Responding to Vulnerable Adult Neglect in King County Page Ulrey Senior Deputy Prosecuting Attorney April 20,

King County Prosecutor’s Office Elder Abuse Project Prosecutes cases of elder financial exploitation, neglect, sexual assault, and homicide Trains first responders, medical community, and public Works to improve systemic response to elder abuse 2

Source: NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011) another twenty-three cases never come to light. 23 For every one case that is reported, 1 Elder Abuse, Neglect, and Exploitation 3

Of the 9 million Americans over age 65 who live alone, 2 million say they have no one to turn to if they need help. U.S. Administration on Aging 4

Even mild abuse, neglect, or exploitation increase premature deaths in the elderly by 300%. Mark Lachs, MD 5

From 1 to 2 million Americans aged 65 or over have been harmed by a caretaker in a domestic or institutional setting. National Research Council 6

Forms of Elder Abuse Neglect* Physical Abuse Sexual Abuse Financial Exploitation (often co-occurring) Emotional/Psychological Abuse (often co- occurring) 7

Indicators of Neglect (usually multiple are present)  Untreated medical conditions  Dehydration  Malnutrition  Unavailability of food and water  Soiled clothing  Poor hygiene  Poor dental, nail care  Pressure ulcers 8

Pressure Ulcers (Bedsores) 9

Pressure Ulcers 10

More Indicators of Neglect  Unsanitary, cluttered living conditions  Soiled bedding / undergarments  Smell of urine, feces  Withholding of medications  Overmedicating  Absence of medical necessities/ assistance devices 11

Common Justifications by Perpetrators of Neglect “I was just following her wishes.” “I promised I’d never put him in a nursing home.” “He refused my help and didn’t want to go to the doctor.” 12

Crimes of Neglect in Washington Criminal Mistreatment 1, 2, 3, and 4 Abandonment 1, 2, and 3 13

Criminal Mistreatment Crimes (1) Defendant recklessly/negligently caused harm, or imminent and substantial risk of harm, by withholding any of the basic necessities of life; (2) Victim was a dependent person; (3) Defendant was employed, entrusted with physical custody of, or assumed responsibility to provide to victim the basic necessities of life; (4) Any of these acts occurred in the State of Washington 14

Basic Necessities of Life Food and water Shelter and clothing Health care Medication 15

Neglect May be Criminal When Some of These Signs / Symptoms are Present Multiple, large / deep pressure sores – Untreated or improperly treated – Odorous – Infected Sepsis Malnutrition Dehydration Poor hygiene 16

Mandatory Reporting in Washington 17

Mandatory Reporting in Washington RCW Persons who are designated as mandatory reporters of vulnerable adult abuse must immediately report abuse, neglect, and exploitation to DSHS and, in many cases, law enforcement. In death cases, must also immediately report to the medical examiner/coroner. 18

Who is Included in Definition of “Mandated Reporter” RCW DSHS employee Law enforcement officer Social worker Individual provider Employees and operators of a facility Employee of a social service, welfare, mental health, adult day health, adult day care, home health, home care, or hospice agency County coroner or medical examiner Health care provider subject to chapter RCW – Paramedics and EMTs 19

Definition of “Vulnerable Adult” RCW (a) Sixty years of age or older who has the functional, mental, or physical inability to care for himself or herself; or (b) Found incapacitated under chapter RCW; or (c) Who has a developmental disability as defined under RCW 71A ; or 20

Definition of “Vulnerable Adult” (d) Admitted to any facility; or (e) Receiving services from home health, hospice, or home care agencies licensed or required to be licensed under chapter RCW; or (f) Receiving services from an individual provider; or (g) Who self-directs his or her own care and receives services from a personal aide under chapter RCW. 21

Specific Reporting Requirements RCW Physical and sexual assault: Immediately report to LE and DSHS Death as result of abuse, neglect, or abandonment: Report to ME, LE, and DSHS in the most expeditious manner possible Neglect, financial exploitation and other abuse: Immediately report to DSHS 22

How to Report to DSHS King County contact numbers: In homes and long-term care facilities: – (Adult Protective Services) DSHS hours: 8 a.m. – 5 p.m., Monday – Friday – Answering machine if after hours 23

When in doubt, report it Failure to report is a gross misdemeanor – RCW If you report in good faith, you are immune from liability – RCW

How You Can Help Us Consider – The possibility that exploitation, abuse or neglect may be occurring – Abuse, neglect, or exploitation as a possible explanation for what you are seeing 25

How You Can Help Us Document – Signs of neglect – Signs of cognitive impairment – Concerns about behavior of caregiver – Concerns about undue influence, financial exploitation, neglect, or abuse – Statements of patient and caregiver 26

How You Can Help Us Request law enforcement at the scene when: – Serious neglect Multiple severe pressure sores; or Sepsis / Osteomyelitis; or Death or near death – Sexual assault – Serious physical assault 27

Feel Free to Contact Us Page Ulrey – – Amanda Froh – –