AREA AGENCY ON AGING by hcj

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									 ADULT PROTECTION
OPERATIONS MANUAL
          FOR
     AREA AGENCIES
           Revised July 2007




  Idaho Commission on Aging
  Location:              3380 Americana Terrace, Suite 120
                         Boise, ID 83706

  Mailing Address:       P.O. Box 83720
                         Boise, ID 83720-0007

  Phone:                 208-334-3833

  Fax:                   208-334-3033

  Web address:           www.idahoaging.com



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                          AREA AGENCY ON AGING
               ADULT PROTECTION OPERATIONS MANUAL (Rev. 7/07)

                                     Table of Contents

                 Introduction                                                 1

                                          Chapter 1

                                    Provision of Service

Section I        Investigative Requirements                                    5
Section II       Supportive Services Requirements                             14
Section III      Guardianships                                                15
Section III      Case Closure                                                 17
Section IV       AP Investigations - State Certified or Licensed Facilities   17
Section V        AP Investigations – Waiver Services                          18

                                          Chapter 2

                                Administrative Requirements

Section I        AP Staff Requirements                                        18
Section II       Case Staffing Assistance                                     19
Section III      Expunging Program Case Records                               19
Section IV       Critical Incidents                                           19
Section V        Conflict of Interest                                         21
Section VI       Allegations of Misconduct                                    21
Section VII      Liability Protection                                         22
Section VIII     AP Training                                                  22
Section IX       Program Reviews/Technical Assistance                         23
Section X        AP Standardized Forms                                        23

                                         Appendices

A.               AP Standardized Forms                                        27
B.               Quarterly Report Requirements                                28




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                                 INTRODUCTION

Adult Protection Program History

The State of Idaho passed its first mandatory reporting law related to adult abuse, neglect,
and exploitation in 1982. In 1992, the law was amended to expand the jurisdiction of the
Department of Health and Welfare (DHW) in providing Adult Protection (AP) services in
Idaho. On July 1, 1995, the Idaho Commission on Aging (ICOA) assumed the
administration of AP services pursuant to a Memorandum of Understanding with DHW.
Statutory authority for AP was formally transferred to the ICOA on July 1, 1996, as a result
of legislative action. In 1998, the law underwent further amendment related to the reporting
of AP allegations, law enforcement response, and interagency cooperation.

Adult Protection Jurisdiction

AP services are specialized services directed toward assisting vulnerable adults in protecting
themselves from abuse, neglect, or exploitation. Pursuant to authority granted in Chapter 50,
Title 67, Idaho Code (I.C. 67-5011) Idaho Senior Services Act, and Chapter 53, Title 39,
Idaho Code (I.C. 39-5302 - I.C. 39-5312), Idaho Adult Abuse, Neglect, and Exploitation
Act, the ICOA administers and provides AP services through Area Agencies on Aging
(AAAs). In accordance with §39-5305, Idaho Code, upon receiving information that a
vulnerable adult is alleged to be abused, neglected, or exploited, the ICOA or appropriate
AAA must initiate an investigation to determine a vulnerable adult’s need for protective
services.

With decreasing resources in communities, more individuals are accessing the Area
Agencies for assistance. Some of those individuals who do not qualify for Case
Management or other services are being referred to AP. AP staff may feel compelled to
resolve (or attempt to resolve) these cases.

However, some of these referrals are made or investigations are undertaken without
regard to Adult Protection’s limited jurisdiction. Adult Protection sole purpose is to
investigate cases that (1) involve a “vulnerable adult” as defined in the Idaho Senior
Services act who (2) is currently suffering from abuse, neglect, self-neglect, or
exploitation. If both of these elements are not present, the case is not within the
jurisdiction of AP and should not be referred to or investigated by the program.

When a potential referral comes into the Area Agency/Adult Protection, it should be
prescreened to try to determine if the case involves a “vulnerable adult.” This means that
the screener should ask as many questions as possible to be able to create a “vulnerable
profile” of the alleged victim.

Idaho Code Section 39-5302(10) provides that a “vulnerable adult” is a person eighteen
(18) years of age or older who is unable to protect himself from abuse, neglect or
exploitation due to physical or mental impairment which affects the person's judgment or
behavior to the extent that he lacks sufficient understanding or capacity to make or

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communicate or implement decisions regarding his person. Age itself does not constitute
vulnerability; there must also be a limiting physical or mental impairment.

A person’s inability to protect himself should be measured by functional limitations and
must directly relate to the allegation. For example, a person confined to a wheelchair
because of a physical disability certainly has a physical impairment. However, that
impairment alone does not make him a “vulnerable adult.” To qualify as a “vulnerable
adult,” the physical impairment must affect his judgment or behavior “to the extent that
he lacks sufficient understanding or capacity to make or communicate or implement
decisions regarding his person.”

Thus, an allegation involving the exploitation of an individual confined to a wheelchair
would not be within AP’s jurisdiction unless the individual was being held against his
will or physically forced to submit to the exploitation. If the individual had signed a
contract he regretted or was a victim of simple fraud, the case would not be within the
jurisdiction of AP if the individual made the decision using his own judgment.

Many times it is not possible to ascertain with certainty an individual’s level of
vulnerability from information received from the initial report. In those cases, AP should
always take whatever action is necessary to make an accurate determination.

If the complaint is determined to involve an individual who appears to be a vulnerable
adult, it should then be prescreened to determine if an act of abuse, neglect, self-neglect,
or exploitation has actually occurred. Sometimes, a complaint is made or an
investigation is initiated because the reporter and/or the AP investigator are concerned
that without intervention abuse, neglect, self-neglect, or exploitation might occur. AP
investigations cannot be initiated using a “what if” rationale. There must be an actual act
of abuse, neglect, or exploitation.

In such cases, the reporter should be asked to monitor the situation and report back
immediately if abuse, neglect, self-neglect, or exploitation does occur. Additionally, the
reporter should also be referred to resources for supportive services for the vulnerable
adult, if appropriate.

If the complaint is determined to involve both a vulnerable adult and an act of abuse,
neglect, self-neglect, or exploitation with a direct relationship to the alleged victim’s
vulnerability, AP has jurisdiction and should begin its investigation.

       A. Individuals Suffering from Mental Disorders

       An individual may lack sufficient understanding or capacity to make or
       communicate or implement decisions for any number of reasons. For example, a
       person suffering from severe depression might be unable to make, communicate,
       or implement decisions. Conversely, a person diagnosed as a schizophrenic, so
       long as he is taking his medication, might be fully capable of making,


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       communicating, or implementing decisions. Thus, whether the individual is a
       “vulnerable adult” depends on the particular circumstances of the case.

       One cannot generalize certain groups of individuals as being or not being
       “vulnerable adults.” Rather, the investigator must engage in some fact-finding
       before a determination may be made. There is no particular formula for how this
       fact-finding must take place. The investigator must gather sufficient evidence on
       which to base his or her determination.

       B. Self-Neglecting Individuals

       Idaho Code Section 39-5302(8) defines self-neglect as the failure of a vulnerable
       adult to provide food, clothing, shelter or medical care necessary to sustain his life
       and health. The question sometimes arises as to whether AP has jurisdiction in
       cases involving “dirty houses.” Whether the situation is such that Case
       Management should handle the matter or whether AP intervention is appropriate
       depends on the particular circumstances of each case.

       The basis of AP’s jurisdiction depends on whether the condition of the house is
       such that it threatens the life and health of the vulnerable adult (i.e. fails to sustain
       his life and health). For example, a “dirty house” where food is rotting on the
       counters, dirty dishes are piled on every available flat surface, garbage is piled
       throughout, rodents and insects are present, and animal and/or human feces and
       urine are present goes beyond the level of a mere “dirty house” and certainly rises
       to the level necessary to involve AP (i.e. the life and health of the vulnerable adult
       are threatened). Conversely, a “dirty house” that merely needs dusting,
       vacuuming, or mopping likely does not threaten the life and health of the
       vulnerable adult (although left long enough it could become an AP case) and is
       appropriately assigned to Case Management.

       Again, one cannot generalize. Rather, the investigator must engage in some fact-
       finding before a determination may be made. There is no particular formula for
       how this fact-finding must take place. The investigator must gather sufficient
       evidence on which to base her determination as to whether the case is within AP’s
       jurisdiction or should be referred to Case Management.

Definitions

Any item not specifically defined in the AP Procedures Manual shall have the same
meaning as those defined in Idaho Code or IDAPA 15.01.01, “Rules Governing Idaho
Senior Services Program.”




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                                          CHAPTER 1

                                  PROVISION OF SERVICE

SECTION I - INVESTIGATIVE REQUIREMENTS

In addition to requirements set forth in IDAPA 15.01.02.031.01 through IDAPA 15.01.02.031.07,
Administrative Rules, AAAs shall comply with the following procedures:

       A.             INVESTIGATIVE PROTOCOL:

              1.      General Non-Emergency Discretionary Response: Upon a determination
                      that a vulnerable adult is alleged to be abused, neglected, or exploited, AP
                      shall determine the appropriate investigative response. 39-5304, Idaho
                      Code. Vulnerability shall be determined through use of a risk assessment
                      tool.

                      a.   AP shall initiate an investigation within 72 hours from the time the
                           report is received; provided, however that if the incident occurred in a
                           nursing facility defined in Section 39-1301 (b), Idaho Code (i.e. a skilled
                           nursing facility), AP shall immediately report the incident to BFS as set
                           forth in Section V below.

                      b.   If appropriate and necessary to ensure the safety of a vulnerable adult
                           who has been abused, neglected (including self-neglect), or exploited,
                           AP may seek the assistance of law enforcement.

                      c.   AP shall determine whether an interview with the vulnerable adult is
                           necessary to the investigation, feasible, and the most efficient use of AP
                           resources.

                      d.   If AP determines that an interview with a vulnerable adult is not
                           necessary to the investigation, or is unfeasible due to the physical or
                           cognitive condition of the vulnerable adult or other circumstances, or is
                           not the most efficient use of AP resources, the reasons for not
                           interviewing the vulnerable adult shall be documented in case progress
                           notes.

                      e.   Upon a determination that the vulnerable adult will be interviewed, AP
                           shall document the method of interview and the reasons for the selected
                           method in case progress notes.

              2.      Resident to Resident Abuse – Discretionary Response: In instances
                      alleging abuse between residents residing in a care facility (other than a
                      skilled nursing facility defined in 39-1301 (b), Idaho Code) that do not
                      involve sex abuse, death or serious physical injury that jeopardizes the

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     life, health, or safety of a vulnerable adult, or repeated resident-to-resident
     physical or verbal altercations that do not result in observable physical or
     mental injury, AP shall determine the appropriate investigative response.
     39-5303A, Idaho Code

     a.          If AP determines that the allegation is an isolated incident, AP may
                 discuss the matter fully with facility staff by telephone and
                 document the date and nature of the occurrence, the name of
                 alleged perpetrator(s), the name of the alleged victim(s), and
                 discuss remedial measures, in a designated facility file.

     b.          If AP determines that the allegation constitutes an ongoing pattern
                 of resident behavior that a facility’s staff is unable to remedy
                 through reasonable efforts, AP shall interview the alleged
                 victim/vulnerable adult in his/her dwelling or care facility and
                 develop a protective action plan pursuant to Section IG, AP
                 Operations Manual.

3.   Emergency Response: AP reports constituting an “emergency” shall require
     a coordinated response with law enforcement. Upon receiving an emergency
     report, AP shall immediately inform law enforcement. AP shall initiate an
     investigation immediately and shall initiate contact with the alleged
     victim/vulnerable adult within 24 hours from the time the report is received.

     a.          Emergency - Definition: An emergency is defined as an exigent
                 circumstance in which a vulnerable adult’s health and safety is
                 placed in imminent danger. Imminent danger is defined as a
                 situation in which death or severe bodily injury could reasonably be
                 expected to occur without intervention.

     b.         Entry onto Private Property: AP staff shall not enter private
                property without consent unless an emergency exists and they are
                accompanied by law enforcement. 39-5305(4), Idaho Code. Law
                enforcement operates under the following guidelines when entering
                private property in an emergency:

          i.        Prior to entry on private property, law enforcement must have
                    reasonable cause to believe that an emergency and immediate
                    need for assistance exists.

          ii.       The entry on private property must not be primarily motivated by
                    an intent to arrest or seize evidence.

          iii.      There must be a reasonable basis to associate the exigent
                    circumstance with the area of private property entered upon on
                    behalf of the vulnerable adult.

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          iv.      Actions upon entry onto public property must be carefully limited
                   to achieving the objectives justifying the entry. Law enforcement
                   may do no more than is reasonably necessary to ascertain
                   whether someone is in need of assistance and to provide that
                   assistance.

          v.      The jurisdiction of law enforcement over a vulnerable adult for
                   removal and transportation under §39-5305(1), Idaho Code, lasts
                   no longer than the emergency necessitating the removal, unless
                   other independent statutory authority exists for continued
                   jurisdiction over the vulnerable adult.

     c.         Law Enforcement - Removal/Transportation: AP shall make
                every effort to arrange for the appropriate and safe placement of a
                vulnerable adult upon removal by law enforcement under exigent
                circumstances. Upon expiration of an emergency, a vulnerable
                adult’s request for discontinuation of services and transportation back
                to the location from which they were removed shall be arranged with
                the assistance of appropriate third parties.

4.   Prioritization: Although many of the clients receiving services through
     the AAAs or their contractors may be prioritized, AP clients generally
     may not. Idaho Code Section 39-5301A(3) provides, in part, that “[t]he
     commission is directed to investigate allegations of abuse, neglect, self-
     neglect or exploitation involving a vulnerable adult, to make appropriate
     referrals to law enforcement, and to arrange for the provision of necessary
     services…” Thus, as the contracted provider of AP services, the AAAs
     are required to investigate all allegations of abuse, neglect, self-neglect, or
     exploitation so long as they involve a vulnerable adult.

     There is some flexibility in terms of the timeframe during which an AP
     investigation must take place. Idaho Code Section 39-5304(2) establishes
     specific guidelines for determining when an AP investigation must be
     initiated.

     Idaho Code Section 39-5304(2) requires only that the investigation to be
     “initiated” within the mandated timeframes. According to Black’s Law
     Dictionary, the term “initiate” means to commence, or to start. The
     activity appropriate to “initiate” an investigation is within the discretion of
     AP staff and may vary, depending upon the particular circumstances of a
     report; provided, however, that the activity must be substantive. In
     addition, AP staff may “prioritize” which reports are responded to first, so
     long as all investigations are initiated within the statutory timeframes.

     Idaho Code Section 39-5304(3) requires that the investigation include a
     determination of the nature, extent and cause of the abuse, neglect, or

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     exploitation, examination of evidence and consultation with persons
     thought to have knowledge of the circumstances and identification, if
     possible, of the person alleged to be responsible for the abuse, neglect or
     exploitation of the vulnerable adult.

     Although each investigation must address the statutorily required
     elements, the depth of the investigation prior to substantiation and referral
     to law enforcement may be tailored to the particular circumstances of the
     case and the staffing limitations of the AP unit.

     There is also some flexibility in terms of the necessity of interviewing the
     vulnerable adult. The decision to interview the vulnerable adult depends
     on the circumstances of each particular report. If no emergency exists, AP
     may determine, based on the review of the report and any initial inquiries,
     that an interview with the vulnerable adult is not necessary to the
     investigation. Idaho Code Section 39-5304(4). If AP determines that an
     interview with the vulnerable adult is necessary, the interview should be
     conducted in person. However, Idaho Code Section 39-5304(4) provides
     that if the AP investigator determines that an in-person visit with the
     vulnerable adult is unnecessary or inappropriate, the interview may be
     conducted by telephone, or by other appropriate means.

     Although prioritization in its broadest terms is not available to the AP
     program, the statutory mandates of the Idaho Code do leave some
     flexibility with respect to how and when AP investigations are conducted.
     All complaints involving a vulnerable adult must be investigated,
     however, there is some flexibility in terms of the timeframe during which
     an investigation must be initiated and the depth of the actual investigation.
     In addition, AP investigators are given some discretion as to whether the
     vulnerable adult will be interviewed and, if so, how and where the
     interview will take place. AP staff should thoroughly document any
     difficulties encountered in complying with statutory mandates.

4.   Notification of Guardians: Notification of the guardian of an alleged
     victim prior to a client interview shall be required in the following
     circumstances:

     a.     When legal consent on behalf of a ward/alleged victim is required
            to gain access onto private property to conduct a client interview in
            a community setting.

     b.     When AP requires that a vulnerable adult make a decision having
            potentially legal consequences, including but not limited to the
            signing of a release of information form or a supportive services
            plan.


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             c.     When AP otherwise deems notification necessary to ensure the
                    health and safety of a vulnerable adult.

          In all other instances, AP workers may determine at their discretion when it is
          appropriate to contact guardians prior to client interviews.

     5.      Establish Communication: In cases involving communication with non-
             English speaking persons, AP shall identify the need for a language
             interpreter, including a sign language interpreter, as deemed necessary by AP
             to obtain clear and correct investigative information.

     6.      Interviewing Alleged Victim: When AP determines that an interview with
             the alleged victim/vulnerable adult is necessary, AP shall, on at least one
             occasion, interview the alleged victim/vulnerable adult outside the presence
             of the alleged perpetrator.

     7.      Interviewing Alleged Perpetrator: If an alleged perpetrator is interviewed
             at the discretion of AP, the alleged perpetrator shall be informed that their
             cooperation in the investigation is voluntary and non-compulsory. The
             alleged perpetrator’s acknowledgment of the voluntary and non-compulsory
             nature of his/her participation in the investigation shall be documented in the
             client case file.

     8.      Law Enforcement Contact: Upon a determination that an alleged
             victim/vulnerable adult requires intervention by law enforcement, AP shall
             immediately request such intervention and document the request and
             subsequent response in the client case file.

B.   INVESTIGATIVE FINDINGS:

     1. Evidentiary Standard: In making the investigative determination that an AP
        allegation is substantiated, AP shall consider whether supporting information
        indicates abuse, neglect, or exploitation by a preponderance of the evidence.

     2. Preponderance of the Evidence - Definition: AP is persuaded by sufficient
        supporting evidence that an investigated allegation is more probably true than
        not true.

     3. Intake/Investigative Report: AP shall use the “Intake/Investigative Report”
        form (ICOA-501) to document initial client information, vulnerability and
        associated risk factors, investigative findings, and protective actions.

     4. Progress Notes: Investigative findings and protective actions shall be supported
        by “Progress Notes” in a client file, including the date /time of documented
        events and appropriate supporting information.


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     5. Felony Abandonment: AP program personnel shall determine whether a
        substantiated allegation of caretaker neglect constitutes abandonment of a
        vulnerable adult as defined in §18-1505A, Idaho Code:

        Any person who abandons a vulnerable adult, as that term is defined in §18-
        1505, Idaho Code, in deliberate disregard of the vulnerable adult’s safety or
        welfare, regardless of whether the vulnerable adult suffered harm from the act of
        abandonment, shall be guilty of a felony and shall be imprisoned in the state
        prison for a period not in excess of five (5) years, or by a fine not exceeding five
        thousand dollars ($5,000), or by both such fine or imprisonment. It shall not be
        a defense to prosecution under the provisions of this section that the perpetrator
        lacked the financial ability or means to provide food, clothing, shelter or medical
        care reasonably necessary to sustain the life and health of a vulnerable adult.
        As used in this section “abandon” means the deserting or willful forsaking of a
        vulnerable adult by any individual, caretaker as defined by subsection (2)(b) of
        §18-1505, Idaho Code, or entity which has assumed responsibility for the care of
        a vulnerable adult by contract, receipt of payment of care, any relationship from
        blood or marriage wherein the vulnerable adult has become the dependent of
        another or by order of a court of competent jurisdiction; provided that abandon
        shall not mean the termination of services to a vulnerable adult by a physician
        licensed under chapter 18, Title 54, Idaho Code, or anyone under his direct
        supervision, where the physician determines, in the exercise of his professional
        judgment, that termination of such services is in the best interests of the patient.

C.   LAW ENFORCEMENT REFERRAL:

     1. Report to Law Enforcement: All substantiated allegations of abuse, neglect
        (excluding self-neglect), or exploitation shall be immediately reported to law
        enforcement. 39-5310, Idaho Code. AP shall use the “Report to Law
        Enforcement” form (ICOA-504). The report to law enforcement shall contain a
        summary of investigative findings based on physical evidence, interviews, and
        other supporting evidence, including but not limited to:

         a.      A list of persons interviewed in the AP investigation, including, if
                 appropriate, names, addresses, and phone numbers of persons who were
                 in the position to directly observe the alleged acts of abuse, neglect, or
                 exploitation.

         b.      An itemization of physical evidence collected or observed in the AP
                 investigation supporting an investigative finding of substantiated abuse,
                 neglect, or exploitation.

         c.      Admissions from an alleged perpetrator that he/she engaged in actions
                 constituting abuse, neglect, or exploitation of a vulnerable adult.



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         d.      Details of underlying circumstances in substantiated neglect cases,
                 including AP’s conclusions as to whether the substantiated neglect by a
                 caretaker was intended to jeopardize the health and safety of the
                 vulnerable adult.

         e.      A statement of AP’s availability to provide judicial testimony on the
                 content of the report to law enforcement and other investigative
                 information in a client case file.

                 Note: AP’s duty to report to law enforcement under §39-5310, Idaho
                 Code, remains in effect regardless of a vulnerable adult’s request that a
                 substantiated allegation of abuse, neglect, or exploitation not be reported
                 to authorities.

     2. Attachments: AP may attach a copy of the “Intake/Investigative Report” form
        to the “Report to Law Enforcement” form and any additional and appropriate
        supporting information related to a substantiated allegation of abuse, neglect, or
        exploitation.

     3. Self-Neglect Allegations: Substantiated self-neglect allegations do not
        necessitate a report to law enforcement under §39-5310, Idaho Code. Self-
        neglect allegations may be referred to law enforcement for assistance during any
        phase of an AP investigation.

D.   CLIENT CONFIDENTIALITY:

     1. Release of Information: AP shall attempt to obtain informed consent from a
        client for the release of information relevant and necessary to the provision of
        service to the client.

     2. Informed Consent - Criteria: To meet the requirement of informed consent for
        the release of client information, the client or his/her legal representative must be
        fully appraised of the following:

         a.      The voluntary nature of the disclosure.

         b.      The nature and extent of the information being released.

         c.      The person, organization, institution, or agency to whom the
                 information will be released.

         d.      The purpose for which the information will be used in providing service
                 to the client.

         e.      The effect on the client (if any) of not allowing the release of all or part
                 of the requested information.

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    f.      The organizations, businesses, institutions, or agencies from which
            necessary information about the client will be requested.

    g.      Any other facts under the circumstances necessary for obtaining
            informed and voluntary consent from the client.

3. Informed Consent - Documentation: A client’s informed consent for the
   release of information may be documented by the signature of the client or
   his/her legal representative on the “Release of Information” form (ICOA-502). If
   a client is unable or unwilling to sign the form, verbal informed consent from the
   client may be documented in “Progress Notes,” in the presence of one (1) or
   more witnesses. The identity of the witness or witnesses shall be documented in
   the “Progress Notes.”
4. Inability to Obtain Informed Consent: If the AP investigator reasonably
   believes that the client does not have sufficient mental capacity to provide an
   informed consent or if the client refuses to consent, the inability of AP to obtain
   informed consent for the release of client information shall be documented in the
   client case file.

5. Discretionary Disclosure: Pursuant to 39-5308(1), Idaho Code, and at the
   discretion of AP, client information may be disclosed to law enforcement
   personnel, DHW personnel, medical personnel, and any other person or entity
   deemed necessary due to their specialized training in providing services to
   vulnerable adults; provided, however, that no medical records may be divulged
   for any purpose without the express written consent of the client or his legal
   representative, or pursuant to court order. 39-5307, Idaho Code. The content of
   the client information, the purpose for information disclosure, the recipient of the
   client information, and the date/time of disclosure shall be documented in the
   client case file.

    Note: Discretionary disclosure of information shall be restricted by express
    limitations as set forth in the Adult Abuse, Neglect, and Exploitation Act.

6. Disclosure Protocols: AP may enter into formal interagency collaborative
   protocols governing the terms and conditions of client information disclosure.

7. Requests for Disclosure: Formal written requests for disclosure of confidential
   AP client information pursuant to federal or state law shall be forwarded to the
   ICOA for response, including civil or criminal discovery requests and court
   orders for disclosure.

8. Disclosure to Department of Health and Welfare Criminal History Unit:




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Idaho Code Section 39-5308(2) requires the ICOA to provide to the CHU a
listing of all alleged perpetrators against whom an allegation of abuse,
neglect, or exploitation has been substantiated. The ICOA provides this
report to the CHU by the 15th day of each month. Upon request by the CHU,
all available supportive information must be provided to enable the CHU to
conduct criminal background checks and other required investigations.
Certain statutes or program rules require an individual to complete a criminal
history and background check. See IDAPA 16.05.06.100 and IDAPA
16.05.06.101.

Individuals who are required to undergo a criminal history and background
check complete an application and submit it to the CHU. This application
authorizes the CHU to obtain information and conduct a review. The CHU
then performs the criminal history and background check and issues a
“clearance” or “denial.” IDAPA 16.05.06.130.

Denials may be “unconditional” or “conditional.” An individual who has
been convicted of committing certain “disqualifying” crimes (e.g., abuse,
neglect or exploitation of a vulnerable adult) will receive an unconditional
denial. See IDAPA 16.05.06.210.01. A conditional denial is issued when an
individual is found to have a “relevant record.” A substantiated adult
protection complaint is included in the definition of “relevant record.”
IDAPA 16.05.06.230.01.

If an individual receives a conditional denial, he or she may request that the
CHU perform an “exemption review.” IDAPA 16.05.06.250. When an
exemption review is requested, the CHU initiates a review of the crimes or
actions (other than “disqualifying” crimes). The review may consist of
examining documents and supplemental information provided by the
individual, a telephone interview, an in-person interview, or any other review
the CHU determines is necessary.

The reviewer also examines the AP case file. If the file documentation is not
clear, concise, and thorough, and the evidence documented does not support
the substantiation, it is likely that the conditional denial will be reversed. The
individual will be given a clearance and he or she will be free to continue
working with vulnerable adults. Thus, it is extremely important to take the
time to carefully document each case file.

If the conditional denial is not reversed, the individual can then file a formal
appeal. To win, however, the individual must establish that the CHU’s denial
was arbitrary and capricious. Again, the AP file will be examined during the
appeal process.

AP sometimes receives calls from individuals who have apparently received
conditional denials and want information or to get their cases

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                   “unsubstantiated.” These individuals need to be referred to the CHU. AP
                   cannot disclose information to these individuals nor can it “unsubstantiate” a
                   case or otherwise assist these individuals.

       E.     PROTECTIVE ACTION PLAN (PAP):

              1. General PAPs: AP shall use the “Intake/Investigative Report” form section
                 designated “Protective Action Plan” to document protective actions to be taken
                 on behalf of a vulnerable adult to reduce risk, including referral to Case
                 Management for development of an SSP. Protective actions may be documented
                 in the PAP and “Progress Notes” at any time during an AP investigation. A PAP
                 does not require the consent or signature of the vulnerable adult.

              2. Facility PAPs: In substantiated cases arising out of state licensed or certified
                 facilities, AP may request that facility administrators develop a PAP, utilizing
                 existing facility remedial procedures and related forms, to reduce identified risk
                 to vulnerable residents. In such instances, AP may disclose to facility employees
                 and administrators general AP investigative information relevant and necessary
                 to the development of the facility PAP; provided, however, that the name of the
                 person who made the original report to AP and any person mentioned in AP’s
                 investigative report may not be disclosed unless those persons specifically
                 request such disclosure.

                   AP shall seek access to client information held by the facility relevant and
                   necessary to provide input into the development of a facility PAP. Upon AP’s
                   review of a developed facility PAP, recommended substantive modifications (if
                   any) shall be brought to the attention of facility administrators. Any substantive
                   modifications to a PAP by the facility, made as a result of AP
                   recommendations, shall be documented in the client case file. A facility’s
                   refusal to accept AP recommendations shall also be documented in the client
                   case file. AP shall place a final copy of the facility PAP in the client case file.

              3. AP shall coordinate long-term care facility based PAPs with the Ombudsman
                 and, if appropriate, refer the facility client to the Ombudsman for
                 implementation and follow-up review of the PAP.

SECTION II - SUPPORTIVE SERVICES REQUIREMENTS

In addition to requirements set forth in IDAPA 15.01.02.032.01 through IDAPA 15.01.02.032.05,
Administrative Rules, AAAs shall comply with the following procedures:

              1.   AP/Case Management: AP may coordinate and refer community client
                   supportive services planning to Case Management for development,
                   implementation, and follow-up review of Supportive Service Plans (SSP).



                                                15
          2.   Client Assessment: AP may assist Case Management in the completion of
               relevant sections of the UAI or other ICOA approved assessment instrument
               to assess vulnerability and client care needs as deemed necessary and
               appropriate by the circumstances of each case.

          3.   Supportive Services Plan: Prior to referring the client to Case Management,
               AP or other collaborating programs, including Case Management, shall obtain
               informed consent from the client or his/her legal representative.

          4. Informed Consent - Criteria: To meet the requirement of informed consent for
             referral to Case Management, the client or his/her legal representative must be
             fully appraised of and understand the intended purpose and anticipated beneficial
             results of the referral to Case Management. The AP investigator’s explanation
             should be made in terms that accord with the client or his/her representative’s
             comprehension level.

          5. Determination of Capacity and Risk: If the client is unable or unwilling to
             grant informed consent to the referral to Case Management, AP shall assess the
             client’s current level of risk and cognitive/physical capacity to determine if
             guardianship/conservatorship proceedings should be initiated by appropriate
             parties.

SECTION III – GUARDIANSHIP

     A.   Screening for Guardianship/Conservatorship: AP shall use the following
          guidelines to determine whether the discretionary initiation of
          guardianship/conservatorship proceedings by interested parties or by the AAA, as
          petitioner pursuant to §39-5306, Idaho Code, or referral to the local Board of
          Community Guardians is appropriate:

          1. AP shall evaluate client vulnerability and associated risk factors utilizing all
             available information obtained by AP and other agencies, organizations, or
             program entities, including Case Management.

          2. AP shall consider whether the level of risk to the client’s health and safety under
             current living conditions warrants immediate intervention under §15-5-310,
             Idaho Code.

          3. AP shall consult with family, physicians, and any other person or entity with
             direct knowledge of the client’s physical and mental condition.

          4. AP shall determine, in consultation with legal counsel, if sufficient client
             information is available to support a determination of incapacity, as defined in
             §15-5-101 (a), Idaho Code, mental illness as defined in §66-317, Idaho Code, or
             developmental disability as defined in §66-402, Idaho Code.


                                            16
     5. AP shall consider if the imposition of guardianship/conservatorship is necessary
        to reduce a high level of risk to the client and will serve as the least restrictive
        mechanism to implement necessary supportive services.

     6. AP shall seek to identify any persons or entities interested in the health, welfare,
        and safety of the client that may have the resources to petition independently for
        guardianship/conservatorship.

     7. AP shall consider if AAA resources exit to serve as petitioner for
        guardianship/conservatorship.

     8. If appropriate, AP may consider in consultation with legal counsel, family, and
        physicians, the possibility of crafting a limited guardianship pursuant to §15-5-
        304(1)(c), Idaho Code.

B.   Petition for Guardianship/Conservatorship-Procedure:

     1. In filing a discretionary petition for guardianship/conservatorship, including
        temporary guardianship under §15-5-310, Idaho Code, AP shall consult with
        legal counsel in the preparation of supporting affidavits, AP testimony, and other
        procedural requirements.

     2. In addition to consultation with legal counsel, AP may refer to the Training
        Handbook for Guardian/Conservators and Boards of Community Guardian, as
        revised, for instruction when assisting in the initiation of a petition for
        guardianship/conservatorship through a local Board of Community Guardian.

             Note: The training handbook contains statutes pertaining to
             guardianships/conservatorships involving incapacitated persons as defined in
             §15-5-101, Idaho Code, mentally ill as defined in §66-317, Idaho Code, and
             developmentally disabled as defined in §66-402, Idaho Code.

     3. Report Seeking Guardianship: AP shall use the “Report Seeking
        Guardianship” form (ICOA-505) to document the need for initiating a petition
        for guardianship/conservatorship through an AAA.

             Note: The above guidelines shall be consistently applied by AP on a case-
             by-case basis, with the full constitutional, statutory, and philosophical
             understanding that initiating a guardianship/conservatorship proceeding is
             the course of last resort in providing necessary supportive services to a
             vulnerable adult. All other alternatives to Guardianship/Conservatorship
             must be carefully and fully considered before a petition is initiated by an
             Area Agency.




                                       17
SECTION IV - CASE CLOSURE

In addition to requirements set forth in IDAPA 15.01.02.032.04 through IDAPA 15.01.02.032.05,
Administrative Rules, each AAA shall comply with the following procedures:

       A.     Case Closure Form: Upon case closure, a “Case Closure” form (ICOA-503) shall
              be completed and placed in the client file. The “Case Closure” form shall
              summarize how identified risks to the vulnerable adult have been reduced to a level
              justifying case closure.

       B.     Client Refusal of Service: A client’s initial refusal of supportive service does not
              preclude AP or Case Management from offering services on subsequent
              occasions, if appropriate. If risk in substantiated cases is not reduced to a level
              justifying case closure as a result of a client’s refusal of supportive service, this
              circumstance shall be documented in the “Case Closure” form.

       C.     Unavailability of Services: If risk in substantiated cases is not reduced due to the
              unavailability of community resources, or the client’s ineligibility for community
              resources, this circumstance shall be documented in the “Case Closure” form.

       D.     Final Disposition: AP shall establish local protocols for tracking and determining
              the final disposition of AP cases referred to law enforcement and cases referred to
              appropriate persons or entities for initiation of guardianship/conservatorship
              proceedings.

SECTION V - AP INVESTIGATIONS - STATE CERTIFIED OR LICENSED
            FACILITIES

       A.     COORDINATION WITH BFS:

              1.   Investigation or Referral: Upon receipt of a report involving an allegation of
                   abuse, neglect, or exploitation of a vulnerable adult residing in a nursing facility
                   defined in Section 39-1301(b), Idaho Code (i.e., a skilled nursing facility), AP
                   shall first determine whether the alleged perpetrator is an employee of the
                   facility or an “unrelated third party” not employed by the facility (e.g., a child of
                   the resident).

                   Where the alleged perpetrator is an employee of the facility, AP shall
                   immediately forward such report to BFS for investigation. If BFS is unable to
                   conduct its investigation in a timely manner or if BFS requests AP assistance in
                   investigating the report, AP shall provide such assistance; provided, however,
                   that in providing such assistance, AP staff shall conduct the investigation in
                   accordance with the Adult Abuse, Neglect and Exploitation Act and applicable
                   AP administrative rules.


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                    Where the alleged perpetrator is an unrelated third party, AP shall investigate
                    the case in the manner set forth in Section 1, Chapter 1 of this manual.

               2.   Final Report to BFS: Upon substantiation of an AP case arising in any state
                    licensed or certified facility, AP shall send a final report to BFS. AP shall send a
                    completed copy of the “Intake/Investigative Report” form, and provide
                    appropriate supporting information, upon request, to BFS.

SECTION VI - AP INVESTIGATION – WAIVER SERVICES

In AP investigations of substantiated abuse, neglect, or exploitation involving clients receiving
services through the Aged and Disabled Waiver, the Developmentally Disabled Waiver or the Idaho
State School and Hospital Developmentally Disabled Waiver, AP shall provide the appropriate
oversight program, Regional Medicaid Unit or the Regional ACCESS Unit, with a completed copy
of the “Intake/Investigative Report” form, and all appropriate supporting documentary information.




                                                 19
                   CHAPTER II - ADMINISTRATIVE REQUIREMENTS

SECTION I - AP STAFF REQUIREMENTS

In addition to requirements set forth in IDAPA 15.01.02.021.01, Administrative Rules, each AAA
shall comply with the following procedures:

       A.     EMERGENCY RESPONSES - 24 HR ON-CALL:

              Each AAA shall establish internal protocols for ensuring that AP is able to initiate
              emergency investigations immediately, twenty-four (24) hours a day:

              1. AAA policy should include requirements for on-call workers to carry a pager or
                 cellular phone to receive and respond to on-call emergency reports.

              2. AAA policy should include provisions enabling employees to move freely
                 (within pager range) during on-call hours, allowing employees to enjoy personal
                 activities during on-call assignment.

              3. To fulfill statutory AP program obligations, AAA policies should allow for the
                 sharing of on-call duties among licensed staff. In addition, unlicensed staff may
                 be assigned to screen on-call emergency reports for on-call licensed staff so long
                 as such unlicensed staff have received training necessary and appropriate to
                 prepare them to provide competent screening services.

       B.     AP WORKER SAFETY:

              Each AAA shall establish internal protocols addressing the personal safety of AP
              workers during AP investigations, including, but not limited to, AP worker safety
              training, AP requests for the assistance of law enforcement in potentially dangerous
              (but non-imminent danger circumstances), office knowledge of AP worker
              investigative whereabouts, and the use of two (2) person AP worker teams when
              appropriate.

       C.     PERPETRATOR REPORT

              1.      Monthly Reports:

              AP shall provide to the ICOA a monthly report of all alleged perpetrators against
              whom an allegation of adult abuse, neglect, or exploitation has been substantiated.
              The report shall include the name of the alleged substantiated perpetrator and shall
              also include, if available, the social security number, date of birth, address and phone
              number of the alleged substantiated perpetrator. Upon request by the ICOA or
              DHW, all other available information shall be provided to enable the DHW to
              conduct criminal background checks, administrative hearings, and other required
              investigations.

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SECTION II - CASE STAFFING ASSISTANCE

At any point during an AP investigation, or on any other matter related to the AP program, AAAs
may request technical assistance from the ICOA in resolving problematic cases.

SECTION III - EXPUNGING PROGRAM CASE RECORDS

In addition to requirements set forth in IDAPA 15.01.02.021.03, Administrative Rules, each AAA
shall comply with the following procedures:

               1.   Unsubstantiated Case Records: Each AAA shall establish internal protocols
                    for ensuring records of unsubstantiated AP allegations are expunged no later
                    than three (3) years following the completion of an investigation.

               2.   Substantiated Case Records: Each AAA shall establish protocols for ensuring
                    substantiated case records are maintained at least three (3) years following case
                    closure.

               3.   Case Records of Deceased Clients: AP may expunge records related to
                    deceased clients within time frames deemed appropriate.

SECTION IV - CRITICAL INCIDENTS

Each AAA shall comply with the following procedures:

       A.      DUTY TO REPORT:

               1.   Critical Incidents: All critical incidents related to the administration or
                    provision of AP services by an AP program shall be reported immediately to the
                    ICOA.

               2.   Definition-Critical Incidents: AP program personnel shall use the following
                    guidelines to determine whether an occurrence is a critical incident requiring
                    immediate notification of the ICOA.

                    Critical Incidents may include, but are not limited to:

                    a. Any situation or incident that poses an imminent hazard to the general public
                       or AP program personnel.

                    b. Any fatality, including those that result from an accident related to AP
                       program activities.

                    c. Any formal criminal charges filed or in the process of being filed against AP
                       program personnel.


                                                 21
                   d. Any civil or criminal legal action started, settled, or decided in court
                      involving the AP program.

                   e. Any public allegation of a conflict of interest between AP personnel and a
                      vulnerable adult receiving AP services.

                   f. Media coverage of an AP investigation involving informational inquires
                      directed at AP program personnel.

                   g. Any public allegation that AAA personnel or Area provider personnel has
                      abused, neglected, or exploited a vulnerable adult.

              3.   Reporting Protocol: After an AAA’s initial contact with the ICOA detailing a
                   critical incident, a written report of the incident shall be made to the ICOA.

SECTION V - CONFLICT OF INTEREST

In addition to requirements set forth in IDAPA 15.01.02.021.04, Administrative Rules, each AAA
shall comply with to the following procedures:

              1.   AAA Policy: Each AAA shall have in place personnel policies and procedures
                   outlining employee conflict of interest issues.

              2.   AP Allegations involving AAAs/Area Providers: Allegations that AAA
                   personnel or subcontracted area provider personnel, including AP staff, have
                   abused, neglected, or exploited a vulnerable adult shall be referred to the ICOA
                   for review and to determine whether an independent investigation by the ICOA
                   is warranted.

SECTION VI - ALLEGATIONS OF MISCONDUCT INVOLVING AP STAFF:

In addition to requirements set forth in IDAPA 15.01.20, Administrative Rules, each AAA shall
comply with to the following procedures:

              1.   Notification: The ICOA shall notify the appropriate AAA Director of a
                   decision to formally review allegations involving misconduct by AP staff.

              2.   Misconduct - Defined:

                   Misconduct includes, but is not limited to:

                   a. Dishonesty or breaches of integrity which reflect negatively on the AAA
                      AP program.

                   b. Violations of civil or criminal law.


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                    c. Alcohol or substance abuse.

                    d. Violations of law, rules, or procedure governing the AP program.

               3.   ICOA Investigation: The objectives of the ICOA investigations shall be as
                    follows:

                    a. To factually establish the circumstances surrounding the alleged misconduct.

                    b. To determine if the AP staff member’s alleged misconduct constitutes a
                       violation of law, rule, or ICOA/AAA policy.

                    c. Factually determine is the alleged misconduct actually occurred.

                    d. Determine whether the misconduct was intentional or unintentional.

                    e. Determine if the misconduct was the result of inadequate rule,
                       policy/procedure, or training.

               4.   Final Determination: Once the investigation is completed, the ICOA shall
                    develop findings and make recommendations to the AAA pursuant to IDAPA
                    15.01.20.57, Administrative Rule.

SECTION VII - LIABILITY PROTECTION

Each AAA shall obtain liability insurance coverage for Professional Errors and Omissions. The
coverage must protect the AAA contractor and its AP program personnel from claims alleging
negligence, error, or omission in the provision of AP services.

SECTION VIII - AP TRAINING

The AAA shall assume the following training responsibilities:

               1.   AP Orientation/Basic Skills Training: Each AAA shall provide a minimum of
                    eight (8) hours of AP Orientation/Basic Skills training for new AP program
                    personnel.

               2.   AP Training-General: Each AAA shall assist AP program personnel in
                    procuring the continuing education hours necessary to maintain professional
                    accreditation. Continuing education hours for AP program personnel shall be
                    documented by the AAA.

                    AP program personnel who are not required to maintain professional
                    accreditation shall also receive general AP training each year sufficient to
                    maintain their competence. Teleconferences between the ICOA and AAAs
                    may be included as AP training hours.

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               3.   State AP Training: The ICOA shall be involved in AP related training through
                    the provision of technical assistance to AAAs, as needed, and by providing
                    State AP training.

SECTION IX - PROGRAM REVIEWS

In addition to requirements set forth in IDAPA 15.01.02.021.05, Administrative Rules, AAAs shall
comply with the following procedures:

       A.      ITEMS OF PROGRAM REVIEW:

               1.   Case File Review: Review of selected AP program case files for content,
                    quality of documentation, and discussion of substantive issues with AP staff.

               2.   AP Training: Review sufficiency of AP related training attended by AP staff
                    and assess additional staff training needs.

               3.   Area Plan: Review AP program progress towards achieving objectives set
                    forth in the “Service Objectives for Adult Protection” section of Area Plan.

               4.   Outcome Measures: Review AP program Outcome Measures as set forth in
                    State Strategic Plan and Area Plan.

               5.   AP Investigations: The State AP Coordinator may serve as an observer during
                    AP investigations at the discretion of the AAA. The AP Coordinator and AP
                    staff may discuss possible courses of action prior to or upon conclusion of on-
                    site investigations.

SECTION X - AP CASE FILES AND STANDARDIZED FORMS

Proper documentation is one of the most important elements of the AP program. Each case file
must contain concise, chronological progress notes regarding the investigation (facts regarding
who, what, when, where, why and how) and the investigative findings (i.e. substantiated or
unsubstantiated) must be supported by well-documented evidence.

An AP case is only as good as the documentation in the case file. If the progress notes do not
document that something happened, it did not happen. If the AP investigator is subpoenaed to
appear in court, his or her testimony could be completely discounted if it is not supported by the
case notes. In the worst case, an alleged perpetrator could be acquitted solely because the AP
investigator did not take the time to fully document the case.

Each AAA shall use the following guidelines in completing AP standardized forms:

       A.      INTAKE/INVESTIGATIVE FORM



                                                 24
1.   Alleged Victim Information: The documentation parameter designated
     “Alleged Victim Information” requires date/time of initial complaint referral,
     name of the alleged vulnerable adult/alleged victim, and their address, telephone
     number, age, and date of birth; the date, time, and manner of contact with the
     alleged vulnerable adult/alleged victim; the name of the reporter, their address,
     telephone number, and their relationship to the victim.

2.   Initial Vulnerability Information: The documentation parameter designated
     “Initial Vulnerability Information” requires information presented in the initial
     report allegation indicating that the alleged victim has a mental or physical
     impairment that makes him/her unable to protect himself/herself from abuse,
     neglect, or exploitation.
3.   Emergency: The documentation parameter designated “Emergency” requires a
     designation of “yes” or “no.” Emergency is defined as an exigent circumstance
     in which a vulnerable adult’s health and safety is placed in imminent danger.
     Imminent danger is when death or severe bodily injury could reasonably be
     expected to occur without intervention.

4.   Police Contact: The documentation parameter designated “Police Contact”
     requires a designation of “yes” or “no.”

5.   Allegation Summary: The documentation parameter designated “Allegation
     Summary” requires a statement of the nature and extent of the alleged abuse,
     neglect, or exploitation, including dates, times, and location(s) of alleged
     occurrence(s).

6.   Alleged Perpetrator Information: The documentation parameter designated
     “Alleged Perpetrator Information” requires, if possible, the name, telephone
     number, address, age, date of birth, social security number, and the relationship
     of the alleged perpetrator to the alleged victim.

7.   AP Worker/ Date and Time Assigned: The documentation parameter
     designated “AP Worker/Date and Time Assigned” requires the name of the AP
     worker assigned to the case, and the date/time of assignment.

8.   Collateral Contacts: The documentation parameter designated “Collateral
     Contacts” requires a designation of third parties other than the alleged victim, or
     the alleged perpetrator, that have been or will be interviewed by AP, their
     addresses, phone numbers, and relationship to the victim.

9.   Vulnerability Status: The documentation parameter designated “Basis of
     Knowledge” requires a statement of the sources of information relied upon to
     reach a vulnerability determination.

     The documentation parameter designated “Functional Limitations / Associated
     Risk Factors” requires a statement of an adult’s normal and instrumental

                                  25
    activities of daily living affected by an identified physical or mental impairment
    and a statement of the current risk to the life, health and safety of an adult as a
    result of identified mental or physical impairments and associated functional
    limitations.

10. Investigative Findings: The documentation parameter designated
    “Investigative Findings” requires a statement of evidence supporting an
    investigative finding by a preponderance of the evidence, including
    testamentary and physical evidence.

11. Protective Action Plan: The documentation parameter designated “Protective
    Action Plan” requires a statement of contemplated AP actions intended to
    reduce risk prior to or upon substantiation of an AP case, including referrals to
    Case Management, law enforcement and other appropriate entities.

12. Referral: The documentation parameter designated “Referral” requires a
    designation of referral to one or more of the following entities: Adult
    Protection, Case Management, Ombudsman, Information and Assistance, BFS,
    RMU, or other entity.

13. Date PAP Completed, Date Reporter Notified, Signature-AP Worker,
    Date, Signature-AP Supervisor, Date: The above documentation parameters
    require the date the PAP was completed, the date when the person reporting the
    allegation was notified that an investigation has been initiated, the
    signature/date of the AP case worker assigned the case, and signature/date of
    the AP Supervisor.

14. Report to Law Enforcement Form:

    a. Law Enforcement Agency, Adult Protection worker, Abuse Report
       Number, Client Name, Address/Phone Number, Alleged Perpetrator
       Name, Address/Phone Number: The above documentation parameters
       require the designation of the law enforcement agency, the name of the AP
       worker submitting the report, the client’s name, address, and phone number,
       and the perpetrator’s name, address and phone number.

    b. Summary of Allegation: The documentation parameter designated
       “Summary of Allegations” requires a statement setting forth supporting
       evidence of a substantiated allegation and any additional information which
       may have a bearing on law enforcement’s decision to proceed with a
       criminal investigation. Information may include a statement of extenuating
       circumstances surrounding the substantiated allegation.

15. Release of Information Form:

    The “Release of Information” form authorizes a designated AAA program and

                                 26
    any of its agencies, institutions, entities, or employees to seek, obtain, and
    release any and all information and documents pertaining to the vulnerable adult
    and deemed by the agency as relevant to providing services to the vulnerable
    adult.

16. Case Closure Form:

    a. Case is Closed for the following reasons: The documentation parameters
       designated “Case is closed for the following reasons” requires a checking of
       appropriate boxes in selections 1 through 8.

    b. Risk to Client Reduced or Eliminated: The documentation parameters
       designated “Risk to client reduced or eliminated” requires an answer of
       “yes” or “no” in regards to successful risk reduction or elimination based on
       AP’s best professional judgment.

    c. Risk to Client Remains: The documentation parameters designated “Risk
       to client remains” requires an answer of “yes” or “no” in regards to
       successful risk reduction or elimination based on AP’s best professional
       judgment.

    d. Additional Information: The documentation parameters designated
       “Additional Information” asks for additional statements (if necessary)
       supporting case closure and, if appropriate, an explanation of why significant
       risk to a client remains upon case closure.

17. Report Seeking Guardianship Form: The “Report Seeking Guardianship”
    form documents evidence indicating incapacity, the necessity for an
    appointment of a guardian/conservator, the suitability of the client for
    guardianship/conservatorship (including the client’s expressed wishes), and the
    suitability of the proposed Guardian/Conservator.




                                27
AP STANDARDIZED FORMS




         28
QUARTERLY REPORT REQUIREMENTS




             29
1.   Clients Served: The TOTAL number of clients served who are victims of
     mistreatment or self-neglect falling under the jurisdiction of AP.

2.   Unit of Service: Each hour, or fraction thereof, spent providing AP services
     including, but not limited to, responding to Adult Protection reports (including
     non-jurisdictional single service contacts), performing client risk assessments,
     developing and implementing protective action plans (including SSPs and/or
     law enforcement referrals), taking any other action directly related to a specific
     report of adult abuse, neglect and/or exploitation, and time spent traveling to
     carry out Adult Protection duties with respect to an Adult Protection case.

3.   AP Reports: TOTAL NUMBER OF REPORTS received by AP during the
     quarter, including non-jurisdictional single service contacts and AP
     jurisdictional allegations handled by AAA AP staff.

4.   AP Investigations: Total number of reports received by AP, which fell under the
     APPROPRIATE JURISDICTION OF AP upon investigation.

5.   AP Investigations Substantiated: Total number of reports received and
     investigated by AP which were VALIDATED BY A PREPONDERANCE OF
     EVIDENCE.

6.   Felony Abandonment Cases: Total number of reported cases that fell within the
     definition of ABANDONMENT under section 18 – 1505, Idaho Code.

7.   AP Investigations – Medicaid Waiver Clients: Total number of AP
     investigations involving a client receiving services through the Aged and
     Disabled Waiver or the Developmental Disability Waiver.

8.   Emergency Referrals: Total number of reports received that were of an
     emergency nature necessitating immediate referral to law enforcement and/or to
     other appropriate emergency services.

9.   Case Management Referrals: Total number of substantiated AP cases requiring
     development and implementation of a Supportive Services Plan, which were
     referred to Case Management.

10. Ombudsman Referrals: Total number of investigated AP cases referred to the
    Ombudsman for resolution on non- – AP issues.

11. Department of Health and Welfare (DHW) Bureau of Family Standards
    Referrals: Total number of substantiated AP cases referred to DHW’s Bureau of
    Facility Standards.




                                  30
12. DHW Mental Health Referrals: Total number of investigated AP cases referred
    to and accepted for the first time by DHW’s Bureau of Mental Health and Adult
    Services.

13. DHW Developmental Disability Referrals: Total number of investigated AP
    cases referred to and accepted for the first time by DHW’s regional program
    serving developmentally disabled clients.

14. Guardianship/Conservatorship - Temporary: Total number of TEMPORARY
    Guardianship/Conservatorship proceedings in which AP has served as
    petitioner, or, for which AP has provided supporting affidavits or testimony.

15. Guardianship/Conservatorship - Full: Total number of TEMPORARY
    Guardianship/Conservatorship proceedings in which AP has served as
    petitioner, or, for which AP has provided supporting affidavits or testimony
    THAT RESULTED IN FULL APPOINTMENT of
    Guardianship/Conservatorship over a vulnerable adult.

16. Law Enforcement Referrals: Total number of SUBSTANTIATED AP
    investigations referred to law enforcement for further investigation.

17. Law Enforcement Prosecutions: Total number of substantiated AP
    investigations referred to law enforcement THAT RESULTED IN CRIMINAL
    PROSECUTION of an alleged perpetrator.

18. Risk Reduced or Eliminated: Total number of substantiated AP investigations
    closed due to AP’s assessment that RISK TO THE VULNERABLE ADULT
    HAD BEEN SIGNIFICANTLY REDUCED OR ELIMINATED.

19. Risk Remains – Client Refused Services: Total number of substantiated AP
    investigations closed in which the vulnerable adult remains at significant risk
    due to his/her REFUSAL OF SUPPORTIVE SERVICES.

20. Risk Remains – Services not Available/Discontinued: Total number of
    CLOSED AP investigations in which the vulnerable adult remains at risk AND
    in which supportive services were discontinued (for any reason).

21. Other Cash Expenditure: “Other Cash” includes funds from all sources
    EXCEPT federal and state grants and client fees and/or donations (Program
    income). Report expenditures of money derived from county or municipal
    sources in the “Other Cash” category.




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