INDIVIDUAL ABUSE PREVENTION PLAN Date Developed: ___________

A. Assessment of Susceptibility to Abuse, Including Self Abuse (Within 30 days of admission)

This is the identification of characteristics which make the individual susceptible to abuse and how these
characteristics cause the individual to be susceptible to abuse.
____, ____, ____, ____1. Unable to express self ____, ____, ____, ____8. Isolation
____, ____, ____, ____2. Blind or limited vision ____, ____, ____, ____9. Malnutrition
____, ____, ____, ____3. Wheelchair bound ____, ____, ____, ____10. Self-abusive
____, ____, ____, ____4. Ambulation losses ____, ____, ____, ____11. Hard of Hearing
____, ____, ____, ____5. Requires assist with transfers ____, ____, ____, ____12. Requires assist with ADL
____, ____, ____, ____6. Dementia/Confusion ____, ____, ____, ____13. Other _______________
____, ____, ____, ____7. Requires medical monitoring d/t __________________________________________

B. Measure taken to minimize the risk of Abuse

These are the actions staff will take to the measures addressed in the Individual Plan of Care. The actions must
be identified here and in the Individual Plan of Care.
ADLS
___Assist client with clothing prn
___Client on 2 hour toileting schedule
___Staff will empty clients catheter bag and monitor
___Assist with feeding
___Assist with toileting
___Staff will assist prn with all tasks requiring fine motor skills
AMBULATION/TRANSFERS/WHEELCHAIRS:
___Assist with all transfers and/or ambulation due to side effects of diagnosis
___Provide T-belt and assist with transfers and ambulation
___Transfer client with the appropriate staffing needs
___Encourage client to ambulate short distances with walker and provide wheelchair for distance
___Ensure client uses cane and/or walker
___Provide stand-by assist due to periods of dizziness
___Provide stand-by assist when client ambulates prn
___Provide assistance PRN for propelling wheelchair
___Use appropriate wheelchair restraint for safety issues resulting from diagnosis
___Encourage independent use of wheelchair
BEHAVIOR:
___Monitor clients agitation level and redirect when appropriate
___Provide 1:1 when agitated
___Remove physically aggressive client from program area involving other clients

COMMUNICATION:

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___Encourage verbalization of needs/concerns
___Encourage to voice needs and concerns to appropriate staff
___Listen carefully, encourage use of gestures and/or written communication
___Try to anticipate needs due to inability to express them
___Observe body language/gestures to assist in anticipating clients needs
___Encourage voice and breath support due to expressive aphasic
___Allow adequate word-find time
___Encourage use of communicator
DEMENTIA:
___Monitor whereabouts due to wandering
___Monitor clients agitation level and redirect when appropriate
___Provide reminders/R.O. as needed due to confusion, forgetfulness
___Provide quiet time when environment affects behavior
___Give simple step-by-step direction
___Decrease stimulation in environment during mealtime
___Report hallucinations to caregiver
___Provide monthly calendar to client and daily inform client of activities taking place
___Provide wake-up call daily for client when attending CEBD
DIET:
___Provide appropriate diet
___Food will be cut into small pieces
___Monitor fluid intake
___Monitor client when eating and/or drinking fluids
EXERCISE:
___Encourage participation in range of motion exercises through exercise program
___Provide adaptive exercises to maintain physical function
___Encourage periodic exercise for client during the day such as walking
HEARING:
___Speak distinctly; use gestures
___Seat client near group leader during group activities
___Get attention by touch prior to speaking and use gestures as needed
___Ensure client is wearing hearing aids
ISOLATION:
___Encourage socialization due to isolation in home environment
___Anticipate needs due to language barrier (i.e. does not speak English)
MEDICAL MONITORING:
___Monitor skin integrity
___Monitor physical symptoms due to diagnosis and report significant changes to nurse, caregiver and
physician
___Monitor physical and emotional comfort for diagnosis

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___Monitor need for and/or reaction to medication
___Medications will be monitored and/or administered appropriately
___Provide skilled nursing treatment
___Encourage naps and/or rest period
___Monitor hypertension and inform caregiver/doctor of changes in blood pressure
___Monitor for shortness of breath. Monitor number & types of activity & rest when experiencing S.O.B.
___Monitor client for extreme weight changes and report significant changes to nurse, caregiver and physician
___Monitor chronic pain
___Monitor number and types of activities and rest periods when appropriate
MENTAL HEALTH:
___Motivate client to join in activities that are beneficial to client
___Encourage client to express feelings
___Monitor anxiety level & intervene when appropriate
___Encourage regular attendance for socialization and stimulation
___Offer emotional support
___Observe for symptoms of depression and notify appropriate staff/caregiver
___Encourage independent decision making
___Encourage social interaction to assist in increasing clients self image
___Provide client with choices of programming to encourage independent decision making
___Provide activities in which client can be successful
SENSORY:
___Provide and encourage participation in activities for stimulation
___Provide variety of sensory groups to maintain current cognitive level
VISION:
___Approach from (R) side and remind to turn head to compensate for field cut
___Approach from (L) side and remind to turn head to compensate for field cut
___Provide verbal cues
___Ensure client is wearing glasses and clean prn
___Encourage client to position self to front of groups to maximize visual ability
___Aware of client wearing contact lenses

Other: _________________________________________________________________________________

STAFF SIGNATURE AND DATE: ________________________________________________________________

CLIENT: _________________________________________________________ FILE #: _________________________

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