Rule 50 Training 2010 (exe) To discontinue while viewing, press the Esc key.

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  1. What is the purpose of this training?
    1. To explain the new definitions of abuse and neglect in Rule 50, using examples;
    2. To remind you how allegations must be reported to OIG; and
    3. To help you understand what OIG might do after an investigation.
  2. Allegations and OIG 
    1. To be reportable to OIG, an allegation must involve an individual and an employee. 
      1. The allegation could instead be against the facility or community agency itself.
    2. OIG does not investigate alleged incidents that are:
      1. Between employees, or
      2. Between individuals
        1. Unless it was caused by an employee.
  3. What if...
    1. Arthur attended an outing at the zoo today. When he returned to his CILA, he complained that Abby, a staff member, slapped him across the face for spitting on the window of the snake display. Arthur said that it hurt, but he is not really injured.
  4. Is that reportable to OIG? 
    1. Remember, for an allegation to be reportable to OIG, the victim must be an individual and the accused must be an employee (or agency or facility).
  5. Is that reportable to OIG?
    1. An "individual" is defined in Rule 50 as: Any person receiving mental health services, developmental disabilities services, or both from a facility or agency while either on site or off site.
    2. Because Arthur receives services in a CILA, he meets the definition of individual.
  6. Is that reportable to OIG?
    1. An "employee" is defined in Rule 50 as: A person who provides services at the facility or the community agency on or off site. The service relationship can be with the individual, the facility or the agency.
  7. Is that reportable to OIG? 
    1. The definition of "employee" also includes:
    2. Any employee or contractual agent of DHS or the community agency involved in providing, monitoring or administering mental health or developmental disability services, which includes but is not limited to: owners, operators, payroll personnel, contractors, subcontractors, and volunteers. 
    3. Anyone who is no longer working for an agency or facility but is the subject of an ongoing investigation for which OIG has jurisdiction.
  8. Is that reportable to OIG? 
    1. Abby provides services to Arthur, so she meets the definition of employee.
    2. Therefore, the alleged incident is between an individual and an employee, and it should be reported to OIG. 
    3. Even though the alleged incident happened off site at the zoo, it is still reportable to OIG.
  9. So, what is "abuse"?
    1. Rule 50 defines "abuse" as any physical abuse, sexual abuse, mental abuse, or financial exploitation.
  10. But what is "physical abuse"?
    1. Rule 50 defines "physical abuse" asan employee's non accidental and inappropriate contact with an individual that causes bodily harm. The definition includes actions that cause bodily harm as a result of an employee directing an individual or person to physically abuse another individual.
  11. What is "bodily harm"?
    1. Rule 50 defines "bodily harm" as either:
      1. Any injury, damage, or impairment to an individual's physical condition (like a cut, bruise, scrape, burn), or
      2. Making physical contact of an insulting or provoking nature with an individual.
  12. Review
    1. Although Arthur did not suffer a visible injury, the act of slapping him across the face for spitting is non accidental, inappropriate physical contact of an insulting or provoking nature and is, therefore, physical abuse.
    2. Even if Abby would have told another individual to slap Arthur for spitting, it would be alleged physical abuse by Abby.
  13. Are you a required reporter?
    1. A required reporter is any employee who suspects, witnesses, or is informed of an allegation of... mental abuse, physical abuse, sexual abuse, neglect, or financial exploitation.
    2. So, yes, you are a required reporter!
  14. How long do you have to report it? 
    1. Allegations must be reported to OIG's Hotline within four hours after they are first discovered.
    2. That means that if Arthur told you about it at 6:00 pm, then the allegation must be reported to the OIG Hotline by 10:00 pm that evening.
  15. OIG's Hotline number is: 800 368 1463
  16. How to report it 
    1. Your agency or facility policy may instruct you to report it through internal procedures. That's OK, but remember: every allegation must get to OIG within four hours of the time it was first discovered.
    2. So, you should report it as soon as you possibly can.
  17. After hours reporting
    1. If you call the Hotline between 4:45 pm and 8:30 am the next morning, you will get OIG's answering service.
      1. It will also answer on weekends and holidays.
    2. The answering service will:
      1. Take information about the incident, and
      2. Tell you that an OIG representative will call you back the next business day.
        1. Someone at your agency/facility who knows about the incident must be available to complete the report.
  18. Do you have to report these incidents to the police, too?
    1. If you need immediate assistance, call the police.
    2. Anytime there is credible evidence of a criminal act in a State operated facility, OIG will contact the Illinois State Police.
    3. If the alleged criminal act is at a community agency, the agency should contact the local police.
    4. Please notify OIG if you have contacted the police.
  19. Should you report? 
    1. If you are unsure or only suspect abuse or neglect might have happened, should you really report it? YES
    2. Report it even if it might have happened a long time ago.
      1. There is no statute of limitations on allegations. So, if someone tells you of abuse that happened 10 or 15 years ago, you still have to report it.
    3. Screening is strictly forbidden.
  20. What is "screening"?
    1. Screening is withholding, altering, or delaying any report of abuse or neglect.
    2. Deciding not to report an allegation of abuse or neglect because you know it did not or could not have happened is also screening.
      1. If anyone complains of abuse or neglect by an employee, you must report it!
  21. What if you don't report it?
    1. You could be disciplined.
    2. If you have a license, your license or certification could be affected.
    3. You could be charged with a crime.
  22. What?? Criminal charges??
    1. Yes, criminal charges.
    2. OIG's statute 20 ILCS 1305/1 17(a) states that the willful late reporting or failure to report an allegation of abuse or neglect is a criminal act.
      1. Willful means intentional.
    3. It is a Class A misdemeanor, and if you are convicted, you could face: 
      1. Up to one year in jail, and/or 
      2. Up to a $2,500.00 fine.
  23. Some cautions about reporting
    1. You are violating the Department of Human Services Act (20 ILCS 1305/1 17), if you:
      1. Create and transmit a false report to the OIG Hotline, or
      2. Cover up an allegation or evidence and don't report it, or
      3. You retaliate against someone who reports abuse or neglect in good faith.
  24. Does anything other than physical abuse need to be reported?
    1. Yes, you must report any allegation of: 
      1. Mental abuse, 
      2. Sexual abuse, 
      3. Financial exploitation, or 
      4. Neglect.
  25. What deaths are reportable?
    1. It must be reported to OIG if the individual dies on site in any program that is operated, licensed, certified or funded by DHS.
      1. Residential facilities and CILAs.
      2. Day treatment and developmental training sites. 
      3. Mental health outpatient programs. 
    2. It is reportable if the individual dies within:
      1. 14 calendar days after discharge or transfer, or
      2. 24 hours after deflection from a residential program or facility.
  26. What is "deflection"?
    1. Deflection is when an individual comes to a facility or agency for admission or services but is not admitted by the staff.
      1. It does not matter why he or she was deflected. If he or she was turned away or sent somewhere else but died within 24 hours, then you must report it to OIG when you hear of it.
    2. Remember: If a death may have resulted from abuse or neglect, it must be reported to OIG within four hours of initial discovery.
  27. What if ...
    1. Barbara, an individual who lives on the unit where you work, mentions that Bob, an employee, always comes into her bedroom at night to straighten her covers. She says that, while doing that, he puts his hand under her pajama top and rubs her breasts.
    2. And Barbara says that Bob brought Bruce with him last night and told him that he could rub her breasts, too, which he did. Barbara says that Bruce is another individual in the program.
  28. Is that sexual abuse? 
    1. Rule 50 defines sexual abuse as: Any sexual behavior, sexual contact, or intimate physical contact between an employee and an individual, including an employee's coercion or encouragement of an individual to engage in sexual activity that results in sexual contact, intimate physical contact, sexual behavior or intimate physical behavior.
  29. What is "sexual contact"? 
    1. According to Rule 50, sexual contact is: Inappropriate sexual contact between an employee and an individual involving either an employee's genital area, anus, buttocks or breasts or an individual's genital area, anus, buttocks or breasts. Sexual contact also includes sexual contact between individuals that is coerced or encouraged by an employee.
  30. Is this sexual abuse?
    1. Barbara is an individual, Bob is an employee, and Bob allegedly rubbed Barbara's breasts. So, this is an allegation of sexual abuse.
    2. What if Bob did not touch Barbara but only encouraged and allowed Bruce, an individual, to touch her breasts? Is it still sexual abuse?
    3. Yes, because Bob encouraged it.
  31. How soon must it be reported?
    1. Since it is a sexual abuse allegation, it must be reported to OIG's Hotline within 4 hours from Barbara alleging it. 
    2. A sexual abuse finding can be referred to law enforcement, and if the employee is charged criminally and convicted, it would be a Class 3 felony which is punishable by two to five years in prison and a fine of up to $25,000.
  32. Sexual misconduct with a person with a disability... 
    1. Is a Class 3 felony (720 ILCS 5/11 9.5).
      1. The victim's consent is not a defense.
    2. In addition to the prison time and a fine, it is also punishable by:
      1. Mandatory registration as a sex offender with supervision for one year;
      2. Immediate loss of job; and
      3. Listing on the Health Care Worker Registry and prohibited from working in any State funded health care in Illinois.
  33. What if...
    1. You hear Carla, the nurse, tell Christina, an individual: "Shower now, because you smell like a pig and look like garbage." Christina then runs to her room crying.
    2. Is this reportable to OIG? 
    3. First: Is the alleged victim an individual? YES
    4. Is the accused person an employee? YES
    5. Then, are Carla's actions abusive?
  34. What is "mental abuse"?
    1. Rule 50 defines mental abuse as:
    2. The use of demeaning, intimidating, or threatening words, signs, gestures, or other actions by an employee... 
    3. about an individual and in the presence of an individual or individuals...
    4. that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.
  35. Is it alleged mental abuse? 
    1. Carla is an employee, and Christina is an individual.
    2. Saying someone smells like a pig and looks like garbage is demeaning.
    3. It resulted in the individual becoming upset and crying. 
    4. Therefore, it is alleged mental abuse, and it is reportable (within four hours of discovery) to OIG.
  36. New to Rule 50 is...
    1. Financial Exploitation 
    2. Financial exploitation is defined in Rule 50 as:
      1. Taking unjust advantage of an individual's assets, property, or financial resources through...
      2. deception, intimidation, or conversion...
      3. for the employee's, facility's, or agency's own advantage or benefit.
        1. ("conversion" means theft)
  37. Financial exploitation
    1. Some examples:
      1. Removing money from an individual's purse.
      2. Taking money from the individual's trust fund. 
      3. Stealing money from a bank account.
      4. Using and not returning an individual's clothing. 
      5. Taking food that belongs to an individual. 
      6. Coercing an individual to trade you for something he or she has that you want.
    2. All of these would be financial exploitation and should be reported to OIG.
  38. What if...
    1. Vinny's mom gives him $20 every week but gives it to him as two $10s. That way, he doesn't have to take it all on one outing, since she knows that he likes to spend everything in his possession.
    2. Staff member Verna convinces Vinny to let her hold onto his second $10 bill, so that he doesn't make his mom mad by spending it right away.
    3. Vinny tells you that Verna never gives him the second $10 back, claiming that if he spends it, his mom would get angry with both of them. He says that Verna has been doing this for the last six months or so.
  39. Is that alleged financial exploitation? 
    1. Yes, because there is a suspicion that Verna is stealing Vinny's money.
    2. Will it be substantiated?
      1. It depends on whether she's keeping his money for him or using it for herself. Just holding onto his money is not financial exploitation.
      2. It's up to the investigation to find out if Verna is keeping the money or using it for her benefit.
      3. Your responsibility is to report his allegation. 
  40. OIG investigates abuse and neglect
    1. OIG investigates allegations of abuse:
      1. Physical abuse, 
      2. Sexual abuse, 
      3. Mental abuse, and 
      4. Financial exploitation.
    2. OIG also investigates allegations of neglect.
  41. What is "neglect"?
    1. Rule 50 defines neglect as: An employee's, agency's, or facility's failure to provide adequate medical care, personal care, or maintenance that, as a consequence:
      1. Causes an individual pain, injury, or emotional distress, or
      2. Results in either an individual's maladaptive behavior or the deterioration of an individual's physical or mental condition, or
      3. Places an individual's health or safety at substantial risk.
  42. What is "egregious neglect"?
    1. If an allegation of neglect is substantiated, the Inspector General determines if it is "egregious neglect." 
    2. It is "egregious neglect" if it both:
      1. Represents a gross failure to adequately provide for, or a callous indifference to, the health, safety, or medical needs of an individual, and
      2. Results in an individual's death or other serious deterioration of an individual's physical or mental condition.
  43. Gross failure? Callous indifference?
    1. Gross failure refers to a failure that is glaring, obvious or outrageous.
    2. Callous indifference refers to an attitude of being unsympathetic, unconcerned or uncaring.
  44. What if...
    1. Eric, an individual, is non ambulatory and confined to bed. A physican's order says to reposition him every 30 minutes. Staff fail to do so, and after approximately 5 days, he develops bedsores.
  45. Is this alleged neglect? 
    1. Yes, because: 
      1. The staff appear to have failed to provide him with adequate medical care, and
      2. The failure appear to have caused him pain and the deterioration of his physical condition.
  46. What if...
    1. The other staff refuse to attend to the bedsores because they feel this is a nursing duty and they are tired of doing nurse Evelyn's job.
    2. After about a month, Eric's bedsores become very deep and cause septicemia (a serious blood infection). He is admitted into the hospital in critical condition but survives.
  47. Might this be egregious neglect?
    1. Yes, because:
      1. The staff knew he had bedsores, yet refused to attend to him, despite the obvious risk:
        1. That could be a gross failure and/or a callous indifference to Eric's medical needs; and
      2. It resulted in a serious deterioration of Eric's physical condition.
    2. So, it may be egregious neglect.
      1. Egregious neglect may be referred to the Health Care Worker Registry.
  48. Health Care Worker Registry 
    1. The Registry is a database maintained by the Illinois Department of Public Health. 
    2. If someone's name and substantiated finding is listed on the Registry, then that person may not work in any State funded health care setting in Illinois.
    3. OIG's findings of physical abuse, sexual abuse, and egregious neglect are listed findings.
  49. Health Care Worker Registry 
    1. OIG refers a person's name to the Registry when it substantiates physical abuse, sexual abuse or egregious neglect by the person. 
    2. OIG will notify the person of his/her right to file an appeal (a "50.90 appeal").
      1. This appeal is only about the referral of his/her name to the Registry.
      2. It does not appeal the finding of the case itself.
    3. OIG will not refer the name until any other pending legal action is resolved.
  50. Health Care Worker Registry
    1. Once on the Registry, a person may appeal to be removed by submitting a 50.100 petition.
      1. A petition can be filed once every twelve months. 
      2. OIG conducts an investigation to determine if the petitioner has met their burden for removal from the Registry and makes a recommendation to the administrative law judge. 
      3. The administrative law judge makes a recommendation to the Department Secretary who then makes the final decision. 
  51. License Referrals 
    1. The Illinois Department of Financial and Professional Regulation (DFPR) also investigates allegations against a licensed professional, such as a doctor or nurse. 
    2. OIG may report allegations to DFPR, and OIG may give its final investigative reports to that agency.
  52. Privacy Concerns 
    1. Confidentiality laws - like HIPAA (the Health Insurance Portability and Accountability Act) - protect personal information.
    2. However, as an investigating entity, OIG has specific exemptions from those laws. 
    3. So, you are not in violation of confidentiality, privacy or HIPAA restrictions when you give OIG information during an investigation.
  53. First investigative steps
    1. The agency/facility must do the following in any allegation of abuse/neglect: 
      1. Ensure the health and safety of everyone;
      2. Order medical exams of alleged victims; 
      3. Remove accused staff from all individuals (if the allegation has any credible evidence); and
      4. Allow only employees trained by OIG to do the following steps:
        1. Secure the scene and keep unauthorized people out,
        2. Photograph the scene and any injuries,
        3. Keep relevant documents and evidence safe, and
        4. Identify and separate witnesses.
  54. OIG case finding
    1. OIG has to prove its investigations by a "preponderance of the evidence" standard. 
      1. Preponderance of evidence means there is enough evidence to show that it is more likely than not that the abuse occurred.
    2. So, if over 50% of the weighted evidence indicates that the abuse or neglect occurred, then OIG substantiates the case.
  55. What findings can OIG cases have? 
    1. Substantiated, again, means there is a preponderance of the evidence to support the allegation. 
    2. Unsubstantiated, means there is credible evidence but less than a preponderance of evidence to support the allegation.
    3. Unfounded, means there is no credible evidence to support the allegation.
  56. Recommendations 
    1. OIG's investigations may find other concerns that relate to abuse/neglect, like training, staffing, or policy issues. 
    2. OIG may cite these in the case report. These are called "recommendations."
    3. By law, the agency/facility must do something to address these concerns. You may see new training courses or a new policy.
  57. Notifications 
    1. When the investigation is complete, OIG notifies the following people of the finding and of their right to request a clarification or reconsideration of the finding:
      1. The agency/facility's authorized representative;
      2. The complainant, if not the agency/facility;
      3. The alleged victim (or guardian); and
      4. iv. All accused employees.
  58. Clarification/Reconsideration
    1. A clarification only asks OIG to explain the investigative finding.
    2. A reconsideration challenges the finding, asking OIG to look at it again.
      1. Rule 50 says that a reconsideration request must provide additional information that OIG was not aware of or did not consider.
  59. Wrap up
    1. Abuse - physical, sexual, and mental abuse and financial exploitation - and neglect involve an individual and staff, on or off site. 
      1. The individual must be receiving services.
    2. You are required to report allegations and even suspicions of abuse/neglect.
    3. Allegations must be reported to the OIG Hotline within four hours, deaths without suspicion within 24 hours.
  60. Wrap up
    1. You are not allowed to screen allegations.
      1. They must all be reported within four hours.
    2. Failure to report may get you disciplined, and it could be a crime.
    3. You must cooperate with OIG investigations.
      1. You must answer questions honestly and fully.
    4. If you are accused in an allegation, you will get a letter with the findings.
  61. Wrap up 
    1. The OIG Hotline number is:  800 368 1463