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.

This policy makes sure that every suspicion that a consumer is being abused, neglected or exploited is reported at once to the people the law names, so that the consumer can be protected, and that no employee is ever unsure of what to do or afraid to do it.

This policy covers suspected abuse, neglect, exploitation and abandonment of any adult consumer, whoever the suspected person is (an Agency employee, a family member, another caregiver, a stranger, or the consumer’s own self-neglect), whether it happens during a visit or the employee learns of it another way.

For the purposes of this policy, the following terms have the meanings below. 28 Pa. Code Chapter 611 calls the person served a "consumer"; 55 Pa. Code Chapter 52 calls a consumer who receives Medical Assistance waiver services a "participant"; the protective services laws call a person who receives care from a facility a "recipient". In this policy these words mean the same person.

The Agency is a "home health care agency" under the Older Adults Protective Services Act, which includes "A public or private agency or organization, or part of an agency or organization, which provides care to a care-dependent individual in the individual's place of residence." (35 P.S. §10225.103). Its employees are therefore mandated reporters under Chapter 7 of that Act. "An employee or an administrator who has reasonable cause to suspect that a recipient is a victim of abuse shall immediately make an oral report to the agency." (35 P.S. §10225.701(a)(1)). Within 48 hours of the oral report, the employee or administrator makes a written report to the agency (§10225.701(a)(2); 6 Pa. Code §15.151(a)(2)). The Department of Aging applies this duty to recipients of any age, not only to people 60 and older.

Where the Agency uses public funds to provide care (for example, as a waiver provider), it is also a "facility" under the Adult Protective Services Act (35 P.S. §10210.103), and an employee or administrator with reasonable cause to suspect that a consumer aged 18 to 59 "is a victim of abuse or neglect shall immediately make an oral report to an agency" (35 P.S. §10210.501(a)(1)).

As the Agency’s own standard, every employee reports every suspicion of abuse, neglect, exploitation or abandonment of any adult consumer, whether or not the law requires that particular report. No one at the Agency may stop, delay, discourage or screen out a report. Abuse of a consumer by anyone at the Agency is prohibited and is grounds for termination.

1. If the consumer is in danger or needs medical help, call 911 now. Stay with the consumer if it is safe for you to do so.
2. If the person suspected is present and you feel unsafe, leave the home and call 911 and your supervisor from a safe place.
3. Do not confront the person suspected, do not investigate, and do not ask the consumer leading questions. Listen, stay calm, and write down the consumer’s own words.
4. Do not clean, move or throw away anything that may be evidence unless you must do so to keep the consumer safe.
5. Make the oral report at Section 6 before you leave the consumer’s home or as soon as you are safe. Do not wait to finish the visit, to reach a supervisor, or for the end of your shift.

The employee who has the suspicion makes the report. Telling a supervisor does not replace the report: the law places the duty on the employee. The employee may ask the Administrator to make the oral and written reports or to help make them (35 P.S. §10225.701(a)(3); 6 Pa. Code §15.151(d)), but the employee stays responsible for making sure the report is made immediately.

When in doubt, report. The statewide hotline 1-800-490-8505 takes reports about adults of any age and will route the call. The protective services agency will tell the caller if any other report is needed (35 P.S. §10225.701(a)(1)).

Written reports are made on the forms supplied or approved by the Department of Aging (or, for consumers 18 to 59, the Department of Human Services form). The report includes, at a minimum, the following (6 Pa. Code §15.153(b); 35 P.S. §10225.701(c)):

• Name, age and address of the consumer.
• Name and address of the consumer’s guardian or next of kin (for consumers 18 to 59, also an attorney-in-fact).
• The Agency’s name and address: Sample Agency, LLC, 100 Example Street, Suite 100, Harrisburg, Pennsylvania 17101.
• A description of the incident: what was seen, heard or told, when, where and by whom.
• Specific comments or observations directly related to the incident and the people involved.

1. Confirms that the oral report was made, records the date, time, the agency called and the name of the person who took the report on Form PA-HC-ANE-01-A, and makes sure the written report is sent within 48 hours. Where the employee asks, the Administrator makes or helps make the reports.
2. Takes any step needed to protect the consumer now, such as changing the worker assigned, adding visits, or helping the consumer reach a safe place, with the consumer’s agreement where the consumer can give it.
3. If an Agency employee is the person suspected, starts Policy PA-HC-ANE-03 at once (plan of supervision or suspension).
4. Sends the written notice to the Department of Health under Policy PA-HC-INC-01, because complaints of patient abuse, "whether or not confirmed by the facility", are reportable events (28 Pa. Code §51.3(g)(6)).
5. If the consumer is a waiver participant, also treats the matter as a critical incident: tells the service coordinator within 24 hours and submits the First Section of the critical incident report within 48 hours (Policy PA-HC-INC-01). For a participant 18 to 59, a report submitted to the incident reporting system also satisfies the duty to report to the agency under 35 P.S. §10210.501(a)(3), but the Agency still makes the telephone report so that protective services can act at once.
6. Cooperates fully with protective services and law enforcement. "To the fullest extent possible, law enforcement officials, the facility and the agency shall coordinate their respective investigations." (35 P.S. §10225.703(c)). The Agency does not conduct its own interviews of the consumer in a way that could interfere with their investigation, and agrees with the investigators before it questions witnesses.
7. Records the outcome the Agency is told, and reviews whether training, supervision or the service plan should change (Policy PA-HC-QM-01).

The following are examples of what may give reasonable cause to suspect. None of them proves abuse, and the employee does not need more than one of them to report.

A report under Chapter 7 of the Older Adults Protective Services Act is confidential (35 P.S. §10225.705(a); 6 Pa. Code §15.157). Information about a report is shared inside the Agency only with those who need it to protect the consumer or to carry out Policy PA-HC-ANE-03. The Agency never tells the person suspected who made the report. HIPAA permits these reports without the consumer’s authorization (45 CFR §164.512(c)).

"Any person making a report or cooperating with the agency, including providing testimony in any administrative or judicial proceeding, and the victim shall be free from any discriminatory, retaliatory or disciplinary action by an employer or by any other person or entity." (35 P.S. §10225.302(c)). The Adult Protective Services Act gives the same protection (35 P.S. §10210.302(d)) and Whistleblower Law protections (35 P.S. §10210.506(d)). Any employee who retaliates against or intimidates a reporter is disciplined up to termination.

"A person required under this chapter to report a case of suspected abuse who willfully fails to do so commits a summary offense for the first violation and a misdemeanor of the third degree for a second or subsequent violation." (35 P.S. §10225.706(c)). An administrator or facility owner who intentionally or willfully fails to comply with, or obstructs, the reporting duties, or retaliates against an employee who complies, may be assessed a civil penalty of not more than $2,500 and commits a misdemeanor of the third degree (35 P.S. §10225.706(a)-(b)). An employee who fails to report suspected abuse, neglect or exploitation under this policy is also subject to discipline up to termination.

Accountability under this policy is allocated as follows.

The Administrator keeps Form PA-HC-ANE-01-A, a copy of each written report, the Department of Health notice and any critical incident report in a confidential abuse report file, separate from the consumer record and from personnel files, for at least six years, as the Agency’s own standard. The consumer record notes only that a report was made and the date, without details of the allegation. The Administrator reviews the abuse report file each quarter, as the Agency’s own standard, to confirm that every report was made immediately and in writing within 48 hours, and that each Department of Health notice and critical incident report was sent.

Recognizing and reporting abuse or neglect is a required subject of the Agency’s competency training or examination for every direct care worker (28 Pa. Code §611.55(b)(9)), and is covered at orientation before a provisional hire works with consumers (6 Pa. Code §15.146(a)(4)). Every employee reviews this policy each year (Policy PA-HC-TRN-01); for waiver services, annual training includes prevention of abuse and exploitation and reporting critical incidents (55 Pa. Code §52.21(d)(1)-(2)). The Agency may use the Department of Aging’s free online mandatory abuse reporting course. Each employee carries the reporting numbers on the back of their identification badge, as the Agency’s own standard.

This policy implements the following authorities.

• Older Adults Protective Services Act §103 (35 P.S. §10225.103), Definitions; §302 (35 P.S. §10225.302), Reporting, protection from retaliation, immunity
• Older Adults Protective Services Act Chapter 7, §§701 to 708 (35 P.S. §§10225.701 to 10225.708), Reporting suspected abuse by employees
• 6 Pa. Code §§15.151 to 15.157, Reporting suspected abuse; restrictions on employees; confidentiality
• Adult Protective Services Act §103 and §302 (35 P.S. §§10210.103, 10210.302); Chapter 5, §§501 to 507 (35 P.S. §§10210.501 to 10210.507)
• 28 Pa. Code §611.55(b)(9), Competency requirements; §51.3(g)(6), Notification
• 55 Pa. Code §52.16, Abuse; §52.17, Critical incident and risk management; §52.21(d), Staff training (waiver providers only)
• 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 15 is amended, the amendment is recorded in this table and a new version of this policy is issued.