The Basics of Conducting Investigations in a Long-Term Care Facility
Jeannine LeCompte, Compliance Research Specialist
All long-term care facilities which accept Medicare/Medicaid funding are obligated to have written procedures for investigating resident abuse, neglect, misappropriation, and exploitation. These procedures must contain a list of clearly defined personnel who are responsible for conducting the investigation, and who have training in ensuring that all evidence is collected and analyzed. Furthermore, these personnel should have training in the handling of evidence, particularly in cases where it appears a crime has been committed. This is necessary in order to preserve all evidence from destruction or tampering.
The first step should be to record the date and time of the incident or allegation, or the date and time when it was first reported. This can be very important for determining response times as required by the Department of Health.
The next step is the full investigation, which will include the collection of all facts pertaining to the incident and the drafting of a conclusion, which should also state what can be done to prevent further occurrences. This investigation must focus only on the facts, because starting out by seeking who to blame often diverts attention away from what actually took place.
If, during any investigation, the facts point to possible abuse, then it is the investigator’s duty to immediately report this to the relevant authorities who must implement a full abuse investigation protocol.
The investigators must identify and interview all involved persons, including the resident/alleged victim; the alleged perpetrator or perpetrators, if known; any witnesses; and all others who might have knowledge of the incident or allegations.
In reviewing the resident’s role in the incident, it is necessary to review their medical records, such as diagnosis and physician orders, medications, the care plan, progress notes, and the resident’s cognitive and functional status, all the while adhering to regulatory privacy requirements.
The investigator should be on the lookout for any notes in the resident’s medical record relevant to the time frame of the event, which might have bearing on the facts of the situation. These could include, for example, any change in the resident’s mood, demeanor, and function before and after the incident. Such changes can, depending upon the nature of the incident, be a good indicator of the accuracy of the allegations. If it appears that a crime has been committed, then local police must be informed at once, and all evidence secured and protected for their investigation.
