1. Vulnerable Adult Maltreatment Reporting Stearns County Human Services Community Supports Division March 2013

2. Minnesota Statute 626.557 – Reporting of Maltreatment of Vulnerable Adults Subdivision 1. Public policy. The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment; to assist in providing safe environments for vulnerable adults; and to provide safe institutional or residential services, community-based services, or living environments for vulnerable adults who have been maltreated. In addition, it is the policy of this state to require the reporting of suspected maltreatment of vulnerable adults, to provide for the voluntary reporting of maltreatment of vulnerable adults, to require the investigation of the reports, and to provide protective and counseling services in appropriate cases.

3. Minnesota Statute 626.5572 Subdivision 16. Mandated reporter. “Mandated reporter” means a professional or professional’s delegate while engaged in: (1) social services; (2) law enforcement; (3) education; (4) the care of vulnerable adults; (5) any of the occupations referred to in section 214.01, subdivision 2; (6) an employee of a rehabilitation facility certified by the commissioner of jobs and training for vocational rehabilitation; (7) an employee or person providing services in a facility as defined in subdivision 6; or (8) a person that performs the duties of the medical examiner or coroner.

4. Definition of a Vulnerable Adult : Categorical: Any adult residing in or a patient of a nursing facility, foster home, hospital, home care agency or receives services from an agency licensed/certified by DHS or MDH. Functional: Any adult who possess a physical or mental infirmity or other physical, mental or emotional dysfunction that impairs the individual’s ability to provide adequately for their own care without assistance AND because of the dysfunction or infirmity and the need for assistance, the individual has an impaired ability to protect themselves from maltreatment.

5. Common Entry Point (CEP) Designated by the County Board to receive reports of vulnerable adult maltreatment In Stearns County, the Common Entry Point is the Human Services Department - Service Entry Unit ­ 656-6000 (non-business hours a message will give you a number to contact)

6. Where to Report To report abuse or neglect of a vulnerable adult in Minnesota, contact the local Common Entry Point (CEP) office in the county where the vulnerable adult lives or where the maltreatment occurred. Common Entry Point (CEP)

7. Reporting Vulnerable Adult Law, Subd. 4 a mandated reporter shall immediately make an oral report to the common entry point. Use of a telecommunications device for the deaf or other similar device shall be considered an oral report. The common entry point may not require written reports. To the extent possible, the report must be of sufficient content to identify the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, any evidence of previous maltreatment, the name and address of the reporter, the time, date, and location of the incident, and any other information that the reporter believes might be helpful in investigating the suspected maltreatment.

8. Maltreatment Categories Abuse – Physical – Emotional – Sexual Neglect – Neglect by caretaker – Self-neglect Financial exploitation – Loss of funds will adversely deprive adult – Adult would be subject to additional harm

9. What Will Be Asked Name, DOB, address, phone number of vulnerable adult? Name, DOB, estimated age, address, phone number of alleged perpetrator? Relationship of alleged perpetrator to the vulnerable adult? Name, professional mailing address and telephone number of reporter? Name, professional mailing address and telephone number of witnesses? Is the vulnerable adult in immediate danger? Reporter call 911? Services that make the vulnerable adult a categorical vulnerable adult? Specific disability that makes them a functional vulnerable adult? Functioning level and self care skills that make them vulnerable. Are they able to protect themselves. Who, where, what, when, and why? Details about what happened? What are current supports for the vulnerable adult?

10. Internal Reporting Each facility shall establish and enforce an ongoing written procedure in compliance with applicable licensing rules to ensure that all cases of suspected maltreatment are reported. If a facility has an internal reporting procedure, a mandated reporter may meet the reporting requirements of this section by reporting internally. However, the facility remains responsible for complying with the immediate reporting requirements of this section.

11. Reports Not Required Vulnerable Adult Law Subd. 3 (Chemical Dependency Counselors) The following events are not required to be reported under this section: (1) A circumstance where federal law specifically prohibits a person from disclosing patient identifying information in connection with a report of suspected maltreatment, unless the vulnerable adult, or the vulnerable adult's guardian, conservator, or legal representative, has consented to disclosure in a manner which conforms to federal requirements. Facilities whose patients or residents are covered by such a federal law shall seek consent to the disclosure of suspected maltreatment from each patient or resident, or a guardian, conservator, or legal representative, upon the patient's or resident's admission to the facility. Persons who are prohibited by federal law from reporting an incident of suspected maltreatment shall immediately seek consent to make a report.

12. Reports Not Required Verbal or physical aggression occurring between patients, residents, or clients of a facility, or self- abusive behavior by these persons does not constitute abuse unless the behavior causes serious harm. The operator of the facility or a designee shall record incidents of aggression and self-abusive behavior to facilitate review by licensing agencies and county and local welfare agencies.

13. Reports Not Required Accident: "Accident" means a sudden, unforeseen, and unexpected occurrence or event which: (1) is not likely to occur and which could not have been prevented by exercise of due care; and (2) if occurring while a vulnerable adult is receiving services from a facility, happens when the facility and the employee or person providing services in the facility are in compliance with the laws and rules relevant to the occurrence or event.

14. On Line Resources DHS on-line mandated reporter training: http://www.dhs.state.mn.us/DSDTraining/WebManRpt/default.htm http://www.dhs.state.mn.us/DSDTraining/WebManRpt/default.htm DHS adult protection services web site: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVER SION&RevisionSelectionMethod=LatestReleased&dDocName=id_005710 http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVER SION&RevisionSelectionMethod=LatestReleased&dDocName=id_005710 Minnesota’s Vulnerable Adult Act: https://www.revisor.mn.gov/statutes/?id=626.557 https://www.revisor.mn.gov/statutes/?id=626.557

15. CEP Functions CEP reports referred to: Lead Agency Maltreatment Investigation Adult Protection Law Enforcement

16. Lead Agency Maltreatment Investigation Hospitals Nursing homes Home care agencies ICF/MR Foster homes Adult day care All others Minnesota Department of Health Office of Health Facility Complaints Minnesota Department of Human Services Licensing County Human Services Department

17. County Maltreatment Investigation Priorities Report alleging abuse: – Physical – Emotional – Sexual – Involuntary Servitude Report alleging neglect: – Neglect by caretaker – Self-neglect Report alleging financial exploitation: – Loss of funds will adversely deprive adult – Adult would be subject to additional harm

18. Maltreatment Investigation Outcomes Inconclusive False Substantiated – preponderance (51%) If substantiated, name goes on “substantiated perpetrator list” at DHS – unable to work in health/human services occupations

19. Adult Protection Services Voluntary (housing, home care, etc.) Involuntary (guardianship, commitment) Conflict: Role to protect v. person’s right to self-determination (refusing health care, substandard living conditions – value system)

20. Law Enforcement Criminal investigation Best practice – joint investigations when possible Maltreatment investigation will follow law enforcement lead

21. Common Entry Point Lead Agency Investigation Adult Protective Services Law Enforcement County (all other) MN Dept of Human Services (foster homes, group homes, adult day care) MN Dept of Health (MDH) (hospitals, nursing homes, home care) Community Supports Division Developmental Disabilities Unit Disability/CD Unit Mental Health Unit Senior & Managed Care Unit Jurisdiction Voluntary Housing Home Care Involuntary Guardianship Commitment Investigation results: Inconclusive False Substantiated If substantiated, name goes on “substantiated perpetrator list” at DHS – unable to work in health/human services occupations * A particular case could include involvement by some or all of these functions *

22. Data / Trends Number of reports – Stearns County: 2008 = 2292010 = 4172012 = 568 2009 = 3902011 = 492 Growing trend of reports are related to financial exploitation: – Through technology (internet, phone scams) – Personal (control of checkbook, bank accounts) – Requests for guardianship

23. Four Case Scenarios Self-neglect Financial exploitation Caregiver neglect Self-determination

24. Case #1 Caller reports his neighbor appears very confused. He has not mowed his lawn for several weeks and has garbage piled up around his back door. This is out of character for him; feels someone needs to check on him. ­ What are the potential concerns? ­ What information do we need? ­ Who do we want to talk to? ­ What are some possible strategies?

25. Case #2 Call from foster home that they are giving an eviction notice to a 48 year old man who owes $4,000 and has not paid in three months. The man’s sister is his power of attorney and has control of his income and checkbook. The sister has failed to respond to foster care provider’s recent calls. ­ What are the potential concerns? ­ What information do we need? ­ Who do we want to talk to? ­ What are some possible strategies?

26. Case #3 Caller reports elderly woman admitted to the hospital with severe bed sores and bruising. Records indicate she has not seen a doctor in a number of years. She lives with her son, who instructs the hospital to not allow any visitors. ­ What are the potential concerns? ­ What information do we need? ­ Who do we want to talk to? ­ What are some possible strategies?

27. Case #4 Caller is concerned about his 87 year old neighbor living in the country who has no running water or indoor plumbing. The elderly man burns wood to heat his home in the winter and is having increasing difficulty getting up and down to the basement. The caller believes he would be better off in an apartment in town. ­ What are the potential concerns? ­ What information do we need? ­ Who do we want to talk to? ­ What are some possible strategies?

28. Questions?