Recognizing and Reporting Abuse, Neglect and Exploitation 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.

People at the end of life are often frail, dependent on others and isolated. Hospice staff are in homes and facilities often enough to notice when something is wrong. This policy makes sure suspected abuse, neglect and exploitation of adults is reported at once to the people who can investigate and protect the patient.

Any adult the Agency serves or meets in its work: patients, and other vulnerable adults in a patient's home (for example a frail spouse). It covers suspected harm by family members, caregivers, facility staff, Agency staff, strangers, and harm caused by the adult's own inability to respond to a harmful situation (self-neglect).

The following terms have the meanings given below when used in this policy. The definitions in MCL 400.11 are summarized here; the statute governs.

Michigan law requires a person employed, licensed, registered or certified to provide health care, and an employee of an agency licensed to provide health care, "who suspects or has reasonable cause to believe that an adult has been abused, neglected, or exploited shall make immediately, by telephone or otherwise, an oral report to the county department of social services of the county in which the abuse, neglect, or exploitation is suspected of having or believed to have occurred" (MCL 400.11a(1)). The Michigan Medicaid program also requires the hospice to report reasonable cause to suspect that a beneficiary may be in danger of abuse, neglect, exploitation, cruelty or other hazards to the Adult or Child Protective Services unit of the local MDHHS office (Michigan Medicaid Provider Manual, Hospice, Section 6.3). In practice every county's reports are taken by MDHHS Centralized Intake. Every Agency employee is therefore a mandated reporter. Volunteers and contractors who are not covered by the statute are required by the Agency to report in the same way.

Staff do not need proof. Reasonable cause to believe is enough. Signs include:

Caregiver exhaustion can lead to neglect without bad intent. The Agency still reports, and at the same time increases support (social work, aide hours, respite, volunteers).

1. Make the patient safe. If the patient is in immediate danger or a crime is in progress, call 911 first.
2. Report by telephone at once to Centralized Intake: Michigan Department of Health and Human Services (MDHHS) Centralized Intake for Abuse and Neglect, toll-free 855-444-3911, any time day or night. The staff member who suspects makes the call personally, from a private place, before leaving the area if safe or as soon as they reach a safe place, and in any case before the end of the shift. Do not wait for a supervisor or for proof.
3. Tell the information you have: the adult's name and a description of the abuse, neglect or exploitation; if known, the adult's age, the names and addresses of the guardian or next of kin and of the people the adult lives with and their relationship; and any other information that might help establish the cause and manner (MCL 400.11a(4)). Write down the intake worker's name, the date and time, and any reference number.
4. Tell your supervisor and the Administrator, Pat Sample, at (517) 555-0100 (after hours through the on-call line (517) 555-0199) immediately after the call. If the person suspected is anyone furnishing services on behalf of the Agency (an employee, contractor or volunteer), the Administrator must be told immediately and Policy MI-HSP-ANE-02 applies (42 CFR §418.52(b)(4)(i)).
5. Complete Form MI-HSP-ANE-01-A the same day. In the clinical record, write what you saw and heard, in the patient's own words where possible, and that a report was made. Do not write opinions or accuse anyone in the record.
6. Do not investigate on your own, confront the person suspected, or promise the patient that nobody will be told.
7. The interdisciplinary care team reviews the patient's plan of care within one business day (Agency standard) to add protection and support, and works with Adult Protective Services.

• For a patient in a nursing facility or ICF/IID, the Agency also reports all alleged violations involving mistreatment, neglect, verbal, mental, sexual and physical abuse, injuries of unknown source and misappropriation of patient property by anyone unrelated to the hospice to the facility administrator within 24 hours of the Agency becoming aware of it (42 CFR §418.112(c)(8); Policy MI-HSP-FAC-01). This is in addition to the telephone report to Centralized Intake.
• For a patient in an adult foster care home, home for the aged or assisted living residence, the Agency reports to Centralized Intake and tells the home's administrator unless the administrator is the person suspected.
• Abuse of a patient in any Michigan facility that receives Medicaid funds may also be reported to the Department of Attorney General, Health Care Fraud Division (Medicaid Fraud Control Unit), at the 24-hour toll-free number listed in the Michigan Medicaid Provider Manual Directory Appendix (Michigan Medicaid Provider Manual, General Information for Providers, Section 15.4).
• Residents of nursing homes, adult foster care homes and homes for the aged may also be helped by the Michigan Long Term Care Ombudsman Program (advocates for residents in nursing homes, adult foster care homes, and homes for the aged), 866-485-9393. Staff give residents and families this number.

When the Agency discloses information about a patient believed to be a victim of abuse, neglect or domestic violence, it promptly informs the patient that a report has been or will be made, unless the staff member, using professional judgment, believes informing the patient would place the patient at risk of serious harm, or would mean informing a personal representative believed to be responsible for the abuse (45 CFR §164.512(c)(2)). The social worker or nurse does this in a calm and supportive way and records it.

• The identity of a person who makes a report is confidential and may be disclosed only with that person's consent or by judicial process. A person acting in good faith who makes a report is immune from civil liability for making it, and good faith is presumed (MCL 400.11c(1)).
• A privileged communication is not a reason for failing to report, except communications between attorney and client (MCL 400.11c(2)).
• A person required to report who fails to do so is civilly liable for the damages proximately caused by the failure and a civil fine of not more than $500.00 for each failure to report (MCL 400.11e(1)).
• Reporting suspected abuse is a disclosure HIPAA permits (45 CFR §164.512(c)).
• No staff member is disciplined, threatened or treated unfairly for making a report in good faith or for cooperating with an investigation. Failing to report is a serious breach of this policy and leads to discipline.

Accountability under this policy is allocated as follows.

Form MI-HSP-ANE-01-A and the related incident report are administrative records (R 325.45201(1)(c)) kept separately from the clinical record, with restricted access, for at least 7 years (Agency retention schedule). The clinical record shows the facts observed and that a report was made. The Administrator keeps a log of all reports and reviews it each quarter with the QAPI program (Policy MI-HSP-QA-01) for timeliness and trends.

At orientation and every year, every staff member and volunteer is trained on the signs of abuse, neglect, self-neglect and exploitation, their personal duty to report by telephone at once, the Centralized Intake number, what to document, and protection from retaliation. Training uses hospice examples such as medication diversion and caregiver exhaustion.

This policy implements the following authorities.

• MCL 400.11, definitions
• MCL 400.11a, mandatory oral report and report contents
• MCL 400.11c, confidentiality of reporter and good-faith immunity
• MCL 400.11e, civil liability and civil fine for failure to report
• Michigan Medicaid Provider Manual, Hospice, Section 6.3, suspected abuse and neglect
• Michigan Medicaid Provider Manual, General Information for Providers, Section 15.4, patient abuse
• Mich. Admin. Code R 325.45201(1)(c), incident and accident reports
• 42 CFR §418.52(b)(4), reporting alleged violations
• 42 CFR §418.112(c)(8), alleged violations in nursing facilities and ICF/IID
• 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.