Recognizing and Reporting Abuse of Elders, Dependent Adults and Children

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.

Hospice staff are in patients' homes and facilities more than almost anyone else. This policy makes sure every staff member can recognize abuse and neglect, knows that California makes them personally responsible for reporting it, and knows exactly where to report and how fast.

This policy covers suspected abuse of any patient and of anyone else staff meet in the course of their work, including children and other adults in the patient's home, whoever the suspected abuser is: family, caregivers, Agency staff, facility staff, other residents or strangers.

The following terms have the meanings given below when used in this policy.

A mandated reporter who, in their professional capacity or within the scope of their employment, observes or has knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse or neglect of an elder or dependent adult, is told of it by the elder or dependent adult, or reasonably suspects it, "shall report the known, suspected, or alleged instance of abuse by telephone or through a confidential internet reporting tool, as authorized by Section 15658, immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an internet report shall be made through the confidential internet reporting tool established in Section 15658, within two working days." (Welf. & Inst. Code §15630(b)(1)). For children, "The mandated reporter shall make an initial report by telephone to the agency immediately or as soon as is practicably possible, and shall prepare and send, fax, or electronically transmit a written followup report within 36 hours of receiving the information concerning the incident." (Penal Code §11166(a)). "The reporting duties under this section are individual, and no supervisor or administrator shall impede or inhibit the reporting duties, and no person making the report shall be subject to any sanction for making the report." (Welf. & Inst. Code §15630(f)). Patients have the right to be free from mistreatment, neglect, abuse, injuries of unknown source and misappropriation of property (42 CFR §418.52(c)(6), if Medicare-certified; Agency standard in any case).

Signs of the dying process (skin mottling, weight loss, bruising from blood thinners or low platelets, skin tears from fragile skin) can look like abuse. When you are not sure, ask the assigned RN, but never let that discussion delay a report you believe you must make. A patient's choice of comfort care, refusal of treatment, or reliance on prayer is not by itself neglect (Welf. & Inst. Code §15610.57(b)(2)).

Anyone in immediate danger: call 911 first, then make the report. If you cannot get through by telephone to report child abuse after reasonable efforts, make a one-time automated written report on the Department of Justice form immediately and be available for a follow-up call (Penal Code §11166(b)). A report about abuse in a facility does not replace the Agency's duty to tell the facility administrator under 42 CFR §418.112(c)(8) (Policy CA-HSP-FAC-01).

1. Make sure the patient (or child) is safe. Call 911 if anyone is in immediate danger. Do not confront the suspected abuser if it is not safe.
2. Make your report yourself, by the route and within the time in Table 2. You do not need anyone's permission.
3. Tell the Administrator (Pat Sample, or after hours the on-call manager) at once. If the suspected abuser is anyone furnishing services on behalf of the Agency (an employee, contractor or volunteer), this internal report is also required by 42 CFR §418.52(b)(4)(i), and Policy CA-HSP-ANE-02 starts. Telling a supervisor is not a substitute for your own report (Penal Code §11166(i)(3)).
4. Complete Form CA-HSP-ANE-01-A the same day: what you saw or were told, when, who you reported to, the date and time, and the report or case number.
5. Make the written report on time (SOC 341 within two working days for an elder or dependent adult if you reported by phone; BCIA 8572 within 36 hours for a child; 24 hours for the written reports in a long-term care facility). Keep a copy for the Agency's file.
6. Document the facts and the care you gave in the clinical record, in plain words, without opinions. Do not write the name of the reporter in the clinical record (Agency standard).
7. The assigned RN updates the plan of care and the social worker offers support to the patient and family. Care continues.
8. The Administrator makes sure any other report needed under Policy CA-HSP-QA-02 is made and, if the patient lives in a facility, that the facility is told as Policy CA-HSP-FAC-01 sets out.

A telephone or internet report of elder or dependent adult abuse includes, if known: your name; the name and age of the elder or dependent adult; their present location; the names and addresses of family members or other adults responsible for their care; the nature and extent of their condition; the date of the incident; and any other information the receiving agency asks for, including what led you to suspect abuse (Welf. & Inst. Code §15630(e)). The written form asks for the reporter's name, address, telephone and occupation; the victim's name and address; the date, time and place; details and observations; statements by the victim; others with knowledge; and those believed responsible and their connection to the victim (§15658(b)).

• Team reports: when two or more mandated reporters know of the same abuse and agree, one of them may make a single report for the team. Anyone who learns that the chosen person did not report must then report (Welf. & Inst. Code §15630(d); Penal Code §11166(h)).
• No one may impede: "no supervisor or administrator shall impede or inhibit the reporting duties" (Welf. & Inst. Code §15630(f)). For child abuse, "An internal policy shall not direct an employee to allow the employee's supervisor to file or process a mandated report under any circumstances," and the Agency may not require an employee to disclose their identity to the Agency (Penal Code §11166(i)(1)-(2)).
• Penalties: failing to report, or impeding or inhibiting a report, of elder or dependent adult abuse is a misdemeanor punishable by up to six months in county jail, a fine of up to $1,000, or both, and more if the abuse results in death or great bodily injury (Welf. & Inst. Code §15630(h)). A mandated reporter who fails to report child abuse or neglect is guilty of a misdemeanor punishable by up to six months in county jail, a fine of $1,000, or both (Penal Code §11166(c)).
• No retaliation: the Agency never disciplines, threatens or retaliates against anyone for making a report or cooperating with an investigation, and protects patients from retaliation by personnel, contractors or volunteers (22 CCR §74880(d)(4)(D)(iii); Policy CA-HSP-ETH-01).
• Clinical judgment exception: a physician, registered nurse or psychotherapist is not required to report an incident a patient describes if all four conditions in Welf. & Inst. Code §15630(b)(3)(A) are met (no independent corroborating evidence; the patient has a diagnosed mental illness or dementia or is under a conservatorship for one; and, in clinical judgment, the clinician reasonably believes the abuse did not occur). A clinician who relies on it records the reasons and discusses it with the DPCS the same day (Agency standard). If there is any doubt, report.

Before starting work, and as a condition of employment, every employee who will be a care custodian or health practitioner signs a statement that they know of Welfare & Institutions Code §15630 and will comply with it; the Agency gives them a copy of §15630 and keeps the signed statement (Welf. & Inst. Code §15659(a)). Every employee who is a mandated reporter of child abuse signs a statement that they know of Penal Code §11166 and will comply, including their reporting obligations and confidentiality rights, and receives copies of Penal Code §§11165.7, 11166 and 11167 (Penal Code §11166.5(a)). The Agency uses one combined statement for both, with this wording: "I understand that I am a mandated reporter under California Welfare and Institutions Code section 15630 and, if I hold a license that makes me one, under Penal Code section 11166. I have received copies of those sections. I will personally report any known or suspected abuse or neglect of an elder, dependent adult or child as those laws require, by telephone or internet immediately or as soon as practicably possible and in writing within the time the law sets. I understand that my supervisor cannot make the report for me, and that failing to report is a crime." The statement is filed in the personnel record (Policy CA-HSP-HR-05). Volunteers sign the same statement (Agency standard).

Each role named below carries the duties shown.

Form CA-HSP-ANE-01-A, copies of written reports and case numbers are kept in a confidential safeguarding file, separate from the clinical record, for at least ten years (Agency standard). Each quarter the Administrator reports to the QAPI program the number of reports, the types, and whether written reports were made on time (Policy CA-HSP-QA-01). Each personnel file audit checks for the signed mandated reporter statement (Policy CA-HSP-HR-05).

All employees, contractors and volunteers are trained at orientation, before their first patient contact, and at least annually (Agency standard) on the signs in Table 1, the routes and time limits in Table 2, and how to use the SOC 341 and BCIA 8572 forms. Management personnel orientation and annual training include criminal misconduct, including investigation and reporting of abuse, neglect and exploitation to law enforcement (22 CCR §74880(d)(4)(C)(v), (e)(1)(C); Policy CA-HSP-HR-01).

This policy implements the following authorities.

• Welfare & Institutions Code §§15610.07, 15610.17, 15610.23, 15610.27, 15610.30, 15610.43, 15610.47, 15610.57, 15610.63, 15630, 15658, 15659
• Penal Code §§11165.6, 11165.7, 11165.9, 11166, 11166.5
• 22 CCR §74880(d)(4)(C)(v), (D)(iii)
• 42 CFR §§418.52(b)(4), (c)(6), 418.112(c)(8) (Medicare-certified hospices)

The following documents are read together with this policy.

This policy is adopted by the governing body of 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.

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.