GA Department of Human Services

Transcription

1 GA Department of Human Services Mission Strengthen Georgia by providing individuals and families access to services that promote self-sufficiency, independence, and protect Georgia's vulnerable children and adults.

2 Mandated Reporting Laws: Ethical Considerations Building Workforce Competency September 25, 2015 Pat King, RN, Team Leader, Forensic Special Initiatives Unit (FSIU) GA Division of Aging Services

3 WARNING Presentation Contains Graphic Photographs.

4 Background & Experience

5 Forensic Special Initiatives Unit Financial Crimes 2010 Team Leader 2006 Serious Incident Reviews 2012 Mission: Supporting those protecting at-risk adults in Georgia.

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7 FSIU Mission Forensic Special Investigation Unit - FSIU Supporting Those Protecting At- Risk Adults Training Technical Assistance Collaborations Data Collection Established in 2006 Policy

8 A Perfect Storm Aging Population Olmstead Ruling of 1999 Demand for Community Services Current Economy Access to Mental Health Services

9 Target Rich Environment For Predators

10 Solution: Training At-Risk Adult Crime Tactics (ACT) Specialist Two Day Boot camp Primary/Secondary Responders ACT Specialists

11 Goals of ACT Protect ACT Prevent Prosecute

12 Mandated Reporters Who? What? When? Where? How? Why?

13 Mandated Reporters Who? What? When? Where? How? Why?

14 Mandated Reporters Who? What? Physical Abuse Sexual Abuse When? Where? How? Why? Neglect Financial Exploitation

15 Indicators Physical Abuse Injuries to head, neck & trunk Worsening injuries/conditions Explanations that do not make sense Injuries in various stages of healing Fractures

16 Indicators Frequent urinary tract infections Difficulty walking/sitting Sexual Abuse Extreme reaction to bathing/changing Multiple attempts to leave home/facility May or may not have associated injuries to genital, oral, anal areas, breasts, thighs, head/neck

17 Indicators New best friend Quick relationship Financial Exploitation Change in legal documents POA misuse Large sums of money moved from accts Banking that is inconsistent with prior habits Victim dependent on suspect Suspect dependent on victim

18 Indicators Unemployed adults in home Neglect Multiple bed sores untreated Inadequate food, water, shelter, medical care Clothing/conditions inappropriate for weather Lack of assistive devices Neglect Is Often The Presenting Indicator Of Financial Exploitation.

19 Mandated Reporters Who? What? REASONABLE CAUSE TO BELIEVE When? Where? How? Why?

20 Mandated Reporters Who? When? How? What? Where? Why? Adult Protective Services (APS) Healthcare Facility Regulation (HFR) Local Law Enforcement

21 Mandated Reporters Who? When? How? What? Where? Why? APS Follow Prompts Report Elder Abuse

22 Mandated Reporters Who? When? How? What? Where? Why? HFR Go to: Healthcare Facility Regulation Go to: File A Complaint

23 Mandated Reporters Who? When? How? What? Where? How? Why? Effective July 1, 2013 Mandatory LOCAL LAW ENFORCEMENT

24 Mandated Reporters Who? When? How? What? Where? Why? GA LAW AS A MANDATED REPORTER IT S A CRIME NOT TO REPORT

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26 Unlicensed Personal Care Homes Unlicensed home Residents: Ages Held against their will Charged $300-$400/month Required to sign over SSA and EBT Clients of Dept of Behavioral Health no appts with DBH >4 yrs Drugged and locked in basement (crawlspace) Locked in backyard surrounded by 8 privacy fence (padlocked) Given 5-Gallon buckets for toilets Drove one resident to Atlanta to have sex with men Filmed sexual acts by owner/operator and men living in the home August 23, 2015

27 Human Trafficking A crime against humanity involving: recruiting, transporting, transferring, harboring or receiving a person through the use of force, coercion or other means, for the purpose of exploiting them. United Nations Office on Drugs and Crime

28 Human Trafficking Defined Commodity An article of trade or commerce, A product not a service Something of use, advantage, or value Human Trafficking in Monthly Benefits Adults eligible for or receiving monthly benefits At-Risk Adults - Adults with Disabilities & Older Adults

29 Human Trafficking The Act Recruitment Shelters Churches Hospitals Licensed Facilities On-line The Means Promises of Benefits Services Not delivered The Purpose Monthly income Food stamps, Social Security, Medicaid Vet s Benefits Other fraud

30 unpch Findings June 2015 Common themes from Federal Research: Residents: Primarily adults with severe and persistent mental illnesses Require assistance with ADLS (dressing) and IADLS (meds) Targeted for monthly benefits SSI and SNAP Sources: Hospitals Homeless Shelters Licensed PCHs RTI preliminary report, July 2015

31 unpch Findings June 2015 Common themes from Federal Research: Unhealthy/unsafe living conditions: Residents locked up Food/cabinets with locks Placed in basements when unable to climb stairs Infestations No heat/air/running water Residents sold $100/person RTI preliminary report, July 2015

32 Residents Receive/Eligible for Public Assistance SNAP (food stamps) Social Security Disability Medicaid Veteran s Benefits Pensions Waycross, GA

33 Suffers from schizophrenia and mild cognitive impairment. He was whipped and burned for taking food from the kitchen.

34 Methods Of Gov t Benefit Payments Card Direct Deposit Check Jason Marbutt, Cobb County ADA

35 Control Money/Resident Become payee Joint bank accounts POA Jason Marbutt, Cobb County ADA

36 Source Of Residents Advertise internet Direct market to hospitals Licensed facility pipeline Referrals Licensed in one place, but not another Employees at licensed opening unlicensed Buying/selling clients Jason Marbutt, Cobb County ADA

37 Owners/Operators Unlicensed entities Licensed/unlicensed entities Multiple properties Multi-jurisdictions Minimal, if any, services Scripting residents

38 Unlicensed Personal Care Homes SFY Unlicensed Personal Care Home Complaints 6 Facility Relocations, 26 residents SFY Unlicensed Personal Care Home Complaints 7 Facility Relocations, 105 residents SFY 2015 (July 1, 2014 to present 25-30/month 17 Facility relocations, 80 residents

39 WALB Update: Woman Charged After Body Found Behind Assisted Living Home Posted: Friday, August 8, :18 PM EDT, Nicholls, GA

40 Remains of elderly person could be connected to missing person from senior care home Posted: Thursday, April 2, :32 PM EDT By Mike Paluska Flowery Branch, GA

41 How Cases Unfold Local law enforcement is notified of unlicensed care home calls to location in past year Five residents all required to turn over EBT cards upon moving in Paying $650-$750/month in rent for ½ bedroom Frig is padlocked Lease agreement includes food (so why need for EBT cards) EBT info reveals: 44 other EBT cards all cards being used outside GA 12 other locations (one licensed facility all others unlicensed) 10 co-conspirators Three jurisdictions Add l locations/co-conspirators identified

42 Frequent Response Ministry Boarding House Licensed Independent Living Foundation Rental Property Law Enforcement Healthcare Facility Regulation Long-Term Care Ombudsman Adult Protective Services Department of Behavioral Health Social Security Administration/OIG Medicaid Fraud Control USDA City/County ordinances Fire Marshall PH GOCA IRS

43 Frequent Response Ministry Boarding House Licensed Independent Living Foundation Rental Property Driven by funding stream / agency authority Referred from one agency to next Lack of coordination Lack of intelligence/data/information sharing Focus Social not Victim Services While Residents: Moved frequently Go without supervision and essential services Suffer abuse, neglect & exploitation

44 Locks on doors have been found at multiple locations to keep people from being able to leave.

45 Outdated food from local stores for residents.

46 Medications often kept behind locked doors.

47 Owners sometimes drive expensive cars while residents live in squalor.

48 Often, one owner with multiple locations in multiple jurisdictions Atlanta Marietta wsbtv

49 Relocations often require significant personnel and resources.

50 Possible Ethical Issues GA is a mandatory reporting state. Do you disclose the limits of confidentiality prior to talking to the patient and/or the caregiver - that what they say may require you to report? Do you speak to the patient/victim in private? Healthcare providers mandatory duty to report supersedes patient wishes, and may cause issues. (Explain your first concern has to be his/her safety and well being.) Competent adults have the right to choose to stay in an abusive and/or unhealthy/unsafe setting

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52 Conflict of interest Possible Ethical Issues Family/caregiver wishes versus at-risk adult s wishes and interests Undue Influence, False Representation, Coercion, etc. Confidentiality follow policies/procedures Decision-making capacity may need assessment for appointment of conservator or guardian Awareness/training on abuse, neglect & exploitation Autonomy respect for at-risk adults wishes/interests (3 rd party involved?) Acute bed vs long-term care bed Discharge to safe environment -

53 GBI ANE Working Group 3/26/12 Initial meeting with GBI Director Keenan 4/19/12 1 st ANE Work Group (local, state, fed. agencies) Governor s Office staff always attends Current Initiatives: Financial Exploitation Working Group Prosecutor Training (for/by) Coroner/Medical Examiner Training Working Groups: Legislation FinExp Work Group Public/Private Funding Marketing ( Power of Attorney: Not a License to Steal ) The lack of emergency beds is a huge obstacle in addressing ANE in Georgia.

54 Outcomes GBI since Working 2012 Group Accomplishments since 2012 Addressing Obstacles contained in 2012 Executive Summary GA Chiefs of Police White Paper Roll Call Training Video produced and paid for with GBI Drug Seizure Funds HB 78 (2013) Prosecutor s Manual Updated (no updates since 1998) Ongoing training seminars Model Protocol SOP for emergency relocation teams Joint Study Committee Emergency Relocations HB72 (2015)

55 Not all agencies listed due to lack of space. Federal: US Attorney US Department of Agriculture OIG US Federal Bureau of Investigation US HHS AOA, OIG US Postal Inspector US Secret Service US Social Security Administration OIG US Veterans Affairs OIG Local: Atlanta PD Cobb Elder Abuse Task Force Dekalb County PD/DA/ME Stephens Co. Coroner GBI Working Group State: Attorney General Criminal Justice Coordinating Council GA Administrative Office of the Courts GA Advocacy Office GA Association of Chiefs of Police GA Bureau of Investigation GA DBHDD GA DCH, HFR, OIG GA DHS DAS, FSIU, APS, LTCO GA DOL GA DOR GA DPH, EMS GPSTC GA Sheriff s Association Governor s Office Prosecuting Attorneys Council of GA

56 YOU MAY BE A VICTIM S ONLY OUTSIDE CONTACT.

57 IF YOU SUSPECT ABUSE, REPORT IT.

58 Contact Information: Pat King, RN Team Leader Forensic Special Initiatives Unit GA Department of Human Services Division of Aging Services (direct line)