{"ref":"TX-HH-SG-01","title":"Abuse, Neglect, and Exploitation: Recognition and Reporting","category":"Safeguarding","own":false,"summary":"Teaches every staff member to recognize abuse, neglect, exploitation, injuries of unknown source, and misappropriation of patient property, and to report: abuse, neglect, or exploitation by Agency staff to HHSC immediately and never later than 24 hours; abuse, neglect, or exploitation by anyone else, or self-neglect, to DFPS immediately; suspected child abuse or neglect to DFPS immediately, and by licensed professionals no later than the 24th hour. Reporting is a personal legal duty that cannot be passed to a supervisor.","inShort":["Abuse, neglect, or exploitation by anyone who works for us: call HHSC on 1-800-458-9858 immediately, never later than 24 hours.","By a family member or anyone else, or self-neglect: call DFPS on 1-800-252-5400 immediately.","Make the patient safe first. Call 911 if they are in danger.","You must make the report yourself. Telling your supervisor is not enough, but tell the office too.","You do not need proof. Reporting in good faith is protected by law."],"primaryCitation":"Tex. Hum. Res. Code §48.051","citations":["Tex. Hum. Res. Code §48.051","Tex. Hum. Res. Code §48.052","Tex. Hum. Res. Code §48.053","Tex. Hum. Res. Code §48.054","Tex. Fam. Code §261.101","Tex. Health & Safety Code §142.018","26 TAC §558.249","26 TAC §558.250","26 TAC §558.282(f)(6)","26 TAC §558.301(a)(9)(K)"],"federalCitations":["42 CFR §484.50(c)(2)","42 CFR §484.50(e)(2)","45 CFR §164.512(c)"],"surveyorAsks":["If an aide sees bruises on a patient and the daughter says he fell, what does the aide do, and whom does she call?","Where would you report an allegation that your own nurse took a patient’s pain medication? And an allegation against the patient’s son?","Show me this patient’s acknowledgment that he received your abuse reporting policy.","Can a staff member wait until the Administrator decides whether the allegation is credible?"],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"TX-HH-SG-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 Home Health Agency, LLC"}]],[["Document owner"],[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}]],[["Authority"],["Adopted under Tex. Hum. Res. Code §48.051, which requires any person with cause to believe that an individual is in a state of abuse, neglect, or exploitation to report immediately, and requires reports about individuals served by a home and community support services agency to be made to HHSC (§48.051(b-1)); Tex. Fam. Code §261.101 (children); Tex. Health & Safety Code §142.018; and 26 TAC §558.249. If the Agency is Medicare-certified (LCHHS), also under 42 CFR §484.50(c)(2) and (e)(2)."]],[["Applies to"],["Every employee, contractor, subcontractor, volunteer, student, officer, and agent of the Agency, in every setting, and every patient regardless of age, diagnosis, or payer."]],[["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"],["The Agency’s own report to HHSC, Form 3613, and the Employee Misconduct Registry process, which are Policy TX-HH-SG-02. The internal investigation, which is Policy TX-HH-QA-02. Complaints that do not involve abuse, neglect, or exploitation, which are Policy TX-HH-CMP-01."]],[["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 at Section 13. Each review is recorded at Section 16 whether or not the text changes."]],[["Amendment"],["Any change requires the approval of the governing body and the issue of a new version number. Superseded versions are retained for five years."]],[["Distribution"],["Master copy held in the policy manual at each licensed location. Every staff member receives Section 6 and the reporting card at orientation. Patients receive Form TX-HH-SG-01-A at the start of care."]],[["Questions"],["Direct to the document owner on ",{"k":"field","name":"agency.phone","text":"(512) 555-0100"}," or ",{"k":"field","name":"agency.email","text":"office@example.com"},"."]]]},"edited":false},{"heading":"1. Purpose","body":["This policy makes sure everyone who works for ",{"k":"field","name":"agency.name","text":"Sample Home Health Agency, LLC"}," (the \"Agency\") can recognize abuse, neglect, and exploitation of a patient and reports it at once to the right state agency. Every patient has the right to be free from abuse, neglect, and exploitation by an Agency employee, volunteer, or contractor (26 TAC §558.282(f)(6)), and, if the Agency is Medicare-certified, to be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect, and misappropriation of property (42 CFR §484.50(c)(2))."],"edited":false},{"heading":"2. Scope","body":["This policy covers abuse, neglect, and exploitation of a patient by anyone: Agency staff, family members, other caregivers, neighbors, or strangers, and self-neglect by a patient who cannot meet their own basic needs. It also covers injuries of unknown source and misappropriation of patient property. It applies to adults and children."],"edited":false},{"heading":"3. Definitions","body":["For the purposes of this policy, the following terms have the meanings below. 26 TAC Chapter 558 says \"client\" and 42 CFR Part 484 says \"patient\"; in this policy the two words mean the same person."],"table":{"caption":null,"headers":[["Term"],["Meaning"]],"rows":[[["Abuse"],["Includes physical, sexual, verbal, mental, and emotional abuse: for example hitting, pushing, rough handling, unreasonable confinement or restraint, threats, intimidation, humiliation, and any sexual contact without consent. The legal definitions are in the rules 26 TAC §558.249(a)(1) adopts (26 TAC Chapter 711 and 40 TAC Chapter 705)."]],[["Neglect"],["Failure to provide the goods or services, including medical services, needed to avoid physical or emotional harm or pain: for example a caregiver withholding food, medicine, hygiene, or needed care, or Agency staff missing care the patient depends on."]],[["Self-neglect"],["A patient’s failure, because of physical or mental limits, to provide for their own basic needs, putting their health or safety at risk."]],[["Exploitation"],["Illegal or improper use of a patient or the patient’s money, property, or identifying information for someone else’s benefit: for example taking money or medication, using a patient’s card, or pressuring a patient for gifts or loans."]],[["Injury of unknown source"],["An injury that no one saw happen and that the patient cannot explain, or that is suspicious because of its location (for example, the inner thigh or face) or the number of injuries seen at one time (42 CFR §484.50(c)(2), (e)(1)(i)(B))."]],[["Misappropriation of property"],["Taking, keeping, or using a patient’s belongings or money without permission."]],[["Cause to believe"],["Knowing, suspecting, or receiving an allegation of abuse, neglect, or exploitation (26 TAC §558.249(a)(4)). Proof is not required."]],[["Employee"],["An officer, an individual directly employed by the Agency, or a contractor, volunteer, or agent working under its auspices (26 TAC §558.249(a)(6))."]],[["Child and adult"],["A child is a patient under 18 who is not and has not been married and has not had the disabilities of minority removed; anyone else is an adult (26 TAC §558.249(a)(2), (5))."]]]},"edited":false},{"heading":"4. Policy Statement (Tex. Hum. Res. Code §48.051)","body":["The Agency does not tolerate abuse, neglect, or exploitation. Any person who has cause to believe that a patient is being, or has been, abused, neglected, or exploited reports it immediately to the state agency in Table 1. The duty is personal: it applies to every person, including those whose communications are otherwise confidential, such as nurses and social workers (Tex. Hum. Res. Code §48.051(c)), and telling a coworker or supervisor does not satisfy it. Staff also report what they found immediately to the Agency (42 CFR §484.50(e)(2)), so the Agency can protect the patient and investigate.\n\nNo one, including the Administrator, decides that an allegation is not credible and need not be reported. Screening or delaying a report for an internal review is a violation of this policy."],"table":{"caption":["Table 1.  Where to report"],"headers":[["Who is suspected"],["Report to"],["When"],["Authority"]],"rows":[[["An Agency employee, contractor, subcontractor, volunteer, or agent (any patient, any age, any payer)"],["HHSC Complaint and Incident Intake: ",{"k":"field","name":"fixed.hhscHotline","text":"1-800-458-9858"},", or online through the HHSC TULIP portal, or ciicomplaints@hhs.texas.gov"],["Immediately, and never later than 24 hours after having cause to believe"],["Tex. Hum. Res. Code §48.051(b-1); Tex. Health & Safety Code §142.018(b); 26 TAC §558.249(c); HHSC PL 2023-12"]],[["Anyone else (family member, other caregiver, neighbor, stranger), or self-neglect, for an adult who is elderly or has a disability"],["DFPS Texas Abuse Hotline: ",{"k":"field","name":"fixed.dfpsHotline","text":"1-800-252-5400"},", or www.txabusehotline.org when no one is in immediate danger"],["Immediately"],["Tex. Hum. Res. Code §48.051(a); HHSC PL 2023-12"]],[["Anyone, where the patient is a child"],["DFPS Texas Abuse Hotline: ",{"k":"field","name":"fixed.dfpsHotline","text":"1-800-252-5400"},". If an Agency employee is suspected, also HHSC as in the first row."],["Immediately. A licensed professional or other professional with direct contact with children reports not later than the 24th hour after first having reasonable cause to believe, and may not delegate the report."],["Tex. Fam. Code §261.101(a)-(b); Tex. Hum. Res. Code §48.051(b-1)"]],[["Anyone, where a crime may have been committed or the patient is in immediate danger"],["911 or local law enforcement, in addition to the report above"],["At once"],["Agency standard"]]]},"note":["HHSC Provider Letter PL 2023-12 tells home and community support services agencies that, from September 1, 2023, abuse, neglect, and exploitation by an agency employee, volunteer, contractor, or subcontractor is reported to HHSC, regardless of payer, and abuse, neglect, or exploitation by anyone else, and self-neglect, is reported to DFPS. If the reporter is unsure which agency to call, they call HHSC on ",{"k":"field","name":"fixed.hhscHotline","text":"1-800-458-9858"}," and follow the intake worker’s direction; a report is never delayed while deciding."],"edited":false},{"heading":"5. Recognizing Warning Signs","body":["Staff in patients’ homes are often the first to notice. Signs include:"],"list":[["Physical: unexplained bruises, burns, cuts, fractures, or marks in different stages of healing; injuries that do not fit the explanation; marks from restraints; pain or bleeding in the genital area."],["Neglect: weight loss, dehydration, untreated pressure injuries, soiled clothing or bedding, missing glasses, hearing aids, or dentures, no food, no heat or cooling, prescriptions not filled."],["Emotional: fear of a particular person, withdrawal, agitation, sudden change in behavior, a caregiver who will not let you see the patient alone."],["Financial: missing money, medication, or belongings; unpaid bills despite enough income; new \"best friends\"; sudden changes to a will, bank account, or power of attorney; a staff member receiving gifts or loans."],["Self-neglect: unsafe or unsanitary living conditions, refusing needed care while unable to understand the risks, hoarding that blocks exits."]],"ordered":false,"edited":false},{"heading":"6. What Every Staff Member Does","body":[],"list":[["Make the patient safe. If the patient is in immediate danger or needs medical care, call 911. Do not leave the patient alone with the person suspected. Do not confront the suspected person."],["Report to the state. Call the number in Table 1 yourself, immediately, and for staff-perpetrated abuse never later than 24 hours. Give the information the intake worker asks for: the patient’s name, age, and address; the name and address of anyone responsible for the patient’s care; the nature and extent of the patient’s condition; how you know; and anything else relevant (Tex. Hum. Res. Code §48.051(d)). Write down the date, time, intake number, and intake worker’s name."],["Tell the Agency immediately. Call the supervising nurse or the Administrator on ",{"k":"field","name":"agency.phone","text":"(512) 555-0100"}," (after hours, ",{"k":"field","name":"agency.afterHoursPhone","text":"(512) 555-0199"},"). If they cannot be reached, call ",{"k":"field","name":"people.alternate.name","text":"Jo Sample"},". Telling the Agency is in addition to, never instead of, your own report."],["Write it down. Complete the Incident Report (Form TX-HH-QA-02-A) the same day with the facts, in the words people used. Document your clinical findings objectively in the clinical record (for example, the size, color, and location of a bruise) without opinions."],["Preserve evidence. Do not clean, move, or throw away anything that may be evidence unless it is needed for the patient’s immediate care."],["Keep it confidential. Discuss the matter only with the Administrator, the supervising nurse, investigators, and law enforcement."]],"ordered":true,"edited":false},{"heading":"7. What the Agency Does","body":[],"list":[["Confirms the state report was made, and makes it if it has not been, immediately and never later than 24 hours (Policy TX-HH-SG-02)."],["For an allegation against Agency staff: starts an investigation immediately, removes the person from all patient contact pending the outcome, and sends Form 3613 to HHSC no later than the 10th day after the report (26 TAC §558.250(b); Policy TX-HH-QA-02)."],["Notifies the patient’s physician or allowed practitioner and, unless that person is suspected, the patient’s representative, and updates the plan of care to protect the patient."],["Tells the patient, or representative, that a report was made, unless doing so would place the patient at risk of serious harm or the person to be told is suspected (45 CFR §164.512(c)(2))."],["Cooperates fully with HHSC, DFPS, and law enforcement."],["Reviews every allegation through QAPI under Policy TX-HH-QA-01."]],"ordered":false,"edited":false},{"heading":"8. Legal Protections and Penalties","body":[],"list":[["A person who reports in good faith is immune from civil or criminal liability for the report (Tex. Hum. Res. Code §48.054)."],["A person who has cause to believe an elderly person or person with a disability has been abused, neglected, or exploited and knowingly fails to report commits a Class A misdemeanor (Tex. Hum. Res. Code §48.052(a))."],["Knowingly or intentionally making a report that the person knows is false or lacks factual foundation is a Class A misdemeanor (Tex. Hum. Res. Code §48.053)."],["The Agency does not retaliate against anyone who reports or cooperates in good faith (26 TAC §558.250(e); Tex. Health & Safety Code §142.0093), and does not reduce, change, or end a patient’s services because a report was made."]],"ordered":false,"edited":false},{"heading":"9. Patient Notice","body":["At the start of care, the admitting clinician gives each patient, and the patient’s representative where applicable, Form TX-HH-SG-01-A, which explains the patient’s right to be free from abuse, neglect, and exploitation and how to report directly to HHSC and DFPS, and files the patient’s signed acknowledgment in the clinical record (26 TAC §558.301(a)(9)(K)). The HHSC and DFPS numbers are also posted in the Agency office."],"edited":false},{"heading":"10. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":["Who is accountable for what"],"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Governing body"],["Adopts this policy; is told of every allegation against the Administrator and appoints the investigator in that case."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Makes sure every report reaches HHSC or DFPS on time; leads the Agency response under Section 7; protects patients; reports to QAPI."]],[[{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", ",{"k":"field","name":"people.alternate.title","text":"Alternate Administrator"}],["Carries out every duty of the Administrator under this policy whenever the Administrator is unavailable."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Takes calls from the field; assesses the patient; notifies the practitioner; revises the plan of care; trains clinicians and aides on warning signs."]],[[{"k":"field","name":"people.alternateSupervisingNurse.name","text":"Casey Sample, RN"},", ",{"k":"field","name":"people.alternateSupervisingNurse.title","text":"Alternate Supervising Nurse"}],["Carries out the supervising nurse’s duties under this policy in the supervising nurse’s absence."]],[["All staff, contractors, and volunteers"],["Recognize warning signs, make the patient safe, report to the state personally and immediately, tell the Agency, and document facts."]]]},"edited":false},{"heading":"11. Records and Compliance Monitoring","body":["Each patient’s acknowledgment of Form TX-HH-SG-01-A is kept in the clinical record (Policy TX-HH-REC-01). Staff acknowledgments of this policy are kept in the personnel record. The Administrator keeps a log of every report (date and time of cause to believe, date and time reported, agency called, intake number) and the confidential file under Policy TX-HH-QA-02. Each quarter, as the Agency’s own standard, the QAPI Committee reviews the log for timeliness and themes and audits a sample of new admissions for the acknowledgment."],"edited":false},{"heading":"12. Staff Training","body":["Every employee, contractor, and volunteer is trained on this policy at orientation, before first patient contact, and signs an acknowledgment; training is repeated annually as the Agency’s own standard. Training covers warning signs, Table 1, the steps in Section 6, and the legal protections and penalties, and uses home health scenarios such as injuries of unknown source found during a visit."],"edited":false},{"heading":"13. References","body":["This policy implements the following authorities."],"list":[["Texas Human Resources Code §48.051, Report; §48.052, Failure to Report; Penalty; §48.053, False Report; Penalty; §48.054, Immunity"],["Texas Family Code §261.101, Persons Required to Report; Time to Report"],["Texas Health and Safety Code §142.018, Reports of Abuse, Exploitation, or Neglect; §142.0093, Retaliation Prohibited"],["26 Texas Administrative Code §558.249, Self-Reported Incidents of Abuse, Neglect, and Exploitation; §558.250, Agency Investigations"],["26 Texas Administrative Code §558.282(f)(6), Client Rights; §558.301(a)(9)(K), Client Records"],["HHSC Provider Letter PL 2023-12, Reporting Abuse, Neglect, and Exploitation for HCSSAs (revised May 22, 2023)"],["42 CFR §484.50(c)(2) and (e)(2), Patient rights"],["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":[[["Policy TX-HH-SG-02"],["Self-Reported Incidents to HHSC"]],[["Policy TX-HH-QA-02"],["Incident Reporting and Agency Investigations"]],[["Policy TX-HH-CMP-01"],["Complaints and Grievances"]],[["Policy TX-HH-PR-01"],["Patient Rights and Responsibilities"]],[["Policy TX-HH-PRV-01"],["HIPAA Privacy and OASIS Confidentiality"]],[["Policy TX-HH-HR-03"],["Background Checks and Verification of Employability"]],[["Policy TX-HH-REC-01"],["Clinical Records: Content, Authentication, Access, and Retention"]],[["Policy TX-HH-QA-01"],["Quality Assessment and Performance Improvement (QAPI)"]],[["Policy TX-HH-AID-02"],["Home Health Aide Assignment and Supervision"]],[["Form TX-HH-SG-01-A"],["How to Report Abuse, Neglect, or Exploitation"]],[["Form TX-HH-QA-02-A"],["Incident Report"]]]},"edited":false},{"heading":"15. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Home Health 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 Section 13 is amended, the amendment is recorded in this table and a new version of this policy is issued."],"edited":false}],"missing":[],"editedCount":0,"pack":"tx-lhhs","state":"Texas","service":"Home health","guides":[{"path":"/guides/abuse-neglect-exploitation-reporting/","h1":"Abuse, neglect and exploitation policies: what each state requires"},{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"sample":true,"agency":{"name":"Sample Home Health Agency","legalName":"Sample Home Health Agency, LLC","logo":null}}