Wisconsin Lawyer
Vol. 77, No. 8, August
2004
Abuse and Neglect in Long-Term Care Facilities:
The Regulatory Agency's Responsibility
Wisconsin's Department of Health and Family Services has various
tools to ensure that entities and individuals provide appropriate care
to vulnerable individuals. Through its regulatory approval, inspection,
and investigations, the department oversees the operation of health care
entities and service providers, investigates allegations of individual
caregiver misconduct, and provides technical support and coordinates its
efforts with other county and local agencies that protect and advocate
for the disabled elderly in Wisconsin.
Sidebars:
by Linda Dawson
The scenario repeats all too often. With little more than a few
weeks' training, a certified nursing assistant (CNA) assigned to provide
direct care to 15 or more frail, elderly residents with dementia or
other conditions requiring skilled nursing care in a nursing home is
stretched too thin. A confused resident repeatedly pushes the call light
because he wants to use the bathroom. His care plan requires that two
persons assist with transfers. Several residents on the unit are calling
out for attention; other CNAs are busy; the nurse is attending to
another resident's medical needs. The CNA has to make a decision. If the
CNA doesn't respond promptly, she could be disciplined. Should she wait
for assistance as required by the resident's plan of care or try it
alone? After all, the resident doesn't weigh much. The CNA knows that
weakened residents who can no longer support their weight are hard for
one person to safely handle. If she decides to try the transfer alone,
rather than wait or use the equipment as required, a fall could result.
Brittle bones break easily against hard surfaces in bathrooms or on
floors. A broken hip in a frail, elderly resident often leads to the
person's untimely death.
Who is responsible for the person's injury or death? Is it the CNA
who took a chance in spite of the known risks or the employer who did
not provide adequate training, staffing, or supervision to ensure that a
resident's care plan was followed? Administrators and direct care staff
in Wisconsin's residential health care facilities make difficult choices
every day. The consequences of those choices can be deadly. Should
someone be held accountable for these decisions? If so, who and to what
extent? Who decides?
Wisconsin's Department of Health and Family Services (DHFS) has
various tools to ensure that entities1 and
individuals provide appropriate care to vulnerable individuals. Through
its regulatory approval, inspection, and investigations, the DHFS
oversees the operation of health care entities and service providers.
The DHFS also investigates allegations of individual caregiver
misconduct, including abuse or neglect of clients or misappropriation of
clients' property. Finally, the DHFS provides technical support and
coordinates its efforts with other county and local agencies that
provide protection and advocacy services to the disabled and elderly in
Wisconsin. These tools enable the DHFS to: 1) ensure the protection of
disabled and vulnerable clients across their lifespan; 2) hold entities
accountable for the care provided; 3) hold caregivers accountable for
intentionally or negligently disregarding their obligations and duties
to those who rely on them for care; and 4) ensure that protection and
advocacy systems effectively and efficiently meet the needs of
Wisconsin's most vulnerable citizens, regardless of where they
reside.
This article outlines the DHFS's regulatory options and the potential
consequences for health care providers and individual caregivers who
neglect, abuse, or financially exploit individuals residing in or
receiving care from Wisconsin's regulated residential care facilities.
It also identifies resources for lawyers who may be representing
entities, individual caregivers, or clients affected by the care of
others.
Regulatory Approval, Survey, and Complaint Investigations: Focusing
on Residential Care Facilities
The Survey, Inspection, and Investigation Process.
Within the DHFS, the Bureau of Quality Assurance is responsible for the
uniform, statewide licensing,2 inspection,
and regulation of nursing homes,3
community-based residential facilities, adult family homes, resident
care apartment complexes, hospitals, and hospices.4 Under its oversight authority, the DHFS determines
whether these entities are in compliance with applicable state laws and
federal regulations.
The DHFS oversees the operation of entities initially through the
license application process, determining whether an applicant is "fit
and qualified" to operate an entity in Wisconsin. The DHFS then monitors
conditions in the entity and compliance with applicable state and
federal law through unannounced compliance inspections or surveys. The
DHFS also investigates complaints concerning conditions, care, or
treatment. These inspections and investigations have three major
components: 1) direct observations of care; 2) interviews; and 3) review
of pertinent records or documents. During the survey or complaint
investigation process, the DHFS looks for evidence that an entity is
ensuring that a resident's rights are protected and the resident is free
from abuse and neglect.5 The
complainant6 may remain anonymous. Providers
are prohibited from retaliating or discriminating against any employee
who provides information to the DHFS or the long-term care
ombudsman.7
Throughout the process, informal meetings between entity
administrators and the department occur. At the end of the survey or
investigation, an exit conference is held during which any suspected
violation is explained and the entity is given an opportunity to
respond. If the DHFS determines that a violation of applicable
regulations or laws has occurred, the entity is served with a written
notice of the violation.
Opportunities exist for further review and appeal. Nursing homes may
request an informal dispute resolution conference, which provides an
opportunity to present additional information. After considering the new
information, the DHFS may retain, amend, or withdraw the violation.
When the DHFS establishes a violation of one or more requirements,
state sanctions or federal remedies may be imposed. The type and level
of sanctions imposed by the DHFS and, as applicable, federal regulators,
depend on the scope and severity of the violation, the economic benefit
to the entity, the extent of harm to the entity's clients, and the
entity's compliance history. In most cases, the entity has the right,
under chapter 227 of the Wisconsin Statutes, to appeal a violation and
imposed sanction.8 Notwithstanding an
appeal, the entity is expected to immediately correct identified
violations and to ensure that the violations will not recur.
Factors Contributing to Abuse, Neglect, and Exploitation in
Facilities. The DHFS's goal in overseeing health care entities
is to reasonably and effectively encourage entities to comply with
applicable regulations so that individuals receive the care they need
and deserve. Most entities provide quality care; however, some do not.
There are several reasons care might decline in an entity.
Expanded residential settings. Nursing homes are serving a
more challenging population. Individuals are increasingly choosing to
remain in their homes with assistance or reside in assisted living
settings. An individual's increasing needs for care and nursing services
can be met through the continuum of available programs and settings.
However, the changing care needs of individuals makes the provision of
highly-skilled, quality care a challenge for entities and their staff.
The unintended result can be resident neglect or harm.
Financial difficulties. Financial difficulties often provide
a warning sign of future care problems. Workforce shortages, staff
turnover, and increasing costs for supplies and services present
significant problems for entities seeking to sustain and improve
quality. Operators face hard decisions when money is tight. A recent
report to Congress found "'strong and compelling' evidence that nursing
homes with a low ratio of nursing personnel to patients were more likely
to provide substandard care."9
Stressed or abusive staff. When an entity lacks sufficient
trained staff to provide care, residents are harmed, often seriously.
Nursing home residents require high levels of individualized care. A CNA
with responsibility for too many residents may not be able to properly
attend to a resident's special dietary needs, causing significant weight
loss, dehydration, choking, or aspiration pneumonia. A few minutes are
too long for many residents to wait to be able to go to the bathroom.
When they can no longer wait for assistance, residents may get up by
themselves, fall, and break a bone. A broken leg can be fatal. When
residents are bed-bound, bedsores (decubiti ulcers) may develop.
Bedsores can rapidly worsen, leading to sepsis. Too often, inadequate
care leads to premature and painful death.
Neglect is prevalent when staff are stressed or overwhelmed. CNAs
often are called on to work double shifts. Pool (temporary) staff cost
more, lack training in an entity's procedures, and are less familiar
with residents' needs. Tired and undertrained staff react
inappropriately to challenging situations, for example, by rushing,
ignoring, or otherwise neglecting residents. Many acts of abuse by a
caregiver are not the result of stress; rather they are often acts of
power and control. Regardless of the cause, in each case these
individuals fail in their duty to the vulnerable persons who rely on
them for compassionate care.
Lack of understanding or awareness. The DHFS has
increasingly emphasized through training sessions and publications that
entities are responsible for preventing and reporting client abuse and
neglect and misappropriation of client property. In 2002, more than 140
violations were issued to nursing homes related to abuse, neglect, and
misappropriation of resident property - a 43 percent increase since
1999. Many of these incidents were self-reported, reflecting a better
identification of prohibited conduct.
Sexual abuse is one form of abuse that now is being reported more
often. In one reported case, a resident with dementia repeatedly
attempted to kiss, touch, and climb into bed with another resident.
Staff dismissed the conduct, stating, "Boys will be boys!" In another
incident, in which a family member committed a sexual assault, the
resident's physician excused the conduct: "Some families are like
that."
Increased awareness about sexual assault has led to increased
reporting. The DHFS, representatives from the Wisconsin Coalition
Against Sexual Assault (WCASA), aging and disability organizations, law
enforcement, and providers developed a protocol for responding to sexual
abuse of a resident.10 In spring 2004, the
WCASA offered training sessions across the state for advocates,
providers, and law enforcement on improved responses to reports of
sexual assault.
Effective Prevention Efforts. Regardless of the
setting, entities must ensure residents' protection. Critical to the
residents' protection is prevention. An entity's prevention approach is
signaled first by the training provided for staff regarding its policies
and procedures and by the provision of supervision to ensure that all
employees follow the entity's policies and procedures. A culture of
safety and responsibility actively encourages prompt reporting of any
suspected mistreatment of clients. All residents, employees, family
members, and visitors should know how to report to the entity suspected
mistreatment of a client by anyone. Perpetrators are less likely to act
when they know that all eyes are watching all the time. When a report is
made or an injury is discovered, the entity must take whatever steps are
necessary to protect clients from further harm. Entities provide
additional, necessary protections when they promptly and thoroughly
investigate and evaluate injuries of unknown origin and pursue and
report to the DHFS, law enforcement, or the appropriate regulatory
agency all incidents of suspected client abuse, neglect, and
exploitation.
Caregiver Misconduct: Focusing on Individuals
The Wisconsin Caregiver Law. In 1997, in response to
concerns about the backgrounds of individuals who were caring for its
most vulnerable citizens, Wisconsin passed a comprehensive caregiver
law.11 The law requires thorough background
checks at least every four years of the following: individuals employed
by or under contract with the entity who have direct, regular contact
with clients served by the entity; persons who are not clients of an
entity but who reside at the entity ("nonclient residents"); and persons
seeking regulatory approval. The background check includes determining
whether the individual has any criminal convictions, findings of
caregiver misconduct, or limitations on any credentials the person
holds.
Individuals with certain serious criminal convictions12 are barred from contracting with, being employed
by, being licensed to operate, or being able to reside (other than as a
client) in regulated entities. Additionally, individuals with findings
by a governmental agency of misconduct, for example, abuse or neglect of
a child or a client or misappropriation of a client's property, are
similarly barred. Barred individuals are eligible for regulatory
approval or employment only after satisfying the DHFS that they are
rehabilitated.13 Additionally, entities are
urged to determine whether other convictions are "substantially related"
to employees' duties or positions.14
Failure to comply with these requirements or knowingly submitting false
information may result in sanctions against the entity or
individual?.15
Reporting and Investigating Caregiver Misconduct.
Another part of the caregiver law involves reporting allegations of
misconduct by caregivers, investigating the reports, and protecting the
due process rights of the accused caregivers.16 The DHFS maintains the Wisconsin Caregiver
Misconduct Registry, an official record of persons found to have abused
or neglected a client or misappropriated a client's property.17
Any person may report suspected misconduct by a caregiver to the
DHFS.18 When an entity becomes aware of an
allegation of caregiver misconduct, it must take steps necessary to
ensure that clients are protected from further harm while a
determination is pending.19 Then the entity
must conduct a preliminary investigation. The entity must report the
alleged misconduct within seven calendar days from the date the entity
first knew or should have known about the misconduct if the entity
determines that: 1) the conduct meets a definition of misconduct; or 2)
the conduct could, after further investigation by an investigating
agency, meet the definition; or 3) caregiver misconduct cannot be
affirmatively ruled out.20 Entities are
required to report to the appropriate agency21 incidents of misconduct. Intentionally failing
to report allegations of caregiver misconduct may result in penalties,
including forfeitures of up to $1,000, license revocation, and notice in
a local newspaper of the failure to act.22
When the DHFS receives a report of caregiver misconduct, it conducts
an investigation and coordinates its efforts with other agencies as
appropriate.23 Because many incidents of
alleged misconduct involve possible criminal activity, the DHFS works
closely with local law enforcement and the Wisconsin Department of
Justice.
After completing its investigation, the DHFS provides written notice
of its determination to the accused caregiver.24 The accused caregiver is given an opportunity to
appeal a substantiated determination.25 If
the DHFS's determination is confirmed, the caregiver's name is placed on
the Wisconsin Caregiver Misconduct Registry.
Identifying Misconduct: Abuse, Neglect, and Misappropriation
of Property. Three types of misconduct are defined in chapter
HFS 13 of the Wisconsin Administrative Code: abuse; neglect; and
misappropriation of property. Abuse includes acts that are intended to
cause harm, sexual assault, the forcible administration of medication
without lawful authority, and harassment.26
Examples of abuse substantiated by the DHFS include massaging a
resident's genitals, slapping a resident, dragging a resident on the
floor causing rug burns, and repeatedly mocking a resident. In November
2003, out of 87 allegations received, 28 (34 percent) involved
allegations of physical or sexual abuse.
Although neglect can lead to serious harm to clients, neglect is
often overlooked or minimized by entities and caregivers. Neglect
includes an individual's act or omission that causes or could reasonably
be expected to cause harm to a client or that disregards a client's
rights or a caregiver's duties.27 Most
commonly, neglect cases involve caregivers who, despite training, fail
to perform their duties - for their own convenience and to the client's
detriment. Examples of neglect substantiated by the DHFS include failure
to supervise a client with a history of wandering (he was found dead
after leaving the facility), leaving clients alone in a van while the
caregivers attended a movie, and leaving a nonverbal quadriplegic
resident unattended for hours (resulting in an injury after a fall).
The final form of misconduct is misappropriation of a client's
property.28 The most common form is theft
of personal property, such as money, jewelry, prescription drugs, or
other items of value. Other forms include theft by fraud or
misrepresentation, theft by a trustee, identity theft, uttering a forged
document involving the property of a client, or the fraudulent use of a
client's financial transaction card. Examples of misappropriation
substantiated by the DHFS include theft of medications, use of a
client's credit card to purchase personal items, use of the client's
telephone to make calls to 900 numbers, theft of jewelry, taking funds
for personal use that were intended as payment for services, and
"borrowing" a large amount of cash from a client with no intent to repay
the client.
Lack of consent is an element of some forms of abuse (for example,
sexual assault) and theft. Although it may be difficult to determine
whether a person has given consent or is capable of giving consent, a
key question is whether the individual is capable of understanding the
nature and consequences of the act. In some cases involving sexual
contact, consent is not a required element.29
In 2002, the DHFS received 1,209 reports of caregiver misconduct. Of
those, 538 involved abuse, 392 involved neglect, and 272 involved
misappropriation. Sixty-five were outside of the DHFS's jurisdiction
either because the caregiver involved was regulated by another
department (for example, the Department of Regulation and Licensing) or
because the entity was not regulated under the caregiver law. The DHFS
completed 851 investigations in 2002. As a result of those
investigations, 164 individuals' names were placed on the caregiver
misconduct registry.30
Dispositions in Caregiver Misconduct Cases.
Caregiver cases can be resolved in several ways. Most cases result in a
finding of misconduct. Federal law requires the DHFS to place a finding
of misconduct on the Wisconsin Caregiver Misconduct Registry when a
conviction results from an offense committed in a federally certified
nursing home.31 A conviction in a state
court for the conduct constitutes "substantial evidence" against the
caregiver.32 In some neglect cases, the
caregiver may request that the finding be removed from the registry
after one year. In other cases, the DHFS may enter into deferred finding
agreements with accused caregivers.33
Disclosure of Information Concerning Findings.
Almost 1,000 names are now listed on the registry. When the DHFS
receives an inquiry about an individual, the DHFS may disclose only
whether the individual's name is on the misconduct registry and, if
listed, whether a rebuttal statement exists.34 Except as authorized, the DHFS may not release
any information from a report when an allegation is not substantiated.
Once placed on the registry, the individual's name remains listed unless
the finding is reversed or the person dies.35
Demonstrating Rehabilitation. Barred caregivers -
those with certain serious convictions or findings - must demonstrate
that they are rehabilitated before they are eligible for consideration
for regulatory approval to operate an entity, for employment, or for
nonclient residency.36 To obtain approval,
applicants must submit information requested by the DHFS.37 The information submitted is reviewed at a panel
meeting.38 The applicant is invited to
appear.
After reviewing the information, panel members determine whether
sufficient information was presented to show that the applicant is
rehabilitated.39 The panel considers
factors related to the applicant's personal development and history, the
position the person is seeking, and the offense. The panel may approve
the applicant, defer a decision for up to six months, or deny the
approval.40 Once granted, approval may be
suspended and withdrawn if an applicant commits a new offense or
violates a condition of approval.41
Entities must verify an individual's approval status when conducting
background checks.
Collaboration Among Other Systems
Wisconsin has long been a leader in elder abuse prevention and
intervention. Despite this history, the number of reported incidents of
elder abuse across Wisconsin jumped 15 percent from 2001 to 2002.42 The increase may be due to increased public
awareness about elder abuse and related crimes. As discussed above,
regulatory oversight, entity practices and policies, and individual
background checks are three methods of protecting vulnerable individuals
from harm. However, one of the most effective prevention and
intervention methods, regardless of where a person resides, is
communication and collaboration among agencies.
Linda Dawson, U.W. 1984, deputy chief
legal counsel for the Wisconsin Department of Health and Family
Services, supervises the DHFS legal staff, litigates cases including
caregiver abuse and regulatory violations in long-term care facilities,
and is assigned to special projects, such as the DHFS Regulatory
Re-Engineering project, the Caregiver Law, and, most recently, as
cochair of the Adult Protective Services modernization project. She also
has provided investigative skills training for many of the DHFS staff
and has been a certified trainer under the Violence Against Women Act.
In addition to her law degree, Dawson holds a B.S. and M.S. in
behavioral disabilities.
There are many resources dedicated to preventing abuse and neglect of
vulnerable adults and the elderly. The DHFS's Bureau of Aging and Long
Term Care Resources provides support for and consultation to county
agencies and providers. Section 46.90 of the Wisconsin Statutes requires
that counties provide a published phone number for reporting elder abuse
and investigating allegations of abuse, neglect, or financial
exploitation. In addition, county and tribal human service agencies
support county efforts in the area of adult protective services. A 2002
Joint Legislative Council Special Committee, cochaired by Sen. Robert
Wirch and Rep. Suzanne Jeskewitz, examined chapter 55 and related
statutes (chapters 51 and 880 and section 46.90 of the Wisconsin
Statutes) and recommended changes codifying recent court
decisions.43 The committee also accepted
many of the recommendations made by the DHFS's Adult Protective Services
Modernization Project. Changes to the guardianship laws are being
separately pursued. The federal Elder Justice Act, if passed, may
provide additional resources and support. The National Clearinghouse on
Abuse in Later Life, through the Wisconsin Coalition Against Domestic
Violence, has been a national leader in developing theories, training
sessions, and policies on the overlap between domestic violence and
elder abuse. Another state resource is the Board on Aging and Long Term
Care's Ombudsman program. The Ombudsman's program offers many services,
including complaint investigation, mediation, training, and
education.44
In 2002, the DHFS provided additional direct service funding to
counties that developed elder abuse interdisciplinary teams (I-Teams).
I-Teams provide a forum to address difficult situations involving
self-neglect, neglect, abuse, and exploitation. Similar models have been
used successfully in addressing domestic violence and child abuse and
neglect. I-Teams include representatives from law enforcement, health
care, faith communities, financial institutions, the county's lead elder
abuse agency, and domestic abuse and sexual assault service providers.
Facilitated by the I-Teams, these providers and agencies can more
effectively coordinate their prevention and intervention efforts and
identify strategies for challenging cases. In addition, lead elder abuse
agencies are required to have in place memorandums of understanding with
law enforcement,45 to define roles and
expectations in responding to situations of neglect, self-neglect,
abuse, or exploitation.
There are many other collaborative efforts in place or emerging to
combat abuse and neglect of adults at risk of abuse, neglect, or
exploitation. Representatives of the U.S. Attorney's Office, the
Wisconsin Department of Justice, the DHFS, the Ombudsman program, and
aging and disability groups meet regularly. The purpose of these
meetings is to share information and to identify cases involving
caregiver or entity abuse and neglect that may be prosecuted criminally
or civilly through the False Claims Act.
It is important that agencies continue to coordinate efforts and
improve resources. Information must be provided to visitors, residents,
family members, and providers on how to identify potential physical,
emotional, and financial harm and report it. The DHFS goal is to end
mistreatment of Wisconsin's most vulnerable citizens. The regulatory
efforts focused on systems and individuals described in this article are
critical means to achieving that goal.
Endnotes
1In this article, the term "entity"
means a facility or program regulated, licensed, certified, or approved
by the DHFS to provide care or treatment services to clients.
2Through its regulatory process,
the DHFS licenses, certifies, registers, or approves various entities
that provide care and treatment services to clients.
3The term "nursing homes" includes
facilities for the developmentally disabled, also referred to as
intermediate care facilities for persons with mental retardation
(ICFs-MR).
4The provisions regarding the DHFS
authority over these providers is found in Wis. Stat. chapter 50.
5Wis. Stat. § 50.09. Among
other things, persons receiving care or treatment services from
regulated health care settings have the right to be free from physical,
sexual, and mental abuse and neglect; the right to be treated with
dignity; the right to prompt and adequate care based on their individual
needs; and the right to have their personal property protected and to be
free from financial exploitation.
6Complaints may be filed by anyone,
most commonly by family members, residents, or clients served by the
entity, entity staff, visitors, or the state's Ombudsman or other
advocates. The Board on Aging and Long Term Care's Ombudsman program is
described more fully later in this article.
7Wis. Stat. § 50.07(1)(e).
8For an explanation of the chapter
227 appeal process by an administrative law judge, see Sean Maloney,
A Primer on Administrative Hearings, 76 Wis. Law. 28 (July
2003).
9Robert Pear, 9 in 10 Nursing
Homes Lack Adequate Staff, Study Finds, N.Y. Times (Feb. 18,
2002).
10The protocol encourages
entities to designate a contact person with specialized training to
support the sexual assault victim and protect the victim and others from
further emotional or physical harm. For more information about domestic
violence and sexual assaults in facility settings, see DDES
Information Memo 2004-03.
11The caregiver law is found in
Wis. Stat. sections 50.065 (health care entities) and 48.685 (child care
entities).
12Serious convictions include
convictions of homicide, felony battery, sexual assault, abuse of
vulnerable adults, patients or residents, and physical or sexual assault
of a child. See Wis. Admin. Code ch. HFS 12 app. A.
13For more information about the
caregiver law and the rehabilitation review process, go to the DHFS Web
site.
14In determining whether a crime
is "substantially related," entities are encouraged to review the
factors related to the person, the job, and the offense identified in
Wis. Admin. Code section HFS 12.06. Certain convictions, such as
misdemeanor battery or disorderly conduct, require employers to examine
the factual basis to determine whether the act is substantially related.
See Wis. Admin. Code ch. HFS 12 app. A.
15Wis. Admin. Code § HFS
12.05.
16Wis. Admin. Code § HFS
13.01.
17Wis. Admin. Code § HFS
13.04(1).
18Wis. Admin. Code § HFS
13.05(4)(a). A copy of the reporting form may be found at: http://dhfs.wisconsin.gov/forms/DDES/DDE2447.pdf.
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19Wis. Admin. Code § HFS
13.05(2).
20Wis. Admin. Code § HFS
13.05(3)(a).
21Wis. Admin. Code section HFS
13.05(3) requires that caregiver misconduct be reported to the DHFS,
except that an entity must report an incident to the Department of
Regulation and Licensing (DRL) if it involves a person who holds a DRL
credential, and incidents of child abuse or neglect must be reported to
the county department of social or human services. Entities also may
report suspected crimes to local law enforcement.
22Wis. Admin. Code § HFS
13.05(3)(e).
23Wis. Admin. Code § HFS
13.05.
24Wis. Admin. Code § HFS
13.05(6)(c).
25Wis. Admin. Code § HFS
13.05(6)(c)2.b.
26Wis. Admin. Code § HFS
13.03(1).
27Wis. Admin. Code § HFS
13.03(14).
28Wis. Admin. Code § HFS
13.03(12).
29For example, Wis. Stat. section
940.225(2)(g) prohibits an employee of an adult family home,
community-based residential facility, inpatient health care facility, or
state treatment center from having sexual contact or sexual intercourse
with a person who is a client of the entity.
30To determine whether an
individual is listed on the Wisconsin Misconduct Registry, contact www.promissor.com or call (877)
224-0235.
3142 C.F.R. §
483.13(c)(1)(iii).
32Wis. Admin. Code § HFS
13.05(6)(d)1.
33In deferred finding agreements,
a finding is not placed on the registry pending successful completion of
the conditions of the agreement. Conditions often include satisfactory
job performance, successful completion of training or education in an
area related to the incident, a written statement about the impact of
the conduct on residents, and no further reported incidents of alleged
misconduct within a time specified.
34Wis. Admin. Code § HFS
13.05(8).
35Wis. Admin. Code § HFS
13.05(8)(c).
36Approval must be granted by the
regulatory agency or tribe that regulates the entity. For the majority
of applicants, that agency is the DHFS. See Wis. Admin. Code
§ HFS 12.12(1), (2).
37Wis. Admin. Code § HFS
12.12(3). An applicant must complete a form required by the DHFS and
include supporting information about the barring offense; a statement
explaining why approval should be given; personal reference checks from
individuals and professionals; evidence of successful completion of
probation or parole; evidence of subsequent training, education, or
community service; criminal history, including information about other
offenses; and pending criminal or civil actions.
38Wis. Admin. Code § HFS
12.12(4)(c).
39Wis. Admin. Code § HFS
12.12(4).
40Wis. Admin. Code § HFS
12.12(5). When an approval is denied, the applicant may appeal the
decision.
41Wis. Admin. Code § HFS
12.12(6).
42Wisconsin Report on Elder
Abuse, 2002.
43Additional information is
available at www.legis.state.wi.us/lc/2002studies/CH55/index.htm
44Wisconsin
Board on Aging and Long Term Care, Ombudsman Program.
45Wis. Stat. §
46.90(3)(a).
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