{"ref":"DC-HSP-ANE-01","title":"Recognizing and Reporting Abuse, Neglect and Exploitation of Adults and Children","category":"Safeguarding","own":false,"summary":"Sets out how staff recognize abuse, neglect, self-neglect and exploitation of adults and abuse and neglect of children, who must report under District law, and how reports are made at once to Adult Protective Services (APS) or the Child and Family Services Agency (CFSA), alongside the federal duty to report every alleged violation immediately to the hospice administrator.","inShort":["If anyone is in danger, call 911 first.","Tell the clinical manager or the Administrator at once about any sign of abuse, neglect or exploitation.","Nurses, social workers and other licensed staff must report an adult at once to APS at (202) 541-3950.","Report a child at once to CFSA at (202) 671-SAFE (202-671-7233) or the police. Aides must report too.","Do not wait for proof or permission. No one may stop you from reporting.","Write down what you saw and who you reported to, and give it to the Administrator the same day."],"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 §4-1321.02","D.C. Code §4-1321.03"],"federalCitations":["42 CFR §418.52(b)(4)(i)","42 CFR §418.52(c)(6)","45 CFR §164.512(c)"],"surveyorAsks":["If you saw bruises you could not explain on a patient, what would you do, and how quickly?","Who do you report suspected abuse of an older or disabled adult to in the District? What is the number?","Who is a mandated reporter of child abuse here, and what must the report include?","How do staff report alleged mistreatment by a hospice employee or volunteer to the administrator?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"DC-HSP-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 the District’s Adult Protective Services law (D.C. Code §§7-1901 to 7-1913, including the reporting duty in §7-1903), the child abuse and neglect reporting law (D.C. Code §§4-1321.02 and 4-1321.03) and 42 CFR §418.52(b)(4)(i). The District does not license hospices; these reporting duties apply to the Agency’s staff by law."]],[["Applies to"],["All employees, volunteers and contracted staff, whether or not they are named as mandatory reporters in District law."]],[["Status"],["Mandatory. Departures require the written approval of the Administrator, recorded with the reason."]],[["Not covered here"],["Investigation of alleged violations by anyone furnishing services on behalf of the Agency, protection of the patient during the investigation, and reports of verified violations (Policy DC-HSP-ANE-02). Adverse event reports to DC Health (Policy DC-HSP-GOV-04)."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months, and within 30 days of any amendment to a rule cited in the References section or of the District adopting hospice licensing rules. Each review is recorded in the Revision History."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for at least six years."]],[["Distribution"],["Master copy in the policy manual; issued to every person in \"Applies to\" at orientation and on each new version."]],[["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 makes sure that every person working for ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," (the \"Agency\") recognizes the signs of abuse, neglect, self-neglect and exploitation, reports them at once to the right authority, and tells the Administrator, so that patients and the children in their homes are protected."],"edited":false},{"heading":"2. Scope","body":["This policy covers suspected abuse, neglect or exploitation of any patient, by anyone (family, caregivers, visitors, facility staff, Agency staff, volunteers or contractors), and of any child or other vulnerable adult staff meet in the course of their work, and suspected self-neglect of an adult."],"edited":false},{"heading":"3. Definitions","body":["The following terms have the meanings given below when used in this policy."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Adult"],["\"an individual 18 years of age or older.\" (D.C. Code §7-1901(1A))"]],[["Adult in need of protective services"],["An individual 18 years of age or older who is highly vulnerable to abuse, neglect, self-neglect or exploitation because of a physical or mental impairment, self-neglect or incapacity; has recently been or is being abused, neglected or exploited by another or meets the criteria for self-neglect; and has no one willing and able to provide adequate protection (D.C. Code §7-1901(2))."]],[["Abuse (adult)"],["Under D.C. Code §7-1901(1): the intentional or reckless infliction of serious physical pain or injury; the use or threatened use of violence to force participation in sexual conduct; the repeated, intentional imposition of unreasonable confinement or threats of it, resulting in severe mental distress; 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 the intentional or deliberately indifferent deprivation of essential food, shelter or health care in violation of a caregiver’s responsibilities, when that deprivation is a serious threat to life or physical health."]],[["Neglect (adult)"],["Under D.C. Code §7-1901(9): the repeated, careless infliction of serious physical pain or injury; the repeated failure of a caregiver to take reasonable steps to protect against abuse; the repeated, careless imposition of unreasonable confinement resulting in severe mental distress; or the careless deprivation of essential food, shelter or health care in violation of a caregiver’s responsibilities, when that deprivation is a serious threat to life or physical health."]],[["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))"]],[["Self-neglect"],["The failure of an adult, due to physical or mental impairments or incapacity, to perform essential self-care tasks, including providing essential food, clothing, shelter or medical care; obtaining goods or services needed for physical and mental health, emotional well-being and general safety; or managing financial affairs (D.C. Code §7-1901(13)). A patient’s informed choice to decline treatment, consistent with the goals of hospice care, is not self-neglect."]],[["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))"]],[["Alleged violation (federal)"],["An allegation of mistreatment, neglect, or verbal, mental, sexual or physical abuse, including injuries of unknown source, or misappropriation of patient property by anyone furnishing services on behalf of the hospice (42 CFR §418.52(b)(4)(i))."]],[["Mandatory reporter (child)"],["Under D.C. Code §4-1321.02(a), includes a physician, a registered nurse, a licensed practical nurse, \"An individual involved in the care and treatment of patients\", a social services worker and a mental health professional. In the Agency this covers every clinical staff member and every hospice aide."]],[["Patient"],["A person who has elected hospice care from the Agency. 42 CFR Part 418 says \"patient\" and 29 DCMR §939 says \"beneficiary\"; the two mean the same person here."]],[["Agency"],[{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},", a Medicare-certified hospice serving patients in the District of Columbia. Its Medicare CMS Certification Number (CCN) is ",{"k":"field","name":"agency.licenseNumber","text":"000000"},"; the license number field of the Agency profile holds the CCN because the District issues no hospice license number."]],[["District hospice licensure"],["The District of Columbia does not issue a hospice license. D.C. Code §44-501(a)(8) defines a hospice, but the District has adopted no hospice licensing rules, and D.C. Code §44-502(c) provides that facilities and agencies that were not subject to licensure before February 24, 1984 \"may operate without a license until 6 months after the adoption of applicable rules\". The Agency therefore operates as a Medicare-certified hospice under 42 CFR Part 418, holds a Certificate of Need where D.C. Code §44-406 requires one, and follows the District laws that apply to every hospice. If the District adopts hospice licensing rules, this manual is reviewed at once."]],[["Agency standard"],["A requirement the Agency sets for itself. It is not a District or federal rule, and the policy says so wherever one is used."]]]},"edited":false},{"heading":"4. Policy Statement (D.C. Code §7-1903)","body":["District law requires that 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\" to Adult Protective Services (D.C. Code §7-1903(a)(1)), and that mandatory reporters who know or have reasonable cause to believe a child has been abused or neglected \"Immediately make an oral report\" to CFSA or the Metropolitan Police Department (§4-1321.03(a)(1)). The Agency also ensures that all alleged violations by anyone furnishing services on its behalf \"are reported immediately by hospice employees and contracted staff to the hospice administrator\" (42 CFR §418.52(b)(4)(i)). Every staff member, licensed or not, follows the reporting steps in Section 7."],"edited":false},{"heading":"5. Who Must Report","body":["Table 1 sets out the District and federal duties. The Agency adds one rule for everyone: any staff member who suspects abuse, neglect, self-neglect or exploitation tells the clinical manager or the Administrator at once, and may report directly to APS or CFSA (Agency standard). D.C. Code §7-1903(a)(2) allows \"Any person\" to report voluntarily."],"table":{"caption":["Table 1.  Reporting duties"],"headers":[["Who"],["Duty"],["Authority"]],"rows":[[["Licensed health professionals (physicians, nurses, therapists, licensed social workers, counselors), the Administrator and other health-care administrators, and social workers"],["Report immediately to APS when they have substantial cause to believe an adult is in need of protective services because of abuse, neglect or exploitation by another"],["D.C. Code §7-1903(a)(1)"]],[["Any person, including hospice aides, homemakers, office staff and volunteers"],["May report suspected abuse, neglect, self-neglect or exploitation of an adult; the Agency requires them to tell the Administrator at once and supports them to report"],["D.C. Code §7-1903(a)(2); Agency standard"]],[["Physicians, RNs, LPNs, individuals involved in the care and treatment of patients (including hospice aides), social services workers and mental health professionals"],["Report immediately, orally, to CFSA or the Metropolitan Police Department when they know or have reasonable cause to believe a child they know in their professional capacity has been or is in immediate danger of being abused or is neglected; also immediately notify the person in charge of the institution, which does not relieve them of their own duty"],["D.C. Code §4-1321.02(a), (b)(1), (b)(4); §4-1321.03(a)"]],[["All employees and contracted staff"],["Report all alleged violations involving anyone furnishing services on behalf of the hospice immediately to the hospice administrator"],["42 CFR §418.52(b)(4)(i)"]]]},"note":["The APS reporting duty in §7-1903(a)(1) does not apply to a social worker or licensed health professional who has as a client or patient, or is employed by a lawyer representing, a third person who is allegedly responsible for the abuse or neglect (§7-1903(b)). Staff who think this exception applies ask the Administrator, who makes the report. Child abuse reporting has its own limited exceptions in §4-1321.02(b)(2)-(3), none of which cover hospice staff acting in their work."],"edited":false},{"heading":"6. Recognizing the Signs","body":["Hospice patients are often frail, bedbound and dependent on others, and some signs of abuse can look like the effects of serious illness. Staff report what they see and hear; they do not need proof. Signs include:"],"list":[["Physical: unexplained bruises, burns, fractures or injuries, especially in different stages of healing or in unusual places; injuries that do not match the explanation; signs of restraint."],["Sexual: injury, bleeding or infection in the genital area; fear of a particular person during personal care."],["Emotional: fear, withdrawal or agitation around a particular person; a caregiver who threatens, insults or isolates the patient, or will not let staff see the patient alone."],["Neglect: being left alone without care, untreated pressure injuries, poor hygiene, dehydration or hunger, comfort medications not given as ordered, missing glasses, dentures or hearing aids, unsafe or unsanitary conditions."],["Exploitation: missing money, belongings or medications (including controlled drugs), sudden changes in bank accounts, wills or property, unpaid bills when money should be available, a new \"friend\" taking control of finances."],["Self-neglect: an adult who is unable, because of impairment, to obtain food, shelter, medical care or other essentials, and has no one willing and able to help."],["Children in the home: injuries, lack of supervision, lack of food, or signs that a child is being harmed."]],"ordered":false,"edited":false},{"heading":"7. Reporting Steps","body":[],"list":[["If anyone is in immediate danger, call 911 first, and stay safe."],["Make the patient as safe as you can without putting yourself at risk. Do not confront the person you suspect."],["Tell the clinical manager or the Administrator at once by telephone (after hours, the on-call nurse, who tells the Administrator). If a hospice employee, volunteer or contractor is involved, the Administrator must be told immediately (42 CFR §418.52(b)(4)(i))."],["For an adult: report to ",{"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"},". A licensed health professional, social worker or the Administrator with substantial cause to believe makes the report immediately. Others may report themselves, and the clinical manager or Administrator makes the report if they do not (Agency standard). The report may be oral or written (D.C. Code §7-1903(c))."],["For a child: the mandatory reporter makes an immediate oral report to ",{"k":"field","name":"fixed.childAbuseReportRoute","text":"the Child and Family Services Agency (CFSA) hotline at (202) 671-SAFE (202-671-7233), 24 hours a day, 7 days a week, or the Metropolitan Police Department"},", makes a written report if CFSA or the police ask for one (D.C. Code §4-1321.03(a)), and also tells the Administrator at once (§4-1321.02(b)(4))."],["Give the information you have (Table 2). Do not delay a report to gather more information or to wait for a manager."],["Write down the report on Form DC-HSP-ANE-01-A: what you saw and heard, the date and time, the agency and person you reported to, and any report number. Give the form to the Administrator the same day."],["Document the clinical facts (injuries, the patient’s words in quotation marks, care given) in the clinical record. Do not write opinions, and do not file Form DC-HSP-ANE-01-A in the clinical record."]],"ordered":true,"note":["No one at the Agency may stop, discourage or delay a report, or require a staff member to get permission before reporting (Agency standard). Telling a manager does not replace the reporter’s own legal duty to report."],"edited":false},{"heading":"8. What a Report Includes","body":["Reports include whatever the reporter knows of the items in Table 2. A reporter may be required to give their name only when they are a required reporter under §7-1903(a)(1) (§7-1903(c))."],"table":{"caption":["Table 2.  Report content"],"headers":[["Adult (D.C. Code §7-1903(c))"],["Child (D.C. Code §4-1321.03(b))"]],"rows":[[["The name, age, physical description and location of the adult alleged to be in need of protective services"],["The name, age, sex and address of the child, the child’s siblings and other children in the household, and the child’s parents or other persons responsible for the child’s care"]],[["The name and location of the persons allegedly responsible"],["The nature and extent of the abuse or neglect and any previous abuse or neglect, if known"]],[["The nature and extent of the abuse, neglect, self-neglect or exploitation"],["Any other information that may help establish the cause and the person responsible"]],[["The basis of the reporter’s knowledge, and any other information that might help an investigation"],["For a required reporter: the reporter’s identity and occupation, how to contact them, and the actions they took concerning the child"]]]},"edited":false},{"heading":"9. After the Report","body":[],"list":[["APS receives reports 24 hours a day, 7 days a week (D.C. Code §7-1903(d)(1)). Under §7-1904, where a report alleges an immediate, substantial risk of life-threatening harm, APS notifies the police and an APS worker begins an investigation within 24 hours; for other reports, within 10 days, excluding Saturdays, Sundays and legal holidays. These are APS’s duties, given here so staff know what to expect; the Agency keeps caring for the patient in the meantime."],["If a hospice employee, volunteer or contractor is alleged to be involved, the Administrator starts the investigation and protective steps in Policy DC-HSP-ANE-02 at once."],["If the patient lives in a nursing facility or ICF/IID and the alleged person is unrelated to the hospice, the Administrator also reports to the facility administrator within 24 hours of the hospice becoming aware (42 CFR §418.112(c)(8); Policy DC-HSP-FAC-01)."],["The IDG reviews the plan of care to address safety, caregiver support and any need for a different setting or level of care, and the social worker coordinates with APS or CFSA."],["The Administrator screens the event for an adverse event report (Policy DC-HSP-GOV-04) and makes sure it is logged."],["Staff cooperate with APS, CFSA and the police. Health information may be disclosed for these reports as 45 CFR §164.512(c) allows (Policy DC-HSP-PRV-01)."]],"ordered":false,"edited":false},{"heading":"10. Protecting Reporters","body":["The Agency does not retaliate against anyone who reports in good faith, inside or outside the Agency, and keeps the reporter’s identity confidential to the extent the law allows (Agency standard). Patients have the right to be free from mistreatment, neglect, abuse and misappropriation of property (42 CFR §418.52(c)(6)), and to exercise their rights without reprisal."],"edited":false},{"heading":"11. Responsibilities","body":["Each role named below carries the duties shown."],"table":{"caption":null,"headers":[["Role"],["Responsibility"]],"rows":[[["All staff, volunteers and contracted staff"],["Recognize the signs, call 911 in danger, tell the clinical manager or Administrator at once, and report directly to APS or CFSA when required or when they choose to."]],[["Licensed health professionals and social workers"],["Make the immediate report to APS or CFSA that District law requires of them personally."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Supports staff in reporting, makes the report if a staff member who may report has not, and leads the IDG safety review."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Receives every allegation immediately, starts investigations under Policy DC-HSP-ANE-02, makes facility and adverse event reports, keeps the log and reports to the governing body."]]]},"edited":false},{"heading":"12. Records and Compliance Monitoring","body":["Forms DC-HSP-ANE-01-A and the log of reports (date, type, agency reported to, report number, outcome) are kept by the Administrator, separately from the clinical record, for at least six years (Agency standard). Each quarter the Administrator reviews the log with the QAPI lead to confirm that every report was made immediately and that every allegation involving Agency personnel was investigated, and reports trends to the Quality Management Committee (Policy DC-HSP-QA-01)."],"edited":false},{"heading":"13. Staff Training","body":["At orientation, before any patient contact, and each year, all staff and volunteers are trained on the definitions, the signs in Section 6, the reporting steps, the APS and CFSA numbers, and their own legal duties (Policy DC-HSP-HR-01). Training records are kept in the personnel file."],"edited":false},{"heading":"14. References","body":["This policy implements the following authorities."],"list":[["D.C. Code §7-1901, Definitions (Adult Protective Services)"],["D.C. Code §7-1903, Reports"],["D.C. Code §7-1904, Investigations"],["D.C. Code §4-1321.02, Mandatory reporters"],["D.C. Code §4-1321.03, Reports of neglected children"],["42 CFR §418.52(b)(4)(i), Reporting alleged violations to the hospice administrator"],["42 CFR §418.52(c)(6), Right to be free from mistreatment, neglect and abuse"],["42 CFR §418.112(c)(8), Reports to facility administrators"],["45 CFR §164.512(c), Disclosures about victims of abuse, neglect or domestic violence"]],"ordered":false,"edited":false},{"heading":"15. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form DC-HSP-ANE-01-A"],["Internal Report of Suspected Abuse, Neglect or Exploitation"]],[["Policy DC-HSP-ANE-02"],["Investigation of Alleged Violations and Protection of Patients"]],[["Policy DC-HSP-GOV-04"],["Reporting Adverse Events and Required Notices to DC Health, SHPDA and CMS"]],[["Policy DC-HSP-QA-02"],["Incident Reporting, Internal Investigation and Learning From Adverse Events"]],[["Policy DC-HSP-FAC-01"],["Hospice Care for Residents of Nursing Facilities, ICF/IIDs and Assisted Living Residences"]],[["Policy DC-HSP-PR-01"],["Patient and Family Rights and Responsibilities"]],[["Policy DC-HSP-PRV-01"],["HIPAA Privacy and District Confidentiality Laws"]],[["Policy DC-HSP-SW-01"],["Medical Social Services"]],[["Policy DC-HSP-MED-02"],["Controlled Substances in the Home: Management and Disposal"]],[["Policy DC-HSP-HR-01"],["Orientation, In-Service Training and Competency"]],[["Policy DC-HSP-QA-01"],["Quality Assessment and Performance Improvement and the Quality Management Committee"]]]},"edited":false},{"heading":"16. 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":"17. 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 the References section 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-hospice","state":"Washington, DC","service":"Hospice","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"sample":true,"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}