DDES INFO MEMO 2006-20
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
DDES Info Memo Series 2006 - 20
To: Listserv
For: Area Administrators / Human Services Area Coordinators
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Area Agencies on Aging Executive Director
Board on Aging and Long Term Care
County COP Coordinators
County Waiver Coordinators
County/Tribal Aging Unit Directors
Developmental Disabilities Coordinators
Long Term Support Coordinators
Lead Adult-at-Risk Agency Contacts
Lead Elder Adult-at-Risk Agency Contacts
DDES Administration
DDES Bureau Directors
DDES Facility Directors
From: Sinikka Santala
Administrator
Subject: Adult-at-Risk, including Elder Adult-at-Risk, Reporting
Requirements
DOCUMENT SUMMARY
This memo explains the role county designated adults-at-risk and elder
adult-at-risk agencies have in responding to incidents of abuse, neglect,
exploitation and self-neglect occurring in entities regulated by the
Department of Health and Family Service's Office of Quality Assurance (OQA).
It explains the process to be used by a county designated adult-at-risk
agency when referring an allegation of abuse, neglect and/or exploitation
to OQA. It also explains why reports initially received by OQA may be
referred to a county designated adults-at-risk agency.
New statutory requirements covering reports of abuse, financial
exploitation, neglect or self-neglect of adults-at-risk, including elder
adults-at-risk, take effect on December 1, 2006 due to Wisconsin Act 388.
For additional information about 2005 Wisconsin Act 388, see http://www.legis.state.wi.us/2005/data/acts/05Act388.pdf
This memorandum focuses specifically on those new reporting
requirements as they relate to clients of health care entities regulated
by the Department of Health and Family Services, Office of Quality
Assurance (OQA). Please also reference OQA Memo # 06-028 (November 15,
2006), issued to all regulated health care entities to ensure a full
understanding of an entity's responsibility to report both allegations of
caregiver misconduct and other incidents involving adults-at-risk.
DEFINITIONS
The 2005 Wisconsin Act 388 reporting requirements discussed in this
memorandum apply to both "adults-at-risk" and "elder
adults-at-risk." For ease of reference, "(elder)
adults-at-risk" will be used to refer to both populations throughout.
- Adult-at-Risk. An "adult-at-risk" is any adult who has a
physical or mental condition that substantially impairs his or her
ability to care for his or her needs and who has experienced, is
currently experiencing, or is at risk of experiencing abuse, neglect,
self-neglect, or financial exploitation.
[s. 55.01(1e)]
- Elder Adult-at-Risk. An "elder adult-at-risk" is any
person age 60 or older who has experienced, is currently experiencing,
or is at risk of experiencing abuse, neglect, self-neglect, or
financial exploitation. [s. 46.90(1)(br)]
ENTITY REPORTING OF CAREGIVER MISCONDUCT INCIDENTS
The revised reporting requirements included in 2005 Wisconsin Act 388
do not affect a regulated health care entity's responsibility to report
incidents of caregiver misconduct to the Department under
s.146.40(4r)(am)1. Wis. Stats. and HFS 13.05 Wisconsin Administrative
Rule. See OQA Memo # 06-028 (November, 2006) for additional information
regarding caregiver misconduct reporting requirements.
LIMITED REQUIRED REPORTING BY EMPLOYEES OF ENTITIES
Wisconsin Act 388 does change reporting requirements for the employees
of entities. State statutes at s.46.90(4)(ab)1 and s.55.043(1m)(a)1
require that any employee of any entity report allegations of abuse,
financial exploitation, neglect or self-neglect if the (elder)
adult-at-risk is seen in the course of the person's professional duties
and one of the following conditions is true:
- The (elder) adult-at-risk has requested the person to make the
report; or
- There is reasonable cause to believe that the (elder) 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; or
- Other (elder) adults-at-risk are at risk of serious bodily harm,
death, sexual assault, or significant property loss inflicted by the
suspected perpetrator.
See OQA Memo # 06-028 (November, 2006) for additional information
regarding entity employee reporting requirements under 2005 Wisconsin Act
388. Note that entity employees are instructed in the OQA memorandum to
report incidents involving (elder) adults-at-risk to the Department of
Health and Family Services. This policy is intended to streamline the
process and eliminate potential confusion associated with reporting to
different agencies. OQA instructs that all incident reports from entity
employees be submitted to OQA. OQA will then forward reports to other
agencies, including the (elder) adult-at-risk agency, as appropriate.
PROTECTIONS FOR REPORTERS
As mentioned above, entities are required to report incidents of
caregiver misconduct to the Department under Chapter 146 of the state
statutes, as well as HFS 13. To the extent that an entity employee,
following the entity's incident response protocol, reports the necessary
information concerning the allegation to one 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 (i.e., Office of Quality Assurance), the employee does not
also have to report to OQA.
However, if the entity fails to report to OQA and any of the conditions
are met that trigger limited required reporting by the entity employee,
the employee must make direct contact with OQA, the county department, the
(elder) adults-at-risk agency, a state or local law enforcement agency, or
the Board on Aging and Long Term Care. If the employee does not, reporter
protections under s.46.90(4) and s.55.043(1m) Wis. Stats. will not apply.
Entity employees are, therefore, encouraged to file reports directly with
OQA to ensure the application of relevant statutory protections.
(ELDER) ADULTS-AT-RISK AGENCIES: RECEIVING REPORTS
While OQA encourages entity employees to file reports with OQA,
employees may, by law, file reports with any of several different
agencies, including the local (elder) adult-at-risk agency. Therefore,
local (elder) adult-at-risk agencies may occasionally receive reports from
entity employees and must act on such reports in compliance with
s.46.90(5) and s.55.043(1r) Wis. Stats.
The following requirements apply to (elder) adults-at-risk agencies,
irrespective of the source of the report (e.g., entity employee, local law
enforcement officer, or any other person):
(Elder) Adult-at-Risk is Client of an Entity; Perpetrator is Caregiver
or Non-Client Resident
If the (elder) adult-at-risk is a "client," as defined in
s.50.065(1)(b), of an "entity," as defined in s.50.065(1)(c),
and the suspected perpetrator is a caregiver or non-client resident of the
entity, the (elder) adult-at-risk agency must refer the report within 24
hours after the report is received (excluding Saturdays, Sundays, and
legal holidays) to the Office of Quality Assurance (OQA) at:
Office of Quality Assurance
Office of Caregiver Quality
2917 International Lane, Suite 300
Madison, WI 53704
Telephone: (608) 243-2019
Fax: (608) 243-2020
The OQA may conduct an investigation of the entity to satisfy relevant
regulatory concerns and will coordinate its regulatory-based investigation
with other investigative agencies or authorities as appropriate. This will
include coordinating with the (elder) adults-at-risk agency to assure that
protective service needs are determined and addressed.
(Elder) Adult-at-Risk is Client of an Entity; Perpetrator is Not
Caregiver or Non-Client Resident
If the (elder) adult-at-risk is a client of an entity, but the
suspected perpetrator is someone other than a caregiver or non-client
resident, the (elder) adult-at-risk agency may still be required to file a
report with the Department within 24 hours. Under these circumstances, the
agency should assess whether the incident arguably involves the entity in
any way. If the incident appears to have a potential impact on licensure
or certification requirements, the report should be referred to OQA within
24 hours after receipt (excluding Saturdays, Sundays, and legal holidays)
at the address and telephone number above. The OQA may conduct an
investigation of the entity to satisfy relevant regulatory concerns and
will coordinate its regulatory-based investigation with other
investigative agencies or authorities as appropriate. This will include
coordinating with the (elder) adults-at-risk agency to assure that
protective service needs are determined and addressed.
Reports Not Referred to the Department of Health and Family Services
As Described Above
The response to any report of abuse not referred to the Department as
described above must commence within 24 hours after the report is
received, excluding Saturdays, Sundays, and legal holidays.
ROLE OF THE (ELDER) ADULTS-AT-RISK AGENCY
By statute, (elder) adults-at-risk agencies are charged with
determining and addressing the protective service needs of (elder)
adults-at-risk. While external agencies may also respond and/or conduct an
investigation, their primary emphasis will not be on protective service
need identification and service provision.
For instance, to the extent that a crime may have been committed, state
and/or local law enforcement agencies may conduct a criminal investigation
of the alleged perpetrator. If the abuse involved a DHFS regulated entity,
any resulting DHFS investigation would be approached from a regulatory
perspective, focusing on the entity's licensing requirements. To the
extent that a non-credentialed or credentialed caregiver may have been
involved, the OQA Office of Caregiver Quality or the Department of
Regulation and Licensing may conduct a caregiver misconduct investigation
of the alleged perpetrator to assess potential violations of licensure or
certification requirements. Again, the (elder) adults-at risk agency would
respond from a protective services perspective.
As such, on a single case, one or more of these different responses
and/or investigations (or, these different components of the same
incident) could proceed concurrently, requiring coordination and
cooperation among the representatives of each agency, including the
(elder) adults-at-risk agency. It is the operation of this
"system" that must be formally documented in the memorandum of
understanding required under s.46.90(3) and s.55.043(1g) Wis. State
Statutes.
Given the unique nature of its role, the appropriate local (elder)
adults-at-risk agency will be informed by the Department whenever it
receives a report of abuse, financial exploitation, neglect and/or
self-neglect (as defined in s.46.90 and Chapter 55) concerning an
adult-at-risk, including an elder adult-at-risk.
QUESTIONS
For issues involving caregiver misconduct or when an (elder)
adult-at-risk is a client of an entity and the perpetrator is a caregiver
or non-client resident contact the Office of Caregiver Quality (OCQ) at caregiver_intake@dhfs.state.wi.us
or (608) 243-2019. If you have questions concerning the appropriate role
of an (elder) adult-at-risk agency in responding to reports involving an
entity contact Jane Raymond at StopAbuse@dhfs.state.wi.us
or 608-266-2568.
CENTRAL OFFICE CONTACT: Jane Raymond
Bureau of Aging and Disability Resources
Division of Disability and Elder Services
1 W. Wilson Street, Room 450
Madison, WI 53703
(608) 266-2568
email: raymoja@dhfs.state.wi.us
MEMO WEB SITE: http://dhfs.wisconsin.gov/dsl_info/
cc: Certified Mental Health and AODA Programs
Community Based Residential Facilities
Facilities for the Developmentally Disabled
Home Health Agencies
Hospices
Hospitals
Licensed Adult Family Homes
Nurse Aide Training Programs
Nursing Homes
Residential Care Apartment Complexes
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Office of Quality Assurance Regional Field Operation Directors
Tribal Chairperson/Human Services Facilitators
Licensing Chiefs / Section Chiefs
Last Revised: November 16, 2007 |
