2.4 Abuse, Neglect, Exploitation, and Misappropriation
Key Takeaways
- Texas requires reporting abuse or serious bodily injury to the facility administrator within 1 hour and to HHSC Complaint and Incident Intake no later than 2 hours; other incidents within 24 hours.
- Report to HHSC Complaint and Incident Intake at 1-800-458-9858 (24/7); community elder reports go to DFPS at 1-800-252-5400.
- A CNA reports objective observations and the resident's words — the CNA does not investigate, confront the accused, search belongings, or decide whether the allegation is proven.
- A validated finding goes on the Texas Nurse Aide Registry (NAR) and the Employee Misconduct Registry (EMR), barring the person from working in HHSC-regulated facilities.
Recognizing and Reporting Mistreatment
Residents have the right to be free from abuse, neglect, exploitation, and misappropriation of property. These terms sound legal, but a CNA must recognize them in real care. Memorize what each one means:
| Term | Definition | Concrete examples |
|---|---|---|
| Abuse | Willful infliction of injury, pain, or mental anguish | Hitting, pinching, pushing, threatening, mocking, yelling insults, unwanted sexual contact, improper isolation or restraint |
| Neglect | Failure to provide needed care or services, causing harm or risk | Leaving a resident in urine or stool, ignoring call lights, withholding fluids or meals, not repositioning per plan, failing to report a change |
| Exploitation | Misusing a resident's resources for personal gain | Pressuring for money, gifts, passwords, checks, or favors; borrowing from a resident; accepting valuable gifts |
| Misappropriation | Taking or using a resident's property without consent | Taking cash, wearing their jewelry, eating their labeled food, using their phone, hiding belongings |
Abuse can be physical, verbal, emotional, or sexual, and can occur with no visible bruise. Neglect is just as serious as a blow — "we were busy" never makes it acceptable. Exploitation can grow out of a seemingly friendly relationship, which is why a CNA must never borrow money from a resident, accept valuable gifts, or sell items to a resident. Misappropriation is theft or unauthorized use of belongings; even a small item or a few dollars counts.
Texas Reporting Duty and Timelines
In Texas, every staff member is a mandated reporter. Under HHSC long-term-care rules, the facility must report allegations to the administrator within 1 hour and to HHSC Complaint and Incident Intake no later than 2 hours when the event involves abuse or results in serious bodily injury, and within 24 hours for incidents that do not involve abuse or serious bodily injury. The investigation results are reported to HHSC within 5 working days. Reporting numbers a CNA should know:
- HHSC Complaint and Incident Intake (nursing-facility allegations): 1-800-458-9858, available 24/7.
- Department of Family and Protective Services (DFPS) Adult Protective Services (community / elder abuse): 1-800-252-5400.
A CNA reports promptly through the chain of command — usually the charge nurse or supervisor first — and follows facility policy for written documentation. If the resident is in immediate danger, protect the resident first and get the nurse or supervisor right away; if emergency help is needed, follow facility emergency procedures.
Reporting is a legal duty, not an option. Under Texas law, a person who fails to report suspected abuse, neglect, or exploitation can face criminal penalties, and a facility that fails to report faces administrative penalties from HHSC. "I assumed someone else would report it" is not a defense, and neither is "the resident has dementia." The duty attaches to reasonable cause to believe — you do not need proof, and you are protected from retaliation for a good-faith report.
A common test trap is the answer that says to 'tell the charge nurse and let her decide whether to report'; the correct stance is that the CNA's report itself is mandatory, and the chain of command is how it travels, not a filter that can stop it.
Do Not Investigate — Protect, Report, Document
The CNA does not investigate. Do not question the resident repeatedly, confront the accused person, search staff bags or other rooms, call family with details, or promise secrecy. Listen calmly, preserve privacy, and report the resident's words as close to verbatim as possible. If you see an injury, report what you saw, where it was, when you noticed it, and what the resident said — never diagnose the cause.
| Concern | CNA action | Avoid |
|---|---|---|
| Resident says staff hit them | Keep the resident safe; report immediately per policy and Texas timeline | Deciding the resident is 'confused' and ignoring it |
| New bruising with fearfulness | Report objective observations and the resident's statements | Guessing who caused it |
| Missing money or jewelry | Report missing property through facility procedure | Searching rooms or accusing a coworker |
| Call lights ignored, care skipped | Report the pattern up the chain of command | Joining in or saying the unit is too busy |
| Staff asks resident for money | Report possible exploitation | Treating it as a private friendship |
The registry consequences are severe and are why this is more than test material. Texas maintains two registries: the Nurse Aide Registry (NAR) and, under Health and Safety Code Chapter 253, the Employee Misconduct Registry (EMR). A validated finding of abuse, neglect, exploitation, or misappropriation is entered on these registries, is disclosed to employers, and bars the person from working in any HHSC-regulated facility in Texas. The aide is entitled to an informal reconsideration and a formal hearing before a finding is placed, but a sustained finding is effectively career-ending.
On exam questions, the safest answer protects the resident, reports through the correct channel within the required time, and avoids personal investigation. A CNA never ignores a concern because the resident has dementia, because the accused coworker is popular, or because the unit is busy.
A CNA sees another aide pull a resident by the arm and say, "Stop acting like a baby," during a transfer. The resident looks frightened. What should the CNA do?
A resident tells the CNA that a staff member borrowed money and promised to pay it back next payday. The resident seems worried about saying anything. What is the best CNA action?
During rounds a CNA finds a dependent resident in a wet brief, the call light on the floor, and an untouched lunch tray across the room. The prior shift charted that the resident was 'fine.' What should the CNA do?