Alabama Department of Human Resources Adult Protective Services County Department of Human Resources Adult Protective Services

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources More than 845,000 people are disabled or elderly in the State of Alabama. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources APS Facts Over 8,000 reports and preventions in FY 2015 (6,244 reports and 1,824 preventions) 63% alleged victims female 76% alleged victims 60 or older 66% neglect, 16% abuse, and 18% exploitation 33% reports indicated Alabama Dept. of Human Resources

Alabama Dept. of Human Resources FY 2015 – AANE Report s– 6244 FY 2015 – Preventions - 1834 Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Summary Data FY 2015 11% Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources June 2016

Alabama Dept. of Human Resources APS Principles Adults have the right to be safe. Adults retain all their civil and constitutional rights unless restricted by the Court. Adults have the right to make decisions that do not conform with societal norms as long as these decisions do not harm others. Adults are presumed to have decision making capacity unless a Court determines otherwise. Adults have the right to accept or refuse services. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources COVERAGE Adults: persons 18 years or older. Mentally or physically incapable of caring for self or managing own affairs, or Because of physical/mental impairment, unable to protect self from abuse/neglect/ exploitation, AND Have no one willing or able to provide protection to the degree needed. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources PURPOSE To prevent injury to self and/or others and or institutionalization; To ensure that emergency services are provided to meet acute physical, mental or other needs that the individual cannot arrange; To protect the individual's due process rights if legal action is needed; To prevent and remedy neglect, abuse, and/or exploitation of the individual; To protect the individual’s financial resources. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources ABUSE Emotional Willful or reckless Infliction of emotional or mental anguish. Use of physical or chemical restraint, medication, or isolation as physical punishment or substitute for treatment or care. Physical Infliction of pain or injury, physical impairment, or substantial pain. Willful deprivation of services necessary to maintain mental or physical health. Sexual Crime under Alabama law. Rape Sodomy Sexual Abuse Torture Sexual Misconduct Indecent Exposure Alabama Dept. of Human Resources

Alabama Dept. of Human Resources ABUSE Infliction of physical pain or injury or willful deprivation of services necessary for the person’s mental and physical health by a caregiver or other person. Bruises or grip marks Rope marks or welts Repeated Unexplained injuries Dismissive attitude Refusal to go to same Doctor or ER Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Sexual Abuse Types of Sexual abuse include rape, incest, sodomy, and indecent exposure Unexplained vaginal or anal bleeding Torn or bloody underwear Bruised breasts Venereal diseases or vaginal infections Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Emotional Abuse Willful or reckless infliction of emotional or mental anguish or use of physical or chemical restraints or isolation as punishment Unreasonably fearful or suspicious Lack of interest in social contacts Chronic physical or mental health problems Evasiveness Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

NEGLECT Alabama Dept. of Human Resources Food, shelter, clothing, medical or health care Caregiver Failure Victim Alabama Dept. of Human Resources

Alabama Dept. of Human Resources NEGLECT Failure of the caretaker to provide food, shelter, clothing, medical services, and/or health care to a person unable to care for him/herself due to mental or physical inability. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources NEGLECT EXAMPLES Disconnected utilities Crowded living conditions Inadequate housing Lack of food Multiple unused prescription medications Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources EXPLOITATION Expenditure, diminution, or use of property, assets, or resources of a protected person without express voluntary consent of the person or the person’s legally authorized representative. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

EXPLOITATION EXAMPLES Large withdrawals from bank account; Unusual ATM activity Signatures on checks don’t match adult’s signature Presence of adults in the home who do not have incomes but have addictions Change of title to property A person residing in an unlicensed ALF that has been court-ordered to close [defined by Act 208-389] Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Protecting Alabama’s Elders Act Code of AL 13A-6-190 establishes the crimes of financial exploitation of an elderly person as well as elder abuse and neglect in the first, second, and third degree. While District Attorneys may continue to prosecute cases under the APS Act, this law provides an additional tool for law enforcement and District Attorneys. Alabama Dept. of Human Resources

Protecting Alabama’s Elder Act This Act defines an elderly person as a person 60 years of age or older for criminal statute purposes only. It also defines financial exploitation to include breach of fiduciary duty to an elderly person by the person’s guardian, conservator, or person who holds power of attorney which results in an unauthorized appropriation, sale, or transfer of the elderly person’s property. The Act also defines deception, intimidation and undue influence. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Perpetrators Usually Related Do Not Understand Care Needs Misuse Drugs or Alcohol Dependent on Victim History of Domestic Abuse Multiple Stressors Present Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Mandated Reporters Physicians Practitioners of the Healing arts Caregivers Community Ombudsman Alabama Dept. of Human Resources

Where to Report County DHR Office where person resides or is present Law Enforcement (will send to DHR within 24 hours) Chiefs of Police in Municipalities Sheriffs in County areas Alabama DHR APS - 1-800-458-7214

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Investigation See client immediately or within 7 days depending on circumstances Interview adult household members Interview person allegedly responsible Interview collateral Secure professional assessments if needed Alabama Dept. of Human Resources

Interviewing for Information Victim All Adults in the Home Witnesses Professionals & Collaterals Person Allegedly Responsible Contact the Reporter, when needed Alabama Dept. of Human Resources

Workers’ preliminary decisions re: a. whether the client is in imminent danger; b. whether the client is an adult in need of protective services; and c. whether emergency protective services and/or placement are necessary and if so, intervene immediately to provide protective services. Alabama Dept. of Human Resources

Theory and Practice of Adult Protective Services It is important to remember that adult protective service clients have a right to make decisions for themselves and to direct their lives. The client retains this right unless it is determined by the Court that there exists immediate danger to his/her health and safety and the client is unwilling to consent or unable to give informed consent to services necessary to insure his/her protection. Alabama Dept. of Human Resources

WHO-WHAT-WHEN-WHERE-HOW Does the reported victim meet the definition of an adult in need of protection? Did Abuse, Neglect or Exploitation occur? Who caused the harm? When and how did this occur? What protection is needed? Alabama Dept. of Human Resources

Working with Others in the Community Assessments may be needed -medically -psychologically Assistance from Law Enforcement may be needed Other assistance may be available from Area Agency on Aging, Health Department, or others Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Collaboration Law enforcement Physicians and other Health Care Professionals Community Resources Dept. of Senior Services Medicaid, Public Health, Senior Services, Mental Health, Attorney General, and others Alabama Dept. of Human Resources

When DHR does Not Investigate (but another State Agency does!) It is a State owned and operated Mental Health facility or a Correctional facility Nursing home reports in which an employee is the alleged perpetrator of abuse or neglect Alabama Dept. of Human Resources

Who Investigates These Cases? State owned and operated Mental Health facilities – Alabama Department of Mental Health and Mental Retardation State Correctional facilities – Alabama Department of Corrections A local or county jail – The governmental entity that operates the facility Nursing home reports in which an employee is the alleged perpetrator – Alabama Department of Public Health, Health Care Facilities Division Alabama Dept. of Human Resources

Alabama Dept. of Human Resources DHR PROGRAM SERVICES Protective Service Investigations Prevention Assessments Case Management Referrals to Community Services Alabama Dept. of Human Resources

Alabama Dept. of Human Resources DHR PROGRAM SERVICES Targeted Case Management Adult Day Care Adult Foster Care Emergency Shelter Diagnosis and Evaluation & Mental Health Counseling Alabama Dept. of Human Resources

Alabama Dept. of Human Resources DHR may assist with Nursing Home Placement when the adult is in need of Protective Services and the physician recommends that it is needed. Alabama Dept. of Human Resources

Alabama Dept. of Human Resources APS Worker CAN: * Petition for protective placement, if needed * Petition for a guardian/conservator, if needed * Assist with locating a placement / sponsor when possible * Assist with Medicaid application; case remains open until Medicaid is determined *Review and report to the Court as required * Assist with re-locating residents when a facility closes or Medicaid/Medicare approval is terminated Alabama Dept. of Human Resources

The APS social worker CANNOT: 1. Sign as a nursing home sponsor for an adult client. 2. Sign permission for medical treatment. 3. Sign Release of Information forms, or HIPPA forms. Alabama Dept. of Human Resources

APS Nursing Home Cases will Remain Open for Services 1. When Medicaid Application is pending, 2. When the client is court-ordered to the placement (reports are made to the court every six months.) Alabama Dept. of Human Resources

Council for Prevention of Elder Abuse Regular Bi-monthly Meetings Committees Increased Prosecutions Surveys (Caregivers, General public, Legal profession) Caregiver Seminars Legislation Alabama Dept. of Human Resources

Foster Care Recruitment Alabama Dept. of Human Resources

Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Where to Report County DHR Office where person resides or is present Law Enforcement (to DHR within 24 hours) Chiefs of Police in Municipalities Sheriffs in County areas Alabama DHR APS - 1-800-458-7214 Alabama Dept. of Human Resources

Alabama Dept. of Human Resources Online Reporting www.dhr.state.al.us/services/Adult_Protective_Services.doc E-mail to: aps@dhr.alabama.gov Alabama Dept. of Human Resources

How to Contact Us any County Department of Human Resources (office located in each of 67 county seats) State of Alabama adult protective services hot line 1-800-458-7214 ~WEB ADDRESS~ aps@dhr.alabama.gov

Community Resources for Assisting Alabama’s Adults Area Agency on Aging 1-800-243-5463 Alabama Disability Advocacy Program (ADAP) 1-800-826-1675 Alabama Department of Mental Health 1-800-367-0955 Alabama Dept. of Human Resources

Community Resources for Assisting Alabama’s Adults Alabama Securities Commission 1-800-222-1253 Alabama Suicide Prevention Hotline 1-800-273-8255 U.S. Federal Trade Commission 1-800-382-4357 Alabama Dept. of Human Resources

Community Resources for Assisting Alabama’s Adults National Center for Victims of Crime 1-800-394-2255 National Foundation for Credit Counseling 1-800-388-2227 Senior Legal Assistance Program 1-800-243-5463 Alabama Dept. of Human Resources

Community Resources for Assisting Alabama’s Adults Housing and Urban Development (HUD) 1-800-225-5342 Alabama Department of Senior Services 1-877-425-2243 Alabama Dept. of Human Resources