Elder Justice Act Crime Reporting: A Practical Guide for Long-Term Care Facilities

The Elder Justice Act (EJA) created nationwide requirements to ensure that suspected crimes against residents of federally funded long-term care facilities are reported quickly and taken seriously. This guide explains what those duties look like in everyday practice so owners, managers, and frontline staff can understand and meet their legal obligations.

1. Why the Elder Justice Act Matters

Older adults in long-term care settings are at heightened risk of abuse, neglect, and financial exploitation. Congress passed the Elder Justice Act in 2010 as the first comprehensive federal law focused specifically on elder abuse and neglect. Among its provisions, it established crime-reporting duties for certain facilities that receive federal funds, aiming to:

• Detect abuse and crimes earlier through prompt reporting
• Ensure law enforcement involvement when criminal conduct is suspected
• Protect residents from retaliation when staff report concerns
• Hold facilities and individuals accountable when they fail to report

These requirements supplement, not replace, other federal and state mandated-reporting rules for elder abuse and neglect.

2. Which Facilities and People Are Covered?

2.1 Facilities Subject to EJA Crime Reporting

The federal crime-reporting provisions apply to long-term care facilities that:

• Provide or arrange for residential long-term care, and
• Receive at least $10,000 in federal funds in the preceding year.

In practice, this typically includes many nursing facilities and certain other residential providers that participate in Medicare or Medicaid and meet the funding threshold.

2.2 Who Is a “Covered Individual”?

Any person in or connected with a covered facility can be subject to these duties. Under the EJA, covered individuals usually include:

• Owners
• Operators
• Employees (clinical and non-clinical)
• Managers and supervisors
• Agents
• Contractors working in or for the facility

If you fall into any of these roles at a qualifying facility, you likely have personal reporting obligations under the EJA.

3. What Must Be Reported?

3.1 “Reasonable Suspicion” of a Crime

The EJA focuses on reasonable suspicion of a crime involving a resident or a person receiving care from the facility. Key points:

• You do not need proof; you only need a reasonable basis to suspect a crime occurred.
• “Crime” is defined by the law of the local jurisdiction (state or local criminal code).
• Suspected acts can include physical abuse, sexual assault, serious neglect, financial exploitation, or other criminal conduct.

Covered individuals must report suspicions involving any resident or individual receiving care, whether the alleged perpetrator is staff, another resident, visitor, or someone else.

3.2 Understanding “Serious Bodily Injury”

Reporting timelines depend on whether the suspected crime resulted in serious bodily injury. Laws and guidance generally describe serious bodily injury as an injury that:

• Involves extreme physical pain, or
• Creates a substantial risk of death, or
• Causes protracted loss or impairment of the function of a body part, organ, or mental faculty, or
• Requires significant medical intervention (such as surgery, hospitalization, or extended rehabilitation).

Facilities should work with legal counsel and local law enforcement to clarify how state law defines serious bodily injury in their jurisdiction.

4. Where and How Fast Must Reports Be Made?

4.1 Recipients of the Report

Under the EJA crime-reporting provision, covered individuals must report suspected crimes to at least two entities:

• The appropriate State Survey Agency (the state agency that inspects and certifies Medicare/Medicaid facilities)
• One or more local law enforcement entities (for example, local police, sheriff, or other designated agency)

Some organizations allow staff to notify an internal hotline that then forwards the report to law enforcement and the State Survey Agency, but that internal step does not remove the individual’s legal duty to ensure a report is made.

4.2 Two Separate Reporting Deadlines

The EJA distinguishes between cases with and without serious bodily injury. The clock starts when the covered individual forms the suspicion, not when the incident originally occurred.

These timelines are echoed in multiple state and provider guidance documents and remain in effect unless federal law is changed.

4.3 Multiple Reporters and Joint Reports

If several covered individuals become aware of the same incident, they may submit a joint report, as long as:

• All concerned individuals are clearly identified in the report, and
• The report is timely and complete.

However, each covered individual remains personally responsible for compliance; if they believe a group report will not be submitted on time or will be incomplete, they should file their own report.

5. Responsibilities of Facility Owners and Operators

5.1 Annual Determination and Notice

Each year, facility owners or operators must determine whether the facility received the minimum amount of federal funds (currently $10,000) in the prior year. If so, they must:

• Notify every covered individual in writing of their duty to report suspected crimes and the applicable timelines.
• Explain reporting channels, including how to contact law enforcement and the State Survey Agency.

5.2 Posting Required Notices

Facilities are expected to post notices in prominent locations describing:

• Employees’ obligations to report suspected crimes
• Employees’ rights to be free from retaliation when they report in good faith

State Survey Agencies may issue specific requirements or templates for these postings.

5.3 Aligning Policies With Federal and State Rules

Facilities should review and update their internal policies to ensure they align with:

• EJA crime-reporting provisions
• Existing Medicare/Medicaid requirements to report abuse, neglect, and misappropriation of resident property (such as 42 C.F.R. § 483.13 and related rules)
• State elder abuse and adult protective services reporting laws

Written procedures should address how staff recognize, document, and escalate suspected incidents, and how leadership coordinates with law enforcement.

6. Penalties and Anti-Retaliation Protections

6.1 Civil Monetary Penalties and Exclusion

Failure to report suspected crimes within the required timeframe can lead to serious consequences. Guidance based on the EJA indicates that covered individuals can face:

• Civil monetary penalties of up to approximately $200,000 for failing to report a crime when required
• Higher penalties (up to about $300,000) if the failure to report results in further harm to the resident or harm to another individual
• Possible exclusion from participation in federal health care programs for certain violations

These penalties are intended to reinforce the importance of prompt reporting and resident protection.

6.2 Protection Against Retaliation

The EJA also contains anti-retaliation provisions. Facilities may not retaliate against employees who, in good faith:

• Report a suspected crime
• Participate in an investigation
• Help others report or provide information

Retaliation can include firing, demotion, reduced hours, intimidation, or other adverse actions. Facilities found to have retaliated may face additional sanctions from federal agencies and state surveyors.

7. Integrating EJA Requirements Into Daily Practice

7.1 Building a Reporting Culture

Compliance is easiest when reporting is seen as a core ethical obligation rather than a mere legal requirement. Effective strategies include:

• Clear leadership messaging that safety and dignity of residents are non-negotiable priorities.
• Accessible reporting options, such as hotlines and simple forms, available on every shift.
• Non-punitive responses when staff raise concerns in good faith, even if the suspicion turns out to be unfounded.

7.2 Training and Scenario Practice

Regular training helps staff recognize when a situation rises to the level of a suspected crime and what steps to take. Effective programs typically:

• Explain the legal definitions of abuse, neglect, exploitation, and serious bodily injury.
• Use case examples to show when to call 911 immediately versus when to follow standard reporting channels.
• Clarify how EJA duties interact with state mandatory-reporting requirements and internal policies.

Some organizations also provide written checklists or flowcharts that walk staff through the decision process and timelines.

7.3 Coordination With Law Enforcement and APS

Facilities are encouraged to build relationships with:

• Local law enforcement, to clarify which incidents they treat as crimes and how they prefer to receive reports
• Adult Protective Services (APS) or equivalent agencies, which investigate abuse and neglect of vulnerable adults at the state level

Early coordination reduces confusion during emergencies and helps ensure that incidents are routed quickly to the right authority.

8. Frequently Asked Questions (FAQs)

Q1: Does the Elder Justice Act replace state mandatory-reporting laws?

No. The EJA crime-reporting rules operate in addition to state laws on reporting elder abuse, neglect, or exploitation. Covered individuals must follow both federal and state requirements and should be trained on how they interact.

Q2: What if I am not sure whether an incident is a crime?

You are not required to investigate or prove that a crime occurred. If you have a reasonable suspicion based on the facts you know, you should report within the applicable 2-hour or 24-hour window. Law enforcement and regulators are responsible for determining whether a crime actually took place.

Q3: Do I still have to report if my supervisor tells me not to?

Yes. EJA duties attach to you personally as a covered individual. Instructions from supervisors or facility policies cannot override federal law. If a supervisor blocks or delays reporting, you should find another way to make the report, document your actions, and, if needed, seek legal advice.

Q4: Are assisted living facilities always covered by the EJA crime-reporting rule?

Not necessarily. Coverage depends on whether the provider meets the federal definition of a long-term care facility and whether it received at least $10,000 in federal funds in the prior year. Some guidance notes that certain assisted living settings may fall outside the statute, while others may be covered if they meet these criteria.

Q5: Can I be punished by my employer for reporting?

No. The Elder Justice Act and related federal rules protect employees from retaliation for good-faith reporting of suspected crimes. Retaliatory actions can expose facilities to enforcement actions and penalties.

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medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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