Adult Protective Services Program Review in CA: Trends, Statistics, and Abuse Investigation

1. Adult Protective Services Program Review Department of Health and Human Services Adult Protective Services Dr. Sherri Z. Heller, Director February 2016

2. CA Aging Trends (1990 – 2020) • California has one of the fastest growing elder populations in the US • 112% increase in the 60 + population • 143% increase in the 85+ population • The number of adults age 60+ will surpass the number of children age 0-17 by 2030 Note: The 85+ population will emerge most strongly between 2030 – 2040, when the first baby boomers reach 85 Adult Protective Services Program Review

3. 2015 Sacramento County Projections Population of adults 60+ - 273,208 • Minority pop -97,325 • Low income – 28,320 • Medi-Cal eligble – 47,073 • SSI/SSP (65+) – 21,123 • Isolated geographically – 6,251 • 75 years+ - 79,836 • Living alone – 56,835 Adult Protective Services Program Review

4. Organizational Structure Small APS program housed within bigger Senior and Adult Services Division • Adult Protective Services • In Home Supportive Services • Senior Volunteer Services • Conservator’s Office Adult Protective Services Program Review

5. APS Program Statistics 8,243 calls in 2015 = 4,414 investigations • 60% increase in investigations since 2010 Investigations have multiple allegations * Confirm over half of all allegations • 857 allegations of Physical Abuse • 1211 allegations of neglect • 1781 allegations of financial • 791 allegations of psychological abuse • Total financial abuse allegations increased 122% since 2010 Adult Protective Services Program Review

6. APS Staffing • Intake unit • One supervisor, six intake social workers • Investigations units • Six supervisors, 39 social workers • Public Health Nurses • One supervisor, six nurses • Family Service Workers • One supervisor, seven paraprofessionals Adult Protective Services Program Review

7. APS On-Call • APS operates 24/7 • On Call • 5:00p.m.- 8:00 a.m. Monday–Friday shift • 2 shifts per day on weekends and holidays • Staffing per shift • One investigator • One supervisor • County Communications will take a message • Can request to speak with supervisor for an emergency Adult Protective Services Program Review

8. APS Training Resources • Northern California Training Academy • Academy For Excellence • APS new worker training • National, state and local conferences • MDT meetings • SacFAST meetings • Monthly APS In-Service trainings Adult Protective Services Program Review

9. Agency Authority • Welfare and Institutions Code • Section 106000 > • Defines APS Goals and Scope of Services • Provides Definitions • Creates and Limits Agency Authority • California Department of Social Services • Regulatory Agency • Statutory elaboration and explanation (ex: All County Letters) • Integration of court cases and rules that impact APS Adult Protective Services Program Review

10. APS: Legal Mandates • Respond to reports of abuse and neglect of elders and dependent adults in Sacramento County. • Make cross-reports as needed • Maintain 24 Hour Intake Hotline Adult Protective Services Program Review

11. Who is an Elder or Dependent Adult? Elder • Resident of the state, and • 65 years of age or older • WIC 15610.27 Approximately 73%of Sacramento County APS clients Dependent Adult • Resident of the state, and • Adult between the ages of 18 and 64, and • Has physical and/or mental limitations, and • Cannot complete normal activities or protect their rights. • Includes persons admitted to a 24 hour health facility Approximately 27% of Sacramento County APS clients Adult Protective Services Program Review

12. Dependent Adult Status • A combination of inability to meet own needs and inability to manage care • APS intake workers will ask lots of questions to determine if someone is a dependent adult • Questions will focus on the client’s ability to complete ADLs and IADLs • A disability does not, in itself, determine dependency Adult Protective Services Program Review

13. Types of Abuse/Neglect Investigated • APS receives reports of abuse and neglect from mandated reporters and non-mandated reporters. • All reports of abuse are handled the same, regardless of the identity of the reporter. • The following are the categories of abuse and neglect investigated by APS: Physical Abuse *** Abandonment *** Neglect *** SexualAbuse ***Self-Neglect *** Abduction Financial Abuse *** Isolation Adult Protective Services Program Review

14. Physical Abuse The non-accidental use of physical force that results or could have resulted in bodily injury, physical pain or impairment Includes over and under medication Includes food and water deprivation Adult Protective Services Program Review

15. Sexual Abuse • A form of physical abuse • Any nonconsensual sexual contact of any kind including (but not limited to): • Unwanted touching • All types of sexual assault and battery • Sexually explicit photography • Forced exposure to pornography • Unwanted relations with a spouse or partner Adult Protective Services Program Review

16. Financial Abuse The illegal or improper use of a Client’s funds, property or assets Funds, property or assets belonging to the client have been taken, secreted, appropriated and/or retained for a wrongful use or with an intent to defraud the client or by undue influence Adult Protective Services Program Review

17. Psychological Abuse • The infliction of fear, anguish, agitation or other emotional distress through verbal or non-verbal acts • Focus is on emotional distress inflicted, not just that the words are hurtful or mean • Mandated reporters do not have to report psychological abuse Adult Protective Services Program Review

18. Isolation • Isolation is the purposeful prevention of communication between a client and others without the client’s consent or knowledge when the action is not in the client’s best interest Adult Protective Services Program Review

19. Abandonment • The desertion or willful forsaking of an elder or dependent adult by anyone having care or custody of that person under circumstances in which a reasonable person would continue to provide care and custody. • Infrequently reported allegation Adult Protective Services Program Review

20. Self-Neglect • The refusal or failure of an adult to exercise self-care or perform essential self-care tasks. • Similar to neglect but there is no perpetrator – the client neglects themselves. Not reported to law enforcement. • Most frequent allegation - 3571 reports in 2015 Adult Protective Services Program Review

21. Financial Self-Neglect • A person is unable to manage their own finances: Not paying bills, difficulty managing bank accounts or investments, or difficulty keeping track of large sums of money. • Consequences may include eviction, homelessness, foreclosure, termination of utilities or health insurance for nonpayment, and inability to afford other necessities such as food and medication. • Might be associated with illness, addiction or dementia. • Inability to manage finances may precede other more obvious symptoms of dementia. Adult Protective Services Program Review

22. How does APS Intervene? • Crisis intervention: Priority 1, 2, and 3 • 24-hour response: One after hours APS social worker • Unannounced home visits • Comprehensive APS assessment • Investigation • Service planning and limited case management (up to 90 days) • Collaboration with law enforcement • Advocacy, education, and referrals • Multidisciplinary teams (MDT, FAST, and EDRT) • Community outreach and education Adult Protective Services Program Review

23. Community Collaborative Partners • Law Enforcement • Sacramento Steps Forward • Meals on Wheels • Long-Term Care Ombudsman • Sacramento Area Emergency Housing • Hospitals • TLCS Respite Center • McGeorge Victim of Crime Resource Center, Senior Legal Hotline • DA Victim Advocates • Senior Safe House Adult Protective Services Program Review

24. Limits to APS Authority? • The APS Program is not intended to interfere with the lifestyle choices of elders or dependent adults, nor to protect those individuals from all the consequences of such choices. • APS is a voluntary program. An elder or dependent adult who has been abused may refuse or withdraw consent at any time to preventative or remedial services by APS (two exceptions: mental incapacity or a report of a crime allow APS to proceed). • APS does not have the authority to place adults in protective custody. APS does not have a facility in which to place vulnerable adults. APS utilizes the same community resources as all other county agencies and residents. Adult Protective Services Program Review

25. If the client is mentally incapacitated? • If APS believes the client is incapacitated to the extent that he or she is unable to consent to adult protective services, a petition for conservatorship may be initiated, if less restrictive alternatives were attempted. • If appropriate family or friends are willing and able, they will initiate the conservatorship. For clients with no one to serve as a conservator, APS may make a conservatorship referral to the Public Guardian/Conservator’s Office. Adult Protective Services Program Review

26. Special Challenges • Mental Health • Substance Abuse • Homelessness Domestic Violence Immediate Housing Need Room & Board Homes Adult Protective Services Program Review

27. Mandated Reporters Three Primary Categories • 1. Care Custodians • 2. Health Practitioners • 3. Officers/Employees of Financial Institutions Adult Protective Services Program Review

28. Mandated Reporters: Financial Institutions • Bank and credit union employees who have direct contact with customers are mandated to report suspected financial abuse. • Bank and credit union employees who review or approve financial documents, transactions, and records in connection with financial services are mandated to report suspected financial abuse, even if they don’t see the customer. Adult Protective Services Program Review

29. Questions of Jurisdiction • Law enforcement has jurisdiction anywhere a crime occurs. For a crime in progress or a life-threatening situation, call 911. • APS has jurisdiction in cases where the abuse occurs outside a Long-Term Care (LTC) Facility or when the abuser is not affiliated with the facility. Mandated reports of abuse occurring outside of LTC Facilities are made to APS or local law enforcement. APS Hotline: 916-874-9377 • The Long-Term Care Ombudsman and local law enforcement have jurisdiction when the abuse occurs in a LTC Facility. Mandated reports of abuse occurring in a LTC Facility are made to the Long-Term Care Ombudsman and/or local law enforcement. Long-Term Care Ombudsman: 916-376-8910 Adult Protective Services Program Review

30. Confidentiality of Elder Abuse Reports • The identity of mandated reporters and the content of an APS report are confidential. Violation of confidentiality is punishable by up to six months in jail and/or a $500 fine. • APS is permitted to disclose confidential information from an elder abuse report or investigation with qualified multidisciplinary team members and representatives of agencies responsible for investigating the client’s case. • All persons and agencies entitled to confidential information from an elder abuse report are required to maintain confidentiality. Adult Protective Services Program Review

31. Confidentiality of Elder Abuse Reports The identity of the reporting party may only be shared with the following: • Local law enforcement, • Office of the district attorney, • Probate court, • Bureau of Medi-Cal Fraud and Elder Abuse, • Long-term Care Ombudsman, • State licensing agencies, • Office of the public guardian, • Department of Consumer Affairs investigative division, and • County counsel representing APS. The identity of the reporting party may also be disclosed to the district attorney in a criminal prosecution, when the person reporting waives confidentiality, or by court order. Adult Protective Services Program Review

32. Trends • Elder population increase = increased reports • Now opening approximately400 new cases a month • Family Justice Center • Increased volume of on-call reports Adult Protective Services Program Review

33. Financial Abuse • Financial abuse in 2015 • Received 2053 allegations • 24% of total allegations • Financial abuse allegations have increased 122% since 2010 • Started financial abuse unit in January 2015 • Developed financial abuse data collection tool • Confirmed $4.3 million loss, with $2.5 million lost to stranger scams • In confirmed case, 45% of the perpetrators were relatives Adult Protective Services Program Review

34. APS Recidivism • State recidivism rates hover around 33% • Sacramento County rates • 2015 – 23% • 2014 – 22% • 2013 – 27% • 2012 -32% • Implemented focus on quality practices (ex. cognitive screenings tools, high risk staffings, keeping cases open longer for safety planning) Adult Protective Services Program Review