Adult-at-Risk, including Elder Adult-at-Risk, Reporting Requirements For
Entities Regulated by the Office of Quality Assurance
PDF Version of OQA 06-028
(PDF 48 KB)
Date: November 15, 2006 -- OQA Memo
06-028
To: Adult
Day Care Centers ADC 11
Licensed
Adult Family Homes AFH 11
Certified Mental Health and AODA
CMHA 04
Community
Based Residential Facilities CBRF 13
Facilities
for the Developmentally Disabled (FDD) FDD 13
Home
Health Agencies HHA 05
Hospices
HSPC 08
Hospitals
HOSP 13
Nurse
Aide Training Programs NATP 04
Nursing
Homes NH 15
Residential
Care Apartment Complexes RCAC 09
Rural
Health Clinics RHC 04
Cc: County [Elder]
Adult-at-Risk Agencies
From: Otis Woods, Director
Office of Quality Assurance
Adult-at-Risk, including Elder Adult-at-Risk, Reporting
Requirements For Entities Regulated by the Office of Quality Assurance
Effective December 1, 2006, Wisconsin Act 388 revises the reporting of,
and responses to, abuse, neglect and exploitation of adults-at-risk
(vulnerable adults age 18 and older), including elder adults-at-risk (age
60 and up). See http://www.legis.state.wi.us/2005/data/acts/05Act388.pdf.
To ensure entities understand their responsibility to report both
allegations of caregiver misconduct and other incidents involving
adults-at-risk; this memo reviews the requirements outlined in BQA Memos
05-012 (nursing homes) and 04-028 (all other regulated entities), and
explains the new Adult-at-Risk reporting requirements.
This memo contains important clarification regarding:
- Reporting Caregiver Misconduct Incidents;
- Reporting Adult-at-Risk Incidents; and
- Response to Reports.
Reporting Caregiver Misconduct Incidents
State Statute 146.40(4r)(am)1. and HFS 13.05(3) require that an entity
report to the Department any allegation of misappropriation of property of
a client; or of neglect or abuse of a client by any person employed by, or
under contract with, the entity if the person is under the control of the
entity. There are no changes to these caregiver misconduct reporting
requirements.
Entities should continue to follow the guidance provided at:
All Entities (except nursing homes)
Reference: BQA Memo 04-028, Revised Caregiver Misconduct
Reporting
Requirements for BQA Entities
Nursing Homes Only
Reference: BQA memo 05-004, Requirements for Reporting
Allegations of
Abuse, Neglect, Misappropriation,
Injuries of Unknown Source
BQA memo 05-012, UPDATE - Requirements for
Reporting Allegations of Abuse,
Neglect,
Misappropriation, Injuries of Unknown Source
For caregiver misconduct allegations involving all staff (noncredentialed
and credentialed), submit the Incident Report to:
Department of Health & Family Services
Division of Quality Assurance (DQA)
Office of Caregiver Quality
P. O. Box 2969
Madison, WI 53701-2969
OQA will review reports involving noncredentialed staff (nurse aides,
caregivers, housekeepers, etc.) for possible investigation. OQA will refer
reports involving credentialed staff (doctors, RNs, LPNs, social workers,
etc.) to the Department of Regulation & Licensing (DRL) for review.
Reporting Adults-at-Risk
State statutes 46.90(4)(ab)1 and 55.043(1m) (a) require that any employee
of any entity report allegations of abuse, neglect or exploitation if the
adult-at-risk is seen in the course of the person's professional duties
and one of the following conditions is true:
- The adult-at-risk has requested the person to make the report;
This first condition is self-explanatory: any entity employee must
make
a report if they are asked to do so.
- There is reasonable cause to believe that the adult-at-risk is
at imminent risk of serious bodily harm, death, sexual assault, or
significant property loss and is unable to make an informed judgment about
whether to report the risk.
This second condition requires a concern about future, serious risk;
it
is not applicable to situations that involve past incidents only.
- Other adults-at-risk are at risk of serious bodily harm, death,
sexual assault, or significant property loss inflicted by the suspected
perpetrator.
This third condition applies to reporting past abuse perpetrated on
an
adult-at-risk only if there is a possibility of harm to others. (For
example, an entity employee must report if he or she
is made aware
of a situation involving a specialized transportation
van driver who
allegedly sexually assaulted a client. Even if the client
no longer
uses the transportation service, other adults-at-risk would
likely be
riding with that van driver in the future.)
No reporting is required in two instances:
- If the professional believes that filing the report would not be in
the best interest of the adult-at-risk, and the professional documents the
reasons for this belief in the suspected victim's case file;
or
- If a health care provider provides treatment by spiritual means
through prayer for healing in lieu of medical care in accordance with his
or her religious tradition, and his or her communications with patients
are required by his or her religious denomination to be held confidential.
If you conclude that you must report an incident involving an
adult-at-risk, including an elder adult-at-risk:
1. Complete an Incident Report form (DDE-2447) and attach
relevant
internal investigation documents; and
2. For allegations involving all perpetrators (family member, friend,
visitor, resident, stranger, etc.), submit the Incident Report within
five
days to
Department of Health & Family Services
Division of Quality Assurance
Office of Caregiver Quality
P. O. Box 2969
Madison, WI 53701-2969
This new reporting process is streamlined to eliminate reporting to
different agencies. All incident reports are submitted to OQA staff who
will forward reports to other agencies such as the county department, the
elder/adult-at-risk agency, state or local law enforcement agency, or the
board on aging and long-term care, as appropriate. You may also submit a
report directly to one of these agencies.
Immunity Provision
Due to the increased reporting provisions, the law enhances protections
for good-faith reporters of incidents involving adults-at-risk. Immunity
provisions apply to all reporters, including situations when a report is
filed with an incorrect agency, if the reporter had a good-faith belief
that the initial report was filed appropriately.
If an employee of the entity, following the entity's incident response
protocol, reports the necessary information concerning the allegation to
someone who is expected to report on behalf of the entity, e.g.,Director
of Nursing, Facility Administrator, etc., and that individual does report
the information to the proper authorities, e.g., Office of Quality
Assurance, the employee does not also have to report to OQA. However, if
the entity fails to report and the situation meets one of the three
conditions that trigger limited-required reporting, the employee must make
direct contact with OQA. If the employee does not, the immunity provisions
will not apply.
To ensure immunity, an employee must report directly to OQA, a county
department, the Elder/Adult-at-Risk Agency, state or local law enforcement
agency, or the Board on Aging and Long-Term Care.
The new law creates a rebuttable presumption that any discharge or act
of retaliation or discrimination taken against a reporter within 120 days
of making the report is retaliatory. The penalty for retaliating against a
reporter is increased to $10,000.
Response to Reports
The DHS Office of Quality Assurance responds to two types of health care
complaints. They are:
1. Complaints regarding entity
activity (inappropriate or inadequate
activity by
an entity); and
2. Complaints of caregiver misconduct
(inappropriate activity by a
caregiver,
e.g., abuse, neglect or misappropriation).
The OQA Office of Caregiver Quality (OCQ) may conduct a caregiver
misconduct investigation by conducting on-site visits, in-person
interviews, or telephone interviews. The entity's OQA regulatory program
(Assisted Living Section, Health Services Section or Resident Care Review
Section) may also conduct a parallel investigation regarding the incident,
to determine if the entity's program requirements were met, and if the
entity bears culpability regarding the incident.
Again, all incident reports must be submitted to OQA who will refer
reports to agencies including the Department of Regulation &
Licensing, the Department of Justice, county departments, adult-at-risk
agencies, local law enforcement agencies, and others, as appropriate. One
or more of these agencies may also respond to an allegation investigated
by OQA.
Questions
Contact the Office of Caregiver Quality (OCQ) at Caregiver_Intake@dhs.state.wi.us
or (608) 243-2019.
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