Abuse, Neglect, and Exploitation of Disabled Adults: Recognition and Reporting to the County Department of Social Services

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 the adults Sample Agency, LLC serves from abuse, neglect and exploitation by making sure staff recognize the signs and make the report North Carolina law requires, quickly and to the right place. Every home care client has the right "To be free of mental and physical abuse, neglect, and exploitation." (G.S. 131E-144.3(6)).

This policy covers suspected abuse, neglect, including self-neglect, and exploitation of any adult patient, and of any other disabled adult staff come across in the course of their work, whoever the suspected person is: a family member, a caregiver, a stranger, or Agency staff.

For the purposes of this policy, the following terms have the meanings below. 10A NCAC 13J and the Home Care Clients’ Bill of Rights (G.S. 131E-144.1 to 131E-144.7) say "client"; 42 CFR Part 484 says "patient". This policy says "patient", and the two words mean the same person here.

"Any person having reasonable cause to believe that a disabled adult is in need of protective services shall report such information to the director." (G.S. 108A-102(a)). The duty belongs to each person who has the reasonable cause. A staff member does not need proof, does not need a supervisor’s permission, and may not be stopped from reporting. Under 42 CFR §484.50(e)(2), staff who identify, notice or recognize mistreatment, neglect, abuse, including injuries of unknown source, or misappropriation of patient property must report it "immediately to the HHA and other appropriate authorities in accordance with state law."

The statute sets no hour limit for the report. The Agency’s standard is that the report to the county department of social services is made immediately, and before the end of the shift in which the staff member forms the belief. If anyone is in immediate danger, staff call 911 first.

Staff watch for the signs in Table 1 at every visit. One sign is not proof, but it is a reason to look further and, where there is reasonable cause, to report.

1. If anyone is in immediate danger, call 911.
2. Stay calm, listen, and do not promise to keep a secret. Do not question the patient in detail, confront the suspected person, or investigate. The county department of social services evaluates the report.
3. Report to the director of the department of social services in the county where the adult lives or is present (G.S. 108A-101(c), 108A-102), orally (by telephone or in person) or in writing; county department of social services contacts are listed at https://www.ncdhhs.gov/divisions/social-services/local-dss-directory, and the NCDHHS Customer Service Center (1-800-662-7030) can help find the right county office. If anyone is in immediate danger, call 911 first. The adult protective services number the Agency uses most, for the county where its office is, is (919) 555-0121. County numbers for every county the Agency serves are posted in the office and in the on-call binder.
4. Give the information G.S. 108A-102(b) asks for (Section 7). The report may be made by telephone, in person or in writing.
5. Write down the date and time of the report, the name of the person you spoke to, and any reference number.
6. Tell the supervising nurse or on-call nurse the same day. Telling a supervisor does not replace your own report; if your supervisor makes the report with you, both names are recorded.
7. If the suspected person is an Agency employee or contractor, also follow Policy NC-HH-SG-02 at once: the Agency must report to Health Care Personnel Investigations within 24 hours.
8. If you also believe a crime has been committed, the supervising nurse or agency director reports it to local law enforcement.

"The report may be made orally or in writing. The report shall include the name and address of the disabled adult; the name and address of the disabled adult's caretaker; the age of the disabled adult; the nature and extent of the disabled adult's injury or condition resulting from abuse or neglect; and other pertinent information." (G.S. 108A-102(b)). Staff give what they know; missing information is not a reason to delay.

• The staff member documents in the clinical record what was seen and heard (in the patient’s own words where possible), the date and time, the report made, to whom, and the reference number. Opinions and accusations are not written in the record.
• The supervising nurse makes sure the plan of care addresses the patient’s safety, tells the physician or allowed practitioner where appropriate, and cooperates with the county department’s evaluation, sharing the information the evaluation needs (45 CFR §164.512(c)).
• Under HIPAA, the Agency promptly tells the patient that a report has been made unless the supervising nurse believes that would place the patient at risk of serious harm, or would mean telling a personal representative the Agency reasonably believes is responsible for the abuse, neglect or injury when telling that person would not be in the patient’s best interests (45 CFR §164.512(c)(2)).
• For information: the county department must begin its evaluation immediately, within 24 hours or within 72 hours depending on the danger to the adult, and complete it within 30 days for abuse or neglect and 45 days for exploitation (G.S. 108A-103). Staff report any new concern to the department while its evaluation is open.
• The report and its outcome are entered on the incident log (Policy NC-HH-QA-03) for review by the QAPI committee.

"Anyone who makes a report pursuant to this statute, who testifies in any judicial proceeding arising from the report, or who participates in a required evaluation shall be immune from any civil or criminal liability on account of such report or testimony or participation, unless such person acted in bad faith or with a malicious purpose." (G.S. 108A-102(c)). The Agency does not discipline or retaliate against anyone for a good faith report, and patients are free from reprisal for raising concerns (42 CFR §484.50(c)(11)). A staff member who fails to report, or who discourages another person from reporting, is disciplined.

Accountability under this policy is allocated as follows.

Each report is documented in the clinical record and on the incident log. The supervising nurse checks the incident log each month for reports without a recorded county department contact, as the Agency’s own standard. Training records are kept in personnel records (Policy NC-HH-HR-02).

Every staff member is trained at orientation, before the first visit, and every year, as the Agency’s own standard, in the signs in Table 1, the duty to report under G.S. 108A-102, how to find the county department of social services, and this policy. The patient handout Form NC-HH-SG-01-A is explained to each patient at admission (Policy NC-HH-PR-01).

This policy implements the following authorities.

• G.S. 108A-99 to 108A-111, Protection of the Abused, Neglected, or Exploited Disabled Adult Act, including 108A-101, 108A-102 and 108A-103
• G.S. 131E-144.3(6), Home Care Clients’ Bill of Rights
• 42 CFR §484.50(c)(2), (c)(11) and (e)(2), Patient rights
• 45 CFR §164.512(c), Disclosures about victims of abuse, neglect or domestic violence
• NCDHHS, Adult Protective Services and Local DSS Directory (https://www.ncdhhs.gov/divisions/social-services/local-dss-directory)

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