ADULT PROTECTIVE SERVICES

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• ADULT PROTECTIVE SERVICES
• COMMUNITY IN-SERVICE
• Developed by
• APS Special Operations Section

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Adult Protective Services

• Training Objectives
• 1. Provide an overview of Elder/Dependent Adult
  abuse to increase awareness.
• 2. Provide an overview of the roles and
  responsibilities of APS.
• 3. Provide information on mandatory reporting
  laws.

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WHERE IS ELDER DEPENDENT ADULT ABUSE OCCURING
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EVERYWHERE!ELDER DEPENDENT ADULT ABUSE OCCURS
IN ALL COMMUNITIES REGARDLESS OF INCOME,
ETHNICITY OR RELIGIOUS BACKGROUND
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PREVALENCE OF ELDER DEPENDENT ADULT ABUSE

• The United States Census Bureau projects that
  California's elderly
• population will nearly double within the next 20
  years -- from 3.7 million to
• more than 6.4 million.
• Studies indicate that each year, an estimated 2.5
  million Americans
• are victims of elder and dependent adult abuse or
  neglect in domestic
• settings.
• Senior population in Los Angeles County according
  to 2000 Census
• is 925,000 and growing steadily. Nearly 3 ½
  million statewide.
• In Los Angeles County alone there are
  approximately 1500-1800 new
• APS referrals a month or over 18,000 per year.
• There are about 125 APS social workers countywide.

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WHAT IS ELDER DEPENDENT ADULT ABUSE?

• Elder/Dependent Adult Abuse refers to any
  knowing, intentional, or negligent act by a
  caregiver or any other person that causes harm or
  a serious risk of harm to a vulnerable adult.

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WHAT IS ADULT PROTECTIVE SERVICES? (APS)

• Adult Protective Services (APS) is a State-
  mandated service program which mandates
  investigation of all abuse/neglect situations
  involving the following persons
• Elderly 65 and over
• Dependent Adult 18-64, who has physical or
  mental limitations

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OPEN 24 HOURS

• APS operates a 24-hour emergency response system
  which provides in-person response in life
  threatening situations.

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TYPES OF ABUSE

• The following is a description of the many
  different forms of abuse that are perpetrated
  against elders and dependent adults. APS is
  responsible for investigating cases involving
  these forms of abuse.
• THE FOLLOWING SLIDES CONTAIN GRAPHIC PICTURES
  OF ABUSED ELDERLY AND DEPENDENT ADULT VICTIMS.

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TYPES OF ABUSE

• Physical, including sexual
• Psychological
• Neglect, Including Self-Neglect
• Isolation
• Financial
• Abandonment
• Abduction

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PHYSICAL ABUSE- the intentional use of physical
force causing pain or bodily harm.
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PHYSICAL ABUSE INCLUDES SEXUAL ABUSE
According to a recent nationwide study, females
represent the largest percentage of
elder/dependent abuse victims. However, trends
seem to indicate that the gap is slowly closing.
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PSYCHOLOGICAL ABUSE

• The intentional infliction of mental
  anguish/suffering by use of threat, intimidation,
  humiliation, or other abusive conduct.

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NEGLECT

• A persons intentional failure to fulfill a
  caregiving obligation needed to maintain an elder
  or dependent adults health and well-being.

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SELF NEGLECT

• A persons failure to provide himself or herself
  with the necessities of life, such as food,
  clothing, shelter, adequate medication, and
  reasonable financial management.

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ISOLATION

• The act of systematic exclusion of a victim from
  all real outside contact.

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ABANDONMENT

• The desertion of a vulnerable elder or dependent
  adult by anyone who has assumed the
  responsibility for care or custody of that
  person.

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IMPORTANT!

• In most cases, elder/dependent adults fall
  victim to more than one form of abuse.
• Neglect Psychological
  Abuse
• Psychological Financial
  Abuse
• Physical Neglect Abuse

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WHAT ARE THE SIGNS OF ABUSE?
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PHYSICAL INDICATORS OF ABUSE

• The following indicators do not signify abuse or
  neglect per se. They can be clues, however, and
  thus helpful in assessing the clients situation.
• Injury that has not been cared for properly
• Any injury incompatible with history
• Pain on touching
• Cuts, lacerations, puncture wounds
• Bruises, welts, discoloration
• Bilaterally on upper arms
• Clustered on trunk, but may be evident over any
  area of the body.
• Morphologically similar to object

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•     
• Pallor
•  
• Sunken eyes, cheeks
•  
• Soiled clothing or bed
• Evidence of inadequate care (e.g., gross decubiti
  without adequate care
• Signs of confinement (tied to furniture, bathroom
  fixtures, locked in a room)
•  
• Dehydration and/or malnourishment without
  illness-related cause loss of weight

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INDICATORS FROM THE FAMILY/CAREGIVER

• The older client may not be given the
  opportunity to speak for him or herself, or to
  see others without the presence of the
  caregiver/suspected abuser
• Obvious absence of assistance, attitudes of
  indifference, or anger toward the dependent
  person
• Family member or caregiver blames the
  client (e.g., accusation that incontinence is a
  deliberate act)
• Aggressive behavior (threats, insults,
  harassment)
• Previous history of abuse to others
• Problems with alcohol or drugs

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INDICATORS FROM THE FAMILY/CAREGIVER (Cont.)

• Flirtations, coyness, etc., as indicators of
  possible inappropriate
• sexual relationship
• Social isolation of family, or isolation or
  restriction of activity of the
• older adult within the family
• Conflicting accounts of incidents by the family,
  supporters victim
• Unwillingness or reluctance to comply with
  service providers in
• planning for care and implementation
• Withholding of security and affection

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POSSIBLE INDICATORS OF FINANCIAL ABUSE

• Unusual interest in the amount of money being
  expended for the care of the older person,
  concern
• that too much is being spent
• Recent acquaintances expressing gushy, undying
  affection for a wealthy older person
• Recent change of title of house in favor of a
  friend when the older person is incapable of
• understanding the nature of the transaction
• Recent will when the person is clearly incapable
  of making a will
• Caretaker asks only financial questions of the
  worker, does not ask care questions
• Placement not commensurate with alleged size of
  the estate
• Lack of amenities, i.e., TV, personal grooming
  items, appropriate clothing when the estate can
  well
• afford it

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What makes an older adult vulnerable to abuse?
Poor Health Dependency Social isolation
Mental impairment (such as dementia or
Alzheimer's disease) Mental Illness History of
Domestic Violence
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WHY DO ABUSERS ABUSE?

• A few theories 
• Overburdened Caregiver/Stress
• Untrained/under-trained Caregiver
• Impairment of victimizer/abuser. e.g. mental
  illness, cognitive impairment, health issues,
  alcoholism
• History or pattern of violent behavior. E.g.
  learned behaviors
• Financial problems/Dependency/Greed

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Typical Abuser Profile

• Male Son (45-55)
• Unemployed
• Dependent on parent/parents for finances
• Alcohol or drug dependent

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However, abusers come in all shapes and sizes!
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California Penal Code Section 368b(1)

• Any person who, under circumstances or
  conditions likely to produce great bodily harm or
  death, willfully causes or permits any elder or
  dependent adult, with knowledge that he or she is
  an elder or a dependent adult, to suffer, or
  inflicts thereon unjustifiable physical pain or
  mental suffering, or having the care or custody
  of any elder or dependent adult, willfully causes
  or permits the person or health of the elder or
  dependent adult to be injured, or willfully
  causes or permits the elder or dependent adult to
  be placed in a situation in which his or her
  person or health is endangered, is punishable by
  imprisonment in a county jail not exceeding one
  year, or by a fine not to exceed six thousand
  dollars (6,000), or by both that fine and
  imprisonment, or in the state prison for two,
  three, or four years.
• Revisions to Section 368 effective January 1,
  2004 add forgery, fraud and identity theft to the
  list of crimes (which includes theft and
  embezzlement) that are punishable under this
  Section of the law.
• Punishment can increase to as much as seven
  years if the victim is 70 years of age or older.
  Punishment is also greater for repeat offenders.

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• Consequences to the abuser
• Violation of PC 368 can result in a misdemeanor
  or felony charge depending upon the seriousness
  of the crime.
• Sentence Range
• Imprisonment in County Jail not exceeding one
  year, or a fine not to exceed six thousand
  dollars
• Up to 7 years imprisonment in State Prison

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What does APS do once a report is made?

• From their first contacts with victims, APS
  workers make critical decisions about clients'
  levels of risk and appropriate interventions.
• Face-to-face contact with the client is
  required to investigate and assess the situation.
  
• APS response times range from immediate to 10
  calendar days.

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What does APS do once a report is made?

• Upon receipt of a report, an APS Social Worker
  will typically make a
• face-to-face contact with the client to
  investigate and assess the
• situation.
• When appropriate, APS staff work closely with
  local law enforcement
• agencies in investigating reports of abuse,
  neglect and exploitation.
• If the client is endangered, has sufficient
  mental capacity, and is
• willing to cooperate, the Social Worker will
  assist the client and
• other interested parties to eliminate or reduce
  the endangerment
• through providing necessary intervention
  services and longer term
• follow-up and monitoring services, as
  appropriate for the client.

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• Other than the activities associated with the
• investigation of alleged criminal abuse, neglect
• or exploitation of the client, the services of
  this
• program are voluntary and are provided only
• with the client's consent.

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What does the APS Social Worker do?

• Interview/Investigate Includes client, abuser,
  family, collaterals, witnesses etc.
• Assess Includes assessment of the clients major
  risk factors such as functional abilities,
  cognitive functioning, mental/emotional health,
  environmental factors, medical care, support
  system and finances.
• Develop Service Plan/Intervention Includes lists
  of interventions and strategies to resolve the
  clients problems.
• Reassess Reassess the service plan if abuse or
  neglect continues.
• Case Resolution/Closure Close case or refer case
  to a monitoring agency.

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SERVICE ACTIVITIES

• The following are some of the specific
  activities that an APS worker would perform in
  assisting recipients (clients) of Adult
  Protective Services
• Mobilizes or obtains the assistance of emergency
  personnel such as law enforcement or paramedics
  in life-threatening situations
• Arranges for available temporary emergency
  shelter for those endangered by an abusive
  environment
• Provides counseling and information and referral
  services

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SERVICE ACTIVITIES

• Provides liaison services to assist the client in
  communicating or dealing more effectively with
  people or agencies, like landlords, doctors,
  hospitals and creditors
• Advocates on behalf of the client in situations
  where he cannot act effectively on his own
  behalf
• Arranges for services on behalf of the clients
  with other service agencies
• Consults with other professionals

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Critical Issues of impact in regard to APS and
Elder/Dependent Adult Abuse Investigations

• Mental Capacity, Consent, and Undue Influence
• Autonomy and Self-Determination
• Role of Culture
• Elder Abuse and Substance Abuse

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EXAMPLES OF APS SITUATIONS
Examples of situations responded to through the
APS program are those involving clients reported
to be Unconscious, immobilized or in severe
pain and in need of immediate medical attention
or hospitalization Severely malnourished or
dehydrated Tied, chained, locked up or
otherwise physically restrained or
confined Exposed to a life-threatening health
or safety hazard Severely mentally or
emotionally disturbed and a serious danger to
themselves or others

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Mandatory Reporting

• There are certain organizations and individuals
  that are bound by law to report suspected
  incidents of elder or dependent adult abuse. APS
  receives cases from mandatory reporters as well
  as individuals who are not mandated, such as
  family members, friends, neighbors or other
  concerned citizens.

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WHO MUST REPORT?

•   Mandated reporters include persons who have
  assumed full or intermittent responsibility for
  the care or custody of an elder or dependent
  adult, whether or not they are compensated for
  their services. Also included are
  administrators, supervisors and licensed staff of
  a public or private facility that provides care
  or services for elders or dependent adults, and
  elder or dependent adult care custodians, health
  practitioners, clergy members, and employees of
  county adult protective services agencies and
  local law enforcement agencies.
• Refer to the Elder and Dependent Adult
  Abuse Reporting Guide for a complete listing of
  mandatory reporters.

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WHAT DOES THE LAW REQUIRE?

•   The W I Code requires the mandated reporter
  to make a report whenever, in his/her
  professional capacity or within the scope of
  his/her employment, the following occurs
• The reporter observes or has knowledge of an
  incident that reasonably appears to be abuse, or
• The reporter is told of an incident by the
  victim, or
• The reporter reasonably suspects abuse.

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WHAT MUST BE REPORTED?

• Physical abuse (including sexual abuse),
  abandonment, abduction, isolation, financial
  abuse, and neglect, including self-neglect.
• Voluntary reports of other types of abuse, such
  as mental abuse, are also strongly encouraged.

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WHAT ARE THE PENALTIES FOR NOT REPORTING?

• Failure to report may result in the following
• A misdemeanor violation, punishable by
  imprisonment in the county jail for up to six
  months, or a fine of up to 1000, or both.
• If the reporter willfully fails to report and the
  abuse results in the victims death or great
  bodily injury, the reporter may be punished by
  imprisonment in the county jail for up to one
  year, or a fine of up to 5000, or both.

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EXCEPTIONS TO THE REPORTING REQUIREMENT

• Excerpts from California WIC, Sections 15630 (2)
  (A)
• A mandated reporter who is a physician and
  surgeon, a registered nurse, or a
  psychotherapist, shall not be required to report
  a suspected incident of abuse where all of the
  following conditions exist
• (I) The mandated reporter has been told by an
  elder or dependent adult that he or she has
  experienced behavior constituting physical abuse,
  abandonment, isolation, financial abuse or
  neglect.
• (ii) The mandated reporter is not aware of any
  independent evidence that collaborates the
  statement that the abuse has occurred.
• (iii) The elder or dependent adult has been
  diagnosed with a mental illness or dementia, or
  is the subject of a court-ordered conservatorship
  because of a mental illness or dementia.
• (iv) In the exercise of clinical judgment, the
  physician and surgeon, the registered nurse, or
  the psychotherapist, as defined in Section 1010
  of the Evidence Code, reasonably believes that
  the abuse did not occur.

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PERSONS REPORTING ELDER OR DEPENDENT ADULT ABUSE
CONTACT OUR CENTRAL INTAKE UNIT (CIU).

•  Adult Protective Services
• Centralized Intake Unit
• 3333 Wilshire Blvd., Suite 400
• Los Angeles, CA 90010
•  
• Telephone [phone]-CIU (888-202-4248)
• Fax [phone]
•  
• After Hours Telephone
  877-4-R-SENIORS
• (877-477-3646)

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Abuse in Long-Term Care Facilities

• When abuse or neglect is suspected to have
  occurred in a long-term care facility (such as
  Nursing Homes, Skilled Nursing Facilities etc),
  report either to the local law enforcement agency
  or to
• Long Term Care Ombudsman
• 1527 Fourth Street, Suite 250
• Santa Monica, Ca. 90401
• Telephone 800/334-WISE
• FAX [phone]
• After Hours Telephone [phone] (State Crisis
  Line)