Assess each patient to determine risk

Never assume that all sex offenders are the same, cautions Michael Fogel, PsyD, a forensic psychologist at The Chicago School of Professional Psychology. Doing so will lead you to either overreact to some patients who pose little harm or underreact to those who truly pose a risk to others.

Illinois requires that anyone being admitted to a long-term care facility be evaluated for criminal history, he notes, which at least helps the provider realize the risk and then respond.

"The risk is not static, and it is not the same for every individual," he says. "It's a matter of looking at the past behavior and where they are at the time of the assessment. Do they continue to maintain the same beliefs and the same behavior? Until you know that kind of information, you won't know whether this person is a real ongoing risk, or whether this is someone with a bad history but who isn't likely to repeat the behavior."

Fogel also notes that risk managers must remember that staff could be assaulted by patients, particularly younger residents. The true risk from any particular resident cannot be determined without thoroughly understanding the background, he says. Simply assigning a sex offender label and treating them all the same is a big mistake, Fogel adds.

"They are not all the same, absolutely not," he says. "This is a very heterogeneous population."

Robin Sax, JD, deputy district attorney for Los Angeles, points out, however, that you must not discount the risk just because the sex offender's past victims were unlike most long-term care residents. If the offender preyed exclusively on young children, for instance, that does not mean that you don't have to worry if your residents are all elderly.

"If one of your residents is visited by her grandchildren, there is the risk," she says.