Older Adult Protective Services Act Denise Getgen, RN, BSN June 4, 2018

1. Older Adult Protective Services ActDenise Getgen, RN, BSN June 4, 2018

2. Role of PDA and AAA PDA • Responsible for Oversight and Implementation • Funds AAAs for all Protective Services • QA AAA • Responsible for Intake, Investigation and Service Delivery • Local Provider of Direct Services • QA

3. What Does Intake Look Like? • Standardized form for intake call Report of Need • Demographics (name, age, address, living arrangements, etc.) • Current concerns (allegation of abuse) • Known physical/health conditions • Any known dangers in the home • Any known assistance in the home (finances, care/services, etc.) • Reporter’s information

4. The PA Older Adults Protective Services Act (OAPSA) • Voluntary Reporting • General Public • Background Checks for LTC employees • All get PA State Police checks • Some get PA State AND FBI Checks • PDA processes the FBI Checks • Mandatory Reporting • Facilities including home health providers • Licensed individuals

5. §10225.301 -- Any person having reasonable cause to believe that an older adult is in need of Protective Services may report to the local Area Agency on Aging Voluntary Reporting Provisions

6. §10225.701 – An employee or an administrator who has reasonable cause to suspect that a recipient is a victim of abuse shall immediately make an oral report the AAA. Mandatory Reporting Provisions

7. Older Adult in Need of Protective Services • Within the jurisdiction of Pennsylvania • 60 or over • No responsible caregiver • Imminent risk of danger to person or property • Incapacitated

8. Immunity & Penalties • Immunity • No person or entity shall be held liable for any action directly related to good faith compliance with the Act. • Penalties • Administrators and facility owners who intentionally or willfully fail to comply or obstruct compliance with the Act or who intimidate or commit a retaliatory act against an employee who complies in good faith with the provisions of the Act are in violation and subject to both administrative and criminal penalties. • Civil - $2,500 fine • Criminal - $2,500 fine or imprisonment • Any person who is required to report under the Act and willfully fails to do so commits a summary offense for the first violation and a misdemeanor for a second or subsequent violation.

9. Why Important to PA?

10. What is Abuse? • The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. • The willful deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health. • Sexual harassment, rape or abuse, as defined in 23 Pa. C.S. Chapter 61 (relating to the Protection From Abuse Act). • An act or course of conduct by a caretaker or another person against an older adult or an older adult’s resources, without the informed consent of the older adult or with consent obtained through misrepresentation, coercion or threats of force, that results in monetary, personal or other benefit, gain or profit for the perpetrator or monetary or personal loss to the older adult. • The desertion of an older adult by a caregiver.

11. Risk Factors for Abuse • Social Isolation • Physical impairment • Cognitive impairment • Mental Illness • Substance Abuse • Accessible Assets • Sense of entitlement by family/caregiver • Dependence of caregiver • Intergenerational abuse history

12. Recognizing Physical Abuse • Bruises, black eyes, lacerations, • Signs of restraints being used • Fractures • Burns • Broken assistive devices (glasses, dentures, cane, etc.) • Changes in behavior • Overt reporting of abuse • Lab results (dehydration, infection, overmedicated, etc.) • Refusal of care/services

13. Four Serious Types of Abuse Requires Additional Reporting by Facilities • “Sexual abuse" • Intentionally, knowingly or recklessly causing or attempting to cause rape, involuntary deviate sexual intercourse, sexual assault, statutory sexual assault, aggravated indecent assault, indecent assault or incest. • "Serious physical injury" • An injury that: • Causes a person severe pain; or • Significantly impairs a person's physical functioning, either temporarily or permanently. • "Serious bodily injury" • Injury which creates a substantial risk of death or which causes serious permanent disfigurement or protracted loss or impairment of the function of a body member or organ. • “Suspicious Death”

15. The failure to provide for oneself OR the failure of a caretaker to provide goods or services essential to avoid a clear and serious threat to physical or mental health. What is Neglect?

16. Recognizing Neglect • Unmet medical needs • Dehydration, malnutrition, under/over medicated • Minimal physician contact • Left alone for extended periods of time • Isolation • Unsanitary or unsafe living conditions • Personal hygiene needs not met • Wounds • Wandering • Falls (care plans not followed)

20. Overlooked & Under-Reported – All Abuse • Overlooked • Staff become desensitized • Dementia and/or psychiatric condition (just part of the dx) • Lack of training/awareness • Challenges/Barriers • Cognitive and/or sensory impairments • Markers of abuse can mimic sign of aging process • Failure to report timely • Lack of screening • Under-reported • Not seen as “abuse”/ seen as “the norm” • Doesn’t remember or no witnesses • Fear of negative consequences

21. Exploitation: $34,000.00 outstanding NH bill Son is POA and unable to be reached despite attempts Consumer has memory loss and believes son is paying the bill monthly APS questions whether guardianship is necessary Neglect: Older adult has some cognitive impairment Older adult’s daughter lives with her and acts as caregiver Daughter leaves older adult home for weekends without care/services Older adult refusing outside caregiver Physician has concerns regarding non-healing wound Case Studies

22. Reported and SubstantiatedMost frequently reported Financial – Caregiver Neglect – Self NeglectMost frequently substantiatedSelf-Neglect – Caregiver Neglect – Financial

23. Report will be taken and taken seriously Report will be categorized and affirmed by PS worker and referrals will be made Comprehensive, unbiased investigation within required timeframes – may be joint visit with licensing Confidentiality and Safeguards for cooperation Ability to report anonymously Assistance/Services offered to consumer/family if substantiated Expectations

24. Reports of Need Physician reports to PS Concerns (unexplained bruises, weight loss, etc.) Hygiene issues Medication concerns Failure to make/keep appointments Confusion PS calls physician’s office for information Capacity assessment HIPPA Exempt Medication List Risk assessment and care plan development Does physician have any concerns Aware of abuse, neglect, exploitation or abandonment Collaboration – AAAs (PS) and Physicians

25. 1-800-490-8505 (or through local AAA) HOW TO REPORT Elder Abuse

26. Protecting Seniors Legal Services for the Elderly Senior LAW: 1.877.727.7529 or 215.988.1242 The Department of Aging’s Institute on Protective Services at Temple University, Harrisburg, continues to provide support, training, resources, and expert consultation to the Area Agencies on Aging (AAAs), criminal investigators and prosecutors, and other local community organizations. These entities work together to uncover, investigate, and prosecute crimes against the elderly. Elder Law Task Force A task force chaired by Supreme Court of Pennsylvania Justice Debra Todd was formed in April 2013 to study the overall issues of access to justice being faced by older Pennsylvanians.

28. Denise Getgen, Director Protective Services, Pennsylvania Department of Aging 717-772-0184 dgetgen@pa.gov

29. Questions