Vulnerable Adult Act

1. Vulnerable Adult Act Annual staff training

3. Definitions • 1. Who • a. Minor - Child under the age of 18 • b. Categorical Vulnerable Adult - person over 18 receiving services from a licensed facility • c. Functional Vulnerable Adult - has a physical or mental difficulty that impairs his or her ability to care for his/her own needs

4. 2. Maltreatment - non-therapeutic conduct resulting in harm • a.Abuse - an act of harm towards a VA (assault, criminal sexual or abuse, hitting, kicking, pinching; malicious oral, written or gestured language; deprivational procedure-separation from the group) • b.Neglect - failure to provide for basic needs of person, home, health, food, clothing or supervision • c.Financial Exploitation - misuse or failure to use person's money by buying unnecessary items or failing to pay for goods or services the person needs

5. 3. Therapeutic Conduct - services done in good faith in the interest of the VA • 4. Mandated Reporters – All staff working in the human service field WHILE they are on the job. -- This includes all ProAct employees during work hours.

6. INCIDENT -Reports must be made for any "incident" resulting in injury to the participant (consumer). • A. Serious injury: • 1. fractures • 2. dislocations • 3. internal injuries • 4. head injuries with loss of consciousness • 5. lacerations with injury to tendons and organs are affected or complications are present • 6. second or third decree burns or burns with complications • 7. second or third degree frostbite or frostbite with complications • 8. injury to teeth • 9. injury to the eye • 10. ingestion of foreign substance or objects that are harmful • 11. near drowning • 12. heat exhaustion or sunstroke • 13. all other injuries considered serious by doctor

7. Incident… • B. Consumer's death • C. Medical emergency/illness/accident requiring physician treatment or hospitalization • D. Consumer's unauthorized absence/elopement • E. Fire or other circumstance involving law enforcement • F. Consumer to consumer aggression causing physical pain or emotional distress • G. Any sexual activity between consumers involving force or coercion • H. Any maltreatment to a minor or a vulnerable adult

8. WHEN to report… 1. Reports must be made when you have reason to believe maltreatment as occurred. 2. Reports must be made within 24 hours of the knowledge of the suspected maltreatment. 3. You are covered by Good Faith Laws if you make a report with the belief harm has come to a VA. 4. You can be prosecuted for not reporting or making a false report. 5. Incidents must be reported to team members within 24-hours of first knowledge and to DHS if the incident is a result of maltreatment.

9. When you DO NOT need to report… 1.A single mistake (med error) 2.Participant to participant abuse not causing serious harm 3.Accidents - unforeseen occurrences not due to lack of care by the person or facility.

10. HOW to report… 1. Fill out R-107 and/or A-30 report with as much information as possible or 2. Verbally report incident to Steve or Sally followed up by written report. or 3. Report incident to Common Entry Point (Goodhue County Health & Human Services 385-3232) or 4. Report incident to law enforcement.

11. Internal Investigation 1.Steve or Sally will investigate report and decide if report to CEP is needed. 2.Contact CEP within 24 hours of knowledge. 651-385-3232 3.Reply with formal letter (R-132) to reporter. **Action taken by ProAct may include suspension, termination and/or criminal action if report is substantiated.**

12. Common Entry Point651-385-3232 • Common Entry Point will investigate reports and decide if report needs to be made to Department of Human Services

13. Department of Human Services • This is the agency that license our program (DTH) and is the investigative body for maltreatment reports. • Reports may be substantiated and punitive action required or… • Incident may be found to be single mistake, accident, etc.

14. Wisconsin – Critical Incident • Any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the physical or mental health, safety or well being of a waiver participant. • Any abuse or neglect of the participant inflicted by others. • Any misappropriation of the person’s funds or property. • A violation of the person’s rights.

15. Critical Incident… • All unexpected, untimely and urgent emergency hospital admissions including any that are or may be the result of substandard care; this excludes urgent care clinic visits for acute physical health issues. • Errors in medical or medication management that result or could result in significant adverse medical reactions or behavioral responses indicating a threat to the person’s health.

16. Critical Incident • The initiation of an investigation by law enforcement authorities of an event or allegation that involves a waiver participant either as a perpetrator or victim that may lead to criminal charges. • Any death of a waiver participant including those by natural causes. • All suspected or confirmed suicide attempts by a waiver participant.

17. Critical Incident • A fire in the home or facility in which the participant lives or where the participant was receiving services if the fire required the response of a fire department and created a significant risk to the participant’s health or safety. • Significant damage to property including but not limited to the property of the waiver participant, service providers, participant’s residence, place of employment or other place the participant frequents if such property damage poses or posed a threat to the person’s health, safety or welfare. Includes acts of nature.

18. Critical Incident • Unsafe or unsanitary environmental conditions in a person’s home or place where the individual receives services. • Use of isolation, seclusion, or restraint (physical or chemical) by a service provider in violation of WI statutes without county and DHS’s prior approval. • Unanticipated absence of the participant including any unauthorized leaving by the participant such as wandering or intentionally leaving which suggest that the participant is at risk of harm.

19. What we do for Wisconsin reports… • We will follow our own procedure for VA reports with the primary difference being how we report it beyond ProAct. Sally will investigate all reports and determine if further action is needed. ProAct will complete the Wisconsin Critical Incident Report and submit it to CHP or appropriate agency within 5 days of knowledge.

20. John wears a Depends. He was not taken to the restroom at all yesterday and went home in the same Depends he came to work in. • What form of maltreatment? • Need to be reported? • What other information is needed?

21. Mark was having a difficult time filling his work pattern correctly. The staff working in his area was overheard saying “Can’t you get this? Boy, are you stupid!” • What form of maltreatment? • Need to be reported? • What other information is needed?

22. Natalie was upset today and began hitting out towards staff. Staff carried her into the Quiet Room and left her in there alone with the door closed. They also prohibited her from coming out of the room. • What form of maltreatment? • Need to be reported? • What other information is needed?

23. Staff did not give Sylvia her noon meds yesterday. The staff seems to forget just about every day he passes meds. • What form of maltreatment? • Need to be reported? • What other information is needed?

24. Staff knowingly do not give Joey down time for being without work when working on piece rated jobs. This causes his average piece rate to go down and consequently, his check is lower. • What form of maltreatment? • Need to be reported? • What other information is needed?

25. Barb had a behavioral incident prior to lunch time. By the time she calmed down lunch time was over. Staff told her that she lost the privilege of lunch and that she needed to return to work. You overhear staff tell Barb that she’d better think about her behavior in the future if she wants to eat lunch. • What form of maltreatment? • Need to be reported? • What other information is needed?

26. John is 25 years old and lives at an adult foster care home.  He also attends a day training and habilitation program five days per week. John has limited communication abilities.  • On Monday morning, John arrives at his day program as usual.  As the day program staff persons are assisting him off of the van they notice a large bruise on the left side of his face and neck.  When asked about the bruise, John is unable to tell the day program staff persons how he sustained the bruise. • What is the responsibility of the staff persons at the day program?

27. A resident’s care plan indicates that the resident is not to be left unsupervised on the side of the bed because of her poor sitting balance. The resident is left sitting on the side of the bed while the nursing assistant left the room quickly to get a clean towel and washcloth. The resident falls and sustains a fracture of her humerus. • Is this incident reportable?

28. Robert is 18 years old and lives in an adult foster care home. Robert enjoys playing video games and owns all of the latest games. One evening while talking with a staff person named Jeff, Robert says that he sure wishes he could get his video golf game disk back from the staff person who works on the weekend. Jeff asks Robert some questions and Robert says that he “loaned” the game disk to a weekend staff person two weeks ago.  Robert tells Jeff that he did not really want to loan the game to the weekend staff person and told him so, but the staff person took the game anyway and said he would return it in two weeks when he worked again.  As they are talking, the weekend staff person comes into work, gives Robert his game disk, and tells Robert “thanks.” • Should Jeff report this to the CEP?

29. Joel is a young man who is diagnosed with bipolar disorder.  He attends an adult day program where he met a new friend, Jill.  Jill also attends the same day program and is diagnosed with depression.  You are the facilitator of a group session at the day program.  After group, Joel tells you that Jill has been “borrowing” money from him and now he is not able to pay his rent.  Joel stated when he asks Jill for his money back, she gets upset with him and calls him names.  This is very upsetting to Joel because he likes Jill.  You’re not sure how much money Jill has borrowed, but you are concerned about Joel and his ability to say “no” to Jill the next time she asks for money.  You are also concerned about Joel’s inability to pay his rent and fear he may get evicted. • Do you call the Common Entry Point (CEP)?