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

2. 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 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

3. 2015 Sacramento County Projections
Population of adults ,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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Adult Protective Services Program Review
Agency Authority
Welfare and Institutions Code
Section >
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

10. 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

11. Who is an Elder or Dependent Adult?
Resident of the state, and
65 years of age or older
WIC
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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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 reports in 2015
February 2016
Adult Protective Services Program Review

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

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

28. 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

29. 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:
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:
February 2016
Adult Protective Services Program Review

30. 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

31. 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

32. 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

33. 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

34. Adult Protective Services Program Review
APS Recidivism
State recidivism rates hover around 33%
Sacramento County rates
2015 – 23%
2014 – 22%
2013 – 27% %
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