Adult Protection 101. Introduction. Introduction (continued) Categorical Vulnerable Adult

Transcription

1 Introduction Adult Protection 101 Jennifer Kirchen, LSW and Deb Siebenaler Aging & Adult Services Minnesota Department of Human Services In 1980, the MN legislature passed MS , which declared the public policy of the State of MN was to protect vulnerable adults. Legislation was implemented at the Department of Human Services (DHS) in 1981 with the creation of the Adult Protective Services (APS) Unit. Introduction (continued) Protect adults who are vulnerable to maltreatment; categorical- dependency on services functional- physical or mental disability Provide safe services and living environments for adults who have been maltreated; Require reporting, investigation and protective services Categorical Vulnerable Adult A person, 18 years of age or older, who is a: Resident or inpatient of a facility, regulated by MDH or DHS, or Receives services from a facility, regulated by MDH or DHS, or Recipient of home care services from MDH facility or PCA services. 1

2 Functional Vulnerable Adult REPORTERS A person 18 years of age or older who, regardless of residence or service has an: impairment or disability, and because of this impairment has: an impaired ability to meet basic needs, and an impaired ability to protect self from maltreatment. MANDATED REPORTERS are required by law to report! Social services Law enforcement educators licensed health & human service professionals Personal Care Attendants Employees of licensed facilities Medical examiner or coroner VOLUNTARY ALL OTHERES! Required To Report The reporter has reason to believe: A vulnerable adult is being maltreated,or A vulnerable adult has been maltreated,or A vulnerable adult has a serious injury and there is no reasonable explanation for the injury. A mandated reporter must make the report immediately which is: as soon as possible, and no later then 24 hours from initial knowledge or belief. Exceptions To Required Reports Federal law requires the consent of chemical dependency clients prior to a CD staff making a report on the client as victim Program participant non serious verbal or physical aggression Transfers of money or property as a gift or for services rendered Errors in the provision of therapeutic care 2

3 Common Entry Point In 1998, the MN legislature passed MS subd. 9 (statewide common entry designation) and subd. 12 (data management) The common entry point intake for (#3243) and investigation summary report (2494) are submitted by counties to DHS for the purposes of collecting data. In 2008, DHS in conjunction with SSIS (Social Services Information System) will implement a project to incorporate the #3243 and #2494 into SSIS. Common Entry Point (CEP) Where do I report? Each County Board designates a CEP The CEP is responsible for receiving maltreatment reports 24/7 CEP may be: -Social Services Generally Monday through Friday 8:00 to 5:00 -Law Enforcement Center Generally Evenings, holidays, weekends -Private Agencies COMMON ENTRY POINT RESPONSIBILITIES Determine immediate risk Screen reports of alleged or suspected maltreatment Make necessary referrals Criminal issues-refer to law enforcement Emergency Protective Services Appropriate Lead Investigative Agency Ombudsman (suspicious death) What is abuse? Criminal conduct - first through fifth degree assault - use of drugs to injure or facilitate a crime - solicitation, inducement or promotion of prostitution - criminal sexual conduct (sexual contact or penetration by caregiver) Caregiver conduct which is neither therapeutic or an accident - hitting, slapping, kicking, punching, biting or corporal punishment -malicious oral, written or gestures -aversive or deprivation procedures (seclusion) and involuntary servitude 3

4 What is neglect? Self-neglect Failure to provide for basic needs; food, clothing, shelter, health care or supervision. Absence of care or services essential to maintain health and safety Neglect may be by caregiver or selfneglect. is defined by the absence or likelihood of absence of care and services essential to obtain or maintain health, safety and comfort of the vulnerable adult. WHAT IS THE ROLE OF THE CASE MANAGER/CARE COORDINATOR? To provide protective services and support to the vulnerable adult Activities may include: Assisting VA during the investigation process Helping VA to obtain emergency medical care: Emergency Room visit, SARS eval, etc. Assessing the impact of the maltreatment on the client s mental and physical health status Arrange/coordinate needed psychiatric or psychological assistance and ongoing medical care Facilitate emergency placement Refer for emergency financial assistance Refer to victims groups Help obtain Orders for Protection Refer to Legal Services SECOND-PARTY PERPETRATOR VULNERABLE ADULT REPORTS REMEMBER: Only a Lead Agency can conduct a maltreatment investigation. If you have knowledge that a client on your caseload is being abused, neglected, or financially exploited by another person, the Vulnerable Adult Law requires that you continue to report these incidents to the Common Entry Point of Adult Protection Services. 4

5 WHAT DO I DO WITH SELF-NEGLECT REPORTS? Decision Making for Self Neglecting Situations Low Risk Self-neglect is the most common and most problematic form of maltreatment of both elderly and disabled persons in all APS programs throughout the U.S. It is important to engage the client s support system while providing protective services The person s routine needs are met by his/herself in an inconsistent manner, the vulnerabilities created are not acutely dangerous, but the ongoing pattern will lead to harm and important consequences. For example, the person can direct cares if assistance is arranged; he/she can sign checks if the checks are filled out by a trusted other; the person takes medication (but may be inconsistent) or can take it if it is set up in a medication box. Low Risk risk Medium Risk The person is cooperative, but doesn t have a predictable support system or the person is uncooperative, but does have a predictable support system. When there is no family or created support system, the case manager would help arrange for waiver services necessary to ensure the needed activities. This could be arranging home care, ongoing transportation, setting up a senior companion, arranging in home respite, homemaker services or lifeline services, etc. How important are the holes in the person s environment? Is there immediate or cumulative danger? This is the most difficult group. The unmet needs impact the person in major areas e.g. at risk of eviction, at risk of serious health problems. The person (if capable) can identify needs and services are available, but the plan isn t working (e.g. mental health issues, level of commitment, etc). Or the person isn t capable and the support system is not predictable. 5

6 High Risk What is financial exploitation? The unmet needs pose a clear & present danger. If an immediate threat call 911. If the threat is health/mental health related, but not a 911 emergency, refer for a health officer hold. (Public health nurse, APS Intake or Mental Health Crisis Team. High risk situations with involuntary clients normally result in court intervention (guardianship or commitment) When a legal relationship exists: Failure to spend for the benefit of the VA, or Unauthorized spending of VA assets,which does or could causes the VA to suffer harm or detriment Without legal relationship: Willful use, withholding or disposal of VA funds; or Obtaining control of VA funds through the use of undue influence, harassment, duress, deception, fraud or coercion Forces, compels, coerces or entices VA against their will to perform services for profit or advantage of another Maltreatment Investigations County Social Services Department of Health Department of Human Services Department of Health OHFC Investigates in all health regulated facilities (nursing homes, hospitals, health licensed homes such as B&C, supervised living and home health agencies) Has jurisdiction for patient Bill of Rights Violations Has many federal investigating responsibilities as well 6

7 Department of Humans Services Licensing Division County Social Service Agencies Investigates in all DHS regulated facilities: (DT&H, CD/MI programs, Adult Day Services, DD homes, Adult Foster Care) Has Background Studies Unit as well (Perpetrator list) ALL OTHERS! Community investigations Extensive involvement with Law Enforcement WHAT ARE PROTECTIVE SERVICES? Social Services ROLE OF COUNTY SOCIAL SERVICE AGENCY AS LEAD AGENCY COUNTY ADULT PROTECTION SHALL INITIATE A RESPONSE IMMEDIATELY! Medical Services Legal Services Law Enforcement Services ASSESS AND OFFER EMERGENCY AND CONTINUING PROTECTIVE SOCIAL SERVICES To Prevent Further Maltreatment To Safeguard the Welfare ARRANGE/MAKE AVAILABLE MEDICAL EXAM/TREATMENT IN CASES WHERE SEX ABUSE SUSPECTED 7

8 Minnesota Rule EMERGENCY PROTECTIVE SERVICES. The local social services agency shall offer emergency and continuing protective social services for purposes of preventing further abuse or neglect and for safeguarding and enhancing the welfare of the abused or neglected vulnerable adult ACTIONS ON BEHALF OF A VULNERABLE ADULT WHO REFUSES SERVICES. If a vulnerable adult who is the victim of abuse or neglect by a caretaker refuses an offer of services from a local social services agency and in the judgment of that agency the vulnerable adult's safety or welfare is in jeopardy, the agency shall seek the authority to intervene on behalf of that adult. If the agency believes it to be in the adult's best interest, it shall seek or help the family or victim seek any of the following: ACTIONS ON BEHALF OF A VULNERABLE ADULT WHO REFUSES SERVICES. (continued) A. a restraining order or a court order for removal of the perpetrator from the residence of the vulnerable adult B. guardianship or conservatorship C. a hold order or civil commitment D. a referral to the prosecuting attorney for possible criminal prosecution of the perpetrator Minnesota Rule COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. Subpart 1. Duty to accept and investigate complaints. The local social services agency shall accept and investigate all complaints alleging that a vulnerable adult has been abused or neglected in that agency's county. 8

9 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (MN RULE ) Subp. 2. Time limits to initiate investigations. A. The local social services agency shall conduct an immediate on-site investigation for complaints alleging or from which it can be inferred that a vulnerable adult is in need of immediate care or protection because the adult is life-threatened or likely to experience physical injury due to abuse or abandonment. B. The local social services agency shall begin its investigation within 24 hours for complaints alleging, or when there is substantial evidence, that a vulnerable adult is not in need of immediate care or protection but is allegedly abused. COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. MN RULE (Subp. 2. continued) C. The local social services agency shall begin its investigation within 72 hours for complaints alleging, or when there is substantial evidence, that a vulnerable adult is not in need of immediate care or protection but is allegedly neglected. COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. MN RULE (Subpart 4) Investigations not related to a facility. When an investigation involves an alleged incident or situation which is not related to a facility, the local social services agency shall assess the validity of the complaint. This investigation shall include the following activities where necessary to make an accurate assessment: COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. MN RULE (Subp. 4. continued) Discussion with the alleged victim; Discussion with the reporter or any corroborating contacts, as necessary; Discussion with the alleged perpetrator; Discussion with the physician or other professionals; and Examination of the physical conditions or the psychological climate of the residence. The local social services agency shall also determine whether the reported abuse or neglect places other vulnerable adults in jeopardy of being abused or neglected. 9

10 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. MN RULE (Subpart 6) FINDINGS Use of outside experts. When it is investigating alleged abuse or neglect of a vulnerable adult, the local social services agency shall consult persons with appropriate expertise if the local agency believes that it lacks the expertise necessary for making judgments pertaining to the allegations. This consultation may include matters of physical health, mental health, specialized treatment such as behavior modification, geriatrics, or other matters. Substantiated -records retained 7 years False -records retained 2 years (3 w/ssis) Inconclusive -records retained 4 years No Determination -records retained 2 years (3 w/ssis) Adult Protection Teams MULTIDISCIPLINARY ADULT PROTECTION TEAM -establishment of team: members -duties: education, resource development, intervention, treatment, case consultation -information sharing Purposes Case consultation/confidentiality A. Signed data privacy agreement B. Conflicts of interest (ex: private providers agree not to solicit discussed clients) Training Education 10

11 Adult Protection Teams No single agency or discipline has all of the resources or expertise needed to effectively resolve all forms of abuse neglect and financial exploitation. Benefits to Clients Choice-broad alternatives tailored to needs Service expertise-highly skilled and experienced practitioners Reduce injury or loss-increase chances victim will receive needed help Benefits to Members Enhance skills and expertise-can be both personally and professionally enriching Familiarity with multiple disciplines-aps, Aging, DV, DD, etc. Current information on community services Community standards-how other professionals handle similar situations Support to members-voice concerns, frustrations and uncertainties Benefits to Communities Improved service response A. identify gaps B. evaluate community services C. Problem solving D. Big picture-limitations and capablities System of checks and balances 11

12 Effective Team Factors Expertise Willingness to contribute time and resources Commitment Agenda Facilitator Attendance Questions??? Contact Information Jennifer Kirchen, LSW Deb Siebenaler