“Most of us hear about abuse in long-term care and we assume some evil person out there tried to take advantage of somebody vulnerable. But the truth is, we all have the potential to be abusive. You can have the best intentions and still be abusive without even knowing it,” says Heather Picotte, administrative manager for the Adult Abuse and Neglect Prevention (AANP) project.

“For instance, if you’re stressed because you’re caring for a family member who’s ill, and you go in to work and you’re trying to bathe someone who doesn’t want a bath, you might get frustrated and react badly. Or if someone doesn’t make it to work, so you have to care for more people, and you’re doing everything in a rush, you could do something abusive without even realizing it. Consumers can be abusive too. If you’re dealing with a family member who’s sick and you’re stressed out, you can take it out on the caregivers, or even your family member. And elders can become combative.

“It can be very hard for us to realize that,” Picotte says. “But once we do, we can improve our lives and the lives of the people we work with and care for by focusing on the most important components of abuse prevention—quality relationships and empowering ourselves and others to make a difference. Quality relationships come through person-centered care. Empowerment comes from having the tools and power to say something when something just doesn’t seem right, to actively listen, de-escalate a situation when an elder becomes combative, or deal with stress regardless of the source.” 

A new approach
AANP is a training program to help long-term care staff recognize and prevent the conditions that lead to resident or client abuse. It was funded by a $1.5 million grant from the Centers for Medicare and Medicaid Services in 2004 and developed in Michigan by Michigan State University, the Michigan Office of Services to the Aging, and BEAM, the state’s nursing home culture change initiative. The three got a lot of help from a team of other long-term care experts.

In 2006 and 2007, 66 specialized AANP trainers delivered the training to nearly 8,000 “direct-access staff” – people who have direct contact with residents and clients, from administrators to CNAs and home health aides. Participants worked in all kinds of long-term care settings, from home care to adult day and adult foster care to nursing homes and assisted living. Results from a formal evaluation, which Picotte characterizes as “very positive,” are due soon from Michigan State University, after CMS releases the formal evaluation of nationwide abuse prevention initiatives being completed by an independent firm. 

Stressbusting tools
The training helps people recognize their “triggers” and gives them tools for dealing with stress. “There are various tools people can take with them and use in various situations when they go back to work,” says Picotte. There are also modules aimed at helping employers recognize and reduce stressors – and allow employees the space to use their own tools for dealing with stress. “If someone says they need to get away for a moment from a situation they can’t deal with, you need to let them just walk away – to cool off, do some deep breathing, whatever,” says Picotte.

The program also covers person-centered care, active listening, de-escalation, identifying and reporting abuse, and other ways of promoting empowerment and positive relationships.

The adult learned-based trainings were “very interactive,” says Picotte. “They give people a chance to share personal experiences. They develop a sense of trust, that what’s said in the group stays in the group.”

Free materials online
AANP training materials and tools can now be downloaded free of charge, along with a facilitator manual. The curriculum team boiled down the best of its 8- and 4- hour trainings into a series of 12 60-minute facilitator instruction modules, or FIMs. Each of the FIMs is packaged with all the materials a facilitator would need to teach it, and each can be taught on its own, though the 12 were designed as a consecutive series.

Although the materials have been available only for a few weeks, several staff educators have already told Picotte they’re using them for in-service trainings. “They say they make planning in-services very easy because they come with the power-points and all the other instructional materials – and they’re fun,” she says. 

To download the training modules, visit BEAM’s website. To get on a waiting list for classes conducted by a specially trained trainer, email Heather at hpicotte@mpro.org or call her at 248-465-7432.

Elise Nakhnikian is PHI’s Senior Online Editor