Working With Adult Protective Services APS Worker Training Working With Adult Protective Services Show Video Tape? Ask: What do you hope to get from this training? Multnomah County Aging and Disability Services April 2012 Multnomah County Aging and Disability Services

After training, participants will: APS Worker Training After training, participants will: Know the definitions of abuse Recognize abuse situations Understand the steps necessary to make a referral to APS Understand the adult protective service worker's role and responsibilities Note: Reference training packet. Highlight referral and case management grid in packet. Multnomah County Aging and Disability Services

Guiding Principles of APS Do no further harm Pursue the least restrictive option Always consider the client’s choice and preferences As long as they have capacity, do not harm others or commit a crime, clients have the right to choose freedom over safety

Mandatory Reporting State law protects the confidentiality of all people reporting abuse Oregon’s abuse reporting law protects anyone who reports abuse in good faith When reporting suspected abuse, HIPAA protected information can be shared with APS. It is up to APS to protect that information.

Mandatory reporters of elder abuse include: Naturopathic, osteopathic, podiatric, chiropractic or general physician or surgeon, including an intern or resident licensed practical nurse, registered nurse, nurse's aide, home health aide or employee of an in-home health service psychologist, licensed clinical social worker, licensed professional counselor, licensed clinical social worker or licensed marriage and family therapist physical therapist, speech therapist, occupational therapist, audiologist or speech language pathologist firefighter or emergency medical technician, peace officer or member of the clergy any public official that comes in contact with older adults in the performance of the official's duties

Making an APS Referral Contact APS Central Screener at 503-988-4450 Screener will ask for information about the suspected abuse, the alleged perpetrator, witnesses and the victim Screener will determine risk factors and response time

Risk of abuse increases with: Advanced age Demanding behaviors Dementia Physical impairment Substance abuse History of family violence Isolation Depression

Types of Abuse Physical Abuse Neglect Financial Exploitation Emotional, Verbal or Psychological Abuse Abandonment Sexual Abuse Self Neglect

APS Worker Training Physical Abuse Any physical injury caused by other than accidental means or that appears to be at variance with the explanation given for the injury; involuntary seclusion and/or physical or chemical restraints Note: Physical abuse can be hitting, kicking, shoving, pinching, slapping. Multnomah County Aging and Disability Services

Indicators of Physical Abuse APS Worker Training Indicators of Physical Abuse Bruising Injuries when explanation is implausible Abrasions Broken bones, sprains, dislocations Over or under medicated Note: This is a partial list. Ask: Can any of you identify a possible indicator of physical abuse? (Or have audience identify them first.) Tell a story? Differences Between Community and Facility Physical Abuse Explain appropriate versus inappropriate uses of restraints in facilities. Differences Between Aging and Disability None Multnomah County Aging and Disability Services

APS Worker Training Sexual Abuse Sexual contact that is forced, tricked, or otherwise coerced upon another person, inappropriate sexual comments or inability to consent to sexual contact Note: A person who is not able to give permission or consent. Multnomah County Aging and Disability Services

Indicators of Sexual Abuse APS Worker Training Indicators of Sexual Abuse Fear exhibited toward caregiver, family member Sexually transmitted diseases Genital or anal pain, irritation or bleeding Bruises on inner thigh Change in behavior Differences Between Community and Facility Sexual Abuse In a facility, it is automatically sexual abuse of a staff person has sex with someone with our without permission. In other facilities, if a person has capacity and consents, it is not considered sexual abuse. Differences Between Aging and Disability The younger disabled population gets pregnant. Younger disabled population are sometimes forced into prostitution. Multnomah County Aging and Disability Services

APS Worker Training Abandonment Desertion or forsaking of an elderly or disabled person or the neglect of duties and obligations owed a dependent adult by a caretaker or other person Note: If a person is capable of being left alone for any length of time, this is not abandonment. The case manager needs to assess the situation thoroughly before referring. Differences Between Community and Facility Occurs in a facility when the staff walk off the job, leaving a vulnerable person or persons alone. Differences Between Aging and Disability In a Relative Foster Care Home — discuss when a client is abandoned — when they need care and the caregiver leaves them alone for an unreasonable time based on care needs. Multnomah County Aging and Disability Services

Indicators of Abandonment Care provider not showing up to work on time, leaving early or not covering assigned duties No one answers telephone No one present to let Meals-on-Wheels drivers into residence Wandering

Financial Exploitation APS Worker Training Financial Exploitation Illegal or improper use of another’s resources for personal profit or gain or theft of items or medications Multnomah County Aging and Disability Services

Indicators of Financial Exploitation APS Worker Training Indicators of Financial Exploitation Caregiver putting name on property or financial accounts or questionable house title changes Sweepstake “junkies” Sudden change in a bank account Bounced checks Bills going unpaid when they used to be paid New “best friend” Differences Between Community and Facility Failure to pay versus financial abuse. Refer only if there is reason to believe financial exploitation. Otherwise, the issue is a case management issue to resolve with client/family. Differences Between Aging and Disability Multnomah County Aging and Disability Services

Emotional, Psychological or Verbal Abuse APS Worker Training Emotional, Psychological or Verbal Abuse Use of derogatory names, profanity, ridicule, harassment, coercion, threats, isolation, or intimidation toward an individual. Denial of civil rights which threatens emotional injury Note: Talk about being locked up by a caregiver as a punishment.. Differences Between Community and Facility Occurs in a facility when the staff walk off the job, leaving a vulnerable person or persons alone. Differences Between Aging and Disability In a Relative Foster Care Home — discuss when a client is abandoned — when they need care and the caregiver leaves them alone for an unreasonable time based on care needs.. Multnomah County Aging and Disability Services

Indicators of Emotional, Psychological or Verbal Abuse APS Worker Training Indicators of Emotional, Psychological or Verbal Abuse Shows fear of caregiver or family member Fears making independent decisions Any reference or inference of punishment by caregiver Differences Between Community and Facility Share that community emotional/psychological/ verbal abuse is more chronic and is more likely to go on for a long time as opposed to in a facility where more people are around. Differences Between Aging and Disability Note: Often accompanied by another type of abuse — physical, financial. Is often more devastating than physical abuse. Multnomah County Aging and Disability Services

APS Worker Training Neglect Failure to provide basic care or maintain emotional well being when agreed to by legal, contractual or otherwise assumed responsibility Note: Explain the difference between intentional and unintentional. This is important, because case managers will handle those that are unintentional. Multnomah County Aging and Disability Services

Indicators of Neglect Malnutrition or dehydration Poor hygiene APS Worker Training Indicators of Neglect Malnutrition or dehydration Poor hygiene Skin ulcers Over or under medicated Wandering Frequent falls Improperly clothed Untreated medical or mental conditions Differences Between Community and Facility Neglect None. Differences Between Aging and Disability None. Multnomah County Aging and Disability Services

APS Worker Training Self Neglect Inability to understand the consequences of action or inaction that may lead to harm or endangerment due to cognitive deficits Note: Capacity versus no capacity as a clinical issue. Competency is a legal concept This may require an example or further explanation of the concept of capacity and competency. Spell out inability to understand — mental illness, dementia, physical illness, stroke, pain, UTI, medication, delirium, cultural factors. Multnomah County Aging and Disability Services

Indicators of Self Neglect APS Worker Training Indicators of Self Neglect Poor hygiene Lack of food, clothing Lack of medical care Failure to use medical care appropriately or to follow medical recommendations Malnutrition Change in behavior causing endangerment Differences Between Community and Facility Self neglect in a facility would be considered neglect by the caregiver. The facility should have a plan if the client resists care. The case manager should first work with the facility to develop an appropriate plan to address the client’s self-neglect “behaviors.” Differences Between Aging and Disability Mentally ill clients also have certain rights. Mentally ill who are in danger of harm to themselves may be committed for treatment. County Crisis Center at Providence will make that determination. Example: An alcoholic or drug abuser can drink or use drugs, but once they lose capacity, they might be considered self-neglecting. Multnomah County Aging and Disability Services

After the Referral — What to Expect of APS APS Worker Training After the Referral — What to Expect of APS All initial APS visits are unannounced Investigates complaints by interviewing victims, perpetrators, witnesses and examining pertinent records Offers intervention and services as available, such as law enforcement, MDT or Public Guardians office Multnomah County Aging and Disability Services

APS in Multnomah County APS receives about 9000 calls per year Investigators write about 4200 reports per year Self neglect was the most common type of abuse followed by financial exploitation 60 % of victims were female Family members were also the most common perpetrators, followed by the victims themselves

All crimes are abuse but not all abuse is a crime APS Worker Training All crimes are abuse but not all abuse is a crime Abuse is not necessarily a crime Abuse situations may be brought to the law enforcement staffing by APS for consultation A crime may be investigated through law enforcement and may be prosecuted by the District Attorney’s office Not all abuse will be investigated by law enforcement Multnomah County Aging and Disability Services

When is law enforcement called? APS workers must notify law enforcement when they believe a crime has occurred APS may call law enforcement when confronted with an unsafe situation or a confrontational perpetrator APS meets monthly with law enforcement to discuss mutual cases and strategize interventions

FAST Team Financial Abuse Specialist Team Two investigators have been assigned to specialize in financial cases FAST team often get more complicated cases of financial abuse All teams can refer cases to law enforcement

Protective Services Tools APS Worker Training Protective Services Tools Restraining orders Relocations Guardianships or Conservatorships Police involvement Mental health involvement MDT Basic cognitive screenings Multnomah County Aging and Disability Services

The Multidisciplinary Team Each area has an MDT which consists of: Social worker Community health nurse Mental health specialist Case manager APS investigator, as appropriate Only ADS or District Center case managers can make referrals to MDT

The MDT (multidisciplinary team): Provides consultation to case managers and other professionals Develops intervention strategies to deal with complex cases Identifies gaps in services Examines ethical issues Collaborates with other disciplines Cultural specialists

The APS team thanks you for your time The End