Goals

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(No Transcript)
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Goals

• Identify risk factors that make adults vulnerable
• Define and identify vulnerable adults,
• Identify abuse, abandonment, exploitation,
  neglect, self-neglect
• Mandatory reporting, to whom, when and what
  information
• APS practice
• Risk factors for caregivers and agencies

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TOPIC 1
Risk Factors
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Identifying risk factors

• Is just one theory of abuse.
• It is not intended to imply that the victim is
  being blamed because they have risks.
• Is a means to identifying preventive measures
  that can be taken.
• Also applies to the caregiver and agency.

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Risk factors for abuse
For client, patient or consumer

• Institutional compliance code of silence
• Substance use
• Need for friendship
• Trust and boundary challenges
• Cognitive limitations

• Functional limitations
• Disruptive or aggressive
• Combative
• Stress
• Conflicts
• Hiring and screening

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Vulnerable Adult
Statutory definition AS 47.24.900

• A person 18 years of age or older who, because
  of physical or mental impairment, is unable to
  meet the persons own needs or to seek help
  without assistance.

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How do you determine if someone is a vulnerable
adult?

• What are their physical abilities?
• What is their mental capacity?
• Are they able to meet their own needs?
• Are they able to seek help without assistance?

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Incapacitated person
Statutory definition AS 47.24.900 (8)

• A person whose ability to receive and evaluate
  information or to communicate decisions is
  impaired to the extent that the person lacks the
  ability to provide or arrange for the essential
  requirements for the persons physical health or
  safety without court-ordered assistance.

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There are degrees of vulnerability.

• Are all people who have identified risks or
  disabilities always vulnerable adults?
• Is a 75 year-old with dementia always going to be
  more vulnerable to abuse compared to a 50
  year-old with dementia?

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TOPIC 2
Defining abuse
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Types of Abuse

• These are the statutory identified types
• Abuse physical, sexual, emotional
• Abandonment
• Exploitation
• Neglect
• Self-neglect

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Abuse
Statutory definition AS 47.24.900 (2 A,B)

• The willful, intentional, or reckless,
  non-accidental and non-therapeutic infliction of
  physical pain, injury, or mental distress.

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Signs of abuse

• Verbal assaults, intimidation or threats
• Unexplained bruises or skin tears
• Unjustified physical or chemical restraints
• Unexplained stained, torn or bloody underwear
  bruises or bleeding, pain or itching in genital
  or anal areas
• Crying or combativeness when a certain caregiver
  is on duty
• Crying or combativeness when a certain person
  visit

BACK
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Abandonment
Statutory definition AS 47.24.900 (1)

• The desertion of a vulnerable adult by a
  caregiver.

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Signs of abandonment

• Failure to stay with person in the Emergency Room
  or doctors office when the person is unable to
  communicate needs
• Ignoring requests by the assisted living home

BACK
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Exploitation
Statutory definition AS 47.24.900 (7)

• The unjust or improper use of another person or
  another persons resources for ones own profit
  or advantage.

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Signs of exploitation

• Reports of no food or not enough food, money,
  needed supplies, medication, etc.

• People have moved into the home

• Complaints that specific personal resources or
  monies are missing
• Complaints of excessive unsubstantiated bills

BACK
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Neglect
Statutory definition AS 47.24.900 (9)

• The intentional failure by a caregiver to
  provide essential care or services to maintain
  the physical and mental health of the vulnerable
  adult.

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Signs of neglect

• Nutrition/Hydration Inadequate provision of
  food or water
• Personal care Fails to dress appropriate for
  weather conditions fails to change soiled
  bedding
• Mobility care Fails to assist with transfers
  pressure ulcers are present

Medical care/medication management Fails to
take to the doctor does not administer meds as
ordered Social needs Isolates a person in their
room environment is lacking adequate mental
stimulation or emotional support
BACK
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Self-neglect
Statutory definition AS 47.24.900 (13)

• An act or omission by a vulnerable adult that
  results, or could result, in the deprivation of
  essential services necessary to maintain minimal
  mental, emotional, or physical health and safety.

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Signs of self-neglect

• Poor personal hygiene
• Inappropriate dress for weather conditions
• Evidence of health or safety hazards
• Inadequate provision of food or water
• Reports of no food or not enough food, money,
  needed supplies, medication, etc.
• Weight loss
• Pressure ulcers
• Receiving shut off notices

BACK
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Self-neglect statistics

• All substantiated cases of elder mistreatment for
  20 states in fiscal year 2004
• 39.3 were cases of self-neglect
• 21.6 were due to caregiver neglect

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Emotional and behavioral signs of possible abuse

• Isolation or withdrawal
• Depression or sadness
• Anxiety or fearfulness
• Disturbance in sleeping or eating
• Vague physical complaints with no identifiable
  cause

• Verbalizations about feeling worthless
• Crying or combativeness when a certain caregiver
  is on duty
• Crying or combativeness when a certain person
  visits
• Neglected or abused pets

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TOPIC 3
Mandatory Reporting
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Mandatory reporters
Statutory definition AS 47.24.010

• Physician or other licensed health care provider
• Mental health professional
• Pharmacist
• Emergency medical technician or paramedic
• Certified nurse aide

• Village health aide
• Employee of a personal care or home health
  program
• Administrator of a nursing home, residential care
  or health care facility
• (continued)

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Mandatory reporters
Statutory definition (continued) AS 47.24.010

• Caregiver of vulnerable adult
• Guardian or conservator
• Social worker
• Police officer
• Village public safety officer
• Clergy members

• Employee of any project funded by the Department
  of Administration for services for Older
  Alaskans, Dept. of Health and Social Services or
  the Council on Domestic Violence and Sexual
  Assault

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Failure to Report
Statutory guideline AS 47.24.010 (c)

• If you have reason to believe that a vulnerable
  adult has suffered abuse, neglect, self-neglect,
  abandonment or exploitation, and you fail to make
  a Report of Harm, you are guilty of a class B
  misdemeanor.

• If you do not report, you may also
• Contribute to the harm of the vulnerable adult
• Receive a fine of not more than 2,000 and/or
  jail time not more than 90 days
• Lose your professional reputation/license

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Reports of Harm
Statutory guideline AS 47.24.010 (a)

• A mandatory reporter who in the performance of
  their professional duties, has reasonable cause
  to believe that a vulnerable adult has been
  abused shall, not later than 24 hours after first
  having cause for the belief, report the belief.

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All reports go to Adult Protective Services.

• They are the centralized intake for all reports
  of harm.

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Reports of Harm
Statutory guideline AS 47.24.010 (e)

• If the person making a report under this section
  believes that immediate action is necessary to
  protect the vulnerable adultthe reporting person
  may make the report to a police officer or a
  village public safety officer.

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Who should you call?
Always call
In an emergency call

• Adult Protective Services (APS)

• Law enforcement first
• Follow up to make sure Adult Protective Services
  (APS) has the report too

• Your duty to report is met when you call APS
  and/or law enforcement and/or Long Term Care
  Ombudsman.

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What to provide in the report.

• Name, address, phone, DOB, medical conditions,
  insurance, capacity of victim
• Name, address, phone, DOB of alleged perpetrator.
• The circumstances and allegations of abuse.
• Your name, address, phone number and role with
  victim.
• Other agency names and involvement.
• Other family members.

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Anonymous reporting.

• Pros and cons.
• When is your name not protected.
• Importance of the reporter.

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Mandatory reporters
Statutory protection AS 47.24.020 (a)

• A reporter is immune from civil or criminal
  liability
• A reporter is free from retaliation by a
  supervisor or employer

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Why dont people report abuse?
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Here are some reasons given to APS.

• Agency policy states they cannot report.
• Didnt think it was reportable.
• Didnt know they needed to report.
• Thought the behavior was justified.
• Didnt think any harm was done.
• Wasnt seen as abusive since that was how they
  were brought up.

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More stated reasons why not reported.

• Thought it was a substance abuse problem.
• Thought it was none of their business.
• Afraid they would lose their job.
• Everyone will know they called.
• No one ever does anything.

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APS Guiding Principles

• APS serves the adult client
• The adult client is in charge of decision-making
• Freedom is more important than safety
• APS simultaneously seeks to achieve freedom,
  safety, least disruption to lifestyle and least
  restrictive options

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APS caseload

• Caseload far exceeds rest of nation
• Statewide APS has three offices, eight
  caseworkers, one supervisor
• Statute allows for designees

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Note You may also fax or email APS
APS phone numbers

• Anchorage
• 269-3666
• Fairbanks
• 451-3187
• Juneau
• 465-4791
• Statewide
• [phone]

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Reporting

• can be done anonymously
• Call within 24 hours
• You do not have to have all of the facts
• The person with firsthand knowledge is to make
  the report

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APS response

• promptly initiate an investigation
• Conduct a face-to-face interview unless this
  could further endanger the vulnerable adult.
• Provide protective service within 10 days or as
  soon as possible.
• Confidentiality is maintained.

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Case

• 68 year old woman who lives with her husband who
  has shown up at her church with bruises on her
  face. She appears to be confused. What do you
  need to find out?

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Case

• 37 year old woman who has MS has come to your
  shelter stating her live-in boyfriend and
  personal care attendant has been abusing her.
  What do you need to know before you report?

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Case

• 55 year old woman what has developmental
  disabilities has a guardian and is reporting that
  her brother is hitting her. What do you need to
  know?

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TOPIC 4
Caregiver Risk Factors and Agency Risk
Factors
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Caregiver risk factors

• Exhaustion
• Burnout
• Compassion fatigue
• History of abusing
• Economic difficulties
• Substance use/abuse
• Gender/female

• code of silence
• Difficulties at home
• Feeling devalued
• Lack of training
• Mental health problems

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Stress does not cause abuse.

• Caregiver abuse often looks more like domestic
  violence.

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Agency risk factors

• Inadequate staff supervision
• Failure to maintain best practice staffing
  patterns
• Inadequate background checks
• Inadequate hiring practices

• code of silence
• Agency policy and state statute conflict
• Mandatory reporting is only for managers or
  supervisors
• Inadequate training
• Different outcome measures

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Questions and comments?

• Thank you for coming.