Abuse, Neglect and Exploitation Reporting and Investigation Department of Aging & Disability Services Presented by: Rosalind Nelson-Gamblin Policy, Rules, and Curriculum Development Unit DADS Regulatory Services (512) 438-3161 April 23, 2014 Objectives: Protection from Abuse, Neglect & Exploitation At the end of this presentation participants will be able to: 1. list the three types of complaints DADS receives relating to hospice agencies 2. Describe the process for reporting abuse, neglect & exploitation complaints and incidents 3. Identify the components of internal investigation 4. Find the forms and telephone numbers for making complaints and reporting incidents 1 2 Client Rights & Agency Responsibilities 40 TAC 97.282 Client Conduct and Responsibility and Client Rights Adopt and enforce a written policy governing client conduct and responsibility and client rights Include a grievance mechanism under which a client can participate without fear of reprisal Abuse, Neglect & Exploitation 3 4 Defining Abuse, Neglect & Exploitation 40 TAC 97.249 Self-Reported Incidents of Abuse, Neglect and Exploitation Cause to believe agency knows, suspects or receives an allegation 40 TAC 97.250 Agency Investigations Managing an incident of Abuse, Neglect & Exploitation Discover initial facts Protect the client(s) Report (Initial calls to DADS/DFPS) Gather policies, procedures, staff Investigate the incident Report findings and facts Document everything 5 6 1
Reporting an Incident to DADS Reportable incidents = Abuse, neglect, and exploitation Report immediately= Less than 24 hours 2 Ways to Report 7 8 2 Ways to Report: 1-800-458-9858 http://www.dads.state.tx.us/services/crs/incidentforms/sri/index.cfm *Click Start Report on the bottom of the page 9 10 March 2013 Gather preliminary information DADS form 3613 Report of Investigation Other forms and formats used by the agency Agency policy and procedures Personnel records Patient or client s chart/record Timely submission of DADS Form 3613 10 calendar days Ensure DADS form 3613 is complete 11 12 2
Provider Investigation Form DADS Form 3613: www.dads.state.tx.us/forms/3613 3613 Form Instructions: www.dads.state.tx.us/handbooks/inst/f3613/ Provider Letter #06-12: www.dads.state.tx.us/providers/communications/2006/letters/p L2006-12.pdf Incident date Any inquiry or adverse affect The alleged victim Any assessments made The alleged perpetrator Any treatment required Any witnesses The investigation summary The allegation Any action taken 13 14 Incident Findings Confirmed: allegation is supported by a preponderance of the evidence Unconfirmed: reasonable to conclude the allegation did not occur or is unlikely Inconclusive: insufficient evidence to support or refute the allegation Unfounded: allegation is untrue or patently without factual basis Agency Investigations for incidents other than ANE o Complaints and grievances made by a client, a client's family or guardian, or a client's health care provider o Failure to provide treatment or care appropriately 15 o Lack of respect for the client's property 16 Agency Investigations for incidents other than ANE Completing Agency Investigations o Document receipt of the complaint and initiate a complaint investigation within 10 days o Document all components of the investigation o An agency must complete the investigation and documentation within 30 days after the agency receives a complaint or report of abuse, neglect, and exploitation, unless the agency has and documents reasonable cause for a delay. 17 18 3
When Medicare Hospice Conditions and State Regulations Differ Read both carefully Meet the higher standard Ask if you have questions Look for rule amendments Participate in the rulemaking process Client s Perception: Client Rights & Agency Responsibilities 3 Factors to consider when assessing a complaint: 1. What is the complainant's experience with your agency? 2. What is complainant's motivational state? 3. How is the complainant's emotional state? Goal: Reduce complaints based on the perceptions of the client before the complaint is made. 19 20 Tracking Client Complaints DADS Regulatory Services Annual Report DADS Regulatory Services Annual Report Most Common Allegations DADS recieves Regulatory Services Annual Reports (SB 190) Top 10 Deficiencies and Top 10 Violations for Home Health & Hospices can be found at: http://www.dads.state.tx.us/providers/reports/sb190/index.html click on: Regulatory Services Annual Report FY 2013 21 22 Top 10 Most Frequent Hospice Allegations (2013Report) Exercise: Compare & Contrast 1. Administration (Ranked No. 1 in fiscal year 2012) 2. Resident Rights/Client Protection (Ranked No. 2 in fiscal year 2012) 3. Care/Services (Ranked No. 3 in fiscal year 2012) 4. Neglect (Ranked No. 4 in fiscal year 2012) 5. Compliance with Federal, State and Local Laws (Ranked No. 6 in fiscal year 2012) 6. Clinical (Ranked No. 5 in fiscal year 2012) 7. Sufficient Staff (Not ranked in fiscal year 2012) 8. Admission, Transfer and Discharge (Ranked No. 9 [TIE] in fiscal year 2012) 9. Staff Qualifications (Ranked No. 9 [TIE] in fiscal year 2012) 10. Billing Irregularities. (Not ranked in fiscal year 2012) 97.249 Self-reported incidents of abuse, neglect and exploitation 418.52(b)(4)(i) Standard: 24 23 4
Exercise: Compare & Contrast Requirements (State/Federal) TAC: 97.249 Immediately report to DADS and DFPS Report no later than 24 hours to DADS and DFPS Employees, volunteers and contractors Abuse, Neglect and Exploitation Injuries of unknown origin not mentioned Ten calendar days to investigate ANE from report to DADS Complaints: Initiate 10 days from receipt Complete investigation 30 days from receipt 25 CFR: 418.52(b)(4)(i) Immediately report to the hospice administrator Report verified violations to the State Survey and Certification Agency Employees and contractors to administrator Investigate all alleged violations: anyone furnishing services Mistreatment, Neglect, Abuse (verbal, mental, sexual, physical) Physical abuse includes injuries of unknown origin Five working days to investigate all violations from the date the person became aware Exercise: Take Time to Practice Incident Received Discover initial facts Protect the client(s) Report (Initial calls to DADS/DFPS) Gather policies, procedures, staff/contractors Investigate the incident Report findings and facts Document everything 26 Who to Contact: Policy & Rule Interpretations Yolanda Chavez, BSN, RN (Policy) E-mail: yolanda.chavez@dads.state.tx.us 27 5