Reporting in an assisted living facility is different than in a skilled nursing facility. A resident may have the same behavior or behavior done to them, but it is reported slightly different. There are two main reporting responsibilities in the ALF. One is reporting Adverse Incidents; the second is reporting to the Department of Children and Families, or otherwise referred to as Adult Protective Services (APS).
Adverse Incident Reporting
There must be someone in the facility who can make the 1-Day and 15-Day reports as required. There are situations when a facility is unable to timely submit these required reports due to a change in administration or other leadership positions. Some organizations only want a select person or persons to be able to submit, and that is understandable. However, if not reviewed on more than an annual basis, circumstances can arise that would cause a facility to be out of compliance with the required timing of a report. Knowing who is registered and making it part of your quarterly reviews can help keep you in compliance with reporting when the need arises.
The Agency for Health Care Administration (AHCA) Incident Reporting System (AIRS) Portal is designed for each person responsible for submitting reports to have an individual login. It takes a few days to acquire login credentials, so if there are changes that need to be made, please consider this fact. For detailed instructions on how to complete the Adverse Incident 1-Day and 15-Day reports, review here.
A few key facts are the following:
- Reporting via the AIRS system is the only way to submit an Adverse Incident Report. No fax or emailed submission will be accepted.
- INITIAL ADVERSE INCIDENT REPORT: The preliminary adverse incident report required by Section 429.23(3), F.S., must be submitted within 1 business day after the incident pursuant to Rule 59A 35.110, F.A.C.
- FULL ADVERSE INCIDENT REPORT: For each adverse incident reported, the facility must submit a full report within 15 days of the incident. The full report must be submitted pursuant to Rule 59A 35.110, F.A.C .
- When a user is no longer employed at your facility, you must request their access be removed by emailing [email protected]. If you do not have them removed, they will continue to have access to all residents’ and staff members’ personal information.
- The information contained in this report is confidential.
- Remember to save your submissions periodically or you could time out and would have to re-enter the content.
- Every report to Adult Protective Services is not an Adverse Incident Reportable in an assisted living facility.
Facilities must check a box in order to file a report of one or more of the following listings for the incident to be reportable as an adverse incident. The incident must be an event over which facility personnel could exercise control rather than as a result of the resident’s condition and results in:
- Death
- Brain or spinal damage
- Permanent disfigurement
- Fracture or dislocation of bones or joints
- Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives.
- Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives.
- Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident.
- An event that is reported to law enforcement or its personnel for investigation.
- Resident elopement stands alone and is always reportable, if the elopement places the resident at risk of harm or injury.
- If the incident involves a death, please check the box for the Medical Examiner.
- If you submit a report as an adverse incident, there should ALWAYS be corrective or proactive actions.
- If you are filing a report which you have determined is not adverse, you can either withdraw it or complete the report with ALL the required information.
Adult Protective Services Reporting
Reporting to Adult Protective Services (APS) must be completed for each and every report of abuse, neglect, exploitation, misappropriation, mistreatment and injury of unknown source of vulnerable adults in the assisted living facility whether probable or not.
“Abuse” is defined as any willful act or threatened act by a relative, caregiver, or household member which causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse includes acts and omissions.
“Neglect” is defined as the failure or omission on the part of the caregiver or vulnerable adult to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, which a prudent person would consider essential for the well-being of a vulnerable adult. The term “neglect” also means the failure of a caregiver or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. “Neglect” is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death.
“Exploitation” is defined as a person who stands in a position of trust and confidence with a vulnerable adult and knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult. It can also be defined as someone who knows or should know that the vulnerable adult lacks the capacity to consent, and obtains or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.
“Exploitation” may include, but is not limited to:
- Breaches of fiduciary relationships, such as the misuse of a power of attorney or the abuse of guardianship duties, resulting in the unauthorized appropriation, sale, or transfer of property;
- Unauthorized taking of personal assets;
- Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a personal or joint account; or
- Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for the necessities required for that person’s support and maintenance.
Assisted living staff are considered mandated reporters. It is not up to the facility administrator to determine if an allegation is considered abuse, neglect or exploitation. Rather, it is required to be reported to APS for the agency to determine if the allegation is substantiated or not. If a resident reports that a staff member was abusive, then the facility administration should immediately suspend the staff member and have him/her leave the premises. This should be reported to APS immediately. Immediately is not defined in the statute, so this needs to be clarified in the facility policy. Immediately is defined for the skilled nursing facilities and could be used as a guide to have APS contacted within two hours from the time the allegation was reported to facility staff. There are times the allegation seems improbable due to the resident’s cognition, but that does not change the requirement of reporting.
Not all allegations of abuse and or neglect meet the definition of an Adverse Incident, but all Adverse Incidents should be considered possible abuse or neglect and reported appropriately to Adult Protective Services.