In Utah, United States, Adult Protective Services (APS) are agencies that provide protective social services to elderly adults (typically those age 60 or 65 and older) as well as vulnerable adults (typically those with serious disabilities). Adult Protective Service agencies are the adult equivalent to Child Protective Services and play a critical role in combating elder abuse or the abuse of other vulnerable adults. Such abuse can include neglect, physical abuse, sexual abuse, emotional or psychological abuse, abandonment, or financial abuse. According to the National Adult Protective Services Association (NAPSA), over the past several decades, Adult Protective Service agencies have developed from the ground up. They first emerged at the state and local levels and only recently received greater support from the federal government. Thus, the development of most Adult Protective Service agencies occurred before the benefit of federal coordination and also before the benefit of comprehensive research in the field of elder or vulnerable adult abuse, a more recent phenomenon. As of today, Adult Protective Services agencies exist in every state and are normally administered at the local or county level. Two-thirds of states place their Adult Protective Service agencies within their Department of Social Services. For the remaining states, Adult Protective Service agencies are placed within a state department on aging or health. In addition, while a few states, such as Ohio, limit Adult Protective Services only to the elderly, most states (90%) provide Adult Protective Service to vulnerable or dependent adults as well as the elderly.
What Services Do Adult Protective Service Agencies Provide?
Upon receiving a report of abuse involving an elderly or vulnerable adult, APS agencies typically provide the following services:
• Evaluations of client risk and mental capacity
• Development and implementation of a case plan tailored to the victim
• Counseling for the client
• Assistance in connecting the client with additional services and benefits
• Ongoing monitoring of the delivery of services
In conducting investigations, APS agencies also work closely with law enforcement in the event that criminal abuse against elderly or vulnerable adults is uncovered.
Principles Guiding APS Agencies
According to the National Adult Protective Services Association (NAPSA, below are the main principles that guide APS agencies in the delivery of services to elder or vulnerable adults:
• The client has a right to self-determination.
• The least restrictive alternative should be used.
• The family unit should be maintained wherever possible.
• The use of community-based services should be preferred over institutions.
• Blaming the victim should be avoided.
• Failure to provide adequate or appropriate services is worse than providing no services.
Filing a Report with Adult Protective Services
If you file a report with Adult Protective Services, the details of the report will first be screened by a trained professional to determine whether Adult Protective Service has jurisdiction to move forward. If so, you can expect an APS caseworker to be assigned to investigate the case and establish a relationship with the potential victim. In some states, a caseworker is required, by law, to contact the potential victim in person within a certain number of days. Utah, for example, requires a caseworker to make such “in-person” contact immediately in cases of imminent danger or, for all other cases, within ten days.
During the investigation, the caseworker will investigate the facts and, where appropriate, report any criminal activity to law enforcement. However, unlike a traditional law enforcement investigation, APS caseworkers are also specifically trained to develop a relationship of trust with the potential victim and to provide a case plan specifically tailored to the potential victim’s needs. While laws vary from state to state, some states allow for APS reports being submitted anonymously. Some states also protect the person making the report from civil and criminal liability, as long as the report was made in good faith. Such laws also protect those initiating reports from any professional disciplinary action. This is to encourage doctors or other medical professionals to report suspicions of abuse without fear of breaching any professional obligations of confidentiality or any privacy laws relating to medical records. To initiate a report of elder abuse or abuse of a vulnerable adult, contact your local Adult Protective Services office. the National Adult Protective Services Association (NAPSA) provides an APS locator on its webpage to assist in locating an office near you.
You also have a right to:
• Be treated with courtesy and respect.
• A caseworker who works with you and listens to your needs and concerns.
• Participate in the development of a Service Plan. A Service Plan identifies the services recommended and who will be responsible for providing those services.
• Clear, honest answers to your questions.
• Be told about other organizations that can help you and your family if APS cannot help.
• Written notification of the case resolution.
• Be served without discrimination on the basis of age, race, national origin; creed; gender; sexual orientation; lifestyle; or physical, mental or developmental disability.
• File a complaint or grievance if you have a problem or concern that cannot be resolved by your caseworker or the supervisor.
• Ask that services be terminated.
You have a responsibility to:
• Provide accurate information.
• Cooperate with your caseworker and others trying to help you.
• Tell your caseworker or your caseworker’s supervisor if you have a problem so they can serve you better.
Services rendered by APS
APS can provide short-term (normally less than 30 days) case management services. In addition, APS can make service referrals to community agencies that can provide long-term support. Examples of these services are listed below.
• Meals on Wheels
• Medical Treatment
• Money Management
• Long term homemaker services
• Chore Services
• Mental Health Counseling and treatment
• Drug or Alcohol assessment and treatment
Immediately you contact APS what happens is that APS will take the report and investigate if APS has jurisdiction and the adult is considered a vulnerable adult. An APS investigator will:
• conduct a home visit, usually unannounced;
• interview other individuals who may have information about the situation; and
• offer protective services if the investigator determines abuse has occurred.
Depending upon the situation, law enforcement may also be called upon to investigate. If abuse is confirmed, APS works closely with others in the community to ensure the health and safety of the vulnerable adult. This may include such things as having a case manager work with the vulnerable adult to determine what care services are needed and helping him/her get those services, emergency shelter, food, medical care, counseling, help moving if it is necessary and follow up to ensure the adult is safe. On the legal front, APS may report the alleged abuser to law enforcement; help get an emergency protective order, an injunction to allow access to an alleged victim or referral for legal assistance. In extreme cases, APS may work with the Attorney General’s office to appoint a guardian. It is important to understand the vulnerable adult has the right to make his/her choices. A vulnerable adult who has been abused has the right to refuse any or all interventions or change his/her mind and withdraw consent to any assistance from APS at any time.
Types of Abuse
• Physical: e.g. Hitting, kicking, burning, dragging, over or under medicating
• Sexual Abuse: e.g. Unwanted sexual contact, sexual exploitation, forced viewing of pornography
• Abandonment: e.g. Desertion or willful forsaking by anyone having responsibility for care
• Isolation: e.g. Preventing the individual from receiving mail, telephone calls, visitor
• Financial: e.g. Theft, misuse of funds or property, extortion, duress, fraud
• Neglect: e.g. Failure to provide food, clothing, shelter, or health care for an individual under one’s care when the means to do so are available.
• Self-neglect: e.g. Failure to provide food, clothing, shelter, or health care for oneself.
• Mental suffering: e.g. Verbal assaults, threats, causing fear.
These are some possible warning signs that abuse might be occurring to an older or disabled adult or that the individual is at increased risk for abuse. If you observe some of these occurring with an older or disabled adult you know, consider alerting County Adult Protective Services.
• Explanation for an injury is inconsistent with its possible cause
• Recent changes in the elder or dependent adult’ s thinking; seems confused or disoriented
• The caregiver is angry, indifferent, or aggressive toward the elder or dependent adult
• Personal belongings, papers, or credit cards are missing
• The elder appears hesitant to talk openly
• Lack of necessities, such as food, water, utilities, medications and medical care
• The caregiver has a history of substance abuse, mental illness, criminal behavior or family violence
• Another person’s name added to the client’s bank account or important documents, or frequent checks made out to cash
When a report of abuse, neglect or exploitation is received, APS’s goal is to create a stable environment where the individual can safely function without requiring on-going intervention from the APS program. Services provided by APS include responding to reports of known or suspected abuse or neglect, conducting an investigation, and arranging for the delivery of services from available community agencies. APS is not intended to interfere with the life style choices of elders or dependent adults, nor to protect those individuals from the consequences of their choices. For this reason, an elder or dependent adult who has been abused may refuse or withdraw consent at any time to preventive and remedial services offered by an APS agency. However, APS is required to conduct an investigation when there is an allegation that a crime has been committed, regardless of whether the elder or dependent adult wants the investigation to go forward or not.
Benefits to Reporting Abuse
• The elder or dependent adult will be given options to keep him/her safe from harm
• The APS worker can link the client, family to needed community resources
• Unaware family members and friends can be alerted to step in to help
• The APS worker can find ways to help the caregiver handle stress
• In some cases, the abuse perpetrator can be prosecuted, lessening the harm to others
• The individual making the report feels relief that a professional is assessing the situation
Failing to Recognize Signs of Abuse
Many family members, friends, or even nursing facility staffs don’t know how to identify the signs of possible abuse or what they should do if they have reason to believe that an elderly adult is being abused. Red flags that may indicate abuse include:
• Unusual changes in behavior, mood, or sleep habits.
• Fear, anxiety, depression, or isolation.
• Broken bones, bruises, welts, cuts or sores.
• Untreated bedsores.
• Torn or bloody underclothing.\
• Unexplained sexually transmitted diseases.
• Dirtiness, poor nutrition, or dehydration.
• A caretaker’s refusal to allow the elder to spend time alone with family or friends.
• A caregiver who exhibits negative behavior toward the elder, including threatening, bullying, or belittling the elder.
• Unsanitary living conditions.
• Lack of medical aids the resident needs, such as glasses, a walker, hearing aids, or dentures.
• Unusual changes in bank account or money management, wills, or other financial documents.
• Forged signatures on financial documents.
• Unpaid bills.
Fear of Retribution
While declining cognitive abilities may leave many elders unable to report abuse, another reason elders may be reluctant to talk about what is happening to them is fear of retribution. This is true for abuse in home settings as well as in skilled nursing facilities. This may be particularly true if the abuser is the elder’s primary caretaker. In institutional settings, fear of retribution may also cause residents to feel uncomfortable about reporting abuse that they witness other residents experiencing. It is hard to report abuse by someone upon whom you are completely dependent. Some of the questions an elder may be asking themselves include:
• Who is going to take care of me if I report this behavior?
• Will my caretaker be angry?
• If I report abuse, will it be investigated? Will my abuser be told that I filed the report?
• If I report my abuser, will they still be responsible for my care? Will I be subjected to worse treatment or other punishment for reporting?
• If I report the abuse of another resident, will the caretaker be disappointed in me? Will they lose their job? Will I be subjected to the same abuse?
• If I report that my family member or caretaker is abusing me at home, will this cause me to have to move to an institution for care?
One of the most prevalent forms of elder abuse is emotional abuse, which may include threats or intimidation. One of the red flag behaviors that may indicate elder abuse is a caretaker who is reluctant to allow the elder to spend time alone with visiting family or friends. Fear of retribution may also be a factor in the failure of staff to report suspected abuse by other staff members. Facility employees may worry that reporting a coworker will cause a time-consuming investigation that supervisors won’t believe the allegations or those supervisors will take the abuser’s side and that making the report could impact the reporting employee’s status at the facility.
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