1. Adult Protective Services Illinois Adult Day Services Association Carol W. Mauck, MSW, LCSW

2. Today you will learn: Definitions of types of adult abuse Risk indicators for all types of abuse Who are mandated reporters How to make an adult abuse report Recommended adult protective procedures for centers

3. Adult Protective Services in Illinois Adult Abuse is to be reported for any Illinois resident age 18-59 living with a disability An adult 60 years of age or older who lives in a domestic setting.

4. Adult Abuse Types Physical, sexual or emotional abuse Neglect-failure to provide necessities of life Confinement-restraining or isolating Financial exploitation- withholding financial resources Willful deprivation-deliberate denying care/treatments Self-neglect-a condition that is the result of an adult’s inability, due to physical or mental impairments, or diminished capacity* What t Professionals Need to Know, State of Illinois, Department on Aging (2014))

5. Financial Exploitation Indicators It is about access: Caregivers situations who have access to account information/passwords Hired caregivers who have access to a purse with credit cards and checks Clients who have credit cards, bank cards with account info in wallet Families who live out of town and cannot monitor hired caregiver No social support system for client or caregiver

6. General Risk Indicators Client has memory loss Impairments in sight and hearing Client has mobility issues Client’s physical appearance has declined through illness, weakness, or poor care Body and house odor No food in house Medication not refilled Observations of reactions between caregiver/client- speech context/physical touching Shows lack of concern

7. General Risk Indicators (cont.) Aggressive caregivers-verbal and physical Verbal threats like putting loved-one in a nursing home “I will leave you alone if you don’t give me the money” Pain medication in the home Estranged family members moves in Financial and sellable resources in the house

8. Caregiver Risks Indicators Close to age of client Not in good physical health Thinks client is “faking it” Does not get enough of a break or sleep, no opportunities to get “away” Has their own health and/or cognitive problems Does not accept disabilities or acknowledge issues Unable to accept “role reversals” Refuses help/services Delays in seeking care

9. Neglect Indicators Client cannot help themselves Caregivers working Client living in family home with several generations Decreased functional ability Incontinence Physical environment of client

10. Definition of Self-neglect A condition that results of adult’s inability, due to physical or mental impairments, or both, or a diminished capacity, to perform essential self-care tasks that threatens their health, including: essential food, clothing, shelter and health care; and obtaining goods and services necessary to maintain physical health, mental health, emotional well-being, and safety.

11. Self-Neglec t Indicators Refusing interventions Doesn’t go to physician May have physical/mental problems Items begin to “pile up” in living environment Decision-making is impaired about what items are garbage Hoarding syndrome Refuses family intervention Unable to see safety issues Note: The amendments to the APS Act did not make reporting self-neglect mandatory for professionals.

12. Behavioral Indicators Observations of behaviors of the client, by themselves may not indicate abuse or neglect; combined with other indicators may change interpretation fear confusion withdrawal disorientation helplessness contradictory statements resignation anger hesitation to talk openly denial implausible stories agitation anxiety sleep disturbances non-responsiveness unexplained changes in behavior or appearance

13. Deciding when to Report Types of reporters: mandated-must report by law voluntary-everyone encouraged to report in all cases of adult abuse self-reporting-by alleged victim Adults because of a disability or impairment who are unable to seek assistance come to the attention of professionals/ state employees must with in 24 hours make a suspected abuse report. The requirement to report is any time the mandated reporter is work engaged. If a mandated reporter is undecided whether or not the adult is being mistreated is able to self-report,IDOA encourages the reporter to voluntarily report the suspected abuse. Physical or mental conditions which might render the adult unable to self-report such as dementia, paralysis, bed-ridden, speech disorder or unable to use a phone. Professional’s decide whether or not the adult is able to self-report.

14. Deciding mental capacity Is the adult able to understand the facts? Is the adult able to express a free choice about the situation? Is the adult able to understand risks and benefits of the choice?

15. “Mandated Reporter” includes any of the following people who suspect abuse of an adult living in a domestic setting while engaged in carrying out their professional duties: A professional / professional delegate while engaged in: Social services Adult care workers Law enforcement Education Medicine/coroner/medical examiner State services to seniors A person who performs the duties of EMT/paramedic Any occupation required to be licensed under……….* What Professionals Need to Know, State of Illinois, Department on Aging (8/13 *

16. Example of ADS Procedures Center personnel should routinely screen for signs of abuse, neglect or exploitation through routine client care or daily contact with clients (such as bathing and nursing assessments) Center personnel should inquire as part of a on-going routine assessment process with clients if they have any concerns or issues about their care. Documentation should be made of these conversations. If abuse, neglect or exploitation is suspected, the person making the assessment should complete an “Incident Report Form” and follow center policy to report to APS

17. What happens when a report is made? Intake: Agency will need information. Be prepared to answer:  Alleged victim’s name, address, telephone number, sex, age and general condition  Alleged abuser’s name, age, relationship to victim and condition  Circumstances that lead to the report  If the person is in immediate danger  Best time to contact the person  Callers confidential information  Any other relevant information

18. What happens when a report is made? (cont.) Assessment: depending on the nature and seriousness of the allegations, a trained caseworker will make a face to face contact with the alleged victim within the following time frame: 24 hours if life threatening situations 72 hours for most neglect and non-life threatening physical abuse report 7calendar days for most financial exploitation and emotional abuse reports

19. What happens when a report is made? (con't) Caseworker has 30 days to complete a comprehensive assessment both to determine if abuse happened and need for treatment and intervention. Follow-up: case may be kept open for 15 months from the date of intake to monitor the situation and to reassess the need for different interventions.

20. Can victims refuse services?  State of Illinois is a client’s right to self- determination program  80% of client’s whose abuse is substantiated accept services  Clients can refuse protection services & interventions  If client has neurocognitive impairment Court petition for Guardianship is filed. Court decides best plan of care to assure all needs are met.

21. Slides reprinted through permission of Laura Mosequda, M. D., Associate Dean of Primary Care Chair and Professor of Family Medicine and Geriatrics Keck School of Medicine of the University of Southern California

26. Report Suspected Abuse Remember: Protecting your clients is your job by reporting suspected abuse of any type Make the call. Remember: It is not your job to decided if there is alleged abuse. Assessing the situation is the job of adult protective workers.

27. SLIDES REPRINTED THROUGH PERMISSION OF LAURA MOSEQUDA, M. D., ASSOCIATE DEAN OF PRIMARY CARE CHAIR AND PROFESSOR OF FAMILY MEDICINE AND GERIATRICS KECK SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTHERN CALIFORNIA

29. Example of A Decision Process to Report 1.Gather information about your client and situation; review medical records as indicated 2.Assess situation regarding: client’s mental and physical status, support system and observations. 3.Notify the appropriate authority and document the phone conversation. Provide referring individual with feedback regarding the call and any outcome information.

30. Please do your part:

31. Preventing Financial Exploitation 2001 State wide B*SAFE program (Bankers and Seniors Against Financial Exploitation) Law enforcement and state agencies to address problem Mandatory training of all bank personal who have direct customer contact Local committees are formed to monitor banking concerns

32. Decision to report “suspected” adult abuse based on clues poor physical appearance/sunken eyes/cheeks/pale/ skin test unusually dirty/filthy home and person refusing assistance excessive clutter/hoarding strong odors/garbage/ soiled clothing items around judgment grossly impaired unable to make decisions fire & safety hazards/no heat or water pest/rodent infestation structure appears unsafe bruises/burns/cuts/wounds which haven’t been treated withdrawn/afraid/helpless Caregivers issues like drug or alcohol abuse/violence hx hiding client/conflicting stories/hostility toward client* * What Professionals Need to Know, State of Illinois, Department on Aging (8/13)