces prejudice of this sort.

7. The investigation process seems contrary to the helping roles most of the persons see themselves fulfilling.

On the contrary, without effective investigations it would be difficult to protect some clients from some staff, visitors, other clients and environmental dangers.

8. It is difficult to reconcile conflicting statements.

This is absolutely true, however, during the course participants will learn how to reconcile such statements based on the evidence collected during the investigation.

9. There is no mechanism to really know the truth.

There is no ANSWER CARD at the end of an investigation, a fact which results in much concern on the part of those conducting the investigation about what they have concluded is the truth.  The only substitute is for one to conduct a competent investigation and rely on the quality of the information collected to draw the appropriate conclusions.

10. Investigations tend to lower staff morale.

Although this is true and will always be true to some extent, part of the problem can be remedied by conducting competent investigations which, where possible, result in convincing conclusions.

11. There are already a multiplicity of investigations conducted by a host of outside agencies, sometimes including the police.

This is true and can result in confusion and additional morale problems.  The course will address how to relate the facility investigation to that of the police and other agencies.