Resident Rights, Dignity, and Abuse Reporting

OBRA 1987 and the Residents' Bill of Rights

Prior to 1987, conditions in many nursing homes across the United States were poor, with widespread reports of neglect, overuse of restraints, and lack of basic dignity. In response, the federal government passed the Omnibus Budget Reconciliation Act (OBRA) of 1987. OBRA revolutionized long-term care by establishing comprehensive standards for facility operation, mandating LNA training (the 75-hour minimum), and most importantly, creating the Residents' Bill of Rights.

When a person moves into a long-term care facility in New Hampshire, they do not surrender their civil or constitutional rights. The facility must provide them with a written copy of their rights upon admission. As an LNA, you interact with residents more than any other staff member, making you the primary guardian of these rights on a daily basis.

Key OBRA Resident Rights Include:

• Right to Dignity and Respect: Residents must be treated as individuals. This means knocking before entering their room, calling them by their preferred name (never 'honey,' 'sweetie,' or their room number), and ensuring their body is covered during personal care.
• Right to Privacy and Confidentiality: Residents have the right to private communication, private visits, and physical privacy during care (closing doors and pulling curtains). Medical and personal information is protected by HIPAA and cannot be shared with anyone outside the immediate care team.
• Right to Make Independent Choices: Residents can choose what to wear, when to go to bed, what activities to attend, and what to eat.
• Right to Refuse Care: A resident has the absolute right to refuse any treatment, medication, or care (including baths or repositioning). Even if the care plan dictates a shower, if a competent resident says 'no,' you cannot force them. Forcing care is considered battery. You must respect the refusal, offer alternatives, document it, and notify the nurse.
• Right to be Free from Restraints: Residents cannot be physically tied down or chemically restrained (sedated) for staff convenience or as a form of discipline. Restraints can only be used with a strict physician's order to treat a medical symptom.
• Right to Voice Grievances: Residents can complain about their care without fear of retaliation or punishment.

Abuse, Neglect, and Exploitation

Despite regulations, vulnerable adults are sometimes subjected to mistreatment. It is vital to understand the definitions of different types of abuse:

• Physical Abuse: Any intentional act that causes injury, trauma, or pain. Examples: hitting, slapping, pinching, pushing, or handling a resident roughly during a transfer.
• Verbal/Emotional Abuse: Using words or actions to cause emotional pain or distress. Examples: yelling, mocking, threatening to withhold food, or ignoring a resident on purpose.
• Sexual Abuse: Any non-consensual sexual contact or behavior, including inappropriate touching or forcing a resident to watch sexual acts.
• Financial Exploitation: The unauthorized or improper use of a resident's money, property, or resources. Examples: stealing cash from a nightstand, tricking a resident into signing a check, or an LNA accepting 'tips' or gifts from a resident.
• Neglect: The failure to provide necessary care, services, or supervision, resulting in harm or risk of harm. Examples: leaving a resident in soiled briefs for hours, failing to reposition a bedbound resident leading to pressure ulcers, or ignoring a call light.

Mandatory Reporting in New Hampshire (RSA 161-F:46)

In New Hampshire, LNAs are mandatory reporters under state law (RSA 161-F:46). This means that if you have a reasonable suspicion that an elderly or incapacitated adult is being abused, neglected, or exploited, you are legally required to report it immediately.

You do not need hard proof to make a report; a reasonable suspicion based on what you saw, heard, or were told is enough.

How to Report in NH:

1. Ensure Immediate Safety: If a resident is in immediate physical danger, stay with them, separate them from the abuser, and call for the nurse or 911.
2. Notify Facility Leadership: Report the incident immediately to your Charge Nurse, the Director of Nursing, or the Administrator, following your facility's internal policy.
3. Report to the State: Mandatory reporters must notify the Bureau of Elderly and Adult Services (BEAS), which is part of the NH Department of Health and Human Services. BEAS investigates claims of elder abuse. You can contact the BEAS Central Information and Referral toll-free number.

Failure to report suspected abuse is a crime (a misdemeanor in NH) and will result in the loss of your LNA license. Furthermore, facilities are strictly prohibited from retaliating against an employee who makes a report in good faith. If you witness a coworker abusing a resident and you do not report it, you are considered complicit and will face disciplinary action alongside the abuser.

The Ombudsman Program

The Long-Term Care Ombudsman is an independent advocate for residents living in nursing homes and assisted living facilities. The Ombudsman program is funded by the state but operates independently of facility management and state surveyors. Their role is to investigate and resolve complaints made by or on behalf of residents. If a resident has a grievance about their care, food, or rights being violated, they can speak to the Ombudsman confidentially. As an LNA, you should support residents in contacting the Ombudsman if they wish to do so.