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Reducing nursing home theft: tips from a consultant.

Let's get one thing straight upfront: Nursing facilities will always lose things. Be it linen, food, personal possessions, even drugs, a certain amount will disappear, and for a variety of reasons. Given the fact that nursing facilities give open, and intimate, access to virtually all kinds of people, this is inevitable.

But, these losses can be minimized. A few simple, and for the most part inexpensive, steps will go a long way toward this. What's more, you can enlist help from some perhaps surprising sources, including your staff and local law enforcement agencies.

Let's take some leading categories of theft, one by one:

Linen: The first thing to do is to look at linen not as a stack of towels or bedsheets, but as a stack of dollar bills. If these seem to be moving out of the facility faster than they should--a good piece of quality linen should have a facility-life of about 16 months--start asking some questions.

What is our inventory? Who decides when a piece of linen should be "ragged out," and what happens to it then? Have we addressed our employees directly about the importance of keeping track of the linens and not losing them? (You should.)

Also keep in mind the various ways "liberated" linen can be used. It's not just a matter of sprucing up one's household. On wet, wintry days I've seen "old" sheets used to cover automobile windshields to protect them from snow and ice. Once used in this way, they get tossed into the back seat and they're on their way.

Employees don't necessarily have to be reprimanded for this. There could be a policy of making truly ragged-out sheets available for this, maybe dyeing them a special color and making dyeing them a at the door. The point is to know where the material is going and why.

Residents' personal possessions: From the administrative standpoint, there are two basic questions: How can we prevent theft of residents' property? Should such theft be reported? The answers to both can be summed up in two words: Be proactive.

In terms of prevention, it is not enough to simply rely on the standard liabiity release form. It is usually written in legalese that virtually no one understands and provides little real protection to anyone. It is better to address the potential theft problem with families upfront.

That is, you should say, "Yes, in a facility such as this--a home away from home -- people have relatively easy access to even the most private spaces. Possessions can be lost in a variety of ways, including theft. But we can work together to make sure that this doesn't happen to your mother's belongings."

Then you offer some suggestions. For example, "Can your mother's wedding ring be downsized so that it isn't so easily removable? Can it be replaced by a gold band, or the stones replaced by paste or zirconium?" Also, "Do you mind if we engrave that radio or that watch with personal data to make it easier to trace?" An electric engraving pencil can be purchased for about $9, or the local police department may even offer a free service in this way.

We can also express our awareness that at discharge is the most vulnerable time for theft. When a resident is admitted to a hospital or passes away, experience has shown that this is when personal property most often is taken. All personal property should be inventoried at this point and the inventory made available to the family.

We should also encourage the family to report any apparent theft to the police. It is at this point that many an administrator tunes out. Who wants the publicity? Maybe a better question is, which is worse--a police report or a negligence suit for failing to fulfill the facility's responsibility to its clients? And the responsibility here, in my view, is not to report the theft directly, but to encourage the family to do so.

What if a newspaper picks this up? Fine, you respond that, yes, this has been reported to the police and we are working with them in the investigation. For one thing, you may have disrupted a pattern of thought that the newspaper reporter -- and, let's face it, much of society -- engages in when thinking about nursing homes. They think our facilities are warehouses for the elderly sick, and essentially they don't do much other than wait for people to die while collecting their money in the process. Here you have shown a proactive interest in looking out for the rights of your residents. Is that so bad?

One other point in dealing with theft of personal property and the staff's perception of this. Some may think that walking off with the five dollars from Grandma's Christmas card or a ring that someone will never wear again isn't so bad in the overall scheme of things. Their minds may change if you treat it not as theft, but as burglary. It is the difference between a misdemeanor and a felony, and most of them understand the distinction. It goes a long way in showing that, in dealing with this problem, you mean business.

Food: Spot-checking, in a variety of ways, is the key to reducing food loss. First, though, as with linens, it should be clearly determined who is ordering the food. Is it also clear that if the person has a food-related business on the side, such as catering -- and there is nothing wrong with that--that facility time and resources are not to be used for this? Just being clear about these matters can help a great deal.

Then it's on to checking. Check prices, for one thing. Every once in a while ask competing vendors for their prices for something you purchased recently, and watch for strange variations. Check how your food shipments are received. Are deliverymen arriving at set hours under controlled conditions, or do they sort of wander in and about at-will? Check the manifest against what is actually delivered, again, not always, but on a random basis. Check the food storage area for any half-eaten food. And, once in a while, check packages and other carrying devices employees take out of the facility, after having published a formal policy for random package checks--an important point, legally. Employees who refuse to have their packages checked aren't necessarily guilty of anything, except for violating facility policy, and they can be dealt with using the same disciplinary action you would use for any such violation.

Finally, in terms of disposal of food waste, have a written policy for that, as well.

Drugs: Again, spot-checking is an important key. The administrator should be "like the wind"--coming who knows when from who knows what direction.

Drop in on the shift-change medication count and see how it's going. Look over the medication reconciliation records. Ask your consultant pharmacist for a monthly report on any apparent discrepanices or out-of-ordinary dispensing patterns, but check with him or her periodically during mid-month periods, as well.

Staffing is, of course, a highly important consideration here. The fact is that most drug diversion takes place for self-medication, rather than marketing on the street (though, obviously, that does occur). This is where your hiring policies come in.

Ask nurse applicants if they are licensed in any state other than your own. Is their license under review or inquiry? They may say no, but see how they say it. Remind them that this is a matter of public record and easily checked. Ask whether, during such a check, any information might come up that they would like to address right now. If there is a story, you are giving them the chance to give their side of it.

Finally, there are many sources of free information regarding prevention of drug diversion. Ask your state board of pharmacy, the various relevant licensing boards or the American Society of Consultant Pharmacists regarding this.

That brings up a final important point:

Where To get Free Advice: A common misconception about facility security is that it costs too much to implement in any reasonably thorough way. As may be obvious by now, this isn't necessarily so. There are a number of resources out there to give you worthwhile, and moneysaving, guidance.

1) Talk to your liability insurance company. Ask them to include anti-theft security in their next risk management survey. They may grumble, but in fact these sorts of losses are covered by your premium, as well. They may even have materials that they can share with you.

2) Touch base with local hospital security directors regarding specific issues that might be bothering you. Experts like to be pumped for their expertise if one is not too demanding on their time.

3) Ask your vendors for tips they might share with you -- a sort of value-added service.

4) Your local police department crime prevention unit might have materials or a program. Perhaps working through the higher-ups -- say, the police chief--might get you a quicker response. It doesn't hurt to cultivate a regular relationship with these people, in any event.

5) Consult with "the great untapped resource"--your staff. Ask them what they would suggest to deal with theft. You might be surprised not only by their creativity, but by how severe they can be, sometimes suggesting methods far more invasive than you would ever have imagined or proposed. In any case, once you have adopted a suggestion or two, you have in effect signed the staff on as a partner in theft prevention. And that is about as effective a way at "getting at the source" as any I can think of.

Patrick F. Donaldson is President and Senior Consultant of Forbes & Associates, Inc., an Oregon-based corporation involved in risk management. He is a frequent speaker and presenter on long-term care security issues.
COPYRIGHT 1992 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Donaldson, Patrick F.
Publication:Nursing Homes
Date:Jan 1, 1992
Next Article:The two minute tool.

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