Medical Monitoring in Group Homes Expert Article

Typically group homes and other residential facilities for individuals with intellectual or developmental disabilities do not provide medical care. Rather, non-medical direct support professionals are responsible for coordination of support to ensure that overall healthcare needs are met.

This article discusses the standard of care for non-medical staff in ensuring the healthcare needs of residents are met.

Healthcare Incidents in Group Homes & Residential Facilities

The supervised care and behavioral health experts at Robson Forensic are frequently retained to investigate incidents where injuries, or death, have occurred in community-based and other residential settings following a change in health status.

A change in health status can include onset of new symptoms, increase in symptoms associated with a current diagnosis, change in mood or behavior, change in physical appearance, and change in baseline activity level.

The claims in these cases can include failure to:

• Adhere to medical protocols
• Recognize and address signs and symptoms of an illness
• Ensure prompt medical care is received
• Administer medications as ordered
• Support individual specific dietary needs
• Support an individual’s mental health needs
• Assist the individual in informed decision-making regarding treatment plan
• Coordinate health and/or wellness services

Agencies licensed to provide residential services to individuals with intellectual/developmental disabilities are not considered medical providers, yet they are tasked with the responsibility of ensuring that residents’ healthcare needs are met.

Client Specific Plans/Plans of Care

To support individuals’ medical needs, client-specific plans are developed for each individual in the residence which describes their medical diagnoses, support needed, medications, and protocols for staff members to follow.

The residential staff (including direct support professionals and residential managers) are specifically trained in each individual’s client-specific plan and knowledgeable about their different diagnoses and specific medical, dietary, medication, and symptom plans and protocols.

Each individual client’s person-centered plan, created by an interdisciplinary team, identifies and describes the level of support required for their overall health and wellness.  

Individuals with intellectual/developmental disabilities often have co-occurring medical and/or psychiatric conditions that require ongoing maintenance and monitoring. Residential staff are responsible for ensuring the support needed to maintain an individual’s healthcare needs are provided.

This is done through supporting the individual to coordinate medical appointments, ensuring any recommendations are implemented and enforced, ensuring medications are obtained and administered as directed, and recognizing and responding to a change in physical, emotional, or behavioral status.

What is a Change in Healthcare Status?

A change in healthcare status can include an individual with a known disorder, such as seizures or diabetes, who begins to experience increased difficulty in managing their diagnosis through their current regimen. A change in mood or behavior can indicate a change in status as it relates to psychiatric symptoms and/or diagnoses.

In addition to coordination of medical care, residential staff are responsible for ensuring all aspects of the individual’s health is monitored and supported as necessary. This includes adherence to dietary orders to maintain the individual’s health and safety and management of mental illness and psychiatric symptoms.

Residential providers ensure that staff members are well-versed in how to recognize signs and symptoms of illness and changes in healthcare status.

Changes in healthcare status can include:

• Physical signs of illness (including runny nose, cough, rash, fever)
• Difficulty in endurance (tires easily, difficulty breathing)
• Potential side effects of medication
• Changes in sleep/appetite patterns
• Difficulty chewing/eating foods
• Change in ambulation ability
• Decrease in motor skills
• Change in energy level
• Increase in symptoms of conditions typically controlled by the individual’s medication (such as seizure activity when the individual’s seizure activity has been stable and controlled by medication)
• Increase in challenging behaviors or unexpected/unexplained decrease in challenging behaviors
• Change in affect (such as the inability to experience the typical range of affective states and emotional response such as happiness, sadness)

Staff members are trained on who to contact when there is a change in an individual’s health status and proper steps to take to obtain appropriate medical care and interventions.

Coordination of Care via Communication Among Service Providers

Communication across providers is critical for the continuity of care of these individuals. While the residence is the main conduit for medical care, external providers such as day programs, vocational programs, school, and case management are also responsible for the overall health and well-being of the individual.

While information sharing between service providers occurs at regularly scheduled meetings, any change in the individual’s medical status is communicated in a timely manner to ensure they receive the care necessary and to avoid negative outcomes.

The steps staff should take can include:

• Monitoring for additional symptoms/change in status
• Reviewing medication administration record for possible medication error
• Adherence to any prescribed medical protocols designed to support that individual’s specific medical needs
• Notification via the on-call system to administrative staff
• Notification to the individual’s medical provider for guidance
• Transportation to urgent care
• 911 for emergency or signs the individual is in distress and requires emergency care

Example

Individual A is normally very active and social within the residence. Staff member B arrives at 7am for their scheduled shift and observes that Individual A is not up and dressed and looking to greet them. Staff B finds Individual A on the couch, with a flat affect and no emotional response to their preferred staff’s arrival. The previous shift also reports that Individual A was awake frequently during the overnight when they typically sleep nine hours without interruption.

The above change in behavior and appearance could indicate onset/worsening of a medical or psychiatric condition that requires consultation with a medical provider. The direct support professional staff should be aware of the necessary steps to take when they make such observations.

Failure to recognize a change in health or behavioral status and communicate that change in status to the appropriate administrative and clinical staff can delay assessment, diagnosis, and care for the individual which can result in lasting implications and sometimes, death.

Supervised Care/Behavioral Health Expert Witness Investigations

The supervision and behavioral health experts at Robson Forensic have hands-on experience working in supervised care settings, implementing and evaluating the process and procedures used to ensure the safety of individuals receiving care. This includes, among others, effectively screening staff during the hiring process, training and retaining staff and reporting/investigating incidents.

For more information, submit an inquiry or call us at 800.813.6736.

Featured Expert

Danielle Dieterich, MA, JD

Supervised Care & Behavioral Health Expert

Danielle Dieterich is a Supervised Care & Behavioral Health Expert with two decades of experience in the management of clinical programs and residential care facilities including day habilitation,… read more.