Recognizing and Reporting Abuse, Neglect, Exploitation, and Extortion of Adults

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 clients from abuse, neglect, exploitation, extortion and misappropriation by making sure every staff member knows the signs, acts to keep the client safe, and reports to the right authority on time, every time.

This policy applies to suspected harm to any adult client of Sample Agency, LLC, and to any other adult the staff member learns about through work, whoever the suspected abuser is: an Agency employee, a family member, another client, a visitor, a stranger, or the client’s own circumstances.

For the purposes of this policy:

The Agency does not tolerate abuse, neglect, exploitation, extortion or misappropriation of any client by anyone. The Agency has policies and procedures for reporting abuse, neglect, extortion and exploitation of clients under R.S. 15:1504 to 1505 and R.S. 40:2009.20, and makes sure staff comply with them (LAC 48:I.5053.E). All employees, contracted or directly employed, report any and all incidents of abuse or mistreatment or misappropriation of client funds, whoever commits them (LAC 48:I.5029.C.5).

"Any person, including but not limited to a health, mental health, and social service practitioner, having cause to believe that an adult's physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall report in accordance with R.S. 15:1505." (R.S. 15:1504(A))

Any home- and community-based service provider employee or worker, personal care attendant, respite worker or other direct caregiver "having knowledge that a consumer's physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall, within twenty-four hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect." (R.S. 40:2009.20(B)(1))

1. Make the client safe. "If the beneficiary needs emergency assistance, the worker must call 911 or the local law enforcement agency before contacting the supervisor." (Medicaid Services Manual, Chapter 30, §30.9) The Agency applies this to every client.
2. Stay with the client if it is safe to do so. Do not confront the suspected abuser, and do not investigate or question the client in detail: listen, and write down the client’s own words.
3. Preserve evidence. Do not clean, move or throw away anything related to the event unless needed for the client’s safety or care.
4. Tell your supervisor or the on-call supervisor on the date of discovery (LAC 48:I.5055.G.7). For LT-PCS clients, staff report to the on-duty supervisor immediately (Medicaid Services Manual, Chapter 30, §30.9); the Agency applies "immediately" to every client.
5. Make the report to the authority yourself, as soon as possible and in any case within 24 hours (R.S. 40:2009.20(B)(1)), using Section 7. "Reporting to a supervisor only, does not satisfy the legal requirement to report." (Medicaid Services Manual, Chapter 30, §30.9) A supervisor may help you make the call, but no one may stop you or tell you not to report.
6. Complete Form LA-HC-ANE-01-A before the end of your shift (the Agency’s own standard).

Report to the authority that fits the situation. When in doubt, report to more than one. The full route is: For an adult aged 18 to 59 with a disability, or an emancipated minor: Adult Protective Services, Louisiana Department of Health, 1-800-898-4910, 24 hours a day, 7 days a week, or the online form at https://redcap.link/APS_Online_Reporting_Form (reports of physical or sexual abuse must be made by phone). For an adult aged 60 or older: Elderly Protective Services, Governor's Office of Elderly Affairs, 1-833-577-6532 (Monday to Friday, 8:00 a.m. to 4:30 p.m.) or 1-844-945-2377 (1-844-94LAEPS) at any hour. A report may also be made to any local or state law enforcement agency. If the person is in immediate danger, call 911 first.

• The name and address of the client, the name and address of the person responsible for the client’s care if available, and any other pertinent information (R.S. 15:1505(B)): what you saw or were told, when and where, the client’s condition, and what you did.
• Reports "need not name the persons suspected of the alleged abuse or neglect" (R.S. 15:1505(A)). Give names if you know them.
• Write down the date and time of the call, the agency called, the name of the person who took the report and any reference number, on Form LA-HC-ANE-01-A.
• Disclosing client information in a report the law requires is permitted under HIPAA (45 CFR §164.512(c)); limit it to what the report needs.

• The supervisor makes sure the client is safe and that a report or referral has been made to the appropriate entity in a timely manner (Medicaid Services Manual, Chapter 30, §30.9). If the worker has not reported, the supervisor reports at once and still documents the worker’s duty.
• The supervisor tells the Administrator the same day. If the Administrator is unavailable, the supervisor tells the designee, Jo Sample.
• As the Agency’s own standard, the Administrator makes sure LDH (Health Standards Section) is told within 24 hours of any allegation that involves Agency staff, and, for a waiver participant, that the support coordinator is told and the critical incident is entered (Policy LA-HC-INC-01).
• As the Agency’s own standard, the Administrator tells the client’s legal representative or family the same day, unless that person is suspected, and arranges any medical care the client needs.
• The Administrator cooperates fully with APS, EPS, HSS and law enforcement, gives them access to records and staff, and does not interfere with their investigation.

• For OAAS waiver participants: "If the allegation involves provider staff, any accused staff cannot serve or have access to the participant until the investigation is completed." (OAAS-PC-21-004)
• As the Agency’s own standard, the same applies to every client: an accused employee or contractor is removed at once from contact with the client and, until the Administrator decides otherwise, from all client contact, pending the investigation.
• The client’s services continue with a back-up worker under the client’s back-up staffing plan (Policy LA-HC-SP-02).
• If client money or property may be involved, the supervisor secures the client’s funds records and receipts (Policy LA-HC-CR-03).

• As the Agency’s own standard, the Administrator or a person the Administrator assigns, who is not involved in the allegation, starts an internal review within 24 hours, without interfering with any outside investigation.
• The review gathers written statements from the reporter, witnesses and the accused person, the client’s account where the client is willing, schedules, EVV records, progress notes and any physical evidence, and is completed in writing.
• Findings, actions taken and changes to prevent recurrence are recorded on Form LA-HC-ANE-01-A. Substantiated misconduct leads to discipline up to termination (Policy LA-HC-HR-04).
• The Agency gives the client and the representative the outcome in a way that respects the privacy of others, and updates the ISP and back-up plan where needed.
• Every allegation is reviewed by the quality enhancement committee in the next quarterly review (LAC 48:I.5061.B.1.c; Policy LA-HC-QE-01).

• A person required to report under R.S. 15:1504(A) who knowingly and willfully fails to report is guilty of a misdemeanor and may be fined up to $500, imprisoned for up to six months, or both (R.S. 14:403.2(A)). A person who knowingly or willfully violates R.S. 40:2009.20 may be fined up to $500, imprisoned for up to two months, or both (R.S. 40:2009.20(B)(2)).
• Abuse, neglect, exploitation, extortion or misappropriation of an individual being supported is prohibited direct service worker conduct (LAC 48:I.9273). When LDH substantiates an allegation, it notifies the worker, who may request an informal dispute resolution within 15 calendar days after delivery of the notice of violation, and an administrative hearing within 30 calendar days after delivery of the notice of violation or of the informal dispute resolution results (LAC 48:I.9277.A.1; §9285.A). A finding placed on the Direct Service Worker Registry bars employment as a direct service worker for the time stated, up to permanently, and a finding of abuse, extortion, misappropriation or exploitation cannot be removed (LAC 48:I.9285.D, E.6).
• The Agency’s license may be revoked for failure to protect a client from a harmful act of an employee, including abuse, neglect, exploitation or extortion, and for failure to notify the proper authorities of suspected cases (LAC 48:I.5021.D.5, D.6).

• A person who reports in good faith, cooperates in an investigation or takes part in related court proceedings has immunity from civil or criminal liability, except a person alleged to be a principal, conspirator or accessory, or a person who makes a report known to be false or with reckless disregard for the truth (R.S. 15:1504(B)). A good-faith reporter under R.S. 40:2009.20, other than the person alleged to be responsible, has immunity from civil liability (R.S. 40:2009.20(C)).
• Retaliating against a person who reports adult abuse, by discharging, demoting or suspending an employee who reports, or threatening, harassing or discriminating against the reporter, is a misdemeanor when the report is made in good faith (R.S. 14:403.2(D)). The Agency never retaliates, and treats retaliation by any staff member as serious misconduct.
• Knowingly making a false report is also a misdemeanor (R.S. 14:403.2(C)).

• Criminal history, registry and exclusion checks before hire and monthly registry checks (Policies LA-HC-HR-02 and LA-HC-HR-03).
• Training on detecting and reporting suspected abuse and neglect, using the department’s approved training curriculum, before a worker provides care (LAC 48:I.5055.H.1.e; Policy LA-HC-TRN-01), and yearly refreshers (Policy LA-HC-TRN-02).
• Unannounced supervisory visits and quarterly home visits that ask the client about satisfaction and safety (Policy LA-HC-SUP-01).
• Controls on client money and property (Policy LA-HC-CR-03), professional boundaries and the ban on photographs and social media posts about clients (Policy LA-HC-ETH-01), and the ban on restraints, seclusion and punishment (Policy LA-HC-SVC-04).

Accountability under this policy is allocated as follows.

Each Form LA-HC-ANE-01-A, with the internal review, is kept in a confidential investigations file, with a reference in the client record, for at least six years (the Agency’s own standard, matching LAC 48:I.5057.B). An abuse, neglect and exploitation log records every allegation, the date of discovery, the date and route of each report, protective action and outcome. The quality enhancement committee reviews the log each quarter (LAC 48:I.5061.B.1.c).

Every direct care worker completes training on detecting and reporting suspected abuse and neglect, using the department’s approved training curriculum, and on reporting critical incidents, as part of the 16 hours of training before providing care (LAC 48:I.5055.H.1.e, f). As the Agency’s own standard, every staff member, including office staff, is trained on this policy at orientation and every year, and signs that he or she knows the reporting numbers.

This policy implements the following authorities.

• La. R.S. 15:1504 and 15:1505 (Adult Protective Services: mandatory reports, immunity, contents of report)
• La. R.S. 40:2009.20 (duty of direct caregivers to report within 24 hours; penalty; immunity)
• La. R.S. 14:403.2 (failure to report; false reports; retaliation)
• LAC 48:I.5003; 5021.D.5, D.6; 5029.B.9, C.5; 5053.E; 5055.G.7, H.1.e, H.1.f; 5061.B.1.c
• LAC 48:I.9201, 9273, 9275, 9277, 9285 (Direct Service Worker Registry)
• Medicaid Services Manual, Chapter 30, Personal Care Services, §30.9
• OAAS-PC-21-004, Direct Service Provider Critical Incident Report Guide (September 29, 2021)
• 45 CFR §164.512(c)

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 Section 18 is amended, the amendment is recorded in this table and a new version of this policy is issued.