ATrain Education

 

Continuing Education for Health Professionals

IA: Abuse of Dependent Adults

Module 7

Reporting Suspected Abuse

Any person who believes that a dependent adult has suffered abuse may make a report of the suspected abuse to DHS. For example, an employee of a financial institution may report suspected financial exploitation of a dependent adult. Greater public awareness of the prevalence of abuse of elders and people with disabilities would bring this crime out of the shadows. People who report suspected abuse even though they are not legally required to are called permissive reporters.

Mandatory Reporters

Iowa law requires certain professionals to report suspected abuse [IC 235B.3(2)]. They are called mandatory reporters. Mandatory reporters are required to complete a minimum of two hours of training on dependent adult abuse within six months of employment and every five years thereafter.

Note: Mandatory reporters may also report suspected abuse outside the scope of their professional practice, as permissive reporters.

Iowa Code sections 235B.3(2) and 235E.2 require all of the following people to report suspected dependent adult abuse to the Department of Human Services or the Department of Inspections and Appeals if the person in the course of employment examines, attends, counsels, or treats a dependent adult and reasonably believes the dependent adult has suffered abuse:

  • A member of the staff of a community mental health center
  • A peace officer
  • An in-home homemaker-home health aide
  • A person employed as an outreach person
  • A health practitioner, as defined in Iowa Code section 232.68
  • A member of the staff or an employee of a supported community living service, sheltered workshop, or work activity center
  • A social worker
  • A certified psychologist

Reportable Criteria

For DHS or DIA to conduct an evaluation/investigation of an abusive situation, the following three criteria must be met:

  • Victim is a dependent adult
  • Allegation of abuse is under the Dependent Adult Abuse Law
  • The alleged perpetrator is the caretaker (or self)

Under the Dependent Adult Abuse Laws, people who suspect a dependent adult is suffering from abuse by a caretaker shall report their belief to the Department of Human Services (DHS) or the Department of Inspections and Appeals (DIA). It is the role of the mandatory reporter to report suspected abuse and it is the role of DHS or DIA to determine if abuse has occurred.

When in doubt, REPORT!

DHS is responsible for the evaluation/assessment of dependent adult abuse in the community. DIA is responsible for the investigation of dependent adult abuse caused by staff or an employee of a facility (health care facility, hospital) or program (Assisted Living, Adult Day Services, Elder Group Homes). Each department must then investigate the report and make an evaluation of the situation.

This is not to say that other forms of abuse which do not fall under the Dependent Adult Abuse Law should be ignored. Avenues are available to pursue abuse that does not involve a dependent adult or caretaker. To locate the appropriate resource, contact the Iowa Department on Aging (IDA), DHS, or DIA.

When, Where, and How to Make a Report

Mandatory reporters shall:

  • Report suspected abuse of a dependent adult within 24 hours of becoming aware of an abusive incident.
  • Make a written report within 48 hours after an oral report.
  • If a staff member or employee, you must immediately notify the department and also immediately notify the person in charge or the person’s designated agent.
  • If the person making the report has reason to believe that immediate protection for the dependent adult is advisable, that person shall also make an oral report to an appropriate law enforcement agency.

Iowa Code Section 235B.3 requires that mandatory reporters of dependent adult abuse who suspect that a dependent adult in the community has been abused must report it to DHS. Iowa Code 235E.2 requires that if the suspected abuse occurred in a healthcare facility, hospital, elder group home, assisted living or adult day services program, it must be reported to DIA. The report should be made by telephone or by other means.

The DHS Central Abuse Registry accepts reports from any person who believes dependent adult abuse has occurred. DHS maintains a toll-free telephone line 800 362 2178, which is available 24/7. Any person may use this number to report cases of suspected dependent adult abuse. All authorized people may also use this number for obtaining dependent adult abuse information. DIA can be contacted at 877 686 0027.

If you believe that immediate protection for the dependent adult is advisable, also make an oral report to the appropriate law enforcement agency. A county attorney or law enforcement agency that receives a report of dependent adult abuse must refer it to DHS.

You must also make a report in writing within 48 hours after your oral report. You may use DHS form 470-2441, Suspected Dependent Adult Abuse Report, or a format you develop that meets the requirements listed below, based on 441 Iowa Administrative Code 176.5(235B).

If you are a staff member or employee, you must also immediately notify the person in charge or the person’s designated agent. “Immediately” means within 24 hours from the time the mandatory reporter suspects abuse of a dependent adult. The employer or supervisor of a mandatory abuse reporter shall not apply any policy, work rule, or other requirement that interferes with the person making a report of dependent adult abuse or that results in the failure of another person to make the report.

If you are a staff member or employee of a facility or program licensed or certified by the DIA, you must immediately notify the person in charge or the person’s designated agent, who then makes the report to the DIA, within 24 hours, unless the person you are to report directly to is the person you suspect of abusing the dependent adult.

Reporting to DHS

When you suspect dependent adult abuse occurring in the community, you must report it within 24 hours to DHS, followed by a written report within 48 hours. The time period begins when you first suspect abuse, not necessarily when the abuse may have occurred.

DHS Intake Form 470-0657 (Oral Report) can be used as a guide for the information the intake worker will be asking during the oral report. Complete the form as much as possible and refer to abuse indicators as described above. Take care to include:

  • Name and address of dependent adult
  • Names of all parties involved
  • Reasons dependency is suspected
  • Name of alleged perpetrator/caretaker
  • What type of abuse is suspected
  • Why you suspect abuse

A Dependent Adult Abuse Notice of Intake Decision form (470-3944) will be sent to the mandatory reporter indicating whether the report was accepted for referral or rejected. Typically, the form is received within 10 days.

Within 48 hours of the oral report a written report (Suspected Dependent Adult Abuse Report 470-2441) shall be submitted. The written report presents, in detail, reasons for concern. It can reinforce the oral report and ensure all the information shared was recorded accurately. It is wise to maintain copies of these forms in a secured confidential file. You can access this form at https://dhs.iowa.gov/sites/default/files/470-2441.pdf.

Suggestion: Within the 24-hour requirement, complete the written report and then make the oral report. On the written report, note the date and time the report is made as well as the name of the individual receiving the report. Ask the intake worker for the fax number and indicate the written report will be faxed as soon as the oral report is complete. This will assist DHS in getting a clearer picture of the situation.

When completing the report be sure to note special communication issues, verify address and phone number, and note if the dependent adult does not have a phone or has a hard-to-locate home. Describe the person’s dependency in accordance with the definitions and carefully note the suspected abuse and information regarding the caretaker(s) involved. Provide all your contact information and note any collateral reporters for the incident. Make a copy and submit the report, preferably by fax, to the local DHS office after making the oral report. Keep the copy in a secured confidential file.

Did You Know . . .

Being listed as a collateral reporter in another person’s report does not fulfill your responsibilities as a mandatory reporter of the incident.

Because you are a mandatory reporter, DHS is required to notify you in writing as to what action was taken regarding your report (Adult Protective Notification 470-2444). If you should disagree with the report, the notice provides information on how to appeal. If you wish to receive a copy of the unfounded or founded report, which is highly recommended, complete the form on the back of the notification and return it to DHS.

Reporting to DIA

When dependent adult abuse is suspected an oral report must be made within 24 hours or the next business day. In addition, federal law requires that a written report must be made within 5 days. Remember the time frame begins when you first suspect abuse.

Per IAC 481—52.2(2)(f) a report of suspected dependent adult abuse shall contain as much of the following information as the person making the report is able to furnish:

  • The date and time of the incident
  • The name, date of birth and diagnoses of the dependent adult
  • Whether the dependent adult sustained an injury and, if yes, whether photographs of the injury were taken
  • The nature and extent of the dependent adult abuse, including evidence of previous dependent adult abuse allegations
  • A list of the staff members working at the time of the incident, including each staff member’s full name, title, date of birth, address and telephone number
  • The alleged perpetrator’s full name, title, date of birth, social security number, address and telephone number
  • Other information which the person making the report believes might be helpful in establishing the cause of the abuse or the identity of the person or people responsible for the abuse or helpful in providing assistance to the dependent adult
  • The name, address and telephone number of the person making the report

A report shall be accepted whether or not it contains all of the information requested. When the report is made to any agency other than the department, that agency shall promptly refer the report to the department [IAC 481-52.2(3)].

Reports are made to DIA at the toll-free complaint intake line (877 686 0027), or faxed to 515 281 7106, or sent via the Internet using the online form at https://dia-hfd.iowa.gov/DIA_HFD/Process.do.

Reports can also be submitted by regular mail to:

Iowa Department of Inspections and Appeals
Health Facilities Division/Complaint Unit
Lucas State Office Building, 3rd Floor
321 East 12th Street
Des Moines IA 50219-0083

Note: If you suspect Medicaid Fraud, call 515 281 5717 or 515 281 7086. If you suspect Medicare Fraud, call 800 447 8477 or email HHSTips@oig.hhs.gov.

The facility or program shall separate the victim and the alleged abuser immediately and shall maintain that separation until the department’s abuse investigation is completed and the abuse determination is made [IC 235E.2(10) & IAC 52.6].

Immunity and Legal Behavior

This section spells out immunity from liability and also covers legal responsibilities and rights as well as sanctions.

Immunity from Liability

Iowa Code 235B.3(10) and 235E.2(7) state that:

A person participating in good faith in reporting or cooperating with or assisting the department in evaluating a case of dependent adult abuse has immunity from liability, civil or criminal, which might otherwise be incurred or imposed based upon the act of making the report or giving the assistance. The person has the same immunity with respect to participating in good faith in a judicial proceeding resulting from the report or cooperation or assistance or relating to the subject matter of the report, cooperation, or assistance.

Legal Responsibilities and Rights

Mandatory reporters:

  • Shall report suspected dependent adult abuse orally and in writing
  • Shall complete two hours of training within six months of initial employment and 2 hours every 5 years thereafter [IC 235B.16(5)(b)]
  • Must report to law enforcement if immediate protection of dependent adult is advisable
  • Must cooperate with DHS and/or DIA

Mandatory reporters have a right to:

  • Receive a copy of the notice of finding of the report
  • Request and receive a copy of the report for founded and unfounded incidents. (IC 235B.6(2)(b)(6) and 235B.6(3) respectively)
  • Immunity from liability civil or criminal [(IC 235B.3(10)]
  • Remain anonymous when the disclosure of the reporter’s identity would be detrimental to the person’s interest [441 IAC 176.10(3)]

Sanctions

  • Any mandatory reporter who knowing and willfully fails to report suspected dependent adult abuse (within 24 hours) is guilty of a simple misdemeanor.
  • Any mandatory reporter who knowingly fails to make a report or knowingly interferes with the making of such a report or applies a requirement that results in such a failure is civilly liable for the dames proximately caused by the failure.

 

Did You Know . . .

HIPAA prevents the release of information about patients to anyone other than the legal representative of the patient. In cases of suspected abuse, HIPAA waives this rule and state law mandates such reports are made (45 CFR 164.512).

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