{"ref":"DC-HC-ANE-01","title":"Recognizing and Reporting Abuse, Neglect, Self-Neglect, and Exploitation of Adults","category":"Safeguarding","own":false,"summary":"How every employee recognizes and reports suspected abuse, neglect, self-neglect and exploitation of an adult client: the District definitions in D.C. Code §7-1901, who must report immediately to Adult Protective Services under §7-1903 and the Agency's rule that every employee reports, what the report contains, protection for reporters, what the Agency does when an employee is accused, and the other reports to DC Health the same event may need.","inShort":["If anyone is in danger, call 911 first.","If you think a client is being abused, neglected or exploited, or cannot care for himself or herself, report it right away to Adult Protective Services at (202) 541-3950.","Also tell the nurse or the Director right away. Telling the Agency does not replace your call to APS.","Do not confront the person you suspect and do not investigate. Write down what you saw and the client's own words.","Fill in the internal report form before the end of your shift.","You will never be punished for a report made in good faith, and your name is kept confidential."],"primaryCitation":"D.C. Code §7-1903","citations":["D.C. Code §7-1901","D.C. Code §7-1903","D.C. Code §7-1904","D.C. Code §7-1908","D.C. Code §7-1912","22-B DCMR §9916.2(h)","22-B DCMR §9917.7","22-B DCMR §9917.8","22-B DCMR §9917.10","22-B DCMR §4701.6"],"federalCitations":[],"surveyorAsks":["What would an aide do if a client told her that her son takes her money?","Who do you report suspected abuse to, and how fast?","Show me the training records showing staff were trained on abuse reporting.","What do you do when an aide is accused of abusing a client?","How do you protect a staff member who reports?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"DC-HC-ANE-01-A","title":"Internal Report of Suspected Abuse, Neglect, or Exploitation"}],"sections":[{"heading":"Terms of Reference","body":["This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1."],"table":{"caption":null,"headers":[["Item"],["Detail"]],"rows":[[["Issued by"],["The governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}]],[["Authority"],["Adopted under D.C. Code §7-1903, which requires a \"health-care administrator, licensed health professional\" or social worker with \"substantial cause to believe that an adult is in need of protective services because of abuse, neglect, or exploitation by another\" to \"immediately report this belief\", and 22-B DCMR §9916.2(h), which gives each client the right \"To be free from mental and physical abuse, neglect, and exploitation by home support agency employees\"."]],[["Applies to"],["Every employee, contractor and volunteer of the Agency, and every member of the governing body."]],[["Status"],["Mandatory. Adherence is a condition of employment and of any contract for services. No provision may be waived, shortened, or varied by any employee."]],[["Not covered here"],["Children (Policy DC-HC-ANE-02). Medical emergencies (Policy DC-HC-SAF-01). The full incident procedure and reports to DC Health (Policy DC-HC-INC-01). Discipline and reports about staff (Policy DC-HC-HR-07). Code of conduct and client property (Policy DC-HC-ETH-01)."]],[["Review"],["Reviewed by the document owner at least annually, as part of the governing body's annual review and evaluation of all policies and procedures required by 22-B DCMR §9906.2(c), and within 30 days of any amendment to a rule cited at Section 16 (the 30-day period is the Agency's own standard). Each review is recorded at Section 19 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body (22-B DCMR §9908.1) and the issue of a new version number. Superseded versions are retained for at least six years, as the Agency's own standard."]],[["Distribution"],["Master copy held in the policy manual at the operating office at ",{"k":"field","name":"agency.address","text":"100 Example Street NW, Suite 100, Washington, DC 20001"},", where it is readily available to staff at all times (22-B DCMR §9908.3). Available to clients, prospective clients and client representatives on request (22-B DCMR §9908.4)."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(202) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy protects clients from abuse, neglect, self-neglect and exploitation by making sure that every employee knows the signs, reports at once to Adult Protective Services and to the Agency, and is protected for reporting, and that the Agency acts at once when an employee is accused."],"edited":false},{"heading":"2. Scope","body":["This policy applies to any suspicion that a client 18 years of age or older is being, or has been, abused, neglected or exploited by anyone (an Agency employee, a family member, a friend, a neighbor, another provider or a stranger), or is neglecting himself or herself."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy:"],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Abuse"],["Under D.C. Code §7-1901(1)(A): \"(i) The intentional or reckless infliction of serious physical pain or injury; (ii) The use or threatened use of violence to force participation in 'sexual conduct,' defined in § 22-3101(5); (iii) The repeated, intentional imposition of unreasonable confinement or threats to impose unreasonable confinement, resulting in severe mental distress; (iv) The repeated use of threats or violence, resulting in shock or an intense, expressed fear for one's life or of serious physical injury; or (v) The intentional or deliberately indifferent deprivation of essential food, shelter, or health care in violation of a caregiver's responsibilities, when that deprivation constitutes a serious threat to one's life or physical health.\""]],[["Neglect"],["Under D.C. Code §7-1901(9)(A), includes \"The repeated, careless infliction of serious physical pain or injury\", \"The repeated, careless imposition of unreasonable confinement, resulting in severe mental distress\", and \"The careless deprivation of essential food, shelter, or health care in violation of a caregiver's responsibilities, when that deprivation constitutes a serious threat to one's life or physical health\", among others."]],[["Self-neglect"],["\"the failure of an adult, due to physical or mental impairments or incapacity, to perform essential self-care tasks, including: (i) Providing essential food, clothing, shelter, or medical care; (ii) Obtaining goods or services necessary to maintain physical health, mental health, emotional well-being, and general safety; or (iii) Managing his or her financial affairs.\" (D.C. Code §7-1901(13)(A))"]],[["Exploitation"],["\"the unlawful appropriation or use of another's 'property,' defined in § 22-3201, for one's own benefit or that of a 3rd person.\" (D.C. Code §7-1901(8))"]],[["Adult in need of protective services"],["An individual 18 years of age or older who \"(i) Is highly vulnerable to abuse, neglect, self-neglect, or exploitation because of a physical or mental impairment, self-neglect, or incapacity; (ii) Has recently been or is being abused, neglected, or exploited by another or meets the criteria for self-neglect; and (iii) Has no one willing and able to provide adequate protection.\" (D.C. Code §7-1901(2)(A))"]],[["Caregiver"],["\"a person that, by law, contract, court order, or voluntary action, is charged with or has assumed the responsibility for an adult's essential food, shelter, or health-care needs.\" (D.C. Code §7-1901(4)) The Agency and its aides are caregivers for the tasks in each client's service plan."]],[["Adult Protective Services (APS)"],["The District office that receives and investigates reports: ",{"k":"field","name":"fixed.abuseReportRoute","text":"Adult Protective Services (APS), District of Columbia Department of Aging and Community Living, APS Hotline (202) 541-3950, available 24 hours a day, 7 days a week"},". Address: ",{"k":"field","name":"fixed.apsAgencyAddress","text":"Department of Aging and Community Living, 500 K Street NE, Washington, DC 20002; (202) 724-5626"},"."]],[["Mandatory reporter"],["A person who must report under D.C. Code §7-1903(a)(1). At the Agency these are the Director and Acting Director (as health-care administrators, in the Agency's reading), the Client Service Coordinator and every registered nurse (licensed health professionals), and any social worker."]],[["Director"],["\"The individual appointed by the governing body to act on its behalf in the overall management of the home support agency.\" (22-B DCMR §9999.1) The Director is the Agency's administrator, currently ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"},"."]],[["Client Service Coordinator"],["\"A registered nurse who is sufficiently qualified to provide general supervision and direction of the services offered by the home support agency and who has at least one (1) year administrative or supervisory experience in personal care, home health care, or related health programs.\" (22-B DCMR §9999.1) Currently ",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"},". If the Director is a registered nurse, the Director carries out these duties (22-B DCMR §9907.7)."]],[["Agency's own standard"],["A requirement the Agency sets for itself that goes beyond, or fills a gap in, the rules. This manual labels each one so that it is never mistaken for a DC Health requirement."]]]},"edited":false},{"heading":"4. Policy Statement (D.C. Code §7-1903)","body":["Whenever a health-care administrator, licensed health professional or social worker \"has as a result of his or her appointment, employment, or practice substantial cause to believe that an adult is in need of protective services because of abuse, neglect, or exploitation by another, he or she shall immediately report this belief\" (D.C. Code §7-1903(a)(1)). \"Any person may voluntarily report an alleged case of abuse, neglect, self-neglect, or exploitation when he or she has reason to believe that an adult is in need of protective services.\" (§7-1903(a)(2)) Aides and office staff are not named as mandatory reporters in §7-1903, so, as the Agency's own standard, every employee who has reason to believe a client is being abused, neglected or exploited, or is neglecting himself or herself, reports it immediately to APS and to the registered nurse or the Director. Each client has the right to be free from mental and physical abuse, neglect and exploitation by Agency employees (22-B DCMR §9916.2(h))."],"edited":false},{"heading":"5. Who Reports","body":["Table 1 shows who must report. No employee needs permission from a supervisor to report to APS, and no supervisor may stop or delay a report."],"table":{"caption":["Table 1.  Duty to report"],"headers":[["Person"],["Duty"],["Source"]],"rows":[[["Director and Acting Director"],["Must report immediately (health-care administrator, in the Agency's reading)"],["D.C. Code §7-1903(a)(1)"]],[["Client Service Coordinator and every registered nurse"],["Must report immediately (licensed health professional)"],["D.C. Code §7-1903(a)(1)"]],[["Any social worker"],["Must report immediately"],["D.C. Code §7-1903(a)(1)"]],[["Home health aides, office staff, contractors and volunteers"],["Report immediately to APS and to the registered nurse or the Director (the Agency's own standard). The law allows any person to report voluntarily."],["D.C. Code §7-1903(a)(2); the Agency's own standard"]],[["Anyone who suspects self-neglect"],["Report to APS (voluntary under the law; required by the Agency's own standard) and to the registered nurse"],["D.C. Code §7-1903(a)(2); the Agency's own standard"]]]},"note":["Under D.C. Code §7-1912(a)(1), a mandatory reporter who willfully fails to report is guilty of a misdemeanor and subject to a fine not exceeding $300, and under §7-1912(a)(5) a licensed health professional or health-care administrator who willfully fails to report is guilty of unprofessional conduct and subject to licensing sanctions. A narrow exception in §7-1903(b) for a licensed health professional whose own patient is the person allegedly responsible does not apply to the Agency's nurses in their work for the Agency, as the Agency's own reading."],"edited":false},{"heading":"6. Signs to Watch For","body":["Staff do not have to be sure, and do not have to prove anything. A report is made on reason to believe. Signs that may point to abuse, neglect, self-neglect or exploitation include, as the Agency's own guidance:"],"table":{"caption":["Table 2.  Possible signs"],"headers":[["Concern"],["Possible signs"]],"rows":[[["Physical abuse"],["Bruises, burns, cuts or fractures that are unexplained or do not match the explanation; injuries in different stages of healing; the client flinches or is afraid of a person"]],[["Sexual abuse"],["Bruising or bleeding in the genital area; torn or stained underclothing; the client says it happened; new fear of being touched"]],[["Emotional abuse and confinement"],["Threats, shouting or humiliation by others; the client is locked in a room or kept from visitors or the phone; the client is withdrawn or very anxious around a person"]],[["Neglect by a caregiver"],["No food in the home; unpaid utilities cut off; the client is left alone when unable to care for himself or herself; untreated sores or illness; medications not obtained"]],[["Self-neglect"],["The client cannot or does not eat, take needed medicines, keep warm or cool, or keep the home safe, because of a physical or mental impairment; hoarding that creates danger; unpaid bills because the client can no longer manage them"]],[["Financial exploitation"],["Money, jewelry or checks missing; new \"friends\" or relatives controlling the client's money; unusual bank withdrawals or new credit cards; the client signs documents he or she does not understand; pressure to change a will or deed"]]]},"edited":false},{"heading":"7. What to Do","body":["Every employee who sees or hears something that gives reason to believe a client is being abused, neglected or exploited, or is neglecting himself or herself:"],"list":[["If anyone is in immediate danger, calls 911 first."],["Makes the client as safe as possible without putting himself or herself in danger. Does not confront the person suspected, and does not try to investigate."],["Listens to the client calmly, does not ask leading questions, and does not promise to keep it secret. Writes down the client's own words."],["Reports immediately to APS, ",{"k":"field","name":"fixed.abuseReportRoute","text":"Adult Protective Services (APS), District of Columbia Department of Aging and Community Living, APS Hotline (202) 541-3950, available 24 hours a day, 7 days a week"},", by phone. The APS Hotline is ",{"k":"field","name":"fixed.abuseHotline","text":"(202) 541-3950"},"."],["Immediately tells the registered nurse or the Director (or the on-call person after hours at ",{"k":"field","name":"agency.afterHoursPhone","text":"(202) 555-0199"},"). Telling the Agency does not replace the report to APS."],["Completes Form DC-HC-ANE-01-A before the end of the shift and gives it to the registered nurse or the Director."]],"ordered":true,"note":["When an aide or office employee reports to the registered nurse or the Director, the nurse or the Director, who is a mandatory reporter, makes sure a report has been made to APS that same day, and makes it personally if there is any doubt. If the employee could not reach APS, the nurse or the Director reports at once. Two reports about the same concern are better than none."],"edited":false},{"heading":"8. What the Report to APS Contains","body":["A report \"may be either oral or written\" (D.C. Code §7-1903(c)). It includes, if known (§7-1903(c)):"],"list":[["The name, age, physical description and location of the adult alleged to be in need of protective services."],["The name and location of the person or persons allegedly responsible for the abuse, neglect or exploitation."],["The nature and extent of the abuse, neglect, self-neglect or exploitation."],["The basis of the reporter's knowledge."],["Any other information the reporter believes might be helpful to an investigation."]],"ordered":false,"note":["\"A reporter may be required to identify himself or herself only when obliged to report under subsection (a)(1) of this section.\" (D.C. Code §7-1903(c)) The person making the report records on Form DC-HC-ANE-01-A the date and time of the call, the name of the APS worker, and any reference number APS gives."],"edited":false},{"heading":"9. Reports to DC Health and Other Reports","body":["The same event may also need these reports. Each one is made on its own time frame (Policy DC-HC-INC-01):"],"table":{"caption":["Table 3.  Other reports"],"headers":[["When"],["Report"],["Authority"]],"rows":[[["The suspected abuse, neglect or exploitation involves a client and occurred in the presence of staff, or is an incident under 22-B DCMR §9999.1 (for example, misappropriation of a client's property or funds)"],["Incident report to DC Health within forty-eight (48) hours, and a complete investigation report within thirty (30) days"],["22-B DCMR §9917.7; §9917.8"]],[["A registered nurse or home health aide is involved"],["Report to DC Health within five (5) business days of the Agency's receipt of the relevant information"],["22-B DCMR §9917.10; Policy DC-HC-HR-07"]],[["An employee subject to criminal background checks resigns or is terminated for criminal, unprofessional or unethical conduct"],["Report to DC Health within ten (10) days"],["22-B DCMR §4701.6; Policy DC-HC-HR-07"]],[["A crime may have been committed"],["Report to the Metropolitan Police Department"],["The Agency's own standard"]]]},"edited":false},{"heading":"10. When an Agency Employee Is Accused","body":["Each client has the right \"To be free from mental and physical abuse, neglect, and exploitation by home support agency employees\" (22-B DCMR §9916.2(h)). When any employee is alleged to have abused, neglected or exploited a client, as the Agency's own standards:"],"list":[["The Director removes the employee from all client contact at once, before the end of the day the Agency learns of it, while the matter is investigated (Policy DC-HC-HR-07)."],["The Client Service Coordinator arranges a replacement aide and visits or calls the client the same day to check on safety and to explain what will happen."],["The Director makes sure the report to APS has been made, and calls the police if a crime may have been committed."],["The Director investigates as an incident under Policy DC-HC-INC-01 and makes the reports in Table 3."],["The Agency cooperates fully with APS, the police and DC Health and does not do anything that would interfere with their investigations."],["At the end, the Director decides on discipline, up to termination, and any further reports (Policy DC-HC-HR-07)."]],"ordered":true,"edited":false},{"heading":"11. Protection for People Who Report","body":["\"Any person who reports an alleged case of abuse, neglect, self-neglect, or exploitation pursuant to § 7-1903 shall be immune from civil or criminal liability for so reporting if he, she, or it has acted in good faith.\" (D.C. Code §7-1908) A person who retaliates against another because of a report, by taking action that adversely affects the latter's rights, privileges, living arrangement or terms of employment, is civilly liable for any damages and subject to punitive damages (§7-1912(a)(4)). \"Any person possessing a report or investigative information acquired pursuant to this chapter shall take reasonable steps to prevent the disclosure of information that might reveal the reporter's identity to the person(s) allegedly responsible for the abuse, neglect, or exploitation.\" (§7-1903(d)(3)) Therefore, the Agency never punishes, threatens or treats differently an employee or client who reports in good faith, and keeps the reporter's name confidential. Willfully making a report known to be false is a misdemeanor (§7-1912(a)(2)) and serious misconduct."],"edited":false},{"heading":"12. What Happens After a Report","body":["If a report alleges an immediate, substantial risk of life-threatening harm, APS must immediately notify the police, and \"within 24 hours of the Department's receiving such a report, an APS worker shall commence an investigation\" (D.C. Code §7-1904(a)(3)). For other reports, an APS worker commences an investigation \"within 10 days (excluding Saturdays, Sundays, and legal holidays)\" of receiving the report (§7-1904(a)(4)). APS must first secure the adult's consent, and if the adult objects and it does not appear the objection comes from fear or intimidation or that the adult is incapacitated, the investigation ends (§7-1904(b)). The Agency:"],"list":[["Keeps providing the client's services and watches for further signs, reporting anything new to APS."],["Gives APS the information it needs to investigate, within the client's rights (Policy DC-HC-PRV-01)."],["Has the registered nurse review the service plan for safety measures (22-B DCMR §9913.3(e)) and, with the client's agreement, refer the client to other help."],["Respects the client's right to make his or her own choices. A client who has capacity may refuse help; the Agency records the client's decision and keeps reporting new concerns."]],"ordered":false,"edited":false},{"heading":"13. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Owns this policy. Reports to APS as a mandatory reporter, removes accused employees from client contact, makes the reports in Table 3, leads investigations, and protects reporters from retaliation."]],[[{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", ",{"k":"field","name":"people.alternate.title","text":"Alternate Administrator"}],["Carries out the Director's duties under this policy when the Director is absent, as a mandatory reporter."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Reports to APS as a mandatory reporter, makes sure each report from an aide has reached APS the same day, checks on the client's safety, and updates the service plan."]],[["Registered nurses"],["Report to APS as mandatory reporters, and watch for signs at every assessment and supervisory visit."]],[["Home health aides, office staff, contractors and volunteers"],["Report immediately to APS and to the nurse or the Director, and complete Form DC-HC-ANE-01-A before the end of the shift."]]]},"edited":false},{"heading":"14. Records and Compliance Monitoring","body":["Form DC-HC-ANE-01-A, the APS reference, notes of the client's words and any incident file are kept with the complaint and incident records for a minimum of five (5) years (22-B DCMR §9915.5). A short cross-reference is placed in the client record (Policy DC-HC-REC-01). The reporter's identity is kept confidential (D.C. Code §7-1903(d)(3)).\n\nAs the Agency's own standard, the Director checks each quarter that every concern recorded in service delivery notes, change in condition reports or complaints was reported to APS, and that every allegation against an employee led to removal from client contact the same day. Findings are part of the annual evaluation (Policy DC-HC-QA-01)."],"edited":false},{"heading":"15. Staff Training","body":["Every employee is trained on this policy at orientation, before working with any client, and at each annual in-service (Policy DC-HC-HR-06). Training covers the definitions, the signs in Table 2, the steps in Section 7, how to call APS, protection for reporters, and practice using real-life examples. The Director, the Acting Director and the registered nurses are also told that they are mandatory reporters and what that means."],"edited":false},{"heading":"16. References","body":["This policy implements the following authorities."],"list":[["D.C. Code §7-1901 (definitions)"],["D.C. Code §7-1903 (reporting requirements)"],["D.C. Code §7-1904 (investigations)"],["D.C. Code §7-1908 (qualified immunity for person reporting)"],["D.C. Code §7-1912 (penalties; retaliation)"],["22-B DCMR §9916.2(h), Client Rights and Responsibilities"],["22-B DCMR §9913.3(e), Client Service Plan (safety measures)"],["22-B DCMR §9917.7, §9917.8 and §9917.10, Management of Complaints and Incidents"],["22-B DCMR §4701.6 (report of separation for cause)"]],"ordered":false,"edited":false},{"heading":"17. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form DC-HC-ANE-01-A"],["Internal Report of Suspected Abuse, Neglect, or Exploitation"]],[["Policy DC-HC-ANE-02"],["Reporting Suspected Child Abuse and Neglect"]],[["Policy DC-HC-INC-01"],["Incident Management and Reporting to DC Health"]],[["Policy DC-HC-HR-07"],["Discipline, Separation, Employee Grievances, and Reports to DC Health"]],[["Policy DC-HC-ETH-01"],["Code of Conduct, Professional Boundaries, and Client Property"]],[["Policy DC-HC-SAF-01"],["Medical Emergencies and Death in the Home"]],[["Policy DC-HC-SP-03"],["Changes in Condition and Needs Beyond Personal Care Services"]],[["Policy DC-HC-PRV-01"],["Confidentiality and Privacy of Client Information"]],[["Policy DC-HC-CMP-01"],["Complaints"]],[["Policy DC-HC-HR-06"],["Orientation, In-Service Training, Competency, and Annual Performance Evaluation"]],[["Policy DC-HC-QA-01"],["Annual Evaluation and Quality Improvement"]]]},"edited":false},{"heading":"18. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},". The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below."],"edited":false},{"heading":"19. Revision History","body":["Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 16 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"dc-hca","state":"Washington, DC","service":"Home care","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}