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 helps every person who works for the Agency recognize abuse, neglect and exploitation of patients and their family members, and makes sure that each of them reports it to the right authority within the time Louisiana law allows, and immediately to the Administrator.

This policy covers abuse, neglect, exploitation and misappropriation of property affecting any patient, whoever is responsible (Agency staff, contractors, volunteers, family members, caregivers, facility staff or others), and abuse or neglect of any child or vulnerable adult that staff learn of in the course of their work, in every setting the Agency serves.

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

Every patient has the right to be treated with respect and dignity (LAC 48:I §8231.A.6) and the Agency protects patients from unsafe skilled and unskilled practices and from being harassed, bribed, and/or any form of mistreatment by any employee or volunteer (§8235.D.2.d-e). Under Louisiana law, any registered nurse, licensed practical nurse, nurse’s aide, physical therapist, or any other direct caregiver, and any person engaged in the practice of medicine, social services or facility administration, 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)). Every person who has cause to believe that an adult is being abused, neglected or exploited must report (R.S. 15:1504(A)), and a mandatory reporter “shall immediately report” suspected child abuse or neglect (Ch.C. art. 610(A)). Failure to notify proper authorities of all suspected cases of neglect, criminal activity, or mental or physical abuse which could potentially cause harm to the patient is a ground for revoking the Agency’s license (LAC 48:I §8207.A.5). If the Agency is Medicare-certified, 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 requires all of these.

Staff are often the only outside people who see a dying patient regularly. They look for the signs below at every visit. A sign is not proof; staff report what they see and hear and let the authorities investigate.

Pain, weakness, confusion, skin fragility and weight loss are common at the end of life. When staff cannot tell whether a sign is part of the illness, they report it. The law protects good faith reports; it does not require the reporter to be certain.

• Every nurse, hospice aide, therapist, social worker, physician and other direct caregiver who has knowledge that a patient’s physical or mental health or welfare has been or may be further adversely affected by abuse, neglect or exploitation must report within 24 hours (R.S. 40:2009.20(B)(1)).
• Any person, including a health, mental health or 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 must report under R.S. 15:1504(A). This includes volunteers and office staff.
• Staff who are health practitioners or mental health/social service practitioners are mandatory reporters of suspected child abuse or neglect and must report in accordance with Children’s Code Article 610 (Ch.C. arts. 603, 609(A)(1)(a)). A member of the clergy is not required to report a confidential communication protected under Code of Evidence Article 511, but must then encourage the person to report it (Ch.C. art. 603); the Agency’s spiritual counselors ask the Administrator for guidance in that situation.
• Every staff member and contracted individual also tells the Administrator immediately (42 CFR §418.52(b)(4)(i); Agency standard for all allegations).
• Telling a supervisor or the Administrator does not take the place of the outside report the law requires of each person. The Administrator or the director of nurses may help make the report, and may make it together with the staff member, but the staff member makes sure it is made within the time limit (Agency standard).

Reports of physical or sexual abuse to Adult Protective Services must be made by telephone, not on the online form. Elderly Protective Services also has a line that answers at any hour. The numbers are in the reporting route above and on Form LA-HSP-ANE-01-A.

• Louisiana law requires every report about an adult to contain 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; reports need not name the persons suspected (R.S. 15:1505(A)-(B)).
• Staff also give what they saw and heard, when, the patient’s condition and any injuries, what they did to keep the patient safe, and how to reach them (Agency standard).
• Staff write down the name of the person who took the report, the date and time, and any reference number, and give this to the Administrator for Form LA-HSP-ANE-02-A.
• Staff report facts and quote what the patient or others said. They do not investigate, interview the person suspected, or confront anyone before the report is made.

• Call 911 for any injury needing urgent care or any immediate danger. Stay with the patient if it is safe to do so; if it is not safe, leave and call 911 (Policy LA-HSP-SAF-02).
• Give care the patient needs and the plan of care allows. Do not wash, clean or change anything that may be evidence unless the patient’s comfort or health requires it.
• Tell the registered nurse case manager and the Administrator, who start Policy LA-HSP-ANE-02.
• Document in the clinical record the facts observed, what the patient said in his or her own words, the care given, and that a report was made (date, time and agency). The record does not contain opinions or the reporter’s conclusions.

• A person, other than the person alleged to be responsible, who reports in good faith under R.S. 40:2009.20 has immunity from civil liability that otherwise might be incurred because of the report, extending to any resulting judicial proceeding (R.S. 40:2009.20(C)). A person who in good faith makes a report under R.S. 15:1504 has immunity from civil or criminal liability; the immunity does not extend to, among others, a principal, conspirator or accessory to the abuse or neglect, or a person who makes a report known to be false or with reckless disregard for the truth (R.S. 15:1504(B)).
• Any person who knowingly or willfully violates R.S. 40:2009.20 shall be fined not more than $500 or imprisoned for not more than two months, or both (R.S. 40:2009.20(B)(2)). A person required to report adult abuse or neglect who knowingly and willfully fails to report is guilty of a misdemeanor (fine of not more than $500 or imprisonment for not more than six months, or both) (R.S. 14:403.2(A)). Knowingly making a false report is also a misdemeanor (R.S. 14:403.2(C)).
• Retaliating against a person who reports adult abuse to an adult protection agency or law enforcement, including discharging, demoting, suspending, threatening or harassing a good faith reporter, is a misdemeanor (R.S. 14:403.2(D)). The Agency never retaliates and disciplines anyone who does.
• Violation of the duties of a mandatory reporter of child abuse subjects the offender to criminal prosecution (Ch.C. art. 609(A)(2)).
• Staff who fail to report as this policy requires are disciplined, up to and including termination (Agency standard).

• At admission the admitting clinician gives the patient or representative Form LA-HSP-ANE-01-A, which explains the right to be free from abuse, neglect, exploitation and misappropriation of property and how to report it, and explains it in a language and manner the person understands. A copy stays in the home folder.
• Patients and families are told they may report directly to the Department, Adult Protective Services, Elderly Protective Services or law enforcement at any time, and that the Agency will not treat them differently for doing so.

Each role named below carries the duties shown.

Compliance is monitored as follows:

• Every report is recorded on Form LA-HSP-ANE-02-A with the date and time the staff member learned of the concern, each outside report made (agency, date, time, reference number) and the person who made it.
• The Administrator keeps these records in a confidential file separate from personnel files and clinical records, for at least six years (Agency standard).
• Each quarter the Administrator reports to the QAPI committee the number and type of reports and whether every outside report was made within 24 hours (Agency standard; Policy LA-HSP-QA-01).

Every staff member and volunteer is trained on this policy at orientation and every year, including the signs in Table 1, the reporting routes and time limits in Table 2, the reporter protections and penalties, and practice scenarios (Agency standard). Mandatory reporters of child abuse are offered the training on reporting child abuse and neglect that the Department of Children and Family Services makes available (Ch.C. art. 609(A)(3)).

This policy implements the following authorities.

• LAC 48:I §8207.A.5, license revocation for failure to notify proper authorities
• LAC 48:I §8231.A.6, right to respect and dignity
• LAC 48:I §8235.D.2.d-e, protection of patients from unsafe practices and mistreatment
• R.S. 14:403.2, abuse and neglect of adults (penalties)
• R.S. 15:1504, mandatory reports and immunity
• R.S. 15:1505, contents of report and agency to receive report
• R.S. 40:2009.20, duty to make complaints; penalty; immunity
• Children’s Code arts. 603, 609 and 610, mandatory reporters and reporting procedure
• 42 CFR §418.52(b)(4)(i), reporting alleged violations to the administrator (Medicare-certified hospices)
• 42 CFR §418.52(c)(6), right to be free from mistreatment, neglect, abuse and misappropriation
• 42 CFR §418.112(c)(8), reporting to the facility administrator
• 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 the References section is amended, the amendment is recorded in this table and a new version of this policy is issued.