Vulnerable Adult/Mandated Reporter Training

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Vulnerable Adult/Mandated Reporter Training

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Vulnerable Adult/Mandated Reporter Training

• Sandra Henkel-Johnson, LICSW
• Lindsay Guinee, SW
• St. Louis County Public Health and
  Human Services

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Vulnerable Adult Law

• 1977, law was created as a result of a rape of a
  30 year old nursing home resident who was
  non-verbal and bed bound
• Not investigated, no one ever charged
• Family persisted to ensure others have more
  protection under the law.

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Vulnerable Adult Law cont..

• In 1980, the MN Legislature passed MS 626.557,
  which declared the public policy of the State of
  MN was to protect vulnerable adults.
• Legislation implemented at DHS in 1981 with the
  creation of the Adult Protective Services (APS)
  Unit.
• Significant changes to the law in 1995 to include
  financial exploitation

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Purpose of VA Law

• Protect adults who are vulnerable to
  maltreatment
• Provide safe living environments for adults who
  have been maltreated
• Assist persons charged with the care of
  vulnerable adults to provide safe environments.

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Adult Protection Services the VA Law

• The adult is the only person we are mandated to
  serve NOT
• -the community, concerned with safety
• -landlords, concerned with property
• -citizens, concerned with crime/morality
• -families, concerned with finances.

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Vulnerable Adults Two Types

• Categorical Dependent on receiving certain
  services
• Functional Impaired ability to meet basic needs
  and protect self from harm

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Categorically a Vulnerable Adult is

• Any person 18 years of age or older who is a
• -Resident or inpatient of a facility, regulated
  by MDH or DHS, or
• -Receives services from a facility, regulated by
  MDH or DHS, or
• -Recipient of home care services from MDH
  facility or PCA services

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Not Categorically Vulnerable

• Persons receiving outpatient services for
  treatment of chemical dependency or mental
  illness
• Domestic abuse victims
• Persons who receive social security disability

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Functionally a Vulnerable Adult is

• A person 18 years of age or older who, regardless
  of residence or service has an
• -Impairment or disability, and because of this
  impairment has
• an impaired ability to meet basic needs
  without assistance, including the provision of
  food, shelter, clothing, health care or
  supervision and
• an impaired ability to protect self from
  maltreatment.

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MALTREATMENT

• Abuse physical, emotional or sexual
• Neglect failure to provide for food, clothing,
  shelter, medical care and/or supervision
• Financial Exploitation misuse of funds, assets
  or property or the failure to use the VAs
  resources to care for VA, which results in or
  likely to result in detriment to the VA.

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What is Abuse?

• Physical Hitting, slapping, kicking, pinching,
  biting or corporal punishment. Also includes
  Assault 1st 5th degrees
• Emotional Repeated or malicious oral, written or
  gestured language or treatment that would be
  considered disparaging, derogatory, humiliating,
  harassing or threatening.
• Mental unauthorized aversive/deprivation
  procedures unreasonable confinement/seclusion

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Abuse continued

• Sexual Criminal sexual conduct 1st 5th degrees
• Involuntary Servitude Forcing, compelling or
  coercing or enticing a vulnerable adult to
  provide services for the advantage of another
• Use of drugs to injure or facilitate a crime

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What is Neglect?

• Failure or omission to provide for basic needs
  food, clothing, shelter, medical care, or
  supervision.
• Absence of care or services essential to maintain
  health and safety
• Neglect may be by caregiver or self-neglect.

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What is Financial Exploitation?

• Person has fiduciary relationship
  guardian/conservator/POA/joint acct/contract/docum
  ented consent/etc
• - and there is unauthorized expenditure of funds
  or failure to use funds for VA and resulting or
  likely to result in detriment to VA

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Financial Exploitation cont..

• Person has No fiduciary relationship and
• - Willfully uses/withholds/disposes of
  funds/property of VA
• - Obtains for self/another services to detriment
  of VA
• - Acquires possession/control/interest in VAs
  property / funds through harassment / undue
  influence / duress / deception /fraud
• Forces / compels / coerces /entices VA to perform
  services for anothers advantage

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Reporters Two Types

• Mandated
• Voluntary

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Mandated Reporters Who are They?

• Social Services
• Law Enforcement
• Educators
• Licensed health human service professionals
• Personal Care Attendants
• Employees of licensed facilities (AFC, group
  homes, day programs, etc)
• Employees of health care facilities or programs
  (Nursing Homes, Home Health Agencies)
• Medical examiner or coroner

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Mandated Reporters

• Are Required by Law to Report
• Identity is considered confidential and may not
  be disclosed.
• -EXCEPTIONsubject of report may compel
  disclosure only with consent of the reporter or
  upon a written finding by a court that the report
  was false and there was evidence that it was made
  in bad faith.

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Reporting

• Any person making a report in good faith is
  immune from civil criminal liability.
• Any one may report, report is protected by law.
• Mandated reporters required to report
  immediately (defined as within 24 hours) if they
  have reason to believe maltreatment to a VA has
  or is occurring.
• -A PROFESSIONAL FAILING TO REPORT IS GUILTY OF A
  MISDEMEANOR.

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Criminal Failure to Report

• Mandated reporter who knows or has reason to
  believe that a VA is being or has been maltreated
  intentionally fails to make a report or knowingly
  provides false, deceptive or misleading
  information or withholds information surrounding
  an incident.
• Penalty 90 days/700 fine

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Criminal Failure to Report

• Mandated reporter who knows or suspects that a VA
  has been maltreated, causing or contributing to
  the death or great bodily harm of VA,
  intentionally failed to report to protect own
  interest.
• Penalty one year/3000 fine

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What to Report

• Time and date of report
• Name, address and phone number of reporter
• Time, date location of incident
• Names, addresses, DOB or age of alleged
  perpetrator victim
• Names of witnesses
• Risk of imminent danger to alleged victim

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What to Report - continued

• Description of suspected maltreatment
• Relationship of perpetrator to victim
• If a facility, who licenses them
• If a facility, who was the initial reporter
  include name, address and phone number of the
  person.

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Reports Not Required When

• Resident to resident verbal or physical
  aggression, or self abusive behavior by those
  residents unless the behavior causes serious harm
  i.e. requires visit to medical provider
  (however facility shall record incidents to
  facilitate review by licensing agencies and
  county and local welfare agencies).

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Reports Not Required cont.

• Single mistake/medication error/ therapeutic
  conduct
• -does not result in injury or harm which
  reasonably requires medical or mental health care
  or
• -does result in injury or harm, which reasonably
  requires the care of a physician but
• the necessary care is provided in a timely
  fashion as dictated by the condition of the VA

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Reports Not Required cont.

• if after receiving care, the health status of
  the VA can be reasonably expected, as determined
  by the attending physician, to be restored to the
  preexisting condition
• the error is not part of a pattern of errors
  by the individual
• internal protocols must be followed
• Transfer of money or property by gift or
  compensation of services rendered

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Reports Not Required cont.

• Accident
• -not likely to occur, could not have been
  prevented by exercise of due care
• -if VA is receiving services from a facility,
  incident occurs when the facility and the person
  providing services in the facility are in
  compliance with the laws and rules relevant to
  the occurrence.

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Reports Not Required cont.

• Examples regarding falls
• -Resident who is independent with walker falls
  while walking in hall. Resident was using walker
  at the time.
• -Resident did not put on call light or call for
  assistance, but got out of bed on own, falls and
  suffers a fractured hip

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Reports Not Required cont.

• Examples regarding falls continued
• -Resident puts on call light for assistance but
  no one answers the light they get out of bed and
  fall, but do not suffer an injury.
• -Falls which are not witnessed. Just because
  the fall is not witnessed does not make this a
  reportable issue. There has to be suspected or
  known neglect or abuse associated with the fall.

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Reports Not Required cont.

• Even if a report is not required to be reported
  to the CEP, a facility still has an internal
  documentation and possible investigation process
  it needs to complete, i.e. incident report to
  licensers, case manager, guardian, etc.

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Retaliation

• Any retaliation or adverse action within 90
  days of report is punishable by law. Penalty up
  to 10,000 fine.
• Adverse action
• -transfer or discharge from facility
• -termination of employment
• -reduction in remuneration of services
• -restriction or prohibition of access to the
  facility or its residents.

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Where to Report

• Reports are made to the Common Entry Point (CEP).
  Available to take a message 24/7. In Minnesota,
  most counties have designated their social
  service agency as the CEP. A complete list of
  CEPs is available at www.mnaging.org or by
  calling 651-296-5563 or 651-297-3984.

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Where to Report continued

• For an incident occurring anywhere in St. Louis
  County
• call 218-726-2164
• Staff on duty 800am 430pm M-F (except
  holidays). Leave message on voice mail at other
  times or
• fax [phone]

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Lead Agencies

• CEP forwards reports to lead agency responsible
  for investigation
• Department of Health
• Investigates reports involving hospitals, home
  care providers, nursing homes, residential care
  homes or board and care homes.
• - Has jurisdiction for patient Bill of Rights
  violations

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Lead Agencies continued

• Department of Human Services
• Investigates reports involving adult day care,
  adult foster care, programs for persons with
  developmental disabilities, mental health
  programs, or chemical health programs.
• - Has background Check Unit as well, which
  includes perpetrator list.

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Lead Agencies - continued

• County Social Services
• - Responsible for all other reports
• - Community investigations
• - Involvement with Law Enforcement. Although
  not a lead agency, law enforcement is the primary
  agency to conduct investigations of any incident
  in which there is reason to believe a crime has
  been committed.

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Investigation

• Upon receiving a report, initial disposition
  needs to be reported within 5 business days,
  provided that notification will not endanger the
  VA or hamper the investigation.
• Final disposition will be completed within 60
  calendar days of receipt of report.

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Investigation Memoranda

• Final report from the lead agency will be issued
  in the form of a public investigation memorandum.
• Report is available to
• VA or their legal guardian
• -Reporter
• -Alleged perpetrator
• -Facility
• -Ombudsman for Long-Term Care or the Ombudsman
  for Mental Health Developmental Disabilities .

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Request for Reconsideration

• The following persons/parties may request
  reconsideration of the final disposition
• -individual or facility which a lead agency has
  determined has maltreated a VA.
• -the VA or an interested person acting on behalf
  of the VA.

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Determinations/Data Destruction

• False 2 years
• Inconclusive 4 years
• Substantiated 7 years
• Non investigated or no final disposition 2 years

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BOTTOM LINE

• The eccentric or culturally different lifestyle
  of a competent person is categorically different
  from the case of self neglect by an incompetent
  individual. And yet, both may look the same.

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So..Competency Means

• People can live a lifestyle others find
  repulsive, even harmful, without interference
  from others.
• People can refuse services which workers believe
  will improve their quality of life.