Abuse Prevention Programs in Senior Living & Social Services
Senior living and social services providers should be aware that states across the country are passing reviver statues, which allow otherwise time-barred claims of childhood sexual abuse to proceed. The statutes vary by jurisdiction, but generally do one of three things:
- (1) Eliminate the statute of limitations for such claims;
- (2) Extend the statute of limitations for such claims;
- (3) Create a window (e.g., a period of a few years) in which otherwise time-barred claims can be filed.
Currently, over 20 states have enacted these statutes, which may have an effect on your insurance renewal.
Amid the reviver statutes, social movements, high profile cases, and a shrinking reinsurance market, many insurance carriers are starting to place very low sublimit or are excluding abuse and molestation on senior living and social services providers’ umbrella or excess liability policies. This exclusion is intended to carve out the perpetrator.
Even though abuse and molestation is a criminal offense, litigation does not always target the perpetrator, but instead a senior living and social services provider. In these cases, most providers are being sued due to failure to supervise, negligent hiring, or negligent training. According to a recent webinar from Philadelphia Insurance Companies:
- The average verdict is $5 million / victim (across all states)
- The average settlement is $750,000 – $1.2 million / victim (across all states)
What can providers in regard to abuse prevention?
Disclosure: Please be advised this resource and the recommendations outlined below are not intended as legal advice and should not be used as or relied upon as legal advice. It is for general informational purposes only.
Consider reviewing your current abuse policy and updating it to be a fully-integrated prevention program model, including but not limited to:
- Adequate hiring and screening of employees, volunteers and contractors
- In-depth training on abuse, neglect, mistreatment, misappropriation and exploitation
- Implement preventative operational risk management strategies
- Confirm thorough internal and external reporting procedures
- Implement investigation procedures following notification of suspected or confirmed abuse
- Incorporate audits and monitoring
Hiring and Screening Practices
of Employees and Volunteers
90% of offenders do not have a criminal background according to a recent webinar from Philadelphia Insurance Companies, thus completing background checks at hire and every two to four years thereafter is not enough to detect and prevent abuse from occurring. Consider implementing a variety of hiring and screening processes for employees and volunteers for your organization. Do not make exceptions for people you know or who have worked for you in the past.
Consult with an attorney to ensure your screening and selection processes do not violate any state or federal laws prohibiting discrimination in the workplace, including Title VII of the Civil Rights Act. Consider the following standard aspects of a screening and selection process:
- Background checks
- Reference checks
- Personal interviews
- Rigorously screen applicants that will have autonomy
- Professional reference checks from past employers
- Personality tests / core value ranking
- Situational and behavioral interview questions
- Analyze potential resume red flags
- Gaps in employment
- Job hopping
- Inconsistent career paths
- Frequent location moves
Regular Training on Abuse Prevention
Training on abuse, neglect, mistreatment, exploitation and misappropriation should be done upon hire, annually and on an as-needed basis. Consider having an education topic related to abuse quarterly.
Training topics may include but not be limited to:
- Clear understanding of appropriate vs. inappropriate communication and touch
- How to recognize behaviors that may lead to abuse or unethical conduct
- Grooming
- Boundary invasion
- Recognizing Signs of Abuse (emotionally, mental and physical)
- Physical / Neglect
- Bruising, grip marks
- Repeated unexplained injuries
- Dismissive attitude about injuries
- Lack of basic hygiene
- Weight loss/sunken eyes
- Emotional/Mental
- Fearful or suspicious
- Withdrawn
- Changes in behavior
- Financial/misappropriation of property
- Member of family or friend frequently asking on account balance
- Having client/resident withdraw money for gifts or requests made with a friend or family member present
- Investigate any financially driven decisions vs. well-being of client/resident – is it appropriate?
- Physical / Neglect
- Gift giving to employee(s) or organization
- Mandated reporting training
- For providers caring for elderly:
- Caring strategies for those with Dementia (e.g. Teepa Snow series)
- For providers caring for persons with disabilities:
- Incorporating Mandt, and other de-escalation training programs into your internal training, policies and procedures
- Resident/client rights
- Internal and external reporting process
- Notification expectations
- Corporate Compliance
- Employee code of conduct/ethics
- Grievance policy and procedure
- Anonymous reporting options
- Whistleblower protection
- Supervisor training on investigation process and expectations
Note: all training/education provided should include competency check-offs through demonstration or quizzes.
Operational Risk Management Strategies
- Have a grievance program (customer service-driven)
- Investigate all complaints (resident/client, family, employee or volunteer driven) through quality assurance or quality assurance performance improvement programs and have a response process
Note: investigations should not be a part of the resident or personnel record
- Investigate all complaints (resident/client, family, employee or volunteer driven) through quality assurance or quality assurance performance improvement programs and have a response process
- Consider strategies to manage risk when employee is alone with one client
- Encourage open door/window policy during 1:1 interactions when able
- Consider including a second individual in the room/enclosed area during private care situations or needed conversations
- Change up employee/client dynamic when able, even if just to audit
- Switch up formal and informal supervision for random and regular observations
- Review physical environment for any vacant or non-monitored areas
- If any areas are identified, what risk mitigation strategies may be implemented?
Reporting Procedure
Providers are well-served by having both internal and external reporting procedures in the event there is suspected or confirmed incidents of abuse, neglect, mistreatment, exploitation or misappropriation of a resident/client’s property.
Internal Reporting:
- Stop and protect resident/client from abuse occurring, if applicable
- Report immediately to supervisor, if supervisor is not involved in the abuse
- Consider a hierarchal reporting structure, especially if a client sustains an injury. For example, which items should be escalated to executive leadership?
- Report immediately to corporate compliance officer or through secure hotline
- Supervisor upon notification is to immediately start investigation procedure
External Reporting:
Providers are well-served by having a procedure in which a designee from the facility/organization reports to applicable third party agencies. Providers should outline what agency is to be reported to for which incidents, the timeframe in which to report, the method in which to report, and a clear description of what is needed to report.
Examples of third party agencies that may be applicable;
- Child Protective Services
- Adult Protective Services
- Law Enforcement
- Division of Quality Assurance
- Department of Health Services
- Managed Care Organizations/Funding Sources
- Department of Safety and Professional Services
- Insurance Agency
Audits & Monitoring
Audits and monitoring should be done through an organization’s quality assurance or quality assurance performance improvement subcommittee. Findings should be reported to the quality assurance or quality assurance performance improvement team. From there, any needed action items or next steps will be assigned.
Examples of action items include but are not limited to:
- Update/review abuse prevention program, at least annually and on an as-needed basis
- Is your organization/facility doing what thpolicy/procedure said your organization/facility would be doing?
Note: It is often not the policy but rather the procedures and execution of the policy that may need to be reviewed or audited to ensure compliance.
- Is your organization/facility doing what thpolicy/procedure said your organization/facility would be doing?
- Regular “unannounced” audits/monitoring of 1:1 behaviors or interactions between employees/volunteers and clients
- “Unannounced” ride along during any typical 1:1 transportation between employees/volunteers and clients
- Regular satisfaction surveys and/or informal check-ins with clients, families and employees
- Formal check-in with employees/volunteers during annual review or other scheduled time (i.e. exit interviews) where supervisors specifically ask about any known misconduct or unethical behavior
- Timeliness of complaint/grievance follow-up/response
- Telematics monitoring of time and location of fleet vehicles
Investigation Procedures Following Notification
Providers should consider having a formal investigation procedure outlined to reference in the event of suspected or confirmed abuse, neglect, mistreatment, exploitation or misappropriation of property.
Important key reminders/considerations
- Investigation should begin immediately following notification
- Any alleged perpetrator is to be removed or asked to restrain from the facility/organization upon notification of suspected or confirmed abuse, neglect, mistreatment, exploitation or misappropriation of property until investigation is complete
- If the alleged perpetrator is an employee, consider placing the individual on administrative leave until investigation is completed
- Investigations cannot guarantee confidentiality of those involved or witness to the alleged incident
- All witnesses or those with information regarding the alleged incident, are to be interviewed immediately during investigation procedure
- The investigation process should be impartial, including avoiding presumptions, bias and conflicts of interest
- Team members assigned to investigating may need to exclude themselves from if any of the above apply
- The investigation should run concurrently with any third party agency investigation (i.e. law enforcement)
Note: do not stop investigating internally because law enforcement or another agency is also involved. - Refer to your record retention and release policy for investigation document retention schedule and any items needed to be released and to whom
- Once investigation is complete, determine appropriate action for alleged perpetrator(s) and document any corresponding action taken. Examples include but are not limited to;
- Disciplinary action, i.e. termination of employment
- Restraining order from facility/organization
- Re-assignment of POA or guardianship
- Discharge from facility/organization
Third Party Resources
Praesidium: A comprehensive array of products and services that allows organizations to assess potential gaps in their programs and implement best practices in each of the eight operations from the Praesidium Safety Equation® (Policies + Screening and Selection + Training + Monitoring and Supervision + Internal Feedback Systems + Consumer Participation + Responding + Administrative Practices = A Safe Environment).
Abuse Prevention Systems: Abuse Prevention Systems helps organizations meet legal standards of care and reduce the risk of sexual abuse by creating preventative measures tailored to fit the needs of camps, schools, youth sports, daycares and other children’s programs. Abuse Prevention systems offers a comprehensive program utilizing a 5-Part Safety System that creates overlapping layers of protection to ensure no situation is overlooked.
Ministry Safe: Ministry Safe was created to help ministries meet legal standards of care and reduce the risk of sexual abuse using tools and technology tailored to fit the needs of churches, camps and ministry programs. Ministry Safe offers a comprehensive program utilizing a 5-Part Safety System that creates overlapping layers of protection to ensure no situation is overlooked.
Key Takeaways
Many states are passing reviver statutes that may affect your insurance renewal. Senior living and social services providers would be best served to review their current abuse prevention program and consult their counsel regarding their policies and procedures. We also encourage you to contact your M3 Account Executive or Risk Manager for assistance in developing an abuse preventative program tailored to your organization.
Disclosure: Please be advised this resource and the recommendations outlined below are not intended as legal advice and should not be used as or relied upon as legal advice. It is for general informational purposes only.
