O nline T racking I nformation S ystem Abuse/Neglect Reporting System J. Michelle Lewis, RN

1. Online Tracking Information System Abuse/Neglect Reporting System J. Michelle Lewis, RN

2. WHAT IS OTIS?

3. OTIS (Online Tracking Incident System) is a web based application created by LDH (formerly DHH) used by applicable Providers to report allegations of abuse, neglect, exploitation, misappropriation of property and injuries unknown origin of a resident. Reports submitted via the internet to meet State and Federal reporting requirements.

4. Abuse - is the willfulinfliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (CMS 11-28-17) Abuse includes the deprivation by an individual, including caretaker, of goods or services that necessary to attain or maintain physical, mental,

5. and psychosocial well-being. Instances of abuse to all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology.

6. Abuse is the willful infliction of injury or the causing of the deterioration of a resident by means including, but not limited to, physical, verbal, emotional, psychological, sexual abuse, exploitation, or extortion of funds or other things of value to such an extent that the resident’s health, moral, or emotional well-being is endangered. (Minimum Licensing Standards- Feb. 2018 )

7. Type of Abuse Physical Abuse Mental Abuse Verbal Abuse Sexual Abuse

8. Identified facility characteristics that could increase the risk of abuse include: Unsympathetic or negative attitudes toward residents; Chronic staffing problems; Lack of administrative oversight, staff burnout, and stressful working conditions;

9. Poor or inadequate preparation or training for care giving responsibilities; Deficiencies of the physical environment; and Facility policies operate in the interests of the institution rather than the resident

10. Physical abuse includes hitting, slapping, pinching and kicking • Corporal Punishment is physical punishment, a means to correct or control behavior (ie. Pinching, spanking, slapping of hands, or flicking, or hitting with an object. Physical Abuse

11. Mental Abuse – use of verbal or nonverbal conduct which causes or has the potential to caue the resident toe experience humiliation, intimidation, fear, shame, agitation, or degradation. Mental and Verbal Abuse

12. Verbal Abuse -use of oral, written or gestured communication, or sounds, to residents within hearing distance regardless of their age, ability to comprehend or disability

13. Mental and Verbal abuse includes but not limited to: • Harassing a resident • Mocking, insulting, ridiculing • Yelling or hovering over a resident, with the intent to imitated

14. Threatening residents, including depriving of care or withholding from contact with family and/or friends • Isolating a resident from social interactions or activities • Keeping /Distributing humiliating photographs and recordings via social media or multimedia messaging.

15. Sexual Abuse – is non-consensual sexual contact of any type with a resident.

16. Sexual Abuse includes, but not limited to: Unwanted intimate touching of any kind especially of breasts or perineal area All types of sexual assault or battery, such as rape, sodomy, and coerced nudity

17. Forced observation of masturbation and/or pornography Taking of sexually explicit photographs and/or video recordings of a resident(s) and maintain and/or distributing them (ie. Posting on social media. Appears to want the contact to occur, but lack the cognitive ability

18. Indicators of Potential Sexual Abuse Bruises around the breasts, genitalia area, or inner thighs Unexplained Sexually Transmitted Disease or genital infections Unexplained vaginal or anal bleeding Torn, stained, or bloody clothing

19. Neglect – the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. (CMS)

20. Neglect is the failure to provide the proper or necessary medical care, nutrition or other care necessary a resident’s well-being, unless the resident exercises his/her right to refuse the necessary care. (Minimum Licensure – Feb. 2018)

21. Neglect of goods and services may occur when staff are aware or should be aware of resident’s care needs, based on assessment and care planning, but are unable to meet the identified needs due to circumstances that include: Lack of training to perform an intervention (suctioning, transfers, use of equipment)

22. Insufficient staffing (response to call lights) Insufficient supplies Staff’s lack of knowledge of the resident’s care needs (use of staffing agency

23. Facilities should investigate Allegations of Caregiver Neglect when altercations occur between Residents. It is important that a facility take reasonable precautions, including providing adequate supervision when the risk of Resident-to-Resident altercations is identified

24. Falls – should be investigated as physical abuse and care giver neglect.

25. Deprivation of Good and Services – abuse also includes the deprivation by staff of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being.

26. Deprivation of Goods and Services: Example: Staff has the knowledge and ability to provide care and services, but choose not to do it, or acknowledge the request for assistance from a resident, which results in care deficits to a resident

27. Exploitation – means “taking advantage of a resident for personal gain, through the use of manipulation, intimidation, threats, or coercion.”

28. Misappropriation of Resident Property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a Resident’s belongings or money without the Resident’s consent.

29. An example of Misappropriation of resident property is: Diversion of a resident’s medications including, but not limited to, controlled substances for staff use or personal gain.

30. Involuntary Seclusion is separation of a Resident from other Residents or from her/his room or confinement to her/his room (with or without roommates) against the Resident’s will, or the will of the Resident’s legal representative.

31. Emergency or short term monitored separation from other Residents will not be considered involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation until professional staff can develop a plan of care to meet the Resident’s needs.

32. Willful • means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. DEFINITIONS

33. Even though a Resident may have a cognitive impairment, he/she could still commit a willful act • There may still be instances when a Resident’s willful intent cannot be determined DEFINITIONS

34. RESTRAINTS The facility must ensure the resident is free from physical and chemical restraints imposed for the purpose of discipline or convenience. When the use of restraints is indicated, the facility must use the least restrictive alternative for least amount of time.

35. Most common non-accidental injuries are the face and neck, chest wall, abdomen and buttocks • Injuries suggestive of defensive maneuvering: • Back of arms and hands • Injuries related to grasping, squeezing or forcible restraint • Color is helpful in dating bruises Clinical/Forensic Markers

36. RESTRAINTS Document ongoing re-evaluation of the need for restraints.

37. Injuries of Unknown Origin must meet the following two criteria: • The source of the injury was not observed by any person or the source of the injury could not be explained by the Resident AND

38. The injury is suspicious because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time

39. Major injuries of unknown origin (fractures, burns, suspicious contusions, head injuries, etc.) for which the facility is unable to determine the cause and could possibly be the result of abuse or neglect shall be reported (Minimum Licensure) Injury of Unknown Origin

40. All other injuries not meeting the two conditions listed should be investigated by the facility and documentation of the investigation retained by the facility. Injury of Unknown Origin

41. Reporting Requirements

42. Incidents that meet the definition of Abuse, Neglect, Misappropriation or Injury of Unknown Origin • Incidents must have been “willful and/or deliberate” andhave caused harmto be considered Abuse or Neglect What is Reportable in OTIS ?

43. CRIMES The facility must develop and implement written policies and procedures that includes: Ensure reporting of crimes occurring in federally-funded long term care facilities in accordance with section 1150B of the Social Security Act. Each person associated with the NH shall report according to the required time frame to the appropriate entities that causes a suspicion

44. CRIMES Examples of reportable crimes: Murder; Manslaughter; Rape; Assault and battery; Sexual Abuse; Theft/Robbery; Drug Diversion for personal use of gain; Identity theft; and Fraud and forgery

45. Alleged violations involving abuse, neglect, exploitation or mistreatment are to be reported immediately, but no later than 2 hours after the allegation is made into the LDH database reporting system , IF: The events that cause the allegation involve abuse or results in serious bodily injury OR

46. No later than 24 hours after the allegation is made/discovered, IF: The event that causes the allegation do not involve abuse and do not result in serious bodily injury. Reporting requirements are based on real (clock) time, not business hours.

47. Report to whom: Administrator of the facility; AND Other officials including: State Survey Agency and Adult Protective Services where state law provides for jurisdiction in long term care facilities) in accordance with State law through established procedures; Law Enforcement

48. Results of the investigation are to be completed in the LDH database reporting system within 5 working days of the incident.

49. The reporting requirement is not met by accessing the system and creating a “placeholder” with little or no information; this may result in surveyors citing a tag. • Minimum information required: • Victim • Accused/Allegation/Incident Category • Statement describing allegation/s in Description • Date discovered in facility

50. Reporter • Name of the person who completed the facility incident report. • May be different than the person who is actually entering the data in the LDH database reporting system. • Witness • Person or persons who witnessed the incident. Can be a staff member, a Resident, a family member, etc. • Other Contacts • May be entered as desired