Abuse, Neglect, Exploitation and Mistreatment

Purpose and Background:

To provide guidance to individuals receiving waiver funded services and their guardians/families, agency providers, Independent Service Coordination (ISC) agencies clarifying the rights and reporting mechanisms for claims of abuse/neglect/exploitation/mistreatment across various living environments and supports.

Policy:

Office of Inspector General (OIG): Protecting individuals with I/DD

The Office of Inspector General (OIG) for the Department of Human Services investigates allegations of abuse, neglect, exploitation, and/or mistreatment of individuals receiving services from mental health facilities, developmental disabilities facilities, and community agencies operated, licensed, funded or certified by the DHS, but not licensed or certified by any other State agency. OIG investigates any assertion, complaint, suspicion or incident of abuse, neglect and exploitation involving conduct by an employee/volunteer, facility, or agency against an individual(s).

OIG Authority:

OIG has the authority to create and maintain Administrative Rule governing investigations including the following:

• 59 Illinois Administrative Code, Chapter 1, Part 50 (RULE 50) was first adopted in October 1998 and amended in 1999, 2002, 2008, 2010, 2014, 2015 and 2017. It includes 10 sections covering definitions, reporting allegations and intake, conducting investigations, processing investigations, written responses, and IDPH Health Care Worker Registry processes. For more specifics, see Rule 50 here: https://www.ilga.gov/commission/jcar/admincode/059/05900050sections.html.
• OIG also has authority to investigate reports of abuse by service provider employees who provide support in community integrated living arrangements (CILA), including intermittent and host family CILA and community day services. Employees include any person who provides services at the facility or agency and the service relationship can be with the individual, facility or agency, including DHS employees or contractual agents involved in providing or monitoring or administering mental health or developmental disability services; owners, operators, payroll personnel, contractors, subcontractors and volunteers; employees who are no longer working for the agency/facility but is the subject of an investigation under OIG jurisdiction;
• OIG does not have authority to investigate potential abuse in private homes by family, friends or a personal support worker hired directly by a person or family and not employed by an agency.
• OIG investigates all reports of abuse, neglect, and mistreatment in a timely manner, to ensure humane, competent, respectful, and caring treatment of persons with mental and developmental disabilities.

OIG investigates:

• Physical abuse: An employee or agency affiliated volunteer's non-accidental and inappropriate contact with an individual that causes bodily harm. Includes actions that cause bodily harm as the result of an employee directing an individual or person to physically abuse another individual.

• Neglect: An employee's, agency's, or facility's passive or intentional failure to provide adequate medical care, personal care, or maintenance, and that results or causes:
  • an individual pain, injury, or emotional distress, or
  • increased behavioral support needs in an individual, or
  • the deterioration of an individual's physical or mental condition, or
  • places the individual's health at substantial risk of possible injury, harm, or death. * Mental abuse: The use of demeaning, intimidating or threatening words, signs, gestures or other actions by an employee about an individual and in the presence of individuals that results in emotional distress or maladaptive behavior, or could result in emotional distress or maladaptive behavior, for any individual present.
• Mental abuse: The use of demeaning, intimidating or threatening words, signs, gestures or other actions by an employee about an individual and in the presence of individuals that results in emotional distress or maladaptive behavior, or could result in emotional distress or maladaptive behavior, for any individual present.
• Sexual abuse: any sexual contact or intimate physical contact between an employee and individual, including an employee's coercion or encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, sexual behavior, or intimate physical behavior. Sexual abuse also includes an employee:
  • Sending or showing sexually explicit images to an individual via computer, cellular phone, or other electronic device/media with or without contact with the individual.
  • Posting of sexually explicit images of an individual online, with or without consent.
  • Sexually explicit images include any material that depicts nudity, sexual conduct, or sadomasochistic abuse, or explicit or detailed descriptions or narrative accounts of sexual excitement, sexual contact, or sadomasochistic abuse. Does not include sex education materials used to teach. Sexual abuse does not include allowing individuals to, of their volition, view movies or images of a sexual nature or read text containing sexual content unless the individual's guardian prohibits the viewing of those movies or images or reading of that material.
• Financial Exploitation: Taking unjust advantage of an individual's assets, property or financial resources through deception, intimidation or coercion for the employee's, facility's or agency's own advantage or benefit. This could include stealing money, taking medications or medical supplies belonging to the person or requiring the person to pay for items that a facility or provider is required to provide.

Reporting Allegations to OIG:

OIG's Intake Hotline (800-368-1463) is a 24-hour Hotline where anyone can call if there is an allegation of abuse, neglect, or exploitation per Rule 50. Even if a person is unsure if the incident rises to the level of abuse , neglect or exploitation, they are encouraged to call the intake number and the OIG staff will either refer the case to the appropriate investigative bureau or make the appropriate referral.

Per Rule 50, required reporters must report allegations to OIG within 4 hours of discovery. A required reporter is any employee of an agency or facility who suspects, witnesses or is informed of an allegation. Screening, delaying, or withholding of allegations is prohibited.

Agencies/facilities have 4 hours to gather enough information for as detailed a report as possible to OIG covering allegation, victim, alleged perpetrator, and witnesses. Deaths, without an allegation of abuse/neglect, must be reported within 24 hours of discovery.

Section 50.30(f) - Initial Incident Response:

The agency/facility's responsibilities after an allegation has been made is the "Initial Incident Response", this includes:

• Notifying OIG as required.
• Initiating the initial steps of the investigation by an employee who has been trained in the OIG-approved methods - statements, gather documents, etc.

OIG provides training covering all the responsibilities under this section of Rule 50: https://www.dhs.state.il.us/page.aspx?item=33342.

For more detail about OIG's investigative process outlined, see their website: https://www.dhs.state.il.us/page.aspx?item=29438#a_WRs.

Ensuring the Health and Safety of Individuals and Staff:

Ensuring the health and safety of individuals and staff is the priority in any situation. If an individual or employee is injured or there is a risk for injury or harm, provide appropriate assistance before starting the initial response to the investigation. Document any assistance provided. Medical assistance should be provided even if it negatively impacts the initial incident response.

OIG Intake Assessment:

OIG's Intake Bureau takes complaints through OIG's Hotline and assesses them to determine if the information is:

• A reportable allegation of abuse/neglect/exploitation/death
• Under the jurisdiction of OIG
• If there is imminent risk or that requires immediate referral to Illinois State Police or local law enforcement is necessary
• If reportable, an intake is generated and sent to an investigative bureau based on location
• If non-reportable to OIG, the issue is referred to:
  • Another investigative entity
  • The appropriate DHS division
  • Another state agency
  • Back to the agency/facility to handle

OIG Investigative Activities:

OIG's investigative activities include the following:

• Investigative planning
• Requests for documentation from all entities involved, including:
  • Agency/facility were incident occurred
  • Hospital/ambulance
  • Illinois State Police/Local Law Enforcement
• Gathering physical evidence from scene, photograph injuries, etc.
• Conducting interviews
  • Victims, witnesses, alleged perpetrator, etc.
  • Anyone determined to have information regarding the incident.

OIG Investigative Reports:

OIG's investigative reports are standalone documents that investigators write at the completion of all investigations. An investigative report documents the following:

• The purpose of the investigation (allegation of abuse/neglect/exploitation)
• The investigative work completed
• A summary of the evidence gathered
• An analysis of evidence to show how each element of the offense is either present and proven, or not.
• The finding (i.e., substantiated, unsubstantiated, unfounded)
• Any recommendations OIG has for the agency/facility

Investigative Findings:

OIG has three categories of findings:

• Substantiated - There is a preponderance of credible evidence to verify the substance of the allegation.
• Unsubstantiated - There is credible evidence, but less than a preponderance of evidence to verify the substance of the allegation.
• Unfounded - There is no credible evidence to verify the substance of the allegation.

Definitions:

Preponderance of the Evidence: There is a greater than 50% chance the claim is true.

Credible evidence: Any evidence related to the allegation or incident and is considered believable and reliable.

Sharing Findings, Responding and Closing out Cases:

• Case Presentation - When the case report is approved, it is signed and mailed to the facility or agency. Individuals who were involved in the incident (the victim, the complainant, the alleged perpetrator) are notified of the result at this time. Involved parties may, within 15 working days, request a reconsideration of the findings if they have additional evidence that was not considered in the investigation. OIG then reviews the additional information and determines whether there are sufficient grounds to reopen its investigation the case or revise the case report. After all questions and additional issues have been resolved, the case report becomes a final report.
• Facility or Agency Response - Substantiated cases of abuse, neglect, or exploitation, and cases that identify other issues, require a response from the facility or agency. This "Written Response" is to detail the steps taken to ensure the protection of those individuals and how further occurrences of this type will be eliminated. It can and normally does take the form of discipline, training, and/or the creation of or changes to a policy or procedure. The Written Response must be submitted to the appropriate DHS program division administrator who reviews it for the DHS Secretary. Approved Written Responses are then forwarded to OIG.
• OIG Follow-up - OIG reviews a random sample of Written Responses to ensure the actions listed by the facility or agency were taken. If these actions have been taken, OIG sends an "in compliance" letter to the facility or agency; if not, then an "out of compliance" letter is sent. OIG conducts these reviews monthly, which provides a timely review of implementation.
• Case Closure - Upon case closure, the alleged perpetrator, the victim (and/or guardian) and the complainant are notified of the outcome.

Release of OIG Reports and Information:

• OIG cannot release unsubstantiated or unfounded reports without a valid court order. Similarly, OIG cannot release its investigative case file records without a valid court order.
  • Mental Health and Developmental Disabilities Act [740 ILCS 110] Section 10 requires a written order by a judge or written consent of the person whose records are sought.
  • DHS Act [20 ILCS 1305] Section 1-17(m) states that raw data used to compile the investigative report cannot be released unless required by law or a valid court order. Raw data includes initial complaint, statements, photos, notes, police reports, incident reports, etc.
• Substantiated reports can be released under certain circumstances but must be redacted prior to being released. OIG cannot release unredacted reports without a valid court order.

Appeal Rights:

• Agency/Facility, victim/guardian and alleged perpetrator have the right to request reconsideration or clarification of a case from OIG.
• State employees have grievance rights under various bargaining agreements and other state appeals.
• If OIG starts the process to place the alleged perpetrator's name onto the Health Care Worker Registry, the alleged perpetrator has right to appeal placement before an Administrative Law Judge (ALJ).

Health Care Worker Registry:

• The Registry is a database maintained by the Illinois Department of Public Health (IDPH).
• If someone's name and substantiated finding is listed on the Registry, that person may not work in any capacity at any state-operated facility, community agency, or program site funded by the state.
• OIG refers an alleged perpetrator's name to the Registry when it substantiates physical abuse, sexual abuse, financial exploitation, or egregious neglect against the alleged perpetrator.
• OIG will first notify the person of their right to file an appeal (a "50.90 appeal").
• This appeal is only about the referral of their name to the Registry.
• It does not appeal the finding of the case itself.
• OIG will not refer a person's name until all other pending legal action is resolved.
• Once on the Registry, a person may appeal to be removed by submitting a Section 50.100 Removal of an Employee's Name.
• A petition can be filed once every twelve months.
• OIG conducts an investigation to determine if the petitioner has provided accurate information in their petition.
• The ALJ then makes a recommendation to the Department Secretary who makes the final decision.
• A person can also request the Health Care Worker Waiver Application  to be able to be employed despite being on the registry.

For more information, please review the Office of the Inspector General webpage.

Adult Protective Services (APS): Protecting Individuals Living in Their Own Homes:

Allegations of abuse, neglect, exploitation, or mistreatment of individuals regardless of where they live by someone other than an employee of an agency, should report the allegation to Adult Protective Services (APS) at 1-866-800-1409, 1-888-206-1327 (TTY).

* As a reminder, if an individual is receiving services in their own home or a family home but abuse, neglect or exploitation occurs with a provider employee there, the allegation should be made to OIG at the contact information above.

APS Authority:

• Effective July 1, 2013, legislation was passed by the General Assembly to expand the Department's current Elder Abuse and Neglect Program (now Adult Protective Services Program) to prevent abuse, neglect, and exploitation of Individuals with disabilities between the ages of 18-59 living in the community.
• The APS Program is locally coordinated through 40 provider agencies which are designated by the Regional Area Agency on Aging and the Illinois Department on Aging.
• Case workers from the APS Provider Agencies conduct investigations and work with adults age 60 or older and adults age 18-59 with disabilities in resolving the abuse, neglect, or financial exploitation situation. All APS case workers are trained and certified by the Department.

Investigation Process:

• Intake - The agency receiving the call will do an intake.
• Assessment - Depending on the nature and seriousness of the allegations, a trained case worker will make an unannounced face-to-face contact with the alleged victim within the following time frames: 24 hours for life-threatening situations, 72 hours for most neglect and non life-threatening physical abuse reports, and 7 calendar days for most financial exploitation and emotional abuse reports. The case worker has 30 days to do a comprehensive assessment both to determine if the individual has been mistreated and to determine his or her needs for services and interventions. If the abuse is substantiated, the case worker involves the adult in the development of a case plan to alleviate the situation. The case worker always attempts to utilize the least restrictive alternatives that will allow the adult to remain independent to the highest degree possible. Alternatives might include in-home care, adult day services, respite, health services, and services such as counseling. Other interventions might include an order of protection, obtaining a representative payee, having the individual change or execute a new power of attorney for financial or health decisions, or assisting the person in obtaining other legal remedies. In some cases, services for the alleged perpetrator are also obtained, including mental health, substance abuse, job placement or other services related to their needs.
• Follow-Up - The case worker may keep the case open 15 months from the date of intake in order to monitor the situation and to continually reassess the need for different interventions. Where the case worker judges that the best interests, safety and well-being of the adult require further follow-up service, the case may stay open for up to an additional 12-month period. If subsequent reports of abuse are received and substantiated, the case may be kept open even longer.
• Confidentiality - All reports and records of the APS Program are subject to strict confidentiality provisions per Section 8 of the APR Act (Chapter 320 ILCS 20/I et seq).

APS Registry:

• The APS Registry is a confidential list of caregivers who have a finding of verified and substantiated abuse, neglect, or financial exploitation based on an Adult Protective Services (APS) investigation.
• The APS Registry will include the identity of caregivers who are found to have abused, neglected, or exploited persons age 60 or over and adults with a disability age 18-59 who reside in a domestic living situation, at the time of report.
• Placement of a caregiver's identity on the APS Registry serves to prohibit the initial or re-employment, retention, compensation, or use of an individual to provide direct care in a position that is regulated by or paid with public funds from the IDoA; Department of Healthcare and Family Services; Department of Human Services; and Department of Public Health; or an entity or direct care provider licensed, certified, or regulated by or paid with public funds from the state of Illinois.
• Access to the APS Registry is limited to direct care providers and state agencies.
• IDoA places a caregiver's identity on the APS Registry after appeal, challenge, and review, if any, have been completed and a finding for placement on the APS Registry has been sustained or upheld. The sole issue heard on appeal is whether the placement of the caregiver's identity on the APS Registry is in the public interest.
• Caregivers who choose to appeal a decision can use the Request for Appeal on APS Registry Form as well as Request for Removal from APS Registry Form.
  

Questions regarding the APS Registry should be sent to the Aging.APSQuestions@illinois.gov

The APS Registry hosts a wealth of information.

Self-Neglect:

Some adults lack the capacity to care for themselves which may substantially threaten his or her own health. The term self-neglect includes compulsive hoarding which significantly impairs the performance of essential self-care tasks or otherwise substantially threatens life or safety. These adults should be reported to the APS Hotline or to a local APS Agency for attention.

Department of Children and Family Services (DCFS): Protecting Children in Waiver Services:

DCFS has the primary responsibility of protecting children through the investigation of suspected abuse, neglect, exploitation or mistreatment by parents and other caregivers in a position of trust or authority over the child.

Mandated Reporters:

State law requires that most professionals in education, health care, law enforcement and social work report suspected neglect or abuse. These individuals are called Mandated Reporters. For more information about the guidelines for mandated reporters in Illinois, read the Mandated Reporter Manual.

For a comprehensive list of all mandated reporters, see the Abused and Neglected Child Reporting Act.
In an effort to assist mandated reporters understand their critical role in protecting children by recognizing and reporting child abuse, DCFS administers an online training course entitled Recognizing and Reporting Child Abuse: Training for Mandated Reporters, available 24 hours a day, seven days a week.

Investigation Process:

• After the child welfare professional at the hotline determines there is enough information to take a report, the case is assigned to a trained investigative specialist.
• The investigative specialist is required by law to initiate the report by seeing the alleged child victim(s) within 24 hours from the time the report is received.
  • If necessary, the investigative specialist will develop a safety plan with the family to maintain the safety of the children during the course of the child abuse and neglect investigation.
• State law requires that the investigative specialist notify the police and the local State's Attorney of all serious allegations of child abuse and neglect, such as those that allege serious physical injury or sexual abuse to a child. The police and the Department may conduct a joint investigation, or the police may conduct their own investigation.
• The investigative specialist is required to gather all available information during the course of the investigation.
  • This includes information tending to show that a person is responsible for committing child abuse and/or neglect as well as information tending to show that person is not responsible for committing child abuse and/or neglect.
• Once all of the available information has been gathered, the investigative specialist, in conjunction with a supervisor, will make a final finding in the case.
• The finding will be based on "Credible evidence" which means the available facts when viewed in light of surrounding circumstances would cause a reasonable person to believe a child was abused or neglected.
• A report can either be "unfounded" or "indicated."
  • Unfounded: the investigative specialist did not find credible evidence that a child was abused or neglect.
  • Indicated: the investigative specialist found credible evidence that a child was abused or neglected.

• Under state law, the Department has 60 days to complete a child abuse and neglect investigation. Most child abuse and neglect investigations are completed within 30 days.
• The Department may seek an extension of the 60-day requirement for good cause. Examples of good cause include a pending police investigation or obtaining reports from medical professionals. DCFS will notify the accused person in writing of the final finding of the Department's investigation and the investigative specialist will contact a person to advise them of the results of the investigation and the reason for the final finding.

State Central Register:

• The final findings of child abuse and neglect investigations are maintained on the Department's State Central Register. The State Central Register is a confidential list of persons who have been found to be indicated perpetrators of child abuse and/or neglect.
• If the investigation is unfounded, the Department's State Central Register will maintain all unfounded reports for a minimum of 5 years following the date of the final finding.
• After the designated time period, the record of the investigation will be removed from the State Central Register.
• If the investigation is indicated, the report will be maintained on the Department's State Central Register for a period from five years to 50 years, depending on the specific allegation that is indicated.

Effective Date:

08/25/2021