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					ADULT PROTECTIVE SERVICES


      COMMUNITY IN-SERVICE



             Developed by
      APS Special Operations Section
     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.
WHERE IS ELDER & DEPENDENT ADULT
         ABUSE OCCURING
EVERYWHERE!
ELDER & DEPENDENT ADULT
ABUSE OCCURS IN ALL
COMMUNITIES REGARDLESS OF
INCOME, ETHNICITY OR
RELIGIOUS BACKGROUND
     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.
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.
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
           OPEN 24 HOURS


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


Physical, including sexual
Psychological
Neglect, Including Self-Neglect
Isolation
Financial
Abandonment
Abduction
PHYSICAL ABUSE- the intentional
use of physical force causing pain
or bodily harm.
PHYSICAL ABUSE INCLUDES
SEXUAL ABUSE
  Sex of Victims of Elder Abuse


  Male
 32.4%




                                  Female
                                  67.3%

 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.
   PSYCHOLOGICAL ABUSE

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


A person’s intentional failure to fulfill a
caregiving obligation needed to maintain an
elder or dependent adult’s health and well-
being.
SELF NEGLECT




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


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


The desertion of a vulnerable elder or dependent
adult by anyone who has assumed the
responsibility for care or custody of that person.
             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
WHAT ARE THE SIGNS OF ABUSE?
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
    client’s 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
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
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
    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
                      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
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
    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
      Typical Abuser Profile


Male Son (45-55)

Unemployed

Dependent on parent/parents for finances

Alcohol or drug dependent
*However, abusers come in all shapes
and sizes!
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.
                   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
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.
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.
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.
What does the APS Social Worker do?



1.   Interview/Investigate: Includes client, abuser, family,
     collaterals, witnesses etc.
2.   Assess: Includes assessment of the client’s major risk
     factors such as: functional abilities, cognitive functioning,
     mental/emotional health, environmental factors, medical
     care, support system and finances.
3.   Develop Service Plan/Intervention: Includes lists of
     interventions and strategies to resolve the client’s problems.
4.   Reassess: Reassess the service plan if abuse or neglect
     continues.
5.   Case Resolution/Closure: Close case or refer case to a
     monitoring agency.
               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;
              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
    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
      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;
            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.
               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.
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.
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.
     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 victim’s 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.
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.
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: 888-202-4-CIU (888-202-4248)
                    Fax: 213-738-6485
                            
         After Hours Telephone: 877-4-R-SENIORS
                       (877-477-3646)
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 310/395-4090

          After Hours Telephone: 800:231-4024 (State Crisis Line)

				
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