Facilities must have processes in place to identify and report allegations involving abuse, neglect, exploitation, mistreatment, injuries of unknown source, and misappropriation of resident property within required federal timeframes. One commonly overlooked requirement is the distinction between events involving serious bodily injury and those that do not.
CMS defines serious bodily injury as an injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; requiring medical intervention such as surgery, hospitalization, or physical rehabilitation; or an injury resulting from criminal sexual abuse.
Examples of alleged violations with injuries that may meet the definition of serious bodily injury include fractures, intracranial hemorrhages, injuries requiring hospitalization or surgery, amputations, severe lacerations requiring extensive treatment, and injuries resulting in death.
Under 42 CFR 483.12(c)(1), facilities must report alleged violations immediately, but not later than 2 hours after the allegation is made if the events that cause the allegation involve abuse or result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures.
A facility’s policies and procedures for reporting under 42 CFR 483.12(b)(5) should specify the following components, which include, but are not limited to: