{"ref":"TX-HSP-ANE-01","title":"Recognizing and Reporting Abuse, Neglect and Exploitation","category":"Safeguarding","own":false,"summary":"Tells every employee, contractor and volunteer how to recognize abuse, neglect and exploitation of a hospice patient and exactly whom to tell: HHSC immediately when Agency staff are suspected, DFPS when someone else is suspected or the patient is self-neglecting, the facility administrator when a resident is harmed by non-hospice staff, and the Administrator every time. Gives every patient a written notice of how to report.","inShort":["If anyone may have abused, neglected or exploited a patient, make the patient safe and tell the Administrator at once.","If Agency staff are suspected, report to HHSC immediately on 1-800-458-9858, never later than 24 hours.","If a family member or anyone else is suspected, or the patient is neglecting themselves, report to DFPS on 1-800-252-5400.","In a nursing facility, harm by facility staff or others is also reported to the facility administrator within 24 hours.","You do not need proof. If you cannot reach the Administrator quickly, make the report yourself. Not reporting is a crime."],"primaryCitation":"26 TAC §558.249","citations":["26 TAC §558.249","Tex. Hum. Res. Code ch. 48","Tex. Hum. Res. Code §48.051","Tex. Hum. Res. Code §48.052","Tex. Hum. Res. Code §48.252(b)","Tex. Fam. Code §261.101","26 TAC §558.282(f)(6)","26 TAC §558.301(a)(9)(K)","26 TAC §558.880(b)(9)","HHSC Provider Letter PL 2023-12"],"federalCitations":["42 CFR §418.52(b)(4)","42 CFR §418.112(c)(8)","45 CFR §164.512(c)"],"surveyorAsks":["Ask an aide: a patient tells you the night caregiver from your agency slapped her. Whom do you call, and how fast?","Ask a nurse: the patient’s son seems to be taking her pain medication. What do you do?","Where is this patient’s signed acknowledgment of your abuse reporting policy?","How do you report a bruise of unknown origin on a nursing facility resident you serve?","Show me your last self-report to HHSC and how long after the Agency learned of it the call was made."],"version":"1.0","effectiveDate":"2026-10-01","reviewDate":"2027-10-01","approvedBy":"Pat Sample, Administrator","forms":[{"ref":"TX-HSP-ANE-01-A","title":"Abuse, Neglect and Exploitation Reporting Notice"}],"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 Hospice, LLC"}]],[["Document owner"],[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}]],[["Authority"],["Adopted under 26 TAC §558.249(b), which requires a written policy on reporting alleged abuse, neglect and exploitation of a client by an agency employee; Tex. Hum. Res. Code §48.051, as amended by H.B. 4696 (88th Legislature), effective September 1, 2023; Tex. Fam. Code §261.101; and, if the Agency is Medicare-certified, 42 CFR §418.52(b)(4) and §418.112(c)(8)."]],[["Applies to"],["Every officer, employee, contractor, volunteer, student and agent of the Agency, in every setting, and every patient of any age and payer."]],[["Status"],["Mandatory. The duty to report is personal and immediate. No one may screen out, delay or talk anyone out of a report."]],[["Not covered here"],["How the Agency investigates and files the HHSC Provider Investigation Report (Policy TX-HSP-ANE-02). Ordinary complaints (Policy TX-HSP-CMP-01)."]],[["Review"],["Reviewed by the document owner at least every ",{"k":"field","name":"settings.reviewFrequencyMonths","text":"12"}," months. HHSC has proposed amending §558.249 and adding a new §558.251 on reporting and training (Texas Register, September 18, 2026); the proposal is not in force and this policy will be revised if it is adopted. Each review is recorded at Section 16."]],[["Amendment"],["Any change requires the approval of the governing body and a new version number. Superseded versions are retained for at least six years."]],[["Distribution"],["Master copy in the policy manual. Every staff member and volunteer receives Sections 5 to 7 at orientation and signs an acknowledgment. Every patient receives Form TX-HSP-ANE-01-A at admission."]],[["Questions"],["Direct to the Administrator on ",{"k":"field","name":"agency.phone","text":"(512) 555-0100"},"; after hours ",{"k":"field","name":"agency.afterHoursPhone","text":"(512) 555-0199"},". Never wait for an answer before making a report."]]]},"edited":false},{"heading":"1. Purpose","body":["Hospice patients are among the most vulnerable people in Texas: often bedbound, confused, unable to speak, and dependent on others for medication and care. Controlled medications in the home create a particular risk of exploitation and diversion. This policy makes sure that everyone at ",{"k":"field","name":"agency.name","text":"Sample Hospice, LLC"}," (the \"Agency\") recognizes abuse, neglect and exploitation and reports it to the right body at once, and that the patient is protected while that happens."],"edited":false},{"heading":"2. Scope","body":["Any act or failure to act, by anyone, that harms or could harm a patient: Agency employees, contractors and volunteers; family members, caregivers, friends and household members; nursing facility, ICF/IID or inpatient facility staff; and the patient’s own self-neglect. It applies at home, in facilities and in the Agency’s inpatient unit if it has one."],"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":[[["Patient"],["A person receiving hospice services. 26 TAC Chapter 558 says \"client\"; the two mean the same person here."]],[["Abuse, neglect and exploitation"],["Have the meanings in the HHSC rules named in 26 TAC §558.249(a)(1): 26 TAC Chapter 711, Subchapter A, where the alleged victim is a child, or an adult receiving services from a provider as defined in Tex. Hum. Res. Code §48.251 (which includes a licensed home and community support services agency); and 40 TAC Chapter 705, Subchapter A, for other adults. In plain terms: abuse is hurting, threatening, confining, humiliating or sexually touching a patient; neglect is failing to give the care, food, medication or supervision a patient needs to avoid harm; exploitation is using a patient’s money, property, medications or identity for someone else’s benefit."]],[["Cause to believe"],["The Agency knows, suspects or receives an allegation regarding abuse, neglect or exploitation (26 TAC §558.249(a)(4)). Proof is not needed."]],[["Employee"],["An officer, an individual directly employed by the Agency, or a contractor, volunteer or agent working under the Agency’s auspices (26 TAC §558.249(a)(6))."]],[["Agent"],["An individual, such as a student or volunteer, not employed by but working under the auspices of the Agency (26 TAC §558.249(a)(3))."]],[["Child; 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; an adult is a patient 18 or older, or under 18 who is or has been married or has had the disabilities of minority removed (26 TAC §558.249(a)(2), (5))."]],[["Alleged violation (Medicare)"],["Mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source, and misappropriation of patient property (42 CFR §418.52(b)(4)(i))."]],[["HHSC CII"],["HHSC Complaint and Incident Intake: ",{"k":"field","name":"fixed.hhscHotline","text":"1-800-458-9858"},"."]]]},"edited":false},{"heading":"4. Policy Statement (26 TAC §558.249; Tex. Hum. Res. Code §48.051)","body":["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)). The Agency adopts and enforces this written policy on reporting alleged abuse, neglect and exploitation of a patient by an Agency employee (26 TAC §558.249(b)).\n\nReporting line when Agency staff are suspected. Texas law requires a person, including an officer, employee, agent, contractor or subcontractor of a licensed home and community support services agency, who has cause to believe that an individual receiving services from the agency is in a state of abuse, neglect or exploitation to report immediately to the Health and Human Services Commission (Tex. Hum. Res. Code §48.051(b-1), effective September 1, 2023). HHSC Provider Letter PL 2023-12 (revised May 22, 2023) directs agencies, from September 1, 2023, to report alleged abuse, neglect or exploitation committed by an employee, volunteer, contractor or subcontractor to HHSC CII, and states that DFPS no longer investigates allegations involving HCSSA providers. The licensing rule still in force, 26 TAC §558.249(c), says that when the Agency has cause to believe a patient has been abused, neglected or exploited by an Agency employee it must report immediately, meaning within 24 hours, to DFPS and to HHSC. The Agency therefore reports to HHSC immediately, and treats 24 hours from the moment the Agency has cause to believe as the outer limit that is never exceeded. Because the statute and HHSC’s letter route these reports to HHSC, and DFPS forwards any such report it receives to HHSC (Tex. Hum. Res. Code §48.252(b)), the Agency does not make a separate DFPS report for staff-perpetrated allegations about an adult, unless HHSC directs otherwise or the rule is amended.\n\nOther perpetrators and self-neglect. A person who has cause to believe an elderly person or a person with a disability is in a state of abuse, neglect or exploitation by someone other than Agency staff, or is self-neglecting, reports immediately to DFPS (Tex. Hum. Res. Code §48.051(a); PL 2023-12).\n\nFailing to report is a crime: a person who has cause to believe that 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)). The duty applies without exception to people whose knowledge comes from their employment or whose communications are otherwise confidential, including medical practitioners, social workers and clergy (Tex. Hum. Res. Code §48.051(c)).\n\nIf the Agency is Medicare-certified, every hospice employee and contracted staff member reports every alleged violation, including injuries of unknown source and misappropriation of patient property, immediately to the hospice administrator (42 CFR §418.52(b)(4)(i)). The Agency applies this as its own standard in all cases."],"edited":false},{"heading":"5. Recognizing Abuse, Neglect and Exploitation","body":["Hospice patients often have bruising, skin breakdown, weight loss, confusion and falls because of their illness. Staff do not dismiss a sign because it could be disease-related; they report what they see and hear and let the investigators decide. Watch for:"],"list":[["Physical: unexplained bruises, burns, fractures or marks in the shape of fingers or objects; injuries at different stages of healing; a patient who flinches or is afraid of a caregiver; restraint marks."],["Sexual: injury, bleeding or infection in the genital area; a patient’s report or sudden fear of a particular person."],["Emotional: threats, insults, isolation from friends or the hospice team, a caregiver who will not let the patient speak alone with staff."],["Neglect: a patient left soiled, hungry, thirsty or alone; untreated pressure injuries; medications or oxygen not given; a caregiver who refuses the care the plan of care needs."],["Exploitation and diversion: missing money, valuables or bank cards; sudden changes to a will, deed or bank account; pain medications that run out early or pill counts that do not match; a caregiver asking for more opioids than the patient seems to use."],["Self-neglect: a patient living alone who cannot meet basic needs and refuses help, where this places the patient at risk."]],"ordered":false,"edited":false},{"heading":"6. Who to Report To","body":["Table 1 shows the report each situation needs. More than one row may apply; make every report that applies. In every case, also tell the Administrator at once (Section 7, step 2)."],"table":{"caption":["Table 1.  Reporting routes"],"headers":[["Situation"],["Report to"],["How fast"],["Authority"]],"rows":[[["Anyone in immediate danger or needing emergency medical care"],["911, then the routes below"],["At once"],["—"]],[["Alleged abuse, neglect or exploitation of a patient by an Agency employee, volunteer, contractor or subcontractor (including a family member the Agency employs)"],["HHSC CII: ",{"k":"field","name":"fixed.hhscHotline","text":"1-800-458-9858"},", online through the HHSC TULIP self-reporting portal (txhhs.force.com/TULIP/s/), or ciicomplaints@hhs.texas.gov"],["Immediately; never later than 24 hours after the Agency has cause to believe"],["Tex. Hum. Res. Code §48.051(b-1); PL 2023-12; 26 TAC §558.249(c)"]],[["Alleged abuse, neglect or exploitation of an adult patient by someone other than Agency staff (family member, friend, household member, other caregiver)"],["DFPS Texas Abuse Hotline: ",{"k":"field","name":"fixed.dfpsHotline","text":"1-800-252-5400"}," or txabusehotline.org"],["Immediately"],["Tex. Hum. Res. Code §48.051(a); PL 2023-12"]],[["A patient in a state of self-neglect"],["DFPS: ",{"k":"field","name":"fixed.dfpsHotline","text":"1-800-252-5400"}," or txabusehotline.org"],["Immediately"],["Tex. Hum. Res. Code §48.051(a); PL 2023-12"]],[["A resident of a nursing facility, SNF or ICF/IID harmed or possibly harmed by someone unrelated to the hospice (for example facility staff, another resident or a visitor), including an injury of unknown source or misappropriation"],["The facility administrator, and HHSC CII (",{"k":"field","name":"fixed.hhscHotline","text":"1-800-458-9858"},") as the agency that licenses the facility"],["Facility administrator within 24 hours of the Agency becoming aware; HHSC immediately"],["42 CFR §418.112(c)(8); 26 TAC §558.880(b)(9); Tex. Hum. Res. Code §48.051(b)"]],[["A child patient (under 18) abused or neglected by anyone"],["DFPS: ",{"k":"field","name":"fixed.dfpsHotline","text":"1-800-252-5400"}," or txabusehotline.org (and HHSC CII as well if Agency staff are suspected)"],["Immediately. A professional (for example a nurse) must report 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)"]],[["A crime may have been committed"],["Local law enforcement, in addition to the above"],["As soon as possible"],["—"]]]},"edited":false},{"heading":"7. Procedure","body":[],"list":[["Protect the patient (any staff member, at once). Make the patient safe; call 911 if needed. Do not leave the patient alone with a suspected perpetrator. Do not confront the suspected person or disturb evidence. If controlled medications may be diverted, follow Policy TX-HSP-MED-02 to secure or count them."],["Tell the Administrator (any staff member, at once). Call ",{"k":"field","name":"people.administrator.name","text":"Pat Sample"}," on ",{"k":"field","name":"agency.phone","text":"(512) 555-0100"},", or the alternate, ",{"k":"field","name":"people.alternate.name","text":"Jo Sample"},", or the on-call line ",{"k":"field","name":"agency.afterHoursPhone","text":"(512) 555-0199"},". Give the patient’s name, what you saw or heard, when, and who was involved. This internal report is required for Medicare (42 CFR §418.52(b)(4)(i)) but never replaces the external report."],["Make the external report (Administrator, or the staff member if the Administrator cannot be reached quickly). Use Table 1. If the Administrator or alternate cannot be reached within the hour, the staff member makes the report personally. Anyone may report directly at any time without asking permission."],["Record the report. Write down the date and time of each call or online submission, the intake worker’s name, and the intake or case number, and give them to the Administrator for the incident file."],["Remove the alleged perpetrator. If an Agency employee, contractor or volunteer is alleged, the Administrator removes that person from all patient contact pending the investigation (Policy TX-HSP-ANE-02)."],["Start the investigation. The Administrator starts the internal investigation immediately and completes the HHSC Provider Investigation Report (Form 3613) under Policy TX-HSP-ANE-02."],["Inform the patient. Unless doing so would place the patient at risk of serious harm, or the person who would be told is the suspected abuser, the Administrator informs the patient or representative that a report was made (45 CFR §164.512(c)(2))."],["Update the plan of care. The interdisciplinary group reviews the patient’s safety, caregiver arrangements and medication management, and documents the facts and the care given in the clinical record without opinions."]],"ordered":true,"edited":false},{"heading":"8. Notice to Patients","body":["At admission, each patient and, where applicable, the legally authorized representative receives Form TX-HSP-ANE-01-A, a written statement of this policy explaining how to report abuse, neglect or exploitation directly to HHSC and DFPS. The patient’s signed acknowledgment of receipt is filed in the clinical record (26 TAC §558.301(a)(9)(K)). The form is available in Spanish and is explained in a language the patient understands. HHSC Provider Letter PL 2023-12 asks agencies to educate patients on whom to contact; the notice does that."],"edited":false},{"heading":"9. No Retaliation","body":["The Agency does not retaliate against any person for making a report in good faith or cooperating with an investigation (26 TAC §558.250(e)), and does not reduce or end a patient’s services because a report was made. Any employee who discourages or delays a report is disciplined."],"edited":false},{"heading":"10. Responsibilities","body":["Accountability under this policy is allocated as follows."],"table":{"caption":null,"headers":[["Role"],["Responsibility under this policy"]],"rows":[[["Governing body"],["Adopts this policy; is told of every allegation against Agency staff; appoints an independent investigator if the Administrator is alleged."]],[[{"k":"field","name":"people.administrator.name","text":"Pat Sample"},", ",{"k":"field","name":"people.administrator.title","text":"Administrator"}],["Receives internal reports, makes or confirms the external reports, removes alleged staff from patient contact, starts the investigation, files Form 3613 and keeps the incident file."]],[[{"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 when the Administrator is unavailable."]],[[{"k":"field","name":"people.supervisingNurse.name","text":"Robin Sample, RN"},", ",{"k":"field","name":"people.supervisingNurse.title","text":"Supervising Nurse"}],["Leads clinical protection of the patient, controlled substance checks and plan of care changes."]],[["Every employee, contractor and volunteer"],["Recognizes the signs, protects the patient, tells the Administrator at once, and makes the external report personally if the Administrator cannot be reached quickly."]],[["QAPI Committee"],["Reviews every allegation, the timeliness of reports, and the effectiveness of action (Policy TX-HSP-QA-01)."]]]},"edited":false},{"heading":"11. Records and Compliance Monitoring","body":["The Administrator keeps a confidential incident file for every allegation, separate from the clinical and personnel records, containing the internal report, the date, time and confirmation number of each external report, Form 3613 and its transmission confirmation, and the outcome. The patient’s signed Form TX-HSP-ANE-01-A is filed in the clinical record. Staff acknowledgments are filed in personnel records. The QAPI Committee audits, at each meeting, the time from first knowledge to external report for every allegation and a sample of new admissions for the signed 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 covers the signs in Section 5, Table 1, the personal duty to report, and the no-retaliation rule. Annual refresher training is the Agency’s own standard. Staff serving facility residents are also trained on the 24-hour report to the facility administrator."],"edited":false},{"heading":"13. References","body":["This policy implements the following authorities."],"list":[["26 Texas Administrative Code §558.249, Self-Reported Incidents of Abuse, Neglect, and Exploitation"],["26 Texas Administrative Code §558.282(f)(6); §558.301(a)(9)(K); §558.880(b)(9)"],["Texas Human Resources Code Chapter 48, including §48.051 (as amended by H.B. 4696, 88th Legislature, effective September 1, 2023), §48.052 and §48.252"],["Texas Family Code §261.101, Persons Required to Report; Time to Report"],["HHSC Long-Term Care Regulation Provider Letter PL 2023-12 (revised May 22, 2023), Revised Process for Reporting Abuse Neglect and Exploitation"],["42 CFR §418.52(b)(4); §418.112(c)(8)"],["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 TX-HSP-ANE-01-A"],["Abuse, Neglect and Exploitation Reporting Notice"]],[["Policy TX-HSP-ANE-02"],["Agency Investigations and Provider Investigation Reports"]],[["Policy TX-HSP-CMP-01"],["Complaints and Grievances"]],[["Policy TX-HSP-FAC-01"],["Hospice Care for Residents of a Nursing Facility or ICF/IID"]],[["Policy TX-HSP-MED-02"],["Controlled Substances in the Home: Management and Disposal"]],[["Policy TX-HSP-PR-01"],["Patient Rights and Responsibilities"]],[["Policy TX-HSP-HR-03"],["Criminal History Checks and Registry Searches"]]]},"edited":false},{"heading":"15. Approval","body":["This policy is adopted by the governing body of ",{"k":"field","name":"agency.name","text":"Sample Hospice, 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-hospice","state":"Texas","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 Hospice","legalName":"Sample Hospice, LLC","logo":null}}