MANE Policy PDF

MANE (Mistreatment, Abuse, Neglect, and Exploitation), Incident Reporting, Mandatory Reporting Mistreatment, Abuse, Neglect, and Exploitation (MANE) Introduction A fundamental right of all people is the right to humane care and treatment. The rights of people with developmental disabilities are no...

MANE (Mistreatment, Abuse, Neglect, and Exploitation), Incident Reporting, Mandatory Reporting Mistreatment, Abuse, Neglect, and Exploitation (MANE) Introduction A fundamental right of all people is the right to humane care and treatment. The rights of people with developmental disabilities are no different: each has the same basic rights as any other citizen. Imagine! is responsible for prohibiting MANE of an individual. All Imagine! employees, contract providers, respite providers, and volunteers are responsible for protecting the health, safety and wellbeing of each individual, including the prevention of MANE. Imagine!’s policy on MANE Imagine! will ensure that appropriate disciplinary actions up to and including termination, and appropriate legal recourse are taken against employees and Contractors who have engaged in MANE. Imagine! employees, contractors, and respite providers are all considered Mandated Reporters and are required, by law, to make a report within twenty-four (24) hours after making the observation or discovery. Prior to providing direct care to an individual in services, all Imagine! employees, contractors, respite providers, and volunteers must pass a criminal background check and a CAPS check (adult protective services data system that includes records of reports of mistreatment of at-risk adults.) Definitions MANE vs Mistreatment The Colorado Department of Health Care Policy and Financing (HCPF) uses the acronym “MANE” in its regulations to refer to Mistreatment, Abuse, Neglect, and Exploitation. However, the HCPF regulations state that the definitions of mistreatment, abuse, neglect, and exploitation must be consistent with state law. The Colorado Department of Human Services, specifically Adult Protective Services (APS), created the definitions of Mistreatment, Abuse, Neglect, and Exploitation. In the APS regulations, “Mistreatment” is the umbrella term that covers Abuse, Neglect, and Exploitation. You may hear “MANE” and “Mistreatment” used interchangeably for this reason. When Adult Protective Servies, Law Enforcement, and Case Management are involved in an incident, they will use the following definitions. Therefore, all Imagine! employees and contractors should be familiar with these definitions. Mistreatment (a) Abuse; (b) Caretaker neglect; (c) Exploitation; or (d) A harmful act. Abuse Any of the following acts or omissions committed against an at-risk adult: a) The nonaccidental infliction of physical pain or injury, as demonstrated by, but not limited to, substantial or multiple skin bruising, bleeding, malnutrition, dehydration, burns, bone fractures, poisoning, subdural hematoma, soft tissue swelling, or suffocation; b) Confinement or restraint that is unreasonable under generally accepted caretaking c) standards; or d) Unlawful sexual behavior as defined in section 16-22-102 (9). Caretaker A person who: a) Is responsible for the care of an at-risk adult as a result of a legal relationship; or b) Has assumed responsibility for the care of an at-risk adult; or c) Is paid to provide care, services, or oversight of services to an at-risk adult. Take note! An adult (18 years and older) who has an intellectual and/or developmental disability is considered an “at-risk adult.” All Imagine! employees, contractors, and respite providers qualify as “caregivers.” Caretaker Neglect Neglect that occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, habilitation, supervision, or other treatment necessary for the health or safety of the at-risk adult is not secured for an at-risk adult or is not provided by a caretaker in a timely manner and with the degree of care that a reasonable person in the same situation would exercise, or a caretaker knowingly uses harassment, undue influence, or intimidation to create a hostile or fearful environment for an at-risk adult. Notwithstanding the provisions of the previous paragraph, the withholding, withdrawing, or refusing of any medication, any medical procedure or device, or any treatment, including but not limited to resuscitation, cardiac pacing, mechanical ventilation, dialysis, artificial nutrition and hydration, any medication or medical procedure or device, in accordance with any valid medical directive or order, or as described in a palliative plan of care, is not deemed caretaker neglect. Medical Directive or Order includes a medical durable power of attorney, a declaration as to medical treatment executed pursuant to section 15-18- 104, C.R.S., a medical order for scope of treatment form executed pursuant to article 18.7 of title 15, C.R.S., and a CPR directive executed pursuant to article 18.6 of title 15, C.R.S Take Note! Following an individual’s advance directives or the directions/decisions of an individual’s medical durable power of attorney to withhold care, is not considered neglect. For example, following an individual’s DNR order or honoring their desire to not be placed on a ventilator or receive a feeding tube, if outlined in a valid medical directive or when the individual is on palliative or hospice care, is not considered caregiver neglect. Exploitation An act or omission that: a) Uses deception, harassment, intimidation, or undue influence to permanently or temporarily deprive an at-risk adult of the use, benefit, or possession of any thing of value; or b) Employs the services of a third party for the profit or advantage of the person or another person to the detriment of the at-risk adult; or c) Forces, compels, coerces, or entices an at-risk adult to perform services for the profit or advantage of the person or another person against the will of the at-risk adult; or d) Misuses the property of an at-risk adult in a manner that adversely affects the at-risk adult’s ability to receive health care or health-care benefits or to pay bills for basic needs or obligations. Harmful Act An act committed against an at-risk adult by a person with a relationship to the at-risk adult when such act is not defined as abuse, caretaker neglect, or exploitation but causes harm to the health, safety, or welfare of an at-risk adult. Potential Indicators of MANE A variety of indicators in an individual’s appearance or behavior can alert you to a possible MANE. These include: Unexplained injuries Frequent injuries Bruising, cuts, welts, burns and/or marks on the body Poor hygiene Poor health Malnutrition or dehydration  Changes in behavior, unusually escalations in behavior Fear around specific caregivers Verbal allegations of abuse from the consumer or others who have contact with the consumer Changes in Behavior If you have contact with the same consumer on a regular basis, keep an eye out for changes in the individual’s behavior. This may include showing fear or distress, or may include an increase in typical behaviors or more serious behaviors. This could be an indication of MANE and staff/providers should be alert to other potential signs. Reporting MANE Duty to Report An Imagine! employee or contractor who observes the mistreatment of an at-risk adult or who has reasonable cause to believe that an at-risk adult has been mistreated or is at imminent risk of mistreatment, is required by law to report incidents to a law enforcement agency not more than twenty-four hours after making the observation or discovery. In addition to notifying law enforcement, Imagine! employees and contractors must report incidents of mistreatment or alleged mistreatment to Adult Protective Services not more than twenty-four hours after making the observation or discovery. Adult Protective Services are managed by county, so the report should be made to the APS department in the county where the individual lives. Imagine! is required to notify the Case Management Agency Case Manager of the alleged victim of mistreatment within 24 hours of the discovery of the actual or alleged incident. (10 CCR 2505-10 8.7411 B). An employee or contractor who has reason to suspect mistreatment, abuse, neglect or exploitation of an adult receiving services and supports through Imagine!, will make an immediate report by phone, upon discovery, to the Supervisor, Program Manager, Assistant Director or designee, of the program where the individual is provided services. A Critical Incident Report (CIR) must be completed and routed to the Case Manager within 24 hours after making the observation or discovery of mistreatment, abuse, neglect, or exploitation. All allegations of mistreatment must be reported, regardless of whether the allegation is believable. Historically, individuals with intellectual and developmental disabilities were dismissed or not believed when they brought forward allegations of mistreatment, which can led to additional and continuing harm of the individual. As caregivers and advocates, it is our job to protect the health, safety and welfare of the individuals we support, which includes reporting mistreatment. Employees and Contractors shall not knowingly make a false report of mistreatment to Adult Protective Services or Law Enforcement. False reports may result in a class 2 misdemeanor and the reporter may be liable for damages. Any person, except a perpetrator or someone assisting the perpetrator, who makes a report shall be immune from any civil or criminal liability, so long as such action was taken in good faith and not in reckless disregard of the truth. Timely Reporting Allegations must be verbally reported immediately after the incident is observed or discovered. Alert your supervisor or coordinator or other designated person as soon as you become aware of the situation. A Critical Incident Report (CIR) must be completed and routed to the Case Manager within 24 hours after making the observation or discovery of mistreatment, abuse, neglect, or exploitation Occurrences Incidents of Mistreatment and Neglect that occur in a group home or to individuals who live in a group home, are required to be reported as an occurrence to the Colorado Department of Public Health and Environment (CDPHE). (6 CCR 1011-1 Chapter 2, Part 4, section 4.2) Occurrences must be reported within one business day of the actual or alleged incident. Supervisors, Program Managers, Assistant Directors, or designees must report, by phone, all occurrences or suspected occurrences as soon as possible to the Designated Occurrence Reporter. Occurrence reporting may occur after a critical incident is written and routed, but not later than one business day of the alleged or actual incident. What happens in the event of MANE? As soon as an alleged or actual incident of MANE has occurred, immediate action must be taken to protect the safety of the affected individual(s). This may include, but is not limited to: Calling 911 for police intervention to deescalate the situation and/or remove the alleged perpetrator from the environment. Calling 911 or taking an individual to the emergency department for care Removing the alleged perpetrator from the environment and placing them on suspension. Placing the individual in emergency respite care Modifying living or work environments Investigating financial records Several agencies may be required to investigate alleged or actual incidents of MANE. These include, but are not limited to: Law enforcement agencies Adult Protective Services Imagine! Department of Public Health and Environment Substantiated incidents of MANE All allegations of MANE are taken seriously. If Imagine!, APS, or Law Enforcement substantiate an incident of MANE, appropriate corrective action will be taken. Corrective action may include immediate termination of employment or the termination of a contract. Perpetrators may also face criminal or civil charges. Direct Care Workers (employees, contractors, respite providers, etc.) with any of the following are prohibited from providing direct care to any individual receiving services. If these findings are discovered before employment or contracting, Imagine! will not employ or contract with the direct care worker. If any of the following happen during employment or contracting, the employment or contract will be terminated. An allegation of MANE or harmful act, substantiated by Adult Protection Services (APS) within the last 10 years, at a severity level of “Moderate” or “Severe.” Three or more allegations of MANE or harmful act, substantiated by APS within the last five years, at the “minor” severity level A criminal conviction of MANE against an at-risk adult Summary You should now have a clear idea of what constitutes an instance of Mistreatment, Abuse, Neglect, and/or Exploitation. You’ve reviewed how to spot warning signs, and you know about how to make a report of any suspected MANE incident. If you have questions or would like to learn more, please review the complete Imagine! Policies and Procedures document regarding MANE. Commented [JG1]: Can someone else please take a shot at summarizing all of this?