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

2. 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.

3. 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

4. Defining Abuse, Neglect & Exploitation

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. Physical Abuse
Intentionally causing a person pain or injury

13. 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

14. 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.

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. 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

30. What can you do?

31. 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

32. 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

33. 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

34. When Should You Report?
When you suspect abuse

35. 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.

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. Report Suspected Abuse
Adults with a disability and adults 60+ who live in a domestic setting
IL Dept on Aging Hotline
Adults with a disabilities living in a licensed facility
Office of Inspector General
Adults 60+ who live in a nursing home or licensed facility
IL Dept of Public Health
Long-term Care Ombudsman Program

43. TOGETHER We can Make a Difference!