Abuse, Neglect, and Exploitation of Adults: Mandatory Reporting to Adult Protective 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 makes sure that every person who works for the Agency recognizes abuse, neglect and exploitation of adults, knows that Ohio law makes them personally responsible for reporting it immediately, and knows exactly how to do it, at any hour.

This policy applies to suspected abuse, neglect or exploitation of any adult patient, and of any other adult the Agency’s staff come across in the course of their work, such as a patient’s spouse, whoever the suspected person is: a family member, a caregiver, a stranger, the adult themselves (self-neglect), or Agency staff.

For the purposes of this policy, the following terms have the meanings below. Ohio’s home health licensing law (ORC Chapter 3740 and OAC Chapter 3701-60) and 42 CFR Part 484 say "patient"; the Ohio Medicaid rules (OAC Chapters 5160-1, 5160-12 and 5160-32) say "individual". This policy uses "patient" for the same person.

Ohio law provides: "No person listed in division (A)(2) of this section having reasonable cause to believe that an adult is being abused, neglected, or exploited, or is in a condition which is the result of abuse, neglect, or exploitation shall knowingly fail to immediately report such belief to the county department of job and family services." (ORC 5101.63(A)(1)). The list includes every employee of a home health agency, and registered nurses, licensed practical nurses and licensed social workers in their own right (ORC 5101.63(A)(2)(e), (g), (j)). Every Agency employee is therefore personally required to report, and the duty cannot be passed to a supervisor. Federal rules also require any Agency staff member who identifies, notices or recognizes mistreatment, neglect, abuse, injuries of unknown source or misappropriation of patient property to report these findings immediately to the Agency and to other appropriate authorities in accordance with state law (42 CFR §484.50(e)(2)). Each patient has the right to be free from verbal, mental, sexual and physical abuse, including injuries of unknown source, neglect and misappropriation of property (42 CFR §484.50(c)(2)).

You do not need proof. Reasonable cause to believe is enough. Report when you see or hear, for example:

• injuries that do not match the explanation, injuries at different stages of healing, burns, restraint marks, or fear of a particular person;
• a caretaker who will not let you see the patient alone, threatens or belittles the patient, or withholds food, medication, glasses, hearing aids or mobility aids;
• a patient left without food, heat, water, medication or help with basic care by the person responsible for providing it, or abandoned;
• self-neglect: a patient who cannot or will not meet their own basic needs and is at risk of harm;
• missing money or property, unpaid bills despite enough income, sudden changes to a will, deed, bank account or power of attorney, or someone pressuring the patient about money;
• a patient telling you they are being hurt, neglected or taken advantage of.

1. If anyone is in immediate danger, call 911 first.
2. Report immediately to Adult Protective Services, a program of the Ohio Department of Job and Family Services: call 1-855-OHIO-APS (1-855-644-6277) at any time, contact the county Job and Family Services office, or use the Ohio Adult Protective Services Online Referral at https://aps.jfs.ohio.gov/. If someone is in immediate danger, call local law enforcement immediately. The county department of job and family services must be available to receive reports 24 hours a day and seven days a week (ORC 5101.63(G)). Hotline: 1-855-OHIO-APS (1-855-644-6277). Online referral: https://aps.jfs.ohio.gov/.
3. A report may be made orally or in writing; an oral report is followed by a written report if the department asks for one (ORC 5101.63(C)). Be ready to give: the name, address and approximate age of the adult; the name and address of the person responsible for the adult’s care, if known; the nature and extent of the suspected abuse, neglect or exploitation; and the basis of your belief (ORC 5101.63(C)(1)-(4)).
4. Tell the clinical manager or on-call nurse as soon as you have made the report, or at the same time, on (614) 555-0100 or after hours (614) 555-0199 (42 CFR §484.50(e)(2)). If you cannot reach a manager, report anyway: the report must not wait.
5. Complete Form OH-HH-SG-01-A with the date and time of the report, who you spoke to and any reference number, and give it to the clinical manager the same day.
6. Record in the clinical record the facts you observed and that a report was made. Do not record opinions about who is to blame.

Two staff members who saw the same thing may each report, or one may report and the other confirm in writing that the report was made. Each person remains responsible for making sure a report was actually made.

• A person with reasonable cause who makes a report, or testifies in a proceeding arising from it, is immune from civil or criminal liability on account of the report or testimony, except liability for perjury, unless the person acted in bad faith or with malicious purpose (ORC 5101.63(D)).
• No employer or other person with authority may discharge, demote, transfer, prepare a negative work performance evaluation, reduce benefits, pay or work privileges, or take any other action detrimental to an employee, or in any way retaliate against the employee, because the employee filed a report (ORC 5101.63(E)). The Agency never does any of these things, and treats retaliation by anyone as serious misconduct.
• Reports and the county’s investigatory reports are confidential and are not public records (ORC 5101.63(F)).
• A staff member who is told by anyone, including a manager, not to report must report anyway and tell the Administrator or a governing body member.

A person required to report who knowingly fails to report immediately is guilty of a misdemeanor of the fourth degree (ORC 5101.99(B)). Failing to report is also a breach of this policy and of 42 CFR §484.50(e)(2), and leads to discipline up to dismissal and, for a licensed professional, may be reported to the licensing board (Policy OH-HH-HR-05).

• Safety first. The clinical manager reviews the patient’s safety the same day and adjusts visits, the plan of care and the emergency plan as needed, without confronting the suspected person in a way that could put the patient at risk.
• Cooperate. The Agency cooperates with the county department’s evaluation and with law enforcement, and provides the information they request, as 45 CFR §164.512(c) and Policy OH-HH-PRV-01 allow.
• Tell the patient. The Agency promptly informs the patient that a report has been or will be made, unless the clinical manager believes that informing them would place them 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 decision is recorded.
• Respect the patient’s choices. A competent adult may refuse help. Continue to offer services, document refusals, and keep reporting new concerns.
• Internal follow-up. The incident is entered on the incident log and reviewed by QAPI (Policies OH-HH-QA-01, OH-HH-QA-02). If Agency staff are involved, Policy OH-HH-SG-03 applies at once.

At the start of care, each patient receives the notice of rights, which includes the right to be free from abuse, neglect and misappropriation of property (42 CFR §484.50(c)(2)) and how to report abuse to adult protective services: 1-855-OHIO-APS (1-855-644-6277) or https://aps.jfs.ohio.gov/ (Policy OH-HH-PR-01). Staff remind patients and families of these numbers whenever a concern is raised.

Accountability under this policy is allocated as follows.

Form OH-HH-SG-01-A and any related investigation records are kept in a confidential safeguarding file, separate from the clinical record, for at least six years, as the Agency’s own standard. The clinical record contains the facts observed and the fact that a report was made. Each quarter the clinical manager reviews the safeguarding file and incident log to check that every concern was reported and followed up, and reports to QAPI.

Every employee, contractor and volunteer is trained at orientation, before their first patient contact, and annually, as the Agency’s own standard, on the definitions, signs, how to report, the other routes in Table 1, protection for reporters and the penalty for not reporting. Training is recorded in the personnel file (Policy OH-HH-HR-01).

This policy implements the following authorities.

• ORC 5101.60, Definitions (adult protective services); ORC 5101.61, County departments of job and family services
• ORC 5101.63, Reporting abuse, neglect or exploitation of an adult
• ORC 5101.99(B), Penalty for failure to report
• ORC 5123.61, Reports of abuse or neglect of individuals with developmental disabilities
• ORC 3721.22, Reports of abuse, neglect or exploitation of long-term care facility residents
• 42 CFR §484.50(c)(2) and (e)(2), Patient rights; investigation and reporting
• 45 CFR §164.512(c), Disclosures about victims of abuse, neglect or domestic violence
• OAC 5160-44-05, Incident management; OAC 173-39-02(B)(3), ODA-certified providers: reporting

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