Recognizing and Reporting Abuse, Neglect and Exploitation

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.

This policy protects patients and the people around them by making sure that anyone at the Agency who suspects abuse, neglect or exploitation reports it at once to the authority Florida law names, and that the Agency acts to keep the patient safe.

This policy covers suspected abuse, neglect or exploitation of any patient, and of any other vulnerable adult or child staff learn about during their work, in homes, facilities, residential units and inpatient settings. It covers suspected harm by family members, caregivers, facility staff, Agency staff, contractors, volunteers or anyone else.

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

Any person, including any nurse, health professional, social worker or other professional adult care staff, "who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited must immediately report such knowledge or suspicion to the central abuse hotline" (s. 415.1034(1)(a), F.S.). For children, "A person is required to report immediately to the central abuse hotline established in s. 39.101, in writing, through a call to the toll-free telephone number, or through electronic reporting, if he or she knows, or has reasonable cause to suspect" child abuse, abandonment or neglect (s. 39.201(1)(a)1., F.S.). Every patient has the right to be free from mistreatment, neglect, abuse, injuries of unknown source and misappropriation of property (42 CFR §418.52(c)(6)). If the Agency is Medicare-certified, it must ensure 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)). The Agency applies this internal reporting rule to every patient.

Staff do not need proof. "Reasonable cause to suspect" is enough. Signs to watch for include those in Table 1. Some signs, such as weight loss, bruising or skin breakdown, can come from the illness itself; when in doubt, report and let the investigators decide.

The Florida Long-Term Care Ombudsman Program (Florida Long-Term Care Ombudsman Program (Florida Department of Elder Affairs), toll-free 1-888-831-0404) can help residents of nursing homes, assisted living facilities and adult family-care homes, but a call to the ombudsman does not replace the Hotline report.

1. Make sure the patient and others are safe. Call 911 if anyone is in immediate danger. Do not confront the suspected abuser or put yourself at risk (Policy FL-HSP-SAF-01).
2. Call the Florida Abuse Hotline yourself, immediately: as soon as you are safe and before you leave the home or end the visit (Agency standard). If you cannot call from the home, call from your car before driving to the next visit. Online reports are not for urgent cases.
3. Give the Hotline what you know, as s. 415.1034(1)(b), F.S. lists: the name, age, race, sex, physical description and location of each victim; names, addresses and phone numbers of family members; name, address and phone number of each alleged perpetrator and of the caregiver if different; your name, address and phone number; a description of injuries; actions you have taken; and any other information that may show the cause.
4. For a child, a nurse or other health care professional must give his or her name to the Hotline counselor (s. 39.201(1)(b)2., F.S.). Staff give their names for adult reports as well (Agency standard). Reporters’ names are kept confidential by law.
5. Write down the Hotline report number, the date and time and the counselor’s name.
6. Call the Administrator immediately (Table 2), then complete Form FL-HSP-ANE-02-A Part 1 before the end of the shift. The Administrator decides whether Policy FL-HSP-ANE-02 applies and whether a facility administrator must be called.
7. Document objective facts in the clinical record: what you saw, what the patient said in his or her own words, injuries and the care given. Do not write opinions about guilt. If there was an injury or error in treatment, also complete Form FL-HSP-QA-01-A.
8. Tell the supervising nurse, who reviews the plan of care and visit frequency for the patient’s safety and works with the social worker on a safety plan.
9. Cooperate with the Department of Children and Families protective investigator and law enforcement (Policy FL-HSP-ANE-02).

If a patient dies and staff suspect that abuse or neglect caused or contributed to the death, staff call the Hotline and law enforcement, and the Administrator makes sure the death is reported to the medical examiner. A hospice death is reported to the medical examiner "if any unusual or unexpected circumstances are present" (s. 400.6095(9), F.S.; Policy FL-HSP-DTH-01).

• On or before the first day services are provided, the patient and immediate family or representative are told of the right to report abuse, neglect or exploitation, with the words the statute requires: To report abuse, neglect, or exploitation, please call toll-free 1-800-962-2873. (s. 408.810(5)(a)2., F.S.; Policy FL-HSP-PR-01).
• Every admission packet includes Form FL-HSP-ANE-01-A in English and Spanish, and staff explain it in the patient’s language (Policy FL-HSP-PR-04).

• A person who reports under s. 415.1034, F.S. "is presumed to be acting in good faith and, unless lack of good faith is shown by clear and convincing evidence, is immune from any liability, civil or criminal, that otherwise might be incurred or imposed" (s. 415.1036(1), F.S.). Good-faith reports about children are also immune (s. 39.203(1)(a), F.S.).
• The Agency never disciplines, threatens, reassigns or otherwise retaliates against anyone for making a report or taking part in an investigation (s. 415.1036, F.S.; s. 39.203(2), F.S.; s. 448.102, F.S.). A report of retaliation goes straight to the Administrator or the governing body.
• Knowingly and willfully failing to report suspected abuse, neglect or exploitation of a vulnerable adult, or preventing someone else from reporting, is a misdemeanor of the second degree (s. 415.111(1), F.S.). For a child, it is a felony of the third degree (s. 39.205(1), F.S.). Knowingly making a false report is a felony of the third degree (s. 415.111(5), F.S.).
• Staff who fail to report are also subject to discipline up to termination.

Reports to the Hotline, DCF investigators and law enforcement are disclosures required by law and are permitted by HIPAA (45 CFR §164.512(a), (b)(1)(ii), (c)). Staff share only what the report or investigation needs, and do not discuss reports with others who do not need to know (Policy FL-HSP-PRV-01).

Each role named below carries the duties shown.

The following are kept for at least six years (Agency standard):

• The abuse report log: date, patient, type of concern, Hotline report number, reporter, date the Administrator was told, facility notice (if any) and outcome.
• Form FL-HSP-ANE-02-A for each report.
• Clinical record entries (Policy FL-HSP-REC-01).
• Signed acknowledgment by each staff member and volunteer of training on this policy.
• The QAUR/QAPI committee reviews the log each quarter for trends and follow-up (Policy FL-HSP-QA-01).

Before patient contact and every year, every employee, contractor and patient care volunteer is trained on the definitions, signs, the Hotline, the immediate reporting duty, the internal report to the Administrator, protection from retaliation and penalties. Training uses hospice examples such as missing opioids and caregiver burnout, and is recorded in the personnel or volunteer file (Policy FL-HSP-HR-01; Policy FL-HSP-VOL-01).

This policy implements the following authorities.

• s. 39.201, F.S., Required reports of child abuse, abandonment or neglect
• s. 39.203, F.S., Immunity from liability
• s. 39.205, F.S., Penalties relating to reporting of child abuse
• s. 400.6095(9), F.S., Report to the medical examiner
• s. 408.810(5), F.S., Notice of the right to report
• s. 415.102, F.S., Definitions
• s. 415.1034, F.S., Mandatory reporting of abuse, neglect or exploitation of vulnerable adults
• s. 415.1036, F.S., Immunity
• s. 415.111, F.S., Criminal penalties
• s. 448.102, F.S., Private whistleblower protection
• 42 CFR §418.52(b)(4), (c)(6), Patient’s rights
• 42 CFR §418.112(c)(8), Reporting alleged violations to the facility administrator
• 45 CFR §164.512, Disclosures required by law and about victims of abuse, neglect or domestic violence

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 statute or rule cited in the References section is amended, the amendment is recorded in this table and a new version of this policy is issued.