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Adult Protective Services Michael Patterson Indiana Director, Adult Protective Services Division of Aging/FSSA 317-232-7148

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Adult Protective Services Purpose To inform the audience of the duties, roles and responsibilities of APS units and the state program office.

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Adult Protective Services Agenda See something; say something What happens next: Role of Adult Protective Services (APS) Unit Role of State APS program office Indiana Abuse Statistics Takeaways

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Adult Protective Services See Something?

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Adult Protective Services Discrepancies between a person's standard of living and his/her financial assets Depletion of assets without adequate explanation Money or personal items such as eyeglasses, jewelry, hearing aids, or dentures are missing without explanation Malnourishment, dehydration or lack of food, poor hygiene, urine sores, or bed sores, or over-sedation Physical injuries, such as bruises, burn marks, welts, rope burns, tufts of hair missing, broken bones -no explanation Withdrawn, apathetic, fearful, or anxious behavior, particularly around certain persons Sudden wish to not visit or receive visits from family or friends. Medical needs not attended to Changes in the victim's living arrangements, such as a younger person moving in to "care for" them shortly after meeting http://www.clarkprosecutor.org/html/aps/apssymp.htmPhotos: Google images Signs of Abuse

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Adult Protective Services Say Something

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Adult Protective Services Mandatory Reporting (If you see something, say something) An individual who believes or has reason to believe that another individual is an endangered adult shall make a report under this chapter. If an individual is required to make a report under this chapter in the individuals capacity as a member of the staff of a medical or other public or private institution, school, hospital, facility, or agency, the individual shall immediately notify the individual in charge of the institution, school, hospital or agency, or the individuals designated agent, who also becomes responsible to report or cause a report to be made. This section does not relieve an individual of the obligation to report on the individuals own behalf, unless a report has already been made to the best of the individuals belief. Reporter may remain anonymous. Issue: Over reporting to play it safe; do a little homework first. IC 12-10-3-9

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Adult Protective Services Failure to Report (Against the law not to report) A person who believes or has reason to believe that an endangered adult is the victim of battery, neglect or exploitation; and Knowingly fails to report the facts supporting that belief to the division of disability and rehabilitative services, the division of aging, the adult protective services unit designated under IC 12-10-3, or a law enforcement agency having jurisdiction over battery, neglect or exploitation of an endangered adult; Commits a Class B misdemeanor IC 35-46-1-13(a)

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Adult Protective Services Immunity (No worries) A person,... who in good faith makes a report... is immune from civil and criminal liability... (Cant get sued or charged with anything) An employer may not discharge, demote, transfer, prepare a negative work performance evaluation... or take any other action to retaliate against an employee who in good faith files a report under this chapter. (The boss cant fire you) IC 12-10-3-11

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Adult Protective Services What happens now?

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Adult Protective Services 18 units conduct investigations for their county and surrounding counties $2.8 Mil annual budget ($3.2 mil in SFY 16) Units 26.5 FTE investigators 17.5 FTE unit directors State Director and Asst Dir 1 Admin (shared with LTC Ombudsman)

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Adult Protective Services 2014 38,594 calls for service (300% increase over last 10 years) 9,602 cases investigated (24% of calls) 33 protective orders filed

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Adult Protective Services Purpose of APS: To provide a legal bases for intervention to protect adults by Receiving reports of adults that may be in endangered Investigating those reports and Providing a coordinated and proper local response 455 IAC 1-2 Legal Authority from IC 12-10-3

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Adult Protective Services Responsibility: Responsibility for investigating reports of neglect, battery or exploitation of endangered adults, as well as securing the appropriate social, medical and legal intervention, shall rest with the APS units. 455 IAC 1-2

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Adult Protective Services How can APS help? Referrals to obtain Placement in facility Home based services Legal assistance Help contact concerned family members Help obtain medical care Protective orders Refer to law enforcement Battery (IC 35-42-2-1) Neglect of a Dependent (IC 35-46-1-4) Financial Exploitation of Endangered Adult (IC 35-46-1-12) Home Improvement Fraud (IC 35-43-6-1 thru 14) Refer to Attorney Generals Office (scams) Refer to Secretary of State (securities fraud)

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So where are these units... ? 18 APS Units Operate in Hubs 1 to 9 counties per hub Report to County Prosecutor County Employees

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Adult Protective Services Duties of APS Units: Accept and document all reports of neglect, battery and exploitation Conduct investigation to ascertain condition and safety of alleged endangered adult Immediately where possibility of physical danger exists or ASAP after receipt of report (within 20 days) Assess adults needs; coordinate with social service agency who will develop service plan Service plan shall be given to endangered adult in writing Approve, monitor and maintain documentation of service plan 455 IAC 1-2

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Adult Protective Services What is an Endangered Adult? At least 18 years of age; and Incapable by reason of mental illness, mental retardation, dementia, habitual drunkenness, excessive use of drugs or other physical or mental incapacity of managing or directing the management of the individuals property or providing or directing the provision of self-care; and Harmed or threatened with harm as a result of Neglect; Battery; or Exploitation of the individuals personal services or property IC 12-10-3-2(a)

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Adult Protective Services Duties of APS Units (cont) Protective Orders: (What if they dont want to go?) Petition for protective order requiring adult receive protective services Does not consent Endangered adult under (IC 12-10-3-2(a)) and in need of services Lacks ability to make informed decisions concerning need for protective services Does not constitute a guardianship (455 IAC 1-2) Petition through prosecuting attorney's office for order to enjoin interference with protective services Issue: Facility must first agree to accept the endangered adult; often depends on ability to pay IC 12-10-3

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Adult Protective Services What if we cant get a Protective Order? Involuntary Commitments Immediate Detention: A law enforcement officer with grounds to believe that a person has a mental illness, is dangerous or gravely disabled may transport the individual to nearest appropriate facility 24 hours only IC 12-26-4- 1 thru 5 Emergency Detention: If facility believes individual should be detained more than 24 hours he/she may apply for 72 hour detention with statement of physician and judges signature Mentally ill and either dangerous or gravely disabled; and In need of immediate restraint IC 12-26-5

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Adult Protective Services Key Limitations APS has no direct services to provide endangered adults; all services must come from other sources No short term emergency placement Not an emergency service Hotline has 5 days to forward report to unit Unit has 20 days to begin investigation Refusing help: client with capacity has a right to be miserable Caseload; limited capacity to review, approve service plans or follow-up on delivery of services Limited feedback to reporter (... at discretion of the APS unit.) (455 IAC 1-2-5)

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Adult Protective Services Duties of APS, Division of Aging/FSSA Do not conduct investigations Contract with county prosecutors to provide APS services Educate public on existence of APS law / services Prescribe forms and procedures to be followed Training and technical assistance Monitor the program and fiscal activities of the units Toll Free Hotline 800-992-6978 Receive reports of abuse 24/7 (not staffed by live person) Document receipt of reports Classify report as emergency or nonemergency Emergency refer to law enforcement; non emergency forward to unit in 5 working days 600 t o 700 calls / month Working with database vender to streamline intake and referral to units (Aug roll-out) 455-IAC 1-2-4

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Adult Protective Services Because We Love Data!

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Adult Protective Services http://www.ncea.aoa.gov/Library/Data/index.aspx The size of the Problem

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Adult Protective Services

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Calls for Service Volume of calls relatively constant since 2010 Exploitation continues to increase (most complex and time consuming to investigate) Neglect and battery slightly down

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Adult Protective Services Exploitation In 2014, APS investigated 1,869 allegations of exploitation which is the highest number in the past ten years and has increased 33% since 2005. Self reporting of exploitation done at higher rate than battery and neglect Only 1 in 14 cases of elder abuse reported Source: National Center on Elder Abuse

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Adult Protective Services Battery In 2014, APS investigated 2,567 allegations of battery, which has dropped since its peak in 2011. However, allegations of battery remain 6% higher than they were 10 years ago. Self reporting of exploitation done at higher rate than battery and neglect Only 1 in 14 cases of elder abuse reported Source: National Center on Elder Abuse

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Adult Protective Services Neglect In 2014, APS investigated 6,396 allegations of neglect and self neglect, which has dropped since its peak in 2011 and has dropped 14% since 2005. Self reporting of exploitation done at higher rate than battery and neglect Only 1 in 14 cases of elder abuse reported Source: National Center on Elder Abuse

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Adult Protective Services Takeaway See something; say something - anonymity and immunity There 18 units that do investigations; know your local unit Units are run by a county prosecutor and are county employees; the state contracts with the county prosecutor for APS services Units substantiate the endangered adult status then facilitate services from other organizations

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Adult Protective Services Michael Patterson Indiana Director, Adult Protective Services Division of Aging/FSSA 317-232-7148