CMS SOM App. B, Tag G430

The patient has the right to—

(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of

unknown source, neglect and misappropriation of property;

Interpretive Guidelines §484.50(c)(2)

The patient has a right to be free from abuse from the HHA staff and others in his or her

home environment. The HHA should address any allegations or evidence of patient abuse

to determine if immediate care is needed, a change in the plan of care is indicated, or if a

referral to an appropriate agency is warranted. (State laws vary in the reporting

requirements of abuse. HHAs should be knowledgeable of these laws and comply with

the reporting requirements.) In addition, the HHA should intervene immediately if, as

indicated by the circumstances, any injury is the result of an HHA staff member’s

actions. The HHA should also immediately remove staff from patient care if there are

allegations of misconduct related to abuse or misappropriation of property.

“Abuse” means the willful infliction of injury, unreasonable confinement, intimidation,

or punishment with resulting physical harm, pain or mental anguish. Abuse may be

verbal, mental, sexual, or physical and includes abuse facilitated or enabled through the

use of technology.

“Verbal abuse” refers to abuse perpetrated through any use of insulting, demeaning,

disrespectful, oral, written or gestured language directed toward and in the presence of

the client.

“Mental abuse” is a type of abuse that includes, but is not limited to, humiliation,

harassment, and threats of punishment or deprivation, sexual coercion and intimidation

(e.g. living in fear in one’s own home).

“Sexual abuse” is a type of abuse that includes any incident where a beneficiary is

coerced, manipulated, or forced to participate in any form of sexual activity for which the

beneficiary did not give affirmative permission (or gave affirmative permission without

the mental capacity required to give permission), or sexual assault against a beneficiary

who is unable to defend him/herself.

“Physical abuse” refers to abuse perpetrated through any action intended to cause

physical harm or pain, trauma or bodily harm (e.g., hitting, slapping, punching, kicking,

pinching, etc.). It includes the use of corporal punishment as well as the use of any

restrictive, intrusive procedure to control inappropriate behavior for purposes of

punishment.

“Injury of unknown” source is an injury that was not witnessed by any person and the

source of the injury cannot be explained by the patient.

“Misappropriation of property” is theft or stealing of items from a patient’s home. The

HHA staff must investigate and take immediate action on any allegations of

misappropriation of patient property by HHA staff and refer to authorities when

appropriate.

Neglect means a failure to provide goods and/or services necessary to avoid physical

harm, mental anguish or mental illness.

Survey Procedures: §484.50(c)(2)

Examine the extent to which the HHA has a system in place to protect patients from

abuse, neglect, and misappropriation of property of all forms, whether from staff or from

other persons. Determine the extent to which the HHA addresses the following issues:

• How does the HHA staff conduct themselves in the patient’s home in regards to

demonstrating respect for persons and property?

• Does the HHA have policies and procedures for investigating allegations of abuse,

neglect and misappropriation of property?

• Interview staff to determine if staff members know what to do if they witness abuse,

neglect or misappropriation of property.

• Ask the HHA if it has had any allegations of patient abuse or neglect from any source

during the past year. If it has, ask the HHA to provide the files and to describe how

the matter was handled. Review the HHA records to see if the appropriate agencies

were notified in accordance with State and federal laws regarding incidents of

substantiated abuse and neglect.