Investigations in a Long-Term Care Facility: The Obligation for Education and Training
Jeannine LeCompte, Compliance Research Specialist
A long-term care facility that is dependent upon Medicare/Medicaid financing has a legal obligation to ensure that its staff are fully knowledgeable with all aspects of investigations into abuse, neglect, exploitation, and misappropriation. Explanation should be included in the employees’ handbook, with training given upon hire, and then at least annually thereafter. A record of the training must also be kept in order to protect the facility should a CMS citation result at any stage. If abuse, neglect, exploitation, or misappropriation has occurred and an employee has not been recently trained in these areas, the facility can be held accountable. Not providing required trainings can also be viewed as a violation of federal and state regulations and potentially fraud, waste, or abuse of government funds paid to the facility for substandard quality of care.
Staff members should be aware that they are obligated to take immediate action upon learning of an incident. The top priority is to protect all residents from further harm, not just the affected individual. This may require obtaining assistance to remove an alleged abuser from the facility, obtaining medical attention for the resident/victim, and/or preserving evidence at the scene.
Thereafter, all details of the incident must be noted and all relevant information/evidence secured and documented. If the incident is thought to be a crime, the local police must be immediately notified. This must occur no later than two hours following the suspicion if the incident resulted in serious bodily injury.
If there is reason to believe abuse, neglect, mistreatment, or exploitation has occurred, the investigator must immediately notify the facility administrator, the Department of Health through the Electronic Incident Reporting System, and complete the investigation as soon as possible. If the event does not meet the abuse definitions, the analysis leading to that conclusion must be clearly documented.
Finally, all incidents must be reported to the facility’s Quality Assurance (QA) and Performance Improvement (PI) programs. This will allow checks to be put in place to prevent, as far as possible, any further such incidents from taking place. A QAPI review should also take note of any immediate medical or nursing care plans which might need to be reviewed and updated in light of the incident.
In conclusion, the facility should be aware of its legal obligations to ensure that all staff are aware of the required procedures, otherwise there can be very serious consequences.
