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					Adult Protective Services




                            1
           APS OVERVIEW
• Adult Protective Services is the only
  statewide service in Tennessee mandated
  to intervene when adults with mental
  and/or physical impairments are in danger
  because they are unable to provide for
  their own needs or when others
  responsible for their care abuse, neglect,
  or exploit them. (T.C.A. 71-6-101 et seq.)

                                               2
Adult Protective Services works to
 protect the vulnerable adults of
           Tennessee
 With a total staff of approx. 150
  people (includes CSA’s and
             Clerical)
     serving the 95 counties
           of the State.
                                     3
               Adult Protective Services
                                                                    • Purpose

        Striving to
               Balance
                                                                      – To prevent abuse,
                              the Rights                                neglect, and financial
                                  of Adults
                                                                        exploitation; and
                                                                      – To provide services to
                                                                        adults in need of
                                                                        protection and who are
                                                                        dependent on the
         Protection                           Self- Determination
                                                                        service to some extent
                                                                        for protection

Protection               VS             Self-Determination                                   4
       BASIC PRINCIPLES
• Client participation
• Remain at home or in the community
• Least restrictive/intrusive action
• Families and caregivers should help meet
  needs
• Legal action is last resort
• Rights restored when decision-making
  ability is regained
                                             5
            APS HISTORY
• Legislation passed in 1974:
     Protective services to be provided to
     adults aged 60 and older

• Legislation amended in 1978:
     Protective services to be provided to
     mentally or physically impaired adults
     regardless of age (18+)
                                              6
       Definition of Self-Neglect
Self-Neglect occurs
 when a dependent          – Approximately 59%
 adult is unable to care     of all APS referrals
                             are self-neglect
 for him/herself or to
 obtain needed care
 and the impairments
 result in significant
 danger to the adult.



                                                7
           Definition of Capacity &
              Imminent Danger
 Capacity to Consent               Imminent Danger
    The mental ability to make        Conditions calculated to and
     a rational decision, which         capable of producing within a
                                        relative short period of time a
     includes the ability to
                                        reasonably strong probability
     perceive, appreciate all           of resultant irreparable
     relevant facts and to reach        physical or mental harm
     a rational judgement upon          and/or the cessation of life if
      such facts.                       such conditions are not

    A decision to refuse                 removed or alleviated.
     services cannot itself be          Both conditions must be
     the sole evidence for               evaluated & met before APS
     finding the adult lacks the          seeks custody of an adult.
     capacity to consent.

                                                                          8
   Title 71 Civil Interventions
• Consent to medical examinations, treatment,
  and/or placement, 71-6-107(a)(1)

• Consent to Provide Services, 71-6-107(b)(1)

• Search Warrant, 71-6-103(f)

• Temporary restraining orders & Injunctions,
  71-6-104 (p.107 FG)
                                                9
   Title 71 Civil Interventions
• Involuntary Order for mental/physical
  examinations, only 71-6-103(1)

• Appointment of a temporary guardian to
  secure and disburse resources,
  71-6-107

• Right of elderly person or disabled adult to
  recover damages for abuse or neglect, sexual
  abuse or exploitation, or theft, 71-6-120

                                                 10
       Title 71 Civil Statutes
• Entry to Health Care Facilities and Private
  Premises; 71-6-103 (e)(f)
• Access to Mental and Physical Health
  Records; 71-6-103 (j)(1)(2)(3)(4)
• Commitments may NOT be made under
  the Tennessee Protection Act; 71-6-108



                                            11
• No involuntary services can be provided
  unless legal standards within the TN Adult
  Protection Act are met and the court
  authorizes a specific legal intervention.
  Custody requires that the adult be
  incapable of understanding the risks and
  consequences of his or her decision and
  that he or she be in danger of irreparable
  harm or death.


                                           12
          Rights VS Protection
     Bill of Rights                Adults have the right to be
     Right to self-                 protected from abuse, neglect,
      determination                  and financial exploitation.
                                     When adults are unable to
     Right to be safe &             protect themselves, APS staff
      protected                      attempt to provide that
     Right to decide what is        protection.
      best when one has
      capacity
                                                          Adult’s
     Right to be respected
                                                           Bill
     Right to live with dignity
     Right to say how one
                                                            of
      feels and what one wants                            Rights
     Right to be heard and
      have people listen
     Right to say NO               Adults, who have capacity, have the
     Right to receive value for   right to refuse services/protection.
      payment                                                              13
   What Happens Once an APS
        Referral Is Made
• A DHS/APS counselor will visit the adult to determine the need for
  protective services.
• Family, friends, or professionals who know about the adult's
  situation may be contacted.
• The APS counselor will work with the adult victim and others (family,
  friends, volunteers, and professionals) to assist the adult and reduce
  the danger.
• If the adult victim is capable, he/she will be encouraged to make
  decisions regarding needed care or services. Whenever it is
  possible, APS staff will assist the adult in remaining in his/her home
  or community.
• Some adults may refuse help. Legally, services cannot be forced on
  an adult, except in special circumstances as specified in the law.
  Involuntary services always require a court order

                                                                       14
Examples of Inappropriate APS
          Referrals
• Quality of care issues
• Violations of civil rights UNLESS the
  violation rises to the level of abuse or
  neglect
• A patient in a NH whose bill is not being
  paid.



                                              15
 Examples of Appropriate APS
          Referrals
• Any suspected abuse (physical, emotional,
  and sexual) and neglect by anyone,
  including employees of the LTC and family
• A facility resident who appears to be self-
  neglecting




                                           16
         DHS/APS DUTIES
• Receive reports of abuse, neglect
  (including self-neglect), and financial
  exploitation as defined in the Adult
  Protection Act
• Intervene to prevent premature or abusive
  death
• Intervene to prevent suffering


                                          17
          DHS/APS DUTIES

Initiate investigation:
       • Private homes
       • On the street
       • All types of facilities (exception:
       state-operated MH/DD institutions)


                                               18
           DHS/APS DUTIES
• Notify law enforcement

• Notify appropriate licensing authority

• Make written reports

• After investigation and assessment, notify
  complainant of determination

• Provide needed protective services when
  resources allow
                                               19
      Statistically Speaking…
• In 2007, Tennessee
  investigated
  approximately 8878
  reports of abuse,
  neglect and
  exploitation of
  vulnerable adults.




                                20
• In 2007, Adult Protective Services
  provided services to 11,239
  vulnerable adults.




                                   21
     Types of Abuse, Neglect or
      Exploitation Investigated

1. Self Neglect
2. Neglect by Others
3. Physical Abuse
4. Sexual Abuse
5. Emotional Abuse
6. Financial Exploitation

                                  22
          APS STATISTICS
              (2007)
Types of Abuse, Neglect or Exploitation
  Investigated
• 56% - Self-neglect
• 34% - Neglect by Others
• 12% - Physical Abuse
• 2% - Sexual Abuse
• 13% - Emotional Abuse
• 13% - Financial Exploitation
                                          23
           APS STATISTICS
               (2007)
• Almost 60% of the cases investigated
  were valid for protective services
• 85% of identified perpetrators were related
  to the victim, including:
   16% spouses
   43% adult children



                                            24
          APS STATISTICS
              (2007)
APS—Addressing the Need

• 82% of clients accepted services
• 18% of client refused services
• Only 2% of cases needed legal actions




                                          25
       Percent of Clients by Age
                 2005   2006   2007
•   18-59        33%    32%     32%
•   60 & over    67%    68%     68%
•   70-79        24%    23%     22%
•   80-89        22%    22%     24%
•   90 & over    6%     6%       5%



                                      26
Percent of Cases Investigated
 Valid for Protective Services


  • 2006                 • 2007

                         61%
   61%

    • National Average

           48.5%                  27
            What is Important

• Our TN Dept. of Human Services APS
  staff have a challenging job trying to help
  the vulnerable adult maintain their self-
  sufficiency, dignity, and respect in all
  aspects of their lives to the greatest extent
  possible.



                                              28
      A Community Concern
• There is NO single agency/organization
  that can provide all the needed services
  and protection that disabled & elderly
  adults require and deserve!
• It takes involvement & interaction from
  everyone to meet the needs of this
  vulnerable population---- TEAMWORK!


                                             29
              Other Resources
• Some other Agencies/Organizations
  –   Long Term Care Ombudsman Program
  –   Disability Law Center and Advocacy
  –   TN Department of Healthcare Facilities
  –   TBI; Medicaid Fraud Control Unit
  –   State Victim Compensation Program, VOCA
  –   Area Agencies on Aging & Disability, TCAD
  –   Legal Aid Society, VOCA
  –   Department of MH/DD & Division of Mental
      Retardation Services
                                                  30
           APS Intake Sites
•   Knoxville---865-594-5685
•   Chattanooga---423-634-6624
•   Nashville---615-532-3492
•   Memphis---901-320-7220
•   TTY: 1-800-270-1349 or 615-532-8569

• Phones are answered M-F, 8A to 4:30P
• After hours—leave a message
                                          31
  APS TOLL-FREE
REPORTING NUMBER

   1-888-APS-TENN

   1-888-277-8366


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