1. Adult Protective Services: Reporting Elder Abuse Policy, Practice, and Communication Robert Wallace Adult Services Program Manager June 2015

2. The Need for Adult Protective Services Across the state there are tens of thousands of reports of abuse, neglect or exploitation of vulnerable and older adults made to North Carolina’s 100 county departments of social services. Reports are made not only by doctors and other professionals but by family members and concerned citizens in our communities.

3. Durham County Residents Age 60 and Older Source: North Carolina Office of State Budget Management and Budget, 2014

4. Adult Protective Services is Governed by Statute North Carolina General Statute 108A – Chapter 6 the protection of the Abused, Neglected, or Exploited Disabled Adult Act – Chapter 6A the Protection of Older Adults From Financial Exploitation – Anyone who suspects that a vulnerable adult is being maltreated is required to make a report to Social Services.

5. Adult Protective Services Defined Social services provided to abused, neglected, or exploited older persons and/or adults with disabilities. When reports regarding abuse, neglect, or exploitation are received Social Services assigns a social worker to evaluate the adult’s circumstances.

6. Types of Reports Evaluated by DSS Physical Abuse Emotional Abuse Sexual abuse Financial or material exploitation Self-neglect, where a person is unable to care for themselves due to physical or cognitive impairments. Neglect by a caregiver

7. Adult Protective Services is Multifaceted Intake to determine if the circumstances reported meets the the criteria for an Evaluation. An Evaluation to determine if a disabled adult is in need of protective services. A capacity decision to determine if the disabled adult is able to consent to protective services. Service Recommendation or Provision

8. Making an APS Report Abuse has to be perpetrated by a caretaker Neglect has to be perpetrated by a caretaker Self-Neglect Exploitation can be committed by anyone

9. Making an APS Report When making an APS report it is helpful to know the following : – Name – Address – Approximate Age – Ability level of the alleged victim – Ability to protect themselves – Supports Friends and relatives, Medical, mental health Recent hospitalizations Other involved agencies

10. Adult Protection Evaluation Initiation Timeframes Initiation Timeframes are mandated by State policy. – Reports involving risk of death are initiated by a social worker immediately. – Reports involving irreparable harm must be initiated within 24 hours. – All other allegations are initiated within 72 Hours.

11. What does an Evaluation entail? Assess Six Functional Areas: - Physical Health - Mental Health - Social Supports - Environmental Situation - Economic Functioning - Activities of Daily Living The Focus of the evaluation is to determine: - Whether the adult is disabled - Whether the adult is abused, neglected, or exploited - Whether the adult is in need of protective services - Whether the adult has or lacks the capacity to consent to protective Services

12. What does the term “Capacity” mean? Capacity is at the heart of being “At Risk” Capacity – Being competent or having adequate ability to make decisions in one’s own best interest.

13. Slide 13 What does the term “Incapacity” mean? Source: American Bar Association 1997 1998 The inability to receive and evaluate information Or to make or communicate decisions so that an individual is unable to meet essential requirements for: – Physical Health – Safety – Self-Care … Even with appropriate technological assistance.

14. The Common Dilemma in APS Evaluations Whether to respect an older adults choice to continue a potentially harmful activity or to decline an intervention that might reduce that harm, or to take action.

15. Self Neglect defined: The inability or refusal to perform activities of daily living. Examples include some combination of – poor hygiene, – squalor in and outside their dwellings, – a lack of utilities, – an excess numbers of pets. (Gerontologist, Dyer, Goodwin, Pickens-Pace, Burnett, & Kelly (2007)

16. Indicators of Self-Neglect Reluctance to leave their homes to visit a doctor’s office, clinic, or hospital Lack of medical care for a prolonged period of time Inability or refusal to see physicians Possible under diagnosis, overmedication, or inadequate care Pressure Ulcers Debilitated homes Filth Signs of Malnutrition General Decline

17. Safety versus Self-determination When these interests compete, clients’ right to exercise self-determination outweighs their safety. People have a right to take risks. There are two exceptions: – The client does not understand risks – The risks or dangers are substantial When these exceptions are present, involuntary actions may be warranted

18. Types of Intervention

19. Time Frames If a reporter claims the possibility of death, DSS must make contact immediately. If irreparable harm is alleged, contact is made within 24 hrs. For All other reports, contact is made within 72 hrs

20. Adult Protective Services and the Court DSS could involve the court through a number of means to assist with the Evaluation of an at risk adult: Protective Orders Guardianship Freezing Assets Court Orders to Access Bank Record Involuntary Commitment Search Warrants.

21. Communication with the Reporter Upon request, a reporter can receive information on the findings of an evaluation by phone or in writing. Due to privacy regulations, the Department of Social Services is limited in the information it can divulge. It is usually limited to whether or not the report was substantiated.

22. Other Information Does a person who is determined to have capacity have the right to refuse services? – Yes. Services can’t be forced upon someone. Can APS compel an older adult to leave their home and go into placement? – Yes. If it is determined that an adult can’t be cared for in their home, and DSS becomes the guardian, DSS could decide to place them.

23. Other Important Information Does the law require someone to make a report? – Yes. NC has a mandatory reporting law. Anyone who suspects that a vulnerable adult is subject to maltreatment is required to make a report to DSS Does a person already have to be mistreated for a report to be accepted? – Yes. There is no prevention component in the law.

24. To make an APS Report to the Durham County Department of Social Services call any time: 919-560-8000