Adult Protective Services Program Review Department of Health and Human Services Adult Protective Services Dr. Sherri Z. Heller, Director February 2016

Adult Protective Services Program Review CA Aging Trends (1990 – 2020) California has one of the fastest growing elder populations in the US 112% increase in the 60 + population 143% increase in the 85+ population The number of adults age 60+ will surpass the number of children age 0-17 by 2030 Note: The 85+ population will emerge most strongly between 2030 – 2040, when the first baby boomers reach 85 February 2016 Adult Protective Services Program Review

2015 Sacramento County Projections Population of adults 60+ - 273,208 Minority pop -97,325 Low income – 28,320 Medi-Cal eligble – 47,073 SSI/SSP (65+) – 21,123 Isolated geographically – 6,251 75 years+ - 79,836 Living alone – 56,835 February 2016 Adult Protective Services Program Review

Organizational Structure Small APS program housed within bigger Senior and Adult Services Division Adult Protective Services In Home Supportive Services Senior Volunteer Services Conservator’s Office February 2016 Adult Protective Services Program Review

APS Program Statistics 8,243 calls in 2015 = 4,414 investigations 60% increase in investigations since 2010 Investigations have multiple allegations * Confirm over half of all allegations 857 allegations of Physical Abuse 1211 allegations of neglect 1781 allegations of financial 791 allegations of psychological abuse Total financial abuse allegations increased 122% since 2010 February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review APS Staffing Intake unit One supervisor, six intake social workers Investigations units Six supervisors, 39 social workers Public Health Nurses One supervisor, six nurses Family Service Workers One supervisor, seven paraprofessionals February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review APS On-Call APS operates 24/7 On Call 5:00p.m.- 8:00 a.m. Monday–Friday shift 2 shifts per day on weekends and holidays Staffing per shift One investigator One supervisor County Communications will take a message Can request to speak with supervisor for an emergency February 2016 Adult Protective Services Program Review

APS Training Resources Northern California Training Academy Academy For Excellence APS new worker training National, state and local conferences MDT meetings SacFAST meetings Monthly APS In-Service trainings February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Agency Authority Welfare and Institutions Code Section 106000 > Defines APS Goals and Scope of Services Provides Definitions Creates and Limits Agency Authority California Department of Social Services Regulatory Agency Statutory elaboration and explanation (ex: All County Letters) Integration of court cases and rules that impact APS February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review APS: Legal Mandates Respond to reports of abuse and neglect of elders and dependent adults in Sacramento County. Make cross-reports as needed Maintain 24 Hour Intake Hotline February 2016 Adult Protective Services Program Review

Who is an Elder or Dependent Adult? Resident of the state, and 65 years of age or older WIC 15610.27 Approximately 73%of Sacramento County APS clients Dependent Adult Adult between the ages of 18 and 64, and Has physical and/or mental limitations, and Cannot complete normal activities or protect their rights. Includes persons admitted to a 24 hour health facility Approximately 27% of Sacramento County APS clients February 2016 Adult Protective Services Program Review

Dependent Adult Status A combination of inability to meet own needs and inability to manage care APS intake workers will ask lots of questions to determine if someone is a dependent adult Questions will focus on the client’s ability to complete ADLs and IADLs A disability does not, in itself, determine dependency February 2016 Adult Protective Services Program Review

Types of Abuse/Neglect Investigated APS receives reports of abuse and neglect from mandated reporters and non-mandated reporters. All reports of abuse are handled the same, regardless of the identity of the reporter. The following are the categories of abuse and neglect investigated by APS: Physical Abuse *** Abandonment *** Neglect *** Sexual Abuse *** Self-Neglect *** Abduction Financial Abuse *** Isolation February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Physical Abuse The non-accidental use of physical force that results or could have resulted in bodily injury, physical pain or impairment Includes over and under medication Includes food and water deprivation February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Sexual Abuse A form of physical abuse Any nonconsensual sexual contact of any kind including (but not limited to): Unwanted touching All types of sexual assault and battery Sexually explicit photography Forced exposure to pornography Unwanted relations with a spouse or partner February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Financial Abuse The illegal or improper use of a Client’s funds, property or assets Funds, property or assets belonging to the client have been taken, secreted, appropriated and/or retained for a wrongful use or with an intent to defraud the client or by undue influence February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Psychological Abuse The infliction of fear, anguish, agitation or other emotional distress through verbal or non-verbal acts Focus is on emotional distress inflicted, not just that the words are hurtful or mean Mandated reporters do not have to report psychological abuse February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Isolation Isolation is the purposeful prevention of communication between a client and others without the client’s consent or knowledge when the action is not in the client’s best interest February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Abandonment The desertion or willful forsaking of an elder or dependent adult by anyone having care or custody of that person under circumstances in which a reasonable person would continue to provide care and custody. Infrequently reported allegation February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Self-Neglect The refusal or failure of an adult to exercise self-care or perform essential self-care tasks. Similar to neglect but there is no perpetrator – the client neglects themselves. Not reported to law enforcement. Most frequent allegation - 3571 reports in 2015 February 2016 Adult Protective Services Program Review

Financial Self-Neglect A person is unable to manage their own finances: Not paying bills, difficulty managing bank accounts or investments, or difficulty keeping track of large sums of money. Consequences may include eviction, homelessness, foreclosure, termination of utilities or health insurance for nonpayment, and inability to afford other necessities such as food and medication. Might be associated with illness, addiction or dementia. Inability to manage finances may precede other more obvious symptoms of dementia. February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review How does APS Intervene? Crisis intervention: Priority 1, 2, and 3 24-hour response: One after hours APS social worker Unannounced home visits Comprehensive APS assessment Investigation Service planning and limited case management (up to 90 days) Collaboration with law enforcement Advocacy, education, and referrals Multidisciplinary teams (MDT, FAST, and EDRT) Community outreach and education February 2016 Adult Protective Services Program Review

Community Collaborative Partners Law Enforcement Sacramento Steps Forward Meals on Wheels Long-Term Care Ombudsman Sacramento Area Emergency Housing Hospitals TLCS Respite Center McGeorge Victim of Crime Resource Center, Senior Legal Hotline DA Victim Advocates Senior Safe House February 2016 Adult Protective Services Program Review

Limits to APS Authority? The APS Program is not intended to interfere with the lifestyle choices of elders or dependent adults, nor to protect those individuals from all the consequences of such choices. APS is a voluntary program. An elder or dependent adult who has been abused may refuse or withdraw consent at any time to preventative or remedial services by APS (two exceptions: mental incapacity or a report of a crime allow APS to proceed). APS does not have the authority to place adults in protective custody. APS does not have a facility in which to place vulnerable adults. APS utilizes the same community resources as all other county agencies and residents. February 2016 Adult Protective Services Program Review

If the client is mentally incapacitated? If APS believes the client is incapacitated to the extent that he or she is unable to consent to adult protective services, a petition for conservatorship may be initiated, if less restrictive alternatives were attempted. If appropriate family or friends are willing and able, they will initiate the conservatorship. For clients with no one to serve as a conservator, APS may make a conservatorship referral to the Public Guardian/Conservator’s Office. February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Special Challenges Mental Health Substance Abuse Homelessness Domestic Violence Immediate Housing Need Room & Board Homes February 2016 Adult Protective Services Program Review

Mandated Reporters Three Primary Categories 1. Care Custodians 2. Health Practitioners 3. Officers/Employees of Financial Institutions February 2016 Adult Protective Services Program Review

Mandated Reporters: Financial Institutions Bank and credit union employees who have direct contact with customers are mandated to report suspected financial abuse. Bank and credit union employees who review or approve financial documents, transactions, and records in connection with financial services are mandated to report suspected financial abuse, even if they don’t see the customer. February 2016 Adult Protective Services Program Review

Questions of Jurisdiction Law enforcement has jurisdiction anywhere a crime occurs. For a crime in progress or a life-threatening situation, call 911. APS has jurisdiction in cases where the abuse occurs outside a Long-Term Care (LTC) Facility or when the abuser is not affiliated with the facility. Mandated reports of abuse occurring outside of LTC Facilities are made to APS or local law enforcement. APS Hotline: 916-874-9377 The Long-Term Care Ombudsman and local law enforcement have jurisdiction when the abuse occurs in a LTC Facility. Mandated reports of abuse occurring in a LTC Facility are made to the Long-Term Care Ombudsman and/or local law enforcement. Long-Term Care Ombudsman: 916-376-8910 February 2016 Adult Protective Services Program Review

Confidentiality of Elder Abuse Reports The identity of mandated reporters and the content of an APS report are confidential. Violation of confidentiality is punishable by up to six months in jail and/or a $500 fine. APS is permitted to disclose confidential information from an elder abuse report or investigation with qualified multidisciplinary team members and representatives of agencies responsible for investigating the client’s case. All persons and agencies entitled to confidential information from an elder abuse report are required to maintain confidentiality. February 2016 Adult Protective Services Program Review

Confidentiality of Elder Abuse Reports The identity of the reporting party may only be shared with the following: Local law enforcement, Office of the district attorney, Probate court, Bureau of Medi-Cal Fraud and Elder Abuse, Long-term Care Ombudsman, State licensing agencies, Office of the public guardian, Department of Consumer Affairs investigative division, and County counsel representing APS. The identity of the reporting party may also be disclosed to the district attorney in a criminal prosecution, when the person reporting waives confidentiality, or by court order. February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Trends Elder population increase = increased reports Now opening approximately400 new cases a month Family Justice Center Increased volume of on-call reports February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review Financial Abuse Financial abuse in 2015 Received 2053 allegations 24% of total allegations Financial abuse allegations have increased 122% since 2010 Started financial abuse unit in January 2015 Developed financial abuse data collection tool Confirmed $4.3 million loss, with $2.5 million lost to stranger scams In confirmed case, 45% of the perpetrators were relatives February 2016 Adult Protective Services Program Review

Adult Protective Services Program Review APS Recidivism State recidivism rates hover around 33% Sacramento County rates 2015 – 23% 2014 – 22% 2013 – 27% 2012 -32% Implemented focus on quality practices (ex. cognitive screenings tools, high risk staffings, keeping cases open longer for safety planning) February 2016 Adult Protective Services Program Review