APSIL Adult Protective Services of Illinois Presented by Erin Davis, Legal Services Developer Illinois Department on Aging

Recent Legislation On July 1, 2013, Governor Pat Quinn signed into law the Adult Protective Services Act (PA 98—0049) which includes some of the nation's strongest safeguards to protect older adults and adults with disabilities. Adding these services to adults with disabilities will provide more thorough investigations in cases of suspected abuse, neglect and financial exploitation. Public Act 98—0049 follows nationally-recognized best practices by creating an Adult Protective Services unit within the Department on Aging. The Adult Protective Services Program is locally coordinated through 41 provider agencies which are designated by the regional Area Agency on Aging and the Department on Aging.

Adult Protective Services Eligibility 60 years of age or older 18-59 with a disability At least one (1) allegation of abuse, neglect, exploitation must exist Alleged abuser must be someone other than the victim Victim must reside in a domestic setting Self-neglect is not currently funded but is part of the Act

Defining Abuse, Neglect & Exploitation

What is Abuse? Abuse is anything that causes harm to an individual. Abuse can be physical, sexual, neglect, psychological/emotional, or economic/financial.

Financial Exploitation Controlling the finances of another person without their permission Withholding money for basic necessities (i.e. food, medication, transportation) Depriving someone of financial benefits Exerting undue influence

Undue Influence Isolation – from information, friends, relatives or usual advisors Dependency – upon the perpetrator Emotional manipulation and/or exploitation of a weakness Acquiescence – the victim’s apparent consent or submission Loss – financial loss

Indicators of Financial Exploitation A gap between income and lifestyle Adult has no knowledge of finances Unusual activity in bank account Unpaid bills despite adequate resources Abuser is evasive about financial arrangements Forging the person’s signature Forcing the person to sign over a new POA with the intent of gaining access to funds Forcing the person to quit claim property

Emotional Abuse Threats Calling someone names, putting them down Threatening to send the person to an institution Harassment Intimidation Threatening to destroy pets or personal belongings

Neglect When caregivers do not meet the needs of people they serve. A caregiver can be someone who is paid to help or a family member. May not be intentional/not always criminal When done intentionally, for reasons of power and control

Indicators of Neglect Leaving a dependent adult alone, or with inadequate supervision Unsanitary or hazardous conditions in home Inadequate food (no food, spoiled food) Removing dentures, glasses, hearing aids from the adult’s reach Not providing enough heat/electricity Removing aids such as a wheelchair or communication device (this is also an emotional tactic) Leaving the person’s medical problems untreated Failure to comply with treatment plan Source: Iowa Department of Elder Affairs, 2001 These are some common indicators of neglect.

Physical Abuse Intentionally causing a person pain or injury

Examples of Physical Abuse Hitting Pushing Slapping, handling someone roughly Pulling hair Giving inappropriate medication - over and under medicating the adult Over medicating with alcohol

Indicators of Physical Abuse Bruises and other physical injuries Bilateral injuries Injuries at various healing stages Over or under medication Dehydration Malnutrition Decubitus ulcers Lack of compliance with plan of care Source: Butler, 1999 Here are some signs of physical abuse. Other signs of physical abuse may be frequent emergency room visits, doctor hopping, and delay between the time of the injury and the time a person seeks medical attention. These may be attempts to hide the fact that abuse is occurring by limiting the victim’s exposure to a physician who knows them well, or by waiting until the injuries begin to heal before seeking medical attention.

Confinement Restraining Isolating Denying access to phone/mail Controlling activities of adult Limiting time the adult spends with loved ones

Sexual Abuse Any non-consensual sexual conduct Any sexual activity with an adult who is unable to understand or give consent Any sexual act committed under threat of harm Any forced sexual act

Statistics Between 1 and 2 million Americans aged 65+ are abused by someone a caregiver Overall reporting of Financial exploitation are at only 1 in 25 cases. There may be as many as least 5 million financial abuse victims yearly Research has found that over 67% of women with physical and cognitive disabilities experienced physical abuse in their lifetime People with disabilities experience violence 1.5 times more often than people with Disabilities

Consequences of Abuse On the Adult Physical- Bruises, bed sores, malnutrition, fractures Emotional- Fear, stress, shame, guilt, isolation, depression, learned helplessness, denial Financial- Loss of home, life savings, belongings

Consequences of Abuse On the Abuser Guilt Remorse Overwhelmed Shame “Shame can cause the offender to hide the maltreatment and may inhibit them from seeking help to improve the situation.” - Holly Ramsey-Klawsnik

Indicators of Abuse On the Adult Change in behavior Withdrawn Depressed Lack of interest in normal activities Change in appearance Appears hungry, unclean, frightened of family members or caregivers May present as afraid, embarrassed, reluctant to answer questions

Indicators of Abuse On the Abuser Attempting to dominate the adult Answers for the adult instead of allowing the adult to answer Verbally, physically abusive to the adult and others Evidence of substance abuse, untreated mental health problems Continual concern regarding the adult’s money

Indicators of Abuse the Environment Family member/caregiver won’t let people in the home Accumulation of mail, newspapers Lack of attention to home, a state of disrepair Large numbers of people using the home

Predictors Abuser characteristics are better predictors of abuse than are victim characteristics, including: Abuser’s mental and emotional health Abuser’s financial dependence on victim Abuser’s use of substances/alcohol

Causes of Abuse Probable Cause Not a Cause Financial dependence of abuser on the victim Pattern of family conflict Abuser’s mental and emotional health Unrealistic expectations and lack of knowledge on the part of abuser Not a Cause The victim The victim’s impairments Victim’s level of dependence Source: Reis, 2000

Profile: Senior Vast majority of elder abuse victims are female Most neglect victims are 80+ years of age Isolation Lives with abuser Impairment (cognitive, physical and/or mental) Substance abuse is sometimes a factor History of family violence Source: Brandl & Cook-Daniels, 2002

Profile: Adult with a Disability Interpersonal violence (IPV) occurs at greater rates among men and women with disabilities (4 to 10 times higher) Women with disabilities experience abuse for longer periods of time than women without disabilities Among abused men with disabilities: 65% experienced physical abuse, 24% experienced sexual abuse Among abused women with disabilities: 67% experienced physical abuse, 53% experienced sexual abuse

Profile: Abuser Female or male Elder Abuse- 80% are family members People with disabilities are abused by family, peers, caregivers Past history of violent relationship with victim Suffers from an impairment (drug and/or alcohol abuse, mental illness, cognitive) Dependent on victim Impaired social relationships

Behavioral Characteristics: Victim Suddenly fears being touched Sudden onset of nightmares Changes in sleep patterns, difficulty sleeping Depression, withdrawal, or mood swings

Behavioral Characteristics: Abuser Refusal to follow directions or complete necessary personal tasks Using threats or menacing looks/body language as a form of intimidation Frequently switches health care providers Displays unwelcoming or uncooperative attitude during home visits Using vehicle, money or other resources without consent

What can you do?

BE ALERT Most suffering done in Silence The abusers blame their victims…it’s your fault Threats if the adult reveals the abuse The adult may be dependent on the abuser for personal care, food, health care support...may feel there are no options Unequal distribution of power (people with disabilities generally lack resources, skills and opportunities often available to other members of society) The adult may feel the need to protect the abuser who is also a family member

Who Should Report Abuse? All people are encouraged to report abuse Certain professionals are mandated by law to report suspected cases, including: Social services staff Educators Licensed professionals Law enforcement State, county, local govt. Formal caregivers

Your Rights & Responsibilities You can make an anonymous report Your identity is held in confidence You are protected from liability You may be instructed to contact law enforcement in some cases

When Should You Report? When you suspect abuse

Self-Neglect Common elements in self-neglect cases include living in filthy conditions untended animals malnutrition poor hygiene Our Act was amended to include Self Neglect however as of now (3/2008) we are not responding to those calls. We are tracking those calls statewide and hope that those numbers will influence legislators to fund the program as it will be impossible to handle those cases without more staff. About 52% of self-neglect cases occur among those over 80 years of age. Common elements in self-neglect cases include living in filthy conditions, untended animals, malnutrition and poor hygiene. Older adults who self-neglect often have medical and social problems and there are high rates of depression and dementia in this population. It is estimated that 75% of self-neglecting elders suffer from some degree of confusion (National Elder Abuse Incidence Study, 1996). Common elelments in SN cases include living in filthy conditions, untended animals, malnutrition and poor hygiene.

Priority and Response Time Life threatening situations Most neglect and non life- threatening physical abuse situations Most emotional abuse or financial exploitation abuse reports Response Time Within 24 Hours Within 72 Hours Within 7 Days

Unable to Substantiate Intervention Process Intake A screening process to determine if there is reason to suspect that abuse, neglect, exploitation or self-neglect has occurred. Substantiation At the close of the assessment, the caseworker and supervisor must decide if the allegations of ANE or self-neglect are: Substantiated Unsubstantiated Unable to Substantiate Assessment A systematic, standardized system to respond to reports of ANE or self-neglect for the purpose of determining whether abuse occurred, the degree of risk to the adult of further harm, and if the need exists for immediate interventions. Intervention Providing immediate and/or long term services to reduce or eliminate ANE or self-neglect from re-occurring. Interventions may be needed at any point in the case. Follow-Up A systematic method for monitoring substantiated cases to prevent further abuse or self-neglect by working with the adult in detecting signs of abuse or self-neglect before the situation becomes life-threatening. Casework Intensive activities to work with the adult to develop and implement intervention strategies for the purpose of stabilizing and reducing risk of further harm. Case Closed The services of the caseworker are no longer needed. 37

Things You Should Know: Some cases of abuse are beyond the scope of Protective Services Victims generally have the right to refuse services In cases where the adult cannot consent, APS provider will contact Guardianship & Advocacy for assistance with a temporary guardianship Some cases of suspected abuse may be unsubstantiated, or are unable to be verified

Guiding Principles: Self Determination Competent adults have the right to: Decide how and where to live Choose whether to accept services and support Make bad decisions which do not harm others Determine if this is an old or new behavior pattern for client Allow room for eccentricity and lifestyle choices which do no harm Honor rights to privacy

Guiding Principles: Intervention Involve the client Respect the adult’s right to confidentiality Be direct in discussing the situation Intervene with the family if possible Recommend community based services rather than institutional Recognize that inappropriate intervention may be worse than none at all The client’s interest comes first

Intervention Services Medical care and expenses Law enforcement support Legal assistance and fees Housing & relocation services Minor environmental aid Respite care, adult day services, in-home care Counseling Translation services

Report Suspected Abuse Adults 18-59 with a disability and adults 60+ who live in a domestic setting IL Dept on Aging Hotline 1-866-800-1409 Adults 18-59 with a disabilities living in a licensed facility Office of Inspector General 1-800-368-1463 Adults 60+ who live in a nursing home or licensed facility IL Dept of Public Health 1-800-252-4343 Long-term Care Ombudsman Program 217-785-3143

TOGETHER We can Make a Difference!