Library: Policy

340:5-7-1. Referrals submitted to Long-Term Care Investigations

Revised 9-14-24

(a) Screening protocols, per Oklahoma Administrative Code 340:5-3-5, are followed for referrals submitted to Long-Term Care Investigations (LTCI). • 1

(b) The Review, Evaluate, and Decide (RED) Unit specialist or designee screens referrals. Referrals are accepted for investigation, screened out when Adult Protective Services (APS) criteria is not met, or are referred to another entity. The RED Unit specialist or designee determines which Long-Term Care social service inspector is assigned the referral. • 2

INSTRUCTIONS TO STAFF 340:5-7-1

Revised 10-8-24

1. When abuse, neglect, or exploitation is alleged, the Abuse and Neglect Hotline specialist enters the referral into the Adult Protective Services (APS) Computer System. The Review, Evaluate, and Decide (RED) Unit specialist or designee screens and assigns all Long-Term Care Investigation (LTCI) referrals.

2. (a) When the incident did not happen in a nursing facility, Intermediate Care Facility/Individuals with Intellectual Disabilities (ICF/IID), or Oklahoma Veterans Nursing facility, the referral is reassigned to Community APS for screening.

(b) When the incident happened in a nursing facility, ICF/IID, or Oklahoma Veterans Nursing facility, but the alleged perpetrator (AP) is not an employee of the facility, the referral is reassigned to Community APS for screening.

(1) A facility employee is defined as anyone who is being paid or is under contract by the facility; or any person volunteering to do work in that facility; or any person hired by the family and allowed to work in the facility. This includes, but is not limited to, home health workers, physical therapy workers, hospice employees, physicians, physician assistants, private sitters, agency workers, volunteers, or any other person the facility knowingly allowed to work with facility residents.

(2) When the AP is also a facility resident, the AP is entered as an alleged victim on the APS referral. "Unknown staff" for the facility is entered as an AP with allegations of caretaker neglect, and the referral is assigned to LTCI. The social service inspector (SSI) updates the AP's information when the name of the AP is identified.

(c) The RED Unit specialist or designee reviews the referral to determine if the facility is responsible for the maltreatment, by action or inaction.

(1) When the facility was not responsible and facility intervention was appropriate, the referral is screened as Information and Referral (I & R) and further action is not required.

(2) When the facility's actions or inactions facilitated or caused resident-to-resident abuse, but the facility took appropriate action, the referral is screened as an I & R. If the facility did not take appropriate action or there have been multiple incidents at the facility, the referral is assigned to a Long-Term Care (LTC) Investigator for investigation.

(A) If the facility participated by encouraging the maltreatment in any fashion, the staff member who was responsible is assigned as the AP.

(B) If the facility or staff member knew or should have known the client was abusive but did not intervene, the case is assigned as neglect against the staff member or members, who should have intervened to prevent abuse.

(d) All complaints are entered into the APS Computer System by client name or other identifying information.

(1) Relevant closed cases are reviewed.

(A) When there is just one past intake, screen as a new case.

(B) When there are multiple past intakes concerning the same victim, consider whether:

(i) the allegations are the same or are similar; and

(ii) staff intervened appropriately.

(C) Screen as new case when staff did not intervene to protect clients. Past failure to protect is considered and weighed in assignment decision.

(2) When an open case already exists:

(A) an LTC referral is received, and there is an open Community APS referral, the RED Unit specialist or designee notifies the APS specialist;

(B) if the open case is assigned to LTCI and a duplicate complaint is received, follow Merge Protocol; or

(C) if the open case is assigned to LTCI and the allegations or AP are not the same, screen as a new case.

(e) Cases are determined to be LTC Investigation cases when there:

(1) is no maltreatment, but there are violations of nursing home rules and regulations or when a referral is received alleging that some aspect of patient care in a nursing facility is bad but no specific patient is named or the allegations do not constitute abuse, neglect, sexual or financial exploitation, verbal abuse, an area of concern regarding general poor patient care or poor environmental conditions, it is not assigned for investigation. This includes complaints, such as the facility is understaffed, linens are dirty, patients are not properly fed or groomed, or air-conditioning or heating is inadequate; the referral is screened as an I & R and a referral is sent to the Oklahoma Department of Health (OSDH). APS takes no further action.

(2) are violations of residents rights, which might include verbal abuse; the referral is screened as an I & R and a referral is sent to the LTC Ombudsman; or

(3) are obvious criminal charges; the RED Unit specialist or designee screens the referral following the steps above. The program manager or designee may send a referral to the Office of the Attorney General, Medicaid Fraud. The Chief Investigator is contacted by phone at 405-521-4274 or email before the referral is sent. When calling, ask for nursing home abuse, Medicaid fraud intake, or the Chief Investigator by name. Not all referrals are investigated.

(4) are allegations against hospitals, dialysis centers, or other medical facilities; the RED Unit specialist or designee screens the referral as an I & R and a referral is sent to Oklahoma State Department of Health (OSDH), Protective Health Services Medical Facilities Service. The phone number is 405-271-6868, toll- free 1 800-747-8419; fax 405-271-4172; toll-free fax 1-866-239-7553, and email at LTCComplaints@health.ok.gov.

(f) When the resident is deceased and the death is suspected to be related to abuse, neglect, or exploitation by the facility, the RED Unit specialist or designee assigns the intake for investigation. The RED Unit specialist or designee refers the intake to OSDH when the resident is deceased and the death is not suspected to be related to maltreatment by the facility. The RED Unit specialist may staff with the program manager or designee.

(g) Non-urgent cases are assigned to LTCI SSI.

(h) When urgent cases are assigned for investigation, the RED Unit specialist or designee emails the program manager and the SSI.