Adult Protective Services and You

1. Adult Protective ServicesandYou

2. What is Adult Protective Services? What Can YOU Do to Help???

3. These questions and many more will be answered for you during this presentation... Let’s start by explaining why we have APS in every county in North Carolina

4. Adult Protective Services is not just the right thing to do it’s authorized by Law! NC General Statute 108A gives county departments of social services the authority to evaluate allegations that a disabled adult is being abused, neglected or exploited and is in need of protection.

5. How does this law apply to You ? NC General Statute 108A requires EVERYONE who has reason to believe that a disabled adult is in need of protection to report that information to Social Services.

6. North Carolina APS Statistics In FY 10-11 19,553 reports were received by county departments of social services alleging the abuse, neglect or exploitation of adults. 10,274 of those reports were accepted for Adult Protective Services evaluation.

7. What do I need to know to make an APS report? As much of the following information as possible… • The name of the disabled adult or enough information for APS to identify him/her • The approximate age of the disabled adult • The address where the adult can be found • What can’t the adult do for himself/herself ? • Does the disabled adult have someone to help take care of him/her? Do not worry that you don’t have all the information listed above, just report what you do know.

8. You don’t have to know if the information you want to report is abuse or neglect or exploitation! Just report the information you have and Social Services will figure it out.

9. IF a report meets the legal criteria, a social worker will make an unannounced visit to the adult in order to complete a thorough evaluation and make a determination about the need for protection.

10. APS Screening Decision Criteria • Disabled Adult • Abused, Neglected, or Exploited • In Need of Protective Services

11. APS SCREENING CRITERIA • Disabled Adult-A person 18 or over or a lawfully emancipated minor present in North Carolina and physically or mentally incapacitated • Abused-Abuse is the willful infliction of physical pain injury or mental anguish; unreasonable confinement; or the willful deprivation by a caretaker of services necessary to maintain mental and physical health. • Neglected-Neglect occurs when the disabled adult is unable to provide the necessary services to maintain mental/physical health; and the disabled adult is not receiving these services from his/her caretaker

12. APS Screening Criteria (cont) • 4. Exploited-Exploitationis the illegal orimproper use of a disabled adult, or the disabled adult’s resources for another’s profit or advantage. • and • 5. A disabled adult is in Need or Protective Services if due to a mental or physical incapacity he or she is unable to perform obtain essential services for him or herself • and • He or she is without willing, able, and responsible persons to perform or obtain the essential services for him or her

13. Receive and Screen Referral Apply Screening Criteria Does Not Meet Criteria Meets Criteria Make Appropriate Referrals within DSS and Community Accept as APS Report Assign for Evaluation

14. An APS report involving an emergency must be initiated within 24 hours. An emergency is a situation where the disabled adult will suffer death of irreparable harm if protective services are not provided. Non-emergency reports are initiated within 72 hours. Time Frames(APS Evaluations)

15. Steps in APS Evaluation • A visit with the disabled adult. The evaluation has not been initiated until a visit has been made with the disabled adult. • Consultation with others who know the disabled adult’s situation. This may include the reporter, neighbors, friends, relatives, other professionals, and facility staff working with the adult, and facility residents. • Medical, psychological and/or psychiatric evaluations, when necessary.

16. What does the evaluation cover? To beginthe social worker assesses the adult in the following areas: Social support Psychological issues Economic status Medical conditions ADL/IADL performance (everyday tasks like cooking, walking, dressing and using the phone) Environmental safety

17. The evaluation continues as the social worker gathers information from others such as: Neighbors and Family Health CareProviders Financial Institutions

18. Then the social worker staffs this information with a team and they make a case decision. They decide if the adult is disabled, has been abused, neglected or exploited and if there is a need for protection at this time.

19. Case Decision • An APS report is substantiated when: • The adult is determined to be a disabled adult; • The adult is determined to be abused, neglected or exploited; and • The adult is determined to be in need of protective services. • An APS report is unsubstantiated if any one of the three criteria above is not met.

20. IF APS determines that there is a need for protection then the capacity of the adult, to consent to services, is determined by assessing his or her ability to understand the situation and the consequences of his or her decisions, if no changes are made.

21. An adult with capacity has the right to self determination even if the choices may not appear to be in his or her best interest.

22. If the adult has capacity to consent then he/she can refuse or accept the help offered by the social worker.

23. If the adult does NOT have capacity to consent then permission to provide the services must be obtained from his/her guardian, durable power of attorney or the court.

24. If a disabled adult is found to be in need of protective services, essential services must be provided immediately to safeguard the disabled adult’s rights and resources, and to maintain the physical or mental well-being of the disabled adult. Essential services may include: the provision of medical care for physical and mental health needs, assistance with personal hygiene, food, clothing, adequately heated and ventilated shelter, protection from health and safety hazards, protection from physical mistreatment and exploitation. Provision of Adult Protective Services

25. What kind of services might be provided? Home management Nutrition Personal care Medical care Facility placement Budgeting

26. What can YOU do to help? Watch for signs of abuse, neglect and exploitation in your community!

27. Some signs you should watch for… ABUSE – unexplained bruises, fractures, black eyes, burns, pinch marks, scratches, fearful of caretaker/family member NEGLECT–poor personal hygiene, decubiti, decayed teeth, lack of prosthetic devices, sudden weight loss, lack of medication, imposed isolation, lack of health care,wandering EXPLOITATION –unpaid bills. sudden change in living style, new “friends” helping with bank accounts, change in ownership of property, no spending money, missing belongings, inappropriate sexual touching, unfair wages for work

28. If you suspect that an adult is being abused, neglected or exploited please let APS know by calling, writing or emailing your local Department of Social Services.

29. Here’s the Link to NC Departments of Social Services: http://www.ncdhhs.gov/dss/local/ • You can look up any NC Department of Social Services contact information.

30. For More Information about Protecting Adults with Disabilities: • Please contact your local Department of Social Services • Visit the NC Division of Aging and Adult Services website- http://www.ncdhhs.gov/aging/ • You can also contact Leshana Baldwin, APS Consultant at the NC Division of Aging and Adult Services- LeShana.Baldwin@dhhs.nc.gov 919.855-3456

31. APS/MFP Transition Scenarios • No one has been adjudicated incompetent. • All meet CAP DA/Nursing Facility Level of Care • Questions to Answer After Each Scenario • What is the role of the Transition Coordinator? • What is the role of APS? • What factors play a role in the decision to involve APS? • What factors will APS consider when making a determination about whether abuse, neglect or exploitation is present?

32. Kelly • Kelly is a young mother who was in a car accident that left her paralyzed. She has transitioned from the nursing facility and back into her family’s home, where her mother serves as her primary caregiver. From the transition coordinator’s perspective, Kelly and her parents love each other but are under tremendous stress because of the new living dynamic. Kelly has reported to the transition coordinator that her mother has repeatedly said really cruel things to her but she doesn’t want APS called because she thinks it will make things more stressful and she knows her mom loves her.

33. Marty • Marty uses a wheelchair and has recently transitioned back into her own apartment with personal aide services through CAP. Marty has the capacity to make her own decisions and likes her aide. However, the CAP case manager has recently learned that the aide and Marty have arranged for Marty to pay the aide extra money out of her own pocket “under the table” (in addition to what the home health agency pays) because the aide has indicated to Marty she may have to look for another job that pays more otherwise.

34. Laura • Laura is a young woman who had a stroke and was admitted to a facility. While able to make her own decisions, she has a long “track record” of making decisions that make her life more difficult and of manipulating transition team members. Upon discharge, she refuses assistance from aides, in part because she does not like their personalities and does not want assistance in bathing. As a result, her hygiene has become compromised to the point of concern for the CAP case manager and her family.

35. Charlene • Charlene recently transitioned out of a nursing facility and into her own apartment. While she has strong opinions about “living her own life,” she appears to be easily influenced and has a history of depression. The CAP case manager has recently become aware that Charlene is having sex with 2 different men in her apartment complex and has heard a rumor that there may have been payment involved.