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Critical Incidents – Health, Safety and Welfare

Abuse, Neglect, Financial Exploitation

Critical incidents – abuse, neglect and financial exploitation – are defined by individual state laws. Generally, these terms refer to actions that may jeopardize the health, safety and well-being of vulnerable adults by causing harm or creating a serious risk of harm, whether or not harm is intended to a person by their caregiver or other trusted individual. 

Critical Incident Types and Definitions

  • Physical abuse is the willful infliction of physical pain or injury, or the willful deprivation of services necessary to the physical safety of an individual
  • Psychological abuse is an act that inflicts emotional harm, invokes fear or humiliation, or otherwise negatively impacts the mental health or safety of an individual
  • Neglect is failure of an agency, facility, employee or caregiver to provide essential services necessary to maintain the physical and or mental health of a vulnerable adult
  • Financial exploitation is the misuse or taking of the vulnerable adult’s property or resource by means of undue influence, breach of fiduciary relationship, deception, harassment, criminal coercion, theft or other unlawful or improper means

Reporting Critical Incidents

Incidents of abuse, neglect and financial exploitation must be reported to the appropriate authorities, as mandated by state law. An incident must be reported before it can be investigated. Reporting an incident gives the victim the opportunity to receive the help they need to stop the abuse; this also may help reduce risk of abuse in the future. The ultimate goal in reporting suspected abuse, neglect or financial exploitation is to protect the victim. Reporting critical incidents also helps improve service quality by identifying potential issues or areas of concern.

Mandated Reporters

Mandated reporters can be employees of facilities, community agencies and certain professionals, including doctors, nurses, psychologists, dentists, social service workers and law enforcement personnel. Mandated reporters are required by law to report abuse, neglect and financial exploitation.

Voluntary Reporters

Everyone is encouraged, even when not required to report incidents of suspected abuse, neglect and financial exploitation. Voluntary reporters may remain anonymous, if desired. No matter who submits the report, the identity of the reporter is not disclosed without the written permission of the reporter, except when required by court order.

How to Report a Critical Incident

To report critical incidents related to MMAI and ICP enrollees, use the Critical Incident Reporting Form.

  • Fax the completed reporting form to the Quality Management Department at 312-946-3899; or
  • Call the Critical Incident Hotline at 855-653-8127 to report the necessary information.

Additionally, you may report a critical incident to a state agency, as follows:

  • For members age 18 and older Contact the Illinois Department on Aging, Adult Protective Services Hotline at 866-800-1409 (TTY 800-544-5340)
  • For members in nursing facilities – Contact the Department of Public Health, Nursing Home Complaint Hotline at 800-252-4343
  • For members in Supportive Living Facilities (SLFs) Contact the Department of Healthcare and Family Services Complaint Hotline at 800-226-0768