1. Self-neglect 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. Self –neglect is considered a category of maltreatment. If a self-neglect report is received by the county as lead agency (after it is forwarded by the CEP) the decision to investigate or to regard as a voluntary adult protective services case will usually be determined by the severity of the self-neglect, the competence of the self-neglecting vulnerable adult and the need to collect data from collateral sources.

2. Adapted from Ramsey County - Dennis Libra Decision Making for Self Neglecting Situations: 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. 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? Low Risk

3. Adapted from Ramsey County - Dennis Libra 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. The case manager would work with the person or the support system to assess and meet the needs. If the person is competent and refusing assistance, the case manager would attempt to make sure the person understands his/her choice or enlist the involvement of the person’s support system. If there is no predictable support system, the case manager would attempt to create the predictable support system through locating family or significant family friends, then mediating or resolving conflicts to repair relationships. If no natural support system is present, then the case manager would attempt to create a predictable community support system through waiver services, a faith community, a social service agency, etc. The situation may look “unsafe” and a decision must be made about waiver services closing – an issue also to be addressed is whether further intervention is necessary. This scenario may be somewhat unusual for the case manager. The case manager should consult with the supervisor early on to strategize, discuss resources and to put the client’s situation into perspective. The case manager should also consider consulting with Adult Protective Services Intake for perspective before the decision to end the waiver is confronted. In complicated and potentially serious situations, an Adult Protection Team Meeting could be arranged to draw people together to discuss a plan – free sharing of information is allowed by law in an Adult Protection Team Meeting. If involuntary action is necessary, the case manager would advocate for, assist and follow the process to ensure that the client is safe. Medium Risk

4. Adapted from Ramsey County - Dennis Libra The unmet needs pose a clear and present danger. If there is an immediate threat of harm, the referral would be 911. If the threat is health or mental health related, but not a “911 emergency”, then it should be referred for a “health officer hold”. This can be addressed by a public health nurse (e.g. home care agency), APS Intake or the Mental Health Crisis Team. High risk situations with involuntary clients normally result in court intervention and the issue of guardianship or commitment should be raised. High Risk

5. SELF-NEGLECT One of the most frequently asked questions about reports of self-neglect is how to track the receipt of a report, assign it for investigation and document the findings. CEP REPORT As the designated Common Entry Point the individual receiving the report must do the following: 1.Determine if the report alleges maltreatment. #See self-neglect example. 2.Notify the appropriate county agency if there is an immediate need for protective services. 3.Notify the appropriate lead agency as soon as possible but not any later than two working days. 4.Log in the CEP in a database maintained for three calendar years after date of receipt. 5.Send a copy of the CEP to Bev Asher, DHS Adult Protection Unit, 540 Cedar St., St. Paul, MN 55155 in order to get the information included in the statewide data report. (note: new address)

6. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 1) 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. The local social services agency shall notify each relevant licensing agency and the local police departments or county sheriffs and shall cooperate in coordinating its investigation with the investigations of the licensing agencies, police departments, and sheriffs. The local social services agency shall immediately send a report of its findings to all other agencies notified concerning the complaint in question.

7. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 2) Subp. 2. Time limits to initiate investigations. The local social services agency shall begin to investigate all complaints within the following time limits: 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.

8. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subp. 2. continued) 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. 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.

9. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 4) Subp. 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: A. discussion with the alleged victim; B. discussion with the reporter or any corroborating contacts, as necessary;

10. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subp. 4. continued) C. discussion with the alleged perpetrator; D. discussion with the physician or other professionals; and E. 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.

11. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 5) Subp. 5. Investigations by agencies which are not in the county of financial responsibility. When a complaint involves a vulnerable adult who is receiving services from a facility located in a county other than the adult's county of financial responsibility, the local social services agency of the host county shall: A. investigate the complaint in accordance with subpart 3 and determine whether the complaint is substantiated, inconclusive, or false; B. notify each relevant licensing agency, the police or sheriff, and the county of financial responsibility;

12. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subp. 5. continued) C. consult with the county of financial responsibility, unless the host county must take immediate emergency measures and representatives of the county of financial responsibility are not available; D. take whatever measures are necessary to correct the situation or to remove the adult from the facility and notify the county of financial responsibility of the actions taken to correct the situation or of the removal of the adult from the facility; and E. complete and transmit all required written forms and findings to appropriate agencies. The local social services agency of the county of financial responsibility shall then resume responsibility for ensuring ongoing planning and services for the vulnerable adult.

13. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 6) Subp. 6. 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.

14. 9555.7300 COMPLAINT INVESTIGATION BY LOCAL SOCIAL SERVICES AGENCIES. (Subpart 7) Subp. 7. Investigations after initial complaint assessment. If upon the initial assessment required by subparts 1 to 6 there appears to be substance to a complaint, the local social services agency shall attempt to determine the following: A. the risk posed if the vulnerable adult remains in the present circumstances; B. the current physical and emotional condition of the vulnerable adult, including the history or pattern of abuse or neglect or related prior injuries; C. the name, address, age, sex, and relationship of the alleged perpetrator to the vulnerable adult; and D. in a complaint of neglect, the relationship of the caretaker to the vulnerable adult, including the agreed- upon roles and responsibilities of the caretaker and the vulnerable adult.

15. From the Minnesota Rule Adult Protection 9555.7400 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.

16. 9555.7600 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: A. a restraining order or a court order for removal of the perpetrator from the residence of the vulnerable adult pursuant to Minnesota Statutes, section 518B.01; B. guardianship or conservatorship pursuant to Minnesota Statutes, sections 525.539 to 525.6198, or guardianship or conservatorship pursuant to Minnesota Statutes, chapter 252A; C. a hold order or commitment pursuant to the Minnesota Hospitalization and Commitment Act, Minnesota Statutes, chapter 253A; or D. a referral to the prosecuting attorney for possible criminal prosecution of the perpetrator under Minnesota Statutes, chapter 609. STAT AUTH: MS s 256E.05 subd 1; 626.557Current as of 01/20/05518B.01525.539 525.6198256E.05626.557

17. ROLE OF COUNTY SOCIAL SERVICE AGENCY AS LEAD AGENCY 1.Determine if the report will be investigated as self- neglect and additional mandates of the Vulnerable Adults Act must be enacted to facilitate the investigation, i.e. access to data about the self-neglecting vulnerable adult from their physician, other service providers, family members, etc. 2.Refer to MS626.557 Subd. 10 to determine need for appointment or replacement of a guardian or conservator. Immediately assess and offer continuing protective social services for the purpose of preventing further maltreatment and to safeguard the welfare of the maltreated vulnerable adult.

18. DOCUMENTATION OF INVESTIGATION 1.Data collected by the county social agency while performing duties as a lead agency are considered welfare data under 13.46. 2.Each agency may document the findings of their investigation of self-neglect 3.according to their established record-keeping procedures. There is no state model at this time 4.Complete the 2494 and submit a copy to Bev Asher, Department of Human Services, Adult Protection, 540 Cedar Street, St. Paul, MN 55155. (note: new address)