{"ref":"NC-HSP-ANE-01","title":"Recognizing and Reporting Abuse, Neglect and Exploitation of Adults and Children","category":"Safeguarding","own":false,"summary":"Tells every staff member and volunteer how to recognize abuse, neglect (including self-neglect) and exploitation of a disabled adult, and abuse or neglect of a child, and how to report it in North Carolina, where there is no statewide hotline: to the director of the department of social services in the county where the person lives or is present, plus local law enforcement immediately when a child is the victim of a violent offense, sexual offense or misdemeanor child abuse, and always to the Administrator at once.","inShort":["If you suspect abuse, neglect, self-neglect or exploitation of a patient or another vulnerable adult, you must report it. You need reasonable cause, not proof.","Call 911 first if anyone is in danger, then tell the Administrator at once.","Report to the department of social services in the county where the person lives or is staying: (919) 555-0121. North Carolina has no statewide hotline.","Report any suspected abuse or neglect of a child to the county department of social services, and to local law enforcement at once if the child is the victim of a violent or sexual offense.","Do not investigate or confront anyone. Write down the facts and the person's own words.","No one may stop you from reporting, and a good faith report is protected by law."],"primaryCitation":"G.S. 108A-102","citations":["G.S. 108A-101","G.S. 108A-102","G.S. 108A-103(d)","G.S. 7B-101","G.S. 7B-301","G.S. 14-318.6(b)","G.S. 131E-144.3(6)","10A NCAC 13K .0402(b)(14)","10A NCAC 13K .0604(a)"],"federalCitations":["42 CFR §418.52(b)(4)","42 CFR §418.52(c)(6)","42 CFR §418.112(c)(8)","45 CFR §164.512(c)"],"surveyorAsks":["Where would you call if you suspected a patient was being financially exploited by a relative? What is the number for this county?","What information do you give the county department of social services when you report?","What do you do if you think a child in the home is being abused?","How are staff trained on abuse reporting? Show me the training record."],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"NC-HSP-ANE-01-A","title":"How to Report 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 Protection of the Abused, Neglected, or Exploited Disabled Adult Act, G.S. 108A-99 et seq., in particular G.S. 108A-101 (definitions), 108A-102 (duty to report) and 108A-103 (duty of the director); G.S. 7B-301 (duty to report a juvenile who is abused, neglected or dependent) and G.S. 14-318.6 (duty to report crimes against juveniles); G.S. 131E-144.3(6), applied to hospice patients by 10A NCAC 13K .0604(a); and 10A NCAC 13K .0402(b)(14) (patient rights training). If the Agency is Medicare-certified, also 42 CFR §418.52(b)(4) and (c)(6), and §418.112(c)(8) for nursing facility and ICF/IID residents."]],[["Applies to"],["Every employee, contractor and volunteer, in every setting."]],[["Status"],["Mandatory. North Carolina's duty to report applies to every person personally; no supervisor may stop or delay a report."]],[["Not covered here"],["Allegations that an Agency staff member, contractor or volunteer harmed a patient, which are also handled under Policy NC-HSP-ANE-02 (Health Care Personnel Registry). Incident reporting in general (Policy NC-HSP-QA-02)."]],[["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 (Agency standard). 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 (45 CFR §164.530(j))."]],[["Distribution"],["Master copy in the policy manual at ",{"k":"field","name":"agency.address","text":"100 Example Street, Suite 100, Raleigh, North Carolina 27601"},", available to Division of Health Service Regulation surveyors on request (10A NCAC 13K .0301(a)). Each person named in \"Applies to\" reads it at orientation and whenever it changes, and signs the reading log."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(919) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy protects patients, and children and other vulnerable people in the homes the Agency visits, by making sure that everyone working for ",{"k":"field","name":"agency.name","text":"Sample Agency, LLC"}," (the \"Agency\") knows the signs of abuse, neglect and exploitation and reports them to the right place at once."],"edited":false},{"heading":"2. Scope","body":["This policy covers suspected abuse, neglect, self-neglect and exploitation of any adult patient or other disabled adult the staff member encounters through work, and suspected abuse, neglect or dependency of any child, by anyone: a family member, caregiver, neighbor, facility staff, or Agency staff. It applies in homes, nursing facilities, adult care homes, ICF/IID, hospitals and the Agency's own facilities."],"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":[[["Agency"],[{"k":"field","name":"agency.name","text":"Sample Agency, LLC"},", a hospice licensed by the Division of Health Service Regulation under the Hospice Licensure Act (G.S. 131E-200 to 131E-208) and 10A NCAC 13K (license ",{"k":"field","name":"agency.licenseNumber","text":"000000"},"). 10A NCAC 13K .0102(1) defines \"Agency\" as \"a licensed hospice as defined in G.S. 131E-201(3).\""]],[["Abuse (adult)"],["\"the willful infliction of physical pain, injury or mental anguish, unreasonable confinement, or the willful deprivation by a caretaker of services which are necessary to maintain mental and physical health.\" (G.S. 108A-101(a))."]],[["Neglect (adult)"],["G.S. 108A-101(m): neglect \"refers to a disabled adult who is either living alone and not able to provide for himself or herself the services which are necessary to maintain the person's mental or physical health or is not receiving services from the person's caretaker.\" It includes self-neglect by a patient who lives alone."]],[["Exploitation (adult)"],["\"the illegal or improper use of a disabled adult or his resources for another's profit or advantage.\" (G.S. 108A-101(j))."]],[["Caretaker"],["An individual who has the responsibility for the care of the disabled adult as a result of family relationship or who has assumed the responsibility voluntarily or by contract (G.S. 108A-101(b))."]],[["Disabled adult"],["A person 18 or older, or a lawfully emancipated minor, present in North Carolina, who is physically or mentally incapacitated because of the conditions listed in G.S. 108A-101(d), which include mental or physical illness and conditions resulting from advanced age. Many hospice patients meet this definition."]],[["In need of protective services"],["A disabled adult who, because of the incapacity, is unable to perform or obtain essential services for himself or herself and is without able, responsible and willing persons to do so (G.S. 108A-101(e))."]],[["Director"],["The director of the county department of social services in the county in which the person resides or is present, or his representative (G.S. 108A-101(c)). For a child, the director of the department of social services in the county where the juvenile resides or is found (G.S. 7B-301(a))."]],[["Juvenile; abused, neglected or dependent juvenile"],["A child under 18. \"Abused\", \"neglected\" and \"dependent\" have the meanings in G.S. 7B-101."]],[["County department of social services (DSS)"],["North Carolina has no statewide adult protective services or child abuse hotline. Reports go to the county DSS: ",{"k":"field","name":"fixed.abuseReportRoute","text":"the director of the department of social services in the county where the adult lives or is present (G.S. 108A-101(c), 108A-102), orally (by telephone or in person) or in writing; county department of social services contacts are listed at https://www.ncdhhs.gov/divisions/social-services/local-dss-directory, and the NCDHHS Customer Service Center (1-800-662-7030) can help find the right county office. If anyone is in immediate danger, call 911 first."}," The numbers for the counties the Agency serves are ",{"k":"field","name":"agency.localProtectiveServicesPhone","text":"(919) 555-0121"},"; the statewide directory is ",{"k":"field","name":"fixed.localDssDirectory","text":"https://www.ncdhhs.gov/divisions/social-services/local-dss-directory"},"."]],[["Administrator"],[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"},": the director under 10A NCAC 13K .0102(6) (\"the person having administrative responsibility for the operation of the hospice\") and, if the Agency is Medicare-certified, the administrator under 42 CFR §418.100(b). In the Administrator's absence the Alternate Administrator (",{"k":"field","name":"people.alternate.name","text":"Jo Sample"},") acts under the order of authority in Policy NC-HSP-GOV-01."]],[["Agency standard"],["A requirement the Agency sets for itself where no rule sets one, or that goes further than a rule. It is labeled \"(Agency standard)\" so that it is never mistaken for a requirement of the Division, CMS or NC Medicaid."]]]},"edited":false},{"heading":"4. Policy Statement (G.S. 108A-102)","body":["\"Any person having reasonable cause to believe that a disabled adult is in need of protective services shall report such information to the director.\" (G.S. 108A-102(a)). \"Any person or institution who has cause to suspect that any juvenile is abused, neglected, or dependent, as defined by G.S. 7B-101, or has died as the result of maltreatment, shall report the case of that juvenile to the director of the department of social services in the county where the juvenile resides or is found.\" (G.S. 7B-301(a)). Every patient has the right \"To be free of mental and physical abuse, neglect, and exploitation.\" (G.S. 131E-144.3(6), applied by 10A NCAC 13K .0604(a)). If the Agency is Medicare-certified, every patient also has the right to be free from mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source, and misappropriation of patient property (42 CFR §418.52(c)(6)). Every staff member reports suspected abuse, neglect and exploitation as this policy sets out."],"edited":false},{"heading":"5. Recognizing Abuse, Neglect and Exploitation","body":["Staff look for these signs on every visit. One sign is not proof; a pattern, an explanation that does not fit, or a patient's own words are reasons to report. Staff do not need proof, only reasonable cause to believe (adults) or cause to suspect (children)."],"table":{"caption":null,"headers":[["Type"],["Possible signs in hospice care"]],"rows":[[["Physical abuse"],["Bruises, burns, fractures or marks in unusual places or patterns; injuries that do not match the explanation; the patient flinching or afraid of a caregiver; delay in getting care for an injury."]],[["Sexual abuse"],["Bruising or bleeding in the genital area; new sexually transmitted infection; the patient's fear of a particular person during personal care."]],[["Emotional abuse"],["Threats, yelling, humiliation, isolating the patient from visitors or the phone; a patient who is withdrawn or fearful."]],[["Neglect by a caretaker"],["Untreated pressure injuries, soiled bedding, dehydration, missing doses, no food in the home, unsafe conditions, the caregiver refusing to let staff in, comfort medications not given as ordered."]],[["Self-neglect"],["A patient living alone who cannot get food, medications, heat or help and has no one able and willing to help."]],[["Exploitation"],["Missing money, possessions or medications (especially controlled substances); sudden changes to bank accounts, wills or deeds; a new \"friend\" controlling finances; bills unpaid while the caregiver spends the patient's money."]],[["Child abuse or neglect"],["Injuries or fear in a child in the home; a child left without care while adults are absorbed in the patient's dying; a child taking on unsafe caregiving."]]]},"edited":false},{"heading":"5.1 What is not neglect","body":["A patient's informed decision to refuse food, fluids, treatment or a visit, or to die at home, is the patient's right (Policy NC-HSP-PR-01) and is not, by itself, neglect. Expected changes at the end of life, such as weight loss or skin breakdown despite good care, are documented and explained to the family. When staff are unsure, they talk to the social worker or the Director of Nursing at once, and they report if they still have reasonable cause to believe."],"edited":false},{"heading":"6. What to Do","body":[],"list":[["If anyone is in immediate danger, call 911 first."],["Tell the Administrator, or the person acting under the order of authority, at once by telephone. For an alleged violation by anyone furnishing services on behalf of the Agency, this report to the Administrator must be immediate (42 CFR §418.52(b)(4)(i)); the Agency applies the same rule to every suspicion (Agency standard)."],["Report to the county DSS: for an adult, ",{"k":"field","name":"fixed.abuseReportRoute","text":"the director of the department of social services in the county where the adult lives or is present (G.S. 108A-101(c), 108A-102), orally (by telephone or in person) or in writing; county department of social services contacts are listed at https://www.ncdhhs.gov/divisions/social-services/local-dss-directory, and the NCDHHS Customer Service Center (1-800-662-7030) can help find the right county office. If anyone is in immediate danger, call 911 first."},"; for a child, ",{"k":"field","name":"fixed.childAbuseReportRoute","text":"the director of the department of social services in the county where the child lives or is found (G.S. 7B-301), orally, by telephone or in writing; and, when a child has been the victim of a violent offense, a sexual offense or misdemeanor child abuse, the local law enforcement agency in that county, immediately (G.S. 14-318.6)"},". Use the county numbers on the Agency list (",{"k":"field","name":"agency.localProtectiveServicesPhone","text":"(919) 555-0121"},") or ",{"k":"field","name":"fixed.localDssDirectory","text":"https://www.ncdhhs.gov/divisions/social-services/local-dss-directory"},". Report the same day you form the suspicion (Agency standard)."],["If you are 18 or older and you know or should reasonably know that a child is the victim of a violent offense, a sexual offense or misdemeanor child abuse, you \"shall immediately report the case of that juvenile to the appropriate local law enforcement agency in the county where the juvenile resides or is found.\" (G.S. 14-318.6(b)). This is in addition to the DSS report."],["If the patient lives in a nursing facility or ICF/IID and the person suspected is not connected with the Agency, the Agency also reports to the facility administrator within 24 hours of becoming aware (42 CFR §418.112(c)(8), if Medicare-certified; Policy NC-HSP-FAC-01). If a crime is suspected against a resident of a long-term care facility, also follow the 2-hour and 24-hour reports in Policy NC-HSP-QA-02, Section 6."],["If the person suspected is an Agency staff member, contractor or volunteer, also follow Policy NC-HSP-ANE-02 at once."],["Write down the facts on Form NC-HSP-QA-02-A and in the clinical record: what you saw and heard, the patient's own words, the date and time, who you reported to and when, and the name of the person who took the DSS report."]],"ordered":true,"edited":false},{"heading":"6.1 What to tell the county DSS","body":["The report may be made orally or in writing (G.S. 108A-102(b); for children, G.S. 7B-301(a)). For an adult, \"The report shall include the name and address of the disabled adult; the name and address of the disabled adult's caretaker; the age of the disabled adult; the nature and extent of the disabled adult's injury or condition resulting from abuse or neglect; and other pertinent information.\" (G.S. 108A-102(b)). Also tell DSS that the person is a hospice patient, his or her prognosis and care needs, and the name and number of the Agency contact (the social worker or Administrator), so DSS can plan its response with the Agency (Agency standard)."],"edited":false},{"heading":"6.2 Who makes the call","body":["The staff member who has the concern makes sure the report is made. The social worker or the Administrator may make the call together with the staff member, but no one may tell a staff member not to report or to wait. If the county office is closed, call its after-hours number, or 911 or local law enforcement if there is danger (Agency standard). A report made in good faith is protected: anyone who makes a report under G.S. 108A-102, testifies in a judicial proceeding arising from it, or takes part in a required evaluation is immune from civil or criminal liability unless acting in bad faith or with a malicious purpose (G.S. 108A-102(c))."],"edited":false},{"heading":"6.3 What not to do","body":[],"list":[["Do not investigate, interview the patient in detail, or confront the person suspected; DSS and law enforcement investigate."],["Do not promise the patient or family that you will keep it secret; explain kindly that you must tell people who can help."],["Do not move, clean or throw away anything that may be evidence, unless it is needed for the patient's immediate care."],["Do not discuss the report with anyone who does not need to know (Policy NC-HSP-PRV-01). HIPAA permits the disclosure of PHI needed for an abuse report required by law (45 CFR §164.512(c))."]],"ordered":false,"edited":false},{"heading":"7. After the Report","body":["The county director must start an evaluation immediately if the report says the adult is in danger of death, within 24 hours if there is danger of irreparable harm, and within 72 hours otherwise (G.S. 108A-103(d)); this is the county's duty and is given here for information so staff know what to expect. The Agency:"],"list":[["Cooperates with DSS and law enforcement and gives the information they ask for, through the social worker or Administrator."],["Holds an IDT review within one working day to update the care plan for the patient's safety, for example more visits, a different caregiver, inpatient respite or a change of setting (Agency standard)."],["Secures the patient's controlled substances (for example, a lock box or fewer doses in the home) if diversion is suspected (Policy NC-HSP-MED-02)."],["Supports the patient, the family and the staff member who reported; the social worker and clergy member offer support."],["Logs the report in the incident log so the quality program can see trends (Policy NC-HSP-QA-02)."]],"ordered":false,"edited":false},{"heading":"8. Telling Patients and Families How to Report","body":["At admission every patient receives Form NC-HSP-ANE-01-A with the rights notice (Policy NC-HSP-PR-01). It explains, in plain language and in Spanish, that the patient has the right to be free from abuse, neglect and exploitation, how to tell the Agency, and how to report directly to the county DSS, law enforcement and the Division of Health Service Regulation."],"edited":false},{"heading":"9. Failure to Report","body":["Not reporting is serious. Failing to report a juvenile as G.S. 7B-301(a) requires is a Class 1 misdemeanor (G.S. 7B-301(b)). An employee who fails to report, or who discourages or delays another person's report, faces discipline up to termination (Agency standard). No one is disciplined or retaliated against for making a good faith report (42 CFR §418.52(b)(1)(iv))."],"edited":false},{"heading":"10. Responsibilities","body":["Each role named below carries the duties shown."],"table":{"caption":null,"headers":[["Role"],["Responsibility"]],"rows":[[["Every staff member, contractor and volunteer"],["Knows the signs, calls 911 when needed, tells the Administrator at once, makes sure the DSS report (and law enforcement report for a child victim) is made, and documents the facts."]],[["Administrator (",{"k":"field","name":"people.administrator.name","text":"Pat Sample"},")"],["Receives every report, makes sure all reports are made on time, decides whether Policy NC-HSP-ANE-02 applies, and keeps the county DSS list current."]],[["Social worker"],["Helps staff make reports, is the Agency contact for DSS, and supports the patient and family."]],[["Director of Nursing (",{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},")"],["Leads the IDT safety review and changes to the care plan."]],[["Coordinator of Patient Family Volunteers (",{"k":"field","name":"people.volunteerCoordinator.name","text":"Quinn Sample"},")"],["Makes sure volunteers know how to report and supports them when they do."]]]},"edited":false},{"heading":"11. Records and Compliance Monitoring","body":["Each report is documented in the clinical record and in the incident log, with the date and time, the agency and person reported to, and the outcome when known. The Administrator keeps the incident file for at least six years (Agency standard). The quality lead reviews the log each quarter for timely reporting and trends (Policy NC-HSP-QA-02)."],"edited":false},{"heading":"12. Staff Training","body":["All staff and patient family volunteers are trained on this policy at orientation, as part of patient rights training (10A NCAC 13K .0402(b)(14)), and every year (Agency standard), including how to find the county DSS number and practice cases about self-neglect, exploitation and children in the home. Managers and on-call nurses are trained on Sections 6 and 7 before taking call."],"edited":false},{"heading":"13. References","body":["This policy implements the following authorities."],"list":[["G.S. 108A-101, definitions; G.S. 108A-102, duty to report, content of report, immunity; G.S. 108A-103, duty of the director"],["G.S. 7B-101, definitions; G.S. 7B-301, duty to report abuse, neglect, dependency or death due to maltreatment"],["G.S. 14-318.6, duty to report crimes against juveniles"],["G.S. 131E-144.3(6), right to be free of abuse, neglect and exploitation (applied by 10A NCAC 13K .0604(a))"],["10A NCAC 13K .0402(b)(14), patient rights training"],["42 CFR §418.52(b)(4), (c)(6); §418.112(c)(8) (Medicare-certified hospices)"],["45 CFR §164.512(c), disclosures about victims of abuse, neglect or domestic violence"]],"ordered":false,"edited":false},{"heading":"14. Related Policies and Forms","body":["The following documents are read together with this policy."],"table":{"caption":null,"headers":[["Reference"],["Title"]],"rows":[[["Form NC-HSP-ANE-01-A"],["How to Report Abuse, Neglect or Exploitation"]],[["Policy NC-HSP-ANE-02"],["Allegations Against Staff: Health Care Personnel Registry Reports, Investigation and Protection"]],[["Policy NC-HSP-QA-02"],["Incidents, Adverse Events and Reports to the Division"]],[["Policy NC-HSP-PR-01"],["Patient Rights and Responsibilities"]],[["Policy NC-HSP-ADM-02"],["Hospice Care for Children and Concurrent Care"]],[["Policy NC-HSP-SW-01"],["Social Work Services"]],[["Policy NC-HSP-MED-02"],["Controlled Substances, Medications in the Home and Disposal"]],[["Policy NC-HSP-FAC-01"],["Hospice Care for Residents of Nursing Facilities, ICF/IID and Adult Care Homes"]],[["Policy NC-HSP-PRV-01"],["HIPAA Privacy and North Carolina Confidentiality Laws"]],[["Policy NC-HSP-HR-01"],["Orientation, Hospice Training and In-Service Education"]]]},"edited":false},{"heading":"15. 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":"16. 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":"nc-hospice","state":"North Carolina","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}}