Adult Protective Services 11

Adult Protective Services Investigates reports of alleged mistreatment against at-risk adults Offers protective services for adults who are at-risk for mistreatment Collaborates with Law Enforcement, City Attorney and District Attorney’s Office to protect at-risk adults 2

APS Priorities Confidentiality Consent Self Determination APS investigations and reports are confidential and can’t be shared except in limited circumstances Consent At-risk adults must consent to protective services. APS does not need consent to conduct an investigation into allegations of mistreatment Self Determination At-risk adults have the right to make their own choices, unless they no longer have capacity, their choices would violate a law, or they are a danger to others Less Restrictive Intervention APS will always try to implement services for the shortest duration and the minimum extent necessary to protect the at-risk adult 3

Right to Refuse Services At-risk adults have the right to make lifestyle choices that others may see as objectionable or even dangerous including: Refusing medical treatment or medication Choosing to abuse alcohol or drugs Living in a dirty or cluttered home Continuing to live with the perpetrator Keeping large numbers of pets Engaging in other behaviors that may not be safe 4

At Risk Adults At-risk adults,18 years or older, who are susceptible to mistreatment or self-neglect: Unable to obtain necessary support services or Lack sufficient understanding or capacity to make or communicate responsible decisions Conditions that increase risk include dementia, physical or medical frailty, developmental disabilities, brain injury, behavioral disorders, and mental illness. 5

Examples of At-Risk Adults 67 Year Old Male With Dementia Can’t remember to pay his bills. Has no water or electricity in his home. 20 Year Old (DD) Female Locked in her bedroom by her caregiver for 8 hours a day without food and water 36 Year Old Wheelchair Bound Female Advanced stages of MS, needs 24/7 care, physically abused by her husband 68 Year Old Male Lives alone, reports he is not eating or bathing, unable to buy groceries 6

Who Is Not At-Risk A 35 year old man who walks with a cane or uses a wheelchair, but is able to perform all activities necessary to provide for his health and safety. A 70 year old who is being discharged from a hospital or rehabilitation facility, has been medically cleared, and requires no protective services. An adult of any age with decision-making capacity who: Makes poor investment decisions or participates in a lottery scam Is involved in a landlord-tenant dispute Chooses to live in a dirty home or with multiple pets Chooses to make poor health care decisions Uses excessive alcohol and/or drugs 7

Please Note: If in doubt as to whether an adult is or is not considered to be “at-risk” according to state statutes, call the county Adult Protective Services for guidance. 8

What is Mistreatment? In Colorado, “mistreatment” refers to an act (or omission of an act) that threatens the health, safety, or welfare of an at-risk adult, or that exposes the adult to a situation or condition that poses an imminent risk of death or serious bodily injury. 9

Mistreatment Includes: Self neglect Caregiver neglect Physical abuse Sexual abuse Exploitation 10

What is Self-Neglect?: Self-neglect is the most commonly reported concern regarding at-risk adults. Self-neglect occurs when an at-risk adult can’t or doesn’t care for him or herself. The reasons for not caring for oneself range from: lifestyle choices to the onset of sensory or medical impairments to a partial or total loss of decision making capacity Related Rule: C.R.S.26-3.1-101 (7) 11

What May Not Be Self-Neglect Choice of lifestyle, by itself, is not necessarily self neglect. If an adult chooses not to clean his home or not to take her prescribed medications, and is competent to make such decisions, he or she has the right to continue making such choices without intervention. 12

Signs of Self-Neglect It is important to know and report the following signs of self-neglect: Untreated medical conditions Improper use of medications or other drugs Malnourishment symptoms, including fatique, dizziness, weight loss Dehydration symptoms, including persistent fatique, lethargy, muscle weakness or cramps, headaches, dizziness, and confusion Unclean physical appearance, soiled clothing, tooth decay Bedsores 13

Caretaker Neglect: Caretaker neglect occurs when an at-risk elder’s caretaker fails to make sure the elder has adequate food, clothing, shelter, psychological care, physical care, medical care, or supervision. OR The caretaker does not provide these things in a timely manner or with the degree of care that a reasonable person in the same situation would use. 14

Who Is a Caretaker? A person who is paid or unpaid and has assumed responsibility for the care of an at-risk elder or has identified him/herself as the elder’s caretaker. A caretaker can be a family member, a home health provider, a facility staff or a neighbor who has agreed to provide recurring assistance to help the elder meet his/her basic needs. A person who does occasional shopping or cleaning for an at-risk elder doesn’t mean he or she has assumed responsibility for the at-risk elder’s care. 15

Signs of Caretaker Neglect Adult has unusual weight loss, malnutrition, dehydration Adult has untreated physical problems, such as bed sores Adult living in unsanitary conditions: dirt, bugs, soiled bedding Adult left in dirty, soiled clothing Adult resides in unsafe living conditions (no heat or running water, faulty electrical wiring, other fire hazards) Adult left alone when unable to take care of or protect self Caretaker fails to provide food and water Caretaker uses improper medications to “control” adult Adult lacks medical aids (glasses, walker or cane, teeth or dentures, hearing aids, medications) 16

Physical Abuse: Physical abuse occurs when someone causes bodily harm to an at-risk elder, such as causing physical pain or bruising; or when unreasonable confinement or restraint is imposed on the at-risk elder. 17

Indicators of Physical Abuse Repeated visits to the emergency room Bruises or injuries in various stages of healing Unconvincing explanations of injuries Elder is isolated from family, friends, and medical care 18

Sexual Abuse: Sexual abuse means subjecting an at-risk elder to unlawful sexual conduct or contact. Physical Signs of Sexual Abuse: Torn, stained, or bloody underclothing Difficulty in walking, sitting, or standing Sexually transmitted diseases Bruises, pain, bleeding, or injuries to the genitals, breast, or anal areas Behavioral Signs of Sexual Abuse: Scared or timid behavior Sudden changes in personality Fear of certain people or of physical characteristics Depressed, withdrawn behavior Unexpected reluctance to cooperate with toileting and/or physical examination of genitalia 19

Exploitation Exploitation means taking an at-risk elder’s money or other assets against his or her will or without his or her knowledge. In other words – stealing from the adult. It also means deceiving, harassing, intimidating or using undue influence to get the elder to do something against his or her will. 20

Examples of Exploitation: Guardians, conservators, representative payees, or agents, under a power of attorney, use the elder’s assets for their own personal use or do not use the elder’s money to secure the elder’s basic needs and care. An at-risk elder’s son uses his power of attorney to access the elder’s account to buy himself a new truck. An at-risk elder has a stroke and cognitive damage. His daughter agrees to move in to help with meals, cleaning and transportation. The daughter routinely tells her father she will put him in a nursing home if he doesn’t give her money. 21

Making a Report Have as much information as possible about the at-risk adult, the perpetrator and what is concerning you. Provide the following information: Name and address of the at-risk adult. A description of the alleged mistreatment and the situation; what did you observe? What is the nature and extent of the injury? Who is the alleged perpetrator; name and address if possible. Any other information that you feel is relevant. Call 720-944-2994 22

What Happens After I Report? APS will screen the report and determine the appropriate response The report will be shared with law enforcement APS will take appropriate action, which may include an investigation APS may request a joint investigation with law enforcement or another agency APS may offer protective services to the at-risk adult 23

So, What Does APS Do? In Colorado, Adult Protective Services (APS) case workers seek to arrange services for consenting at-risk adults that will help ensure that the adult’s health and safety are protected. Case workers may assist at-risk adults for whom actual or potential risk exists from mistreatment or self neglect. Denver County accepts and exercises certain levels of authority in order to assist its at-risk adults clients: representative payee and guardianship. 24

Mandatory Reporting Physical abuse Sexual abuse Caretaker neglect As of July 1, 2014, certain professionals must report mistreatment of elders: Physical abuse Sexual abuse Caretaker neglect Exploitation 25

Mandatory Reporting Who is an At-Risk Elder? The law defines an at-risk elder as any person 70 years or older. 26

Mandatory Reporters Physicians, surgeons, physicians assistants, osteopaths Physicians in training, podiatrists, occupational therapists Medical examiners and coroners Registered nurses, licensed practical nurses, and nurse practitioners Hospital and long-term care facility personnel Psychologists and other mental health professionals Social work practitioners Dentists Law enforcement officials and personnel Court appointed guardians and conservators Fire protection personnel Pharmacists Community centered board staff Personnel of banks, savings and loan associations, credit unions, and other lending or financial institutions Caretakers, staff members, employees, volunteers or consultants for a licensed or certified care facility, agency home, or governing board, including, but not limited to home health providers. Emergency medical service providers Physical therapists Chiropractors Clergy (as defined in the children’s code CRS 19-3-304(2)(AA) and CRS 13-90-109 (1)(C) 27

Everyone Continues to Be Urged to Report Reporting Everyone Continues to Be Urged to Report Physical abuse Sexual abuse Caretaker neglect Exploitation Self-neglect An at-risk adult is defined as someone, age 18 and older, who is susceptible to mistreatment because they are unable to perform or obtain services necessary for their health, safety or welfare, or who lacks sufficient understanding/capacity to make or communicate responsible decisions. 28

Contact Information Denver County Adult Protective Services: Intake Line: 720-944-2994 Denver Police Department: Non-Emergency: 720-913-2000 Emergency: 911 Denver District Attorney Fraud Hotline: 720-913-9179 29

Questions? 30