Protection and Advocacy systems were created by Congress to address widespread abuse, neglect, and the lack of services for people with disabilities, especially those in institutions. Consistent with our federal mandate, Disability Rights North Carolina (DRNC) monitors in facilities where people with disabilities live and receive professional services. However, we are not a regulatory entity. We monitor to prevent or detect and address instances of abuse, neglect or exploitation and help ensure facilities comply with federal law and regulations intended to protect the rights and safety of people with disabilities. Our unique congressional authority also gives DRNC the authority to launch investigations into serious allegations of abuse, neglect and exploitation and make suggestions for improvement or report the occurrences to the appropriate authorities for enforcement.
Examples of Abuse, Neglect, and Exploitation
Abuse means any action—or failure to act—by an employee of a facility that is done on purpose, or with carelessness, and causes or could cause harm or death to a person with a disability. This includes things like
- Hitting or using too much force when putting someone in restraints
- Verbal or emotional harassment
- Sexual assault or rape
- Using physical or chemical restraints in unsafe or illegal ways
- Any other action likely to cause serious physical or emotional harm or likely to result in long-term harm
Abuse can also take the form of exploitation. Exploitation includes taking away someone’s rights or property for the benefit of someone other than the individual with a disability.[1] This includes behavior like
- Misusing or stealing a person’s money
- Forcing someone to sign a document for the benefit of someone other than the person with a disability
- Forcing someone to perform chores or activities that are not part of their individual support plan and/or for little or no pay
Neglect occurs when someone who is responsible for providing services, supports, or other assistance to a person with a disability acts, or fails to act, in a way that causes or could cause harm, serious injury, or death. Examples include
- Not making or following a care or treatment plan
- Not giving enough food, clothing, or medical care
- Not providing a safe place to live or stay
- Not having enough trained staff
- Not stopping self-harm, bullying, or assault from others
DRNC has a dedicated team of advocates and investigators who regularly monitor and investigate allegations of abuse, neglect, and exploitation across the entire state. We also often receive requests from individuals and/or family members to monitor in a particular facility or investigate an action or lack of action that harmed them or a loved one. We receive more requests to monitor or investigate than we can handle. While we take each report seriously and try to provide some type of assistance for every request, we are not able to monitor in every facility immediately or open an investigation each time one is requested. When we are unable to monitor immediately or open a requested investigation, there are steps you can take to protect your loved one or bring attention to unsafe conditions you experienced in a facility.
If you have a complaint about abuse, neglect, or exploitation of a child or an adult with a disability, please contact the Department of Social Services immediately.
The Department of Social Services (DSS)
Any person or institution who reasonably suspects that a child under the age of 18 is abused or neglected must make a report to the county department of social services (DSS).[2] Likewise, any person who reasonably believes that a disabled adult is in need of services to protect the adult from abuse, neglect, or exploitation, must file a report with the county DSS.[3]
Other Agencies and Entities
There are other agencies or entities to which you should report suspicions of abuse, neglect, or exploitation activities. They include the Division of State Operated Healthcare Facilities, Division of Health Service Regulation, Long-term Care Ombudsman Program, and Managed Care Organizations.
Reporting Tips
- Think about what type of facility it is. There are different regulatory entities that oversee different facility types. DRNC is not a regulatory entity.
- Create a timeline of This will help if you provide a sequence and context for the events. (DHSR has a complaint form if applicable, see below).
- Collect all of your notes and documentation to support your claim of neglect/abuse.
- Make your complaint in writing and keep a copy. If you have conversations with staff, follow up with an email or a letter confirming what you discussed in conversation so that you have documentation and proof.
- Request an investigation by the facility’s staff and ask the entity to call you with the results (if possible).
Division of State-Operated Healthcare Facilities (DSOHF)
DSOHF supervises and manages the 13 state-operated healthcare facilities that treat adults and children with mental illness, developmental disabilities, substance use disorders, and neuro-medical needs. See https://www.ncdhhs.gov/divisions/state-operated-healthcare-facilities/patientsresidents-rights
- Psychiatric Hospitals (Broughton, Central Regional, Cherry)
- Developmental Disability Centers/Intermediate Care Facilities (ICFs) for People with Intellectual Disabilities (Caswell, J. Iverson Riddle, Murdoch)
- Alcohol and Drug Abuse Treatment Centers (Julian F. Keith, Walter B. Jones)
- Neuro-Medical Treatment Centers (Black Mountain, Longleaf, O’Berry)
- Residential Programs for Children (Whitaker School, Wright School)
You should report occurrences of abuse, neglect, and/or exploitation to Internal Advocacy prior to calling DRNC, as they may be able to respond to your complaint more quickly. The contact person for each facility listed above can be found at https://www.ncdhhs.gov/documents/files/dsohf-advocacy-contact-list-april-2023/download?attachment.
If you do not receive a timely response, you may contact the DSOHF Advocacy Team leader Paula Appel at paula.appel@dhhs.nc.gov.
Division of Health Service Regulation (DHSR)
DHSR licenses and regulates medical, mental health and adult care facilities in North Carolina, including nursing homes, intermediate care facilities, psychiatric residential treatment facilities, and group homes. If you or someone you know has been abused, neglected, or exploited, you should file a complaint with DHSR within a year of the incident. You may file a complaint by phone, fax, email, or mail. The forms and instructions can be found at https://info.ncdhhs.gov/dhsr/ciu/filecomplaint.html or https://info.ncdhhs.gov/dhsr/ciu/pdf/complaint_form2.pdf.
Long-term Care Ombudsman Program
A long-term care ombudsman can explain residents’ rights and laws and regulations and/or refer you or your loved one to regulatory agencies or other organizations, including DRNC, when concerns or grievances cannot be resolved through the Long-Term Care Ombudsman Program alone. You can find more information about the program at https://www.ncdhhs.gov/divisions/aging/long-term-care-ombudsman. The NCDHHS website also provides a regional ombudsman list.
Local Management Entity/Managed Care Organization
LME/MCOs manage the care of NC Medicaid beneficiaries who receive services for mental health, developmental disabilities or substance use disorders. MCOs are also required to have policies and procedures in place to prevent, detect, investigate and report suspected abuse, fraud, and waste. If your rights have been violated or you suspect others have, you may contact your local MCO to file a complaint or grievance. They may begin an investigation and/or report the incident to the appropriate regulatory agency. See https://www.ncdhhs.gov/providers/lme-mco-directory. Each website will have information on its complaint/grievance policy and include contact information. You may request an investigation from your local MCO.
Summary
People with disabilities deserve to live free from abuse, neglect, and exploitation. If you or someone you know is being hurt or not cared for properly, tell someone right away. Start with your local Department of Social Services (DSS) and, depending on the type of facility, also notify the Division of State-Operated Healthcare Facilities, the Division of Health Service Regulation, or your LME/MCO. You can also reach out to the Long-Term Care Ombudsman Program for help to resolve concerns or find the right agency to help. If you do not receive a response or need additional support, contact Disability Rights North Carolina for advocacy or investigation assistance.
[1] The definitions and examples of abuse, neglect, and exploitation are based on definitions found at 45 C.F.R. 1326.19 and 42 C.F.R. 51.2.