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.
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
WARNING Presentation Contains Graphic Photographs.
Background & Experience
Forensic Special Initiatives Unit Financial Crimes 2010 Team Leader 2006 Serious Incident Reviews 2012 Mission: Supporting those protecting at-risk adults in Georgia.
FSIU Mission Forensic Special Investigation Unit - FSIU Supporting Those Protecting At- Risk Adults Training Technical Assistance Collaborations Data Collection Established in 2006 Policy
A Perfect Storm Aging Population Olmstead Ruling of 1999 Demand for Community Services Current Economy Access to Mental Health Services
Target Rich Environment For Predators
Solution: Training At-Risk Adult Crime Tactics (ACT) Specialist Two Day Boot camp Primary/Secondary Responders 1600+ ACT Specialists
Goals of ACT Protect ACT Prevent Prosecute
Mandated Reporters Who? What? When? Where? How? Why?
Mandated Reporters Who? What? When? Where? How? Why?
Mandated Reporters Who? What? Physical Abuse Sexual Abuse When? Where? How? Why? Neglect Financial Exploitation
Indicators Physical Abuse Injuries to head, neck & trunk Worsening injuries/conditions Explanations that do not make sense Injuries in various stages of healing Fractures
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
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
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.
Mandated Reporters Who? What? REASONABLE CAUSE TO BELIEVE When? Where? How? Why?
Mandated Reporters Who? When? How? What? Where? Why? Adult Protective Services (APS) Healthcare Facility Regulation (HFR) Local Law Enforcement
Mandated Reporters Who? When? How? What? Where? Why? APS 1-866-552-4464 Follow Prompts www.aging.ga.gov Report Elder Abuse
Mandated Reporters Who? When? How? What? Where? Why? HFR 1-800-878-6442 www.dch.ga.gov Go to: Healthcare Facility Regulation Go to: File A Complaint
Mandated Reporters Who? When? How? What? Where? How? Why? Effective July 1, 2013 Mandatory LOCAL LAW ENFORCEMENT
Mandated Reporters Who? When? How? What? Where? Why? GA LAW AS A MANDATED REPORTER IT S A CRIME NOT TO REPORT
Unlicensed Personal Care Homes Unlicensed home Residents: Ages 52-71 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
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
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
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
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
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
Residents Receive/Eligible for Public Assistance SNAP (food stamps) Social Security Disability Medicaid Veteran s Benefits Pensions Waycross, GA
Suffers from schizophrenia and mild cognitive impairment. He was whipped and burned for taking food from the kitchen.
Methods Of Gov t Benefit Payments Card Direct Deposit Check Jason Marbutt, Cobb County ADA
Control Money/Resident Become payee Joint bank accounts POA Jason Marbutt, Cobb County ADA
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
Owners/Operators Unlicensed entities Licensed/unlicensed entities Multiple properties Multi-jurisdictions Minimal, if any, services Scripting residents
Unlicensed Personal Care Homes SFY 2013 253 Unlicensed Personal Care Home Complaints 6 Facility Relocations, 26 residents SFY 2014 293 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
WALB Update: Woman Charged After Body Found Behind Assisted Living Home Posted: Friday, August 8, 2014 8:18 PM EDT, Nicholls, GA
Remains of elderly person could be connected to missing person from senior care home Posted: Thursday, April 2, 2015 9:32 PM EDT By Mike Paluska Flowery Branch, GA
How Cases Unfold Local law enforcement is notified of unlicensed care home 60 911 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
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
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
Locks on doors have been found at multiple locations to keep people from being able to leave.
Outdated food from local stores for residents.
Medications often kept behind locked doors.
Owners sometimes drive expensive cars while residents live in squalor.
Often, one owner with multiple locations in multiple jurisdictions Atlanta Marietta wsbtv
Relocations often require significant personnel and resources.
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
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 - www.gamap2care.info
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.
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)
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
YOU MAY BE A VICTIM S ONLY OUTSIDE CONTACT.
IF YOU SUSPECT ABUSE, REPORT IT.
Contact Information: Pat King, RN Team Leader Forensic Special Initiatives Unit GA Department of Human Services Division of Aging Services Pat.king@dhs.ga.gov 404-657-1197 (direct line)