Abuse, Neglect, and Exploitation of Adults: Recognition and Mandatory Reporting

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.

Home health staff are often the only outsiders who see a patient regularly at home. This policy makes sure that everyone at Sample Agency, LLC (the "Agency") knows the signs of abuse, neglect and exploitation, reports them on time to the right agency as Louisiana law requires, protects the patient, and never discourages or punishes a report. Every patient has the right to "be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property" (LAC 48:I §9125.A.2).

This policy covers suspected abuse, neglect, exploitation, extortion, isolation, abandonment, sexual abuse, self-neglect and misappropriation of property of any patient aged 18 or older (and of an emancipated minor), by anyone: family members, caregivers, visitors, other providers, Agency staff or contract staff. It covers recognition, immediate protection, reporting inside and outside the Agency, investigation, actions concerning staff, and documentation.

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

Any registered nurse, licensed practical nurse, nurse's aide, physical therapist or "any 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)). The law does not define "the unit"; the Agency therefore reports to the Louisiana Department of Health or to local law enforcement, and in addition to the adult protection agency. Separately, "Any person ... 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" to any adult protection agency or to any local or state law enforcement agency (R.S. 15:1504(A); R.S. 15:1505(A)).

The Agency protects and promotes each patient's right to be free from abuse, neglect and misappropriation (LAC 48:I §9125.A.2), and never allows a failure to notify an appropriate governmental agency of suspected neglect, criminal activity, or mental or physical abuse; LDH must immediately deny or revoke a license where an agency knowingly and willfully or through gross negligence allowed or directed such a failure (§9111.C.4). No one is subjected to discrimination or reprisal for reporting (§9125.A.11).

If the Agency is Medicare-certified, any staff member who identifies, notices or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual or physical abuse, including injuries of unknown source, or misappropriation of patient property "must report these findings immediately to the HHA and other appropriate authorities in accordance with state law" (42 CFR §484.50(e)(2)), and the Agency investigates, documents and takes action to prevent further violations, including retaliation, while it investigates (§484.50(e)(1)). As the Agency's own standard, these federal duties apply to all patients.

Staff do not need proof. A reasonable suspicion is enough to report. Signs include:

1. Every staff member who has knowledge or cause to believe that a patient has been, or may be further, harmed by abuse, neglect or exploitation must make sure a report reaches an outside agency within 24 hours (R.S. 40:2009.20(B)(1)). If the patient is in danger, call 911 first.
2. If the Agency is Medicare-certified, the staff member reports immediately to the Agency and to the appropriate authorities (42 CFR §484.50(e)(2)). The Agency's own standard for all patients is: tell the clinical manager, Robin Sample, RN, or the registered nurse on call at (225) 555-0199 by telephone at once, and make the outside report as soon as possible, and in every case within 24 hours.
3. The duty to report is personal. Telling a supervisor does not, by itself, meet it. The staff member may make the outside report together with the clinical manager, but the staff member makes sure it is made, and records the report number or the name of the person who took it.
4. No supervisor, manager or owner may stop, delay, screen or change a report, or tell a staff member not to report. Anyone who is pressured not to report reports anyway and tells the Administrator, or the governing body if the pressure came from the Administrator.
5. Staff report even if the patient asks them not to, even if a family member promises to deal with it, and even if they are not sure. The receiving agency decides whether to investigate.

Reporting routes for adults: 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.

When the Agency reports under R.S. 40:2009.20, it reports to the Louisiana Department of Health or local law enforcement and also to the adult protection agency for the patient's age, so that both duties are met with one set of calls. A report made in line with this policy is a disclosure required by law and is allowed under HIPAA (45 CFR §164.512(c); Policy LA-HH-PRV-01).

• Every report contains the name and address of the adult, the name and address of the person responsible for the care of the adult, if available, and any other pertinent information (R.S. 15:1505(B)).
• A report need not name the persons suspected (R.S. 15:1505(A)), but staff give any names they know.
• Other pertinent information includes: what the staff member saw or heard, when, the patient's own words, injuries observed, the patient's condition and needs, any immediate danger, and how the reporter can be reached.
• The staff member writes down the date and time of the report, the agency and person reached, and any report or intake number, and gives these to the clinical manager the same day.

• Make sure the patient is safe. If the patient is in immediate danger, call 911 and stay with the patient if it is safe to do so.
• Give or arrange needed care and tell the patient's authorized healthcare provider about injuries or changes in condition (Policy LA-HH-QA-02).
• Do not confront or accuse the suspected person, and do not promise the patient secrecy.
• Do not wash, move or throw away anything that may be evidence unless the patient's safety or care requires it.
• Record the facts in the clinical record: what was seen and heard, the patient's words in quotation marks, injuries (size, color and location), care given, and who was told. Do not write opinions or conclusions about guilt (Policy LA-HH-REC-01).
• The clinical manager reviews the plan of care and visit schedule the same day and adds visits, a social work referral or other services where needed, with the patient's agreement.

• The clinical manager removes the accused employee or contract staff member from all patient care at once, pending the investigation, as the Agency's own standard. The person is not assigned to any patient until the Administrator decides.
• The Administrator decides on any further action (for example paid or unpaid leave) in line with the personnel policies (Policy LA-HH-HR-01), without waiting for the outside agency's result where the evidence supports action.
• If the allegation is substantiated, the Agency takes disciplinary action up to termination, and the clinical manager refers licensed staff to their licensing board and impaired personnel to the proper authorities (LAC 48:I §9103.B.2.f).
• If a finding of abuse, neglect, exploitation, extortion or misappropriation is placed against a non-licensed staff member on the Direct Service Worker Registry or the Certified Nurse Aide Registry, that person may not continue employment as a non-licensed person with the Agency (§9120.B.2; Policy LA-HH-HR-04).
• The accused person is told of the allegation in general terms, is not given the name of the reporter, and is reminded that retaliation is prohibited.

• The clinical manager opens an internal investigation the same day, using the Internal Report of Suspected Abuse, Neglect, or Exploitation (Form LA-HH-SG-01-A). If the clinical manager is involved, the Administrator investigates; if the Administrator is involved, the governing body names the investigator.
• The internal investigation never replaces or delays the outside report, and it is coordinated so that it does not interfere with an investigation by an adult protection agency, LDH or law enforcement.
• The investigator interviews the reporter and witnesses, reviews the clinical record, schedules, EVV data and visit notes, and records findings and actions on Form LA-HH-SG-01-A. As the Agency's own standard, the investigation is completed within five business days unless an outside agency asks the Agency to wait.
• The Agency documents both the existence of the allegation and its resolution, and takes action to prevent further potential violations, including retaliation, while it investigates (42 CFR §484.50(e)(1)(ii) and (iii); Agency standard for all patients).
• The Administrator informs the governing body in writing of every allegation against Agency staff and of its outcome (LAC 48:I §9102.B.3.c; Policy LA-HH-GOV-01). Allegations and outcomes are reported, without names, to the QAPI program (Policy LA-HH-QA-01).

Accountability under this policy is allocated as follows.

The clinical manager keeps each completed Form LA-HH-SG-01-A, with the outside report details, investigation notes, findings and actions, in a confidential safeguarding file separate from the clinical record, for at least six years as the Agency's own standard. Facts and care are recorded in the clinical record. Each quarter the Administrator reviews every report for timeliness (outside report within 24 hours; internal investigation within five business days) and reports the results, without names, to the QAPI program. Any late report is investigated as a serious incident.

Every staff member is trained on this policy at orientation, before the first patient visit, and every year, as the Agency's own standard (Policy LA-HH-HR-01). Home health aides also cover it in their in-service hours (Policy LA-HH-AID-01). Training covers the definitions and signs, the 24-hour rule, who to call for each age group, what to say, protecting the patient and evidence, documentation, and protection from retaliation. Each person signs that they understand that the duty to report is personal. Staff carry the reporting numbers on a card or in the Agency's mobile application.

This policy implements the following authorities.

• R.S. 40:2009.20, Duty to make complaints; penalty; immunity
• R.S. 15:1503, Adult protective services: definitions
• R.S. 15:1504, Mandatory reports and immunity
• R.S. 15:1505, Contents of report and agency to receive report
• R.S. 14:403.2, Abuse and neglect of adults (failure to report; false reports; retaliation)
• LAC 48:I §9101, Definitions (Abuse; Misappropriation; Neglect)
• LAC 48:I §9103.B.2.f, Clinical manager refers impaired personnel and performs complaint investigations
• LAC 48:I §9111.C.4, Failure to notify as a ground for immediate denial or revocation
• LAC 48:I §9120.B, Registry findings and continued employment
• LAC 48:I §9125.A.2 and A.11, Freedom from abuse; freedom from reprisal
• 42 CFR §484.50(e), Investigation of complaints and reporting of mistreatment (if Medicare-certified)
• 45 CFR §164.512(c), Disclosures 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 rule cited in Section 16 is amended, the amendment is recorded in this table and a new version of this policy is issued.