PPT

Report
APSIL
Adult Protective Services of Illinois
Presented by Erin Davis, Legal Services Developer
Illinois Department on Aging
Recent Legislation

On July 1, 2013, Governor Pat Quinn signed into law the Adult Protective
Services Act (PA 98—0049) which includes some of the nation's strongest
safeguards to protect older adults and adults with disabilities.

Adding these services to adults with disabilities will provide more thorough
investigations in cases of suspected abuse, neglect and financial exploitation.

Public Act 98—0049 follows nationally-recognized best practices by creating
an Adult Protective Services unit within the Department on Aging.

The Adult Protective Services Program is locally coordinated through 41
provider agencies which are designated by the regional Area Agency on
Aging and the Department on Aging.
Adult Protective Services
Eligibility

60 years of age or older

18-59 with a disability

At least one (1) allegation of abuse, neglect, exploitation must exist

Alleged abuser must be someone other than the victim

Victim must reside in a domestic setting

Self-neglect is not currently funded but is part of the Act
Defining Abuse, Neglect & Exploitation
What is Abuse?

Abuse is anything that causes harm to an individual.

Abuse can be physical, sexual, neglect, psychological/emotional, or
economic/financial.
Financial Exploitation

Controlling the finances of another person without their permission

Withholding money for basic necessities (i.e. food, medication, transportation)

Depriving someone of financial benefits

Exerting undue influence
Undue Influence

Isolation – from information, friends, relatives or usual advisors

Dependency – upon the perpetrator

Emotional manipulation and/or exploitation of a weakness

Acquiescence – the victim’s apparent consent or submission

Loss – financial loss
Indicators of Financial Exploitation

A gap between income and lifestyle

Adult has no knowledge of finances

Unusual activity in bank account

Unpaid bills despite adequate resources

Abuser is evasive about financial arrangements

Forging the person’s signature

Forcing the person to sign over a new POA with the intent of gaining
access to funds

Forcing the person to quit claim property
Emotional Abuse

Threats

Calling someone names, putting them down

Threatening to send the person to an institution

Harassment

Intimidation

Threatening to destroy pets or personal belongings
Neglect

When caregivers do not meet the needs of people they serve.

A caregiver can be someone who is paid to help or a family member.

May not be intentional/not always criminal

When done intentionally, for reasons of power and control
Indicators of Neglect

Leaving a dependent adult alone, or with inadequate supervision

Unsanitary or hazardous conditions in home

Inadequate food (no food, spoiled food)

Removing dentures, glasses, hearing aids from the adult’s reach

Not providing enough heat/electricity

Removing aids such as a wheelchair or communication device (this is also an
emotional tactic)

Leaving the person’s medical problems untreated

Failure to comply with treatment plan
Source: Iowa Department of Elder Affairs, 2001
Physical Abuse

Intentionally causing a person pain or injury
Examples of Physical Abuse

Hitting

Pushing

Slapping, handling someone roughly

Pulling hair

Giving inappropriate medication - over and under medicating the adult

Over medicating with alcohol
Indicators of Physical Abuse







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Bruises and other physical injuries
Bilateral injuries
Injuries at various healing stages
Over or under medication
Dehydration
Malnutrition
Decubitus ulcers
Lack of compliance with plan of care
Source: Butler, 1999
Confinement

Restraining

Isolating

Denying access to phone/mail

Controlling activities of adult

Limiting time the adult spends with loved ones
Sexual Abuse

Any non-consensual sexual conduct

Any sexual activity with an adult who is unable to understand or give consent

Any sexual act committed under threat of harm

Any forced sexual act
Statistics

Between 1 and 2 million Americans aged 65+ are abused by someone a
caregiver

Overall reporting of Financial exploitation are at only 1 in 25 cases. There
may be as many as least 5 million financial abuse victims yearly

Research has found that over 67% of women with physical and cognitive
disabilities experienced physical abuse in their lifetime

People with disabilities experience violence 1.5 times more often than people
with Disabilities
Consequences of Abuse
On the Adult

Physical- Bruises, bed sores, malnutrition, fractures

Emotional- Fear, stress, shame, guilt, isolation, depression,
learned helplessness, denial

Financial- Loss of home, life savings, belongings
Consequences of Abuse
On the Abuser

Guilt

Remorse

Overwhelmed

Shame
“Shame can cause the offender to hide the
maltreatment and may inhibit them from
seeking help to improve the situation.”
- Holly Ramsey-Klawsnik
Indicators of Abuse
On the Adult

Change in behavior

Withdrawn

Depressed

Lack of interest in normal activities

Change in appearance

Appears hungry, unclean, frightened of family members or caregivers

May present as afraid, embarrassed, reluctant to answer questions
Indicators of Abuse
On the Abuser

Attempting to dominate the adult

Answers for the adult instead of allowing the adult to answer

Verbally, physically abusive to the adult and others

Evidence of substance abuse, untreated mental health problems

Continual concern regarding the adult’s money
Indicators of Abuse
the Environment

Family member/caregiver won’t let people in the home

Accumulation of mail, newspapers

Lack of attention to home, a state of disrepair

Large numbers of people using the home
Predictors
Abuser characteristics are better predictors of abuse than are
victim characteristics, including:

Abuser’s mental and emotional health

Abuser’s financial dependence on victim

Abuser’s use of substances/alcohol
Causes of Abuse
Probable Cause

Financial dependence of abuser on
the victim

Pattern of family conflict

Abuser’s mental and emotional
health

Unrealistic expectations and lack
of knowledge on the part of
abuser
Source: Reis, 2000
Not a Cause

The victim

The victim’s impairments

Victim’s level of dependence
Profile: Senior

Vast majority of elder abuse victims are female

Most neglect victims are 80+ years of age

Isolation

Lives with abuser

Impairment (cognitive, physical and/or mental)

Substance abuse is sometimes a factor

History of family violence
Source: Brandl & Cook-Daniels, 2002
Profile: Adult with a Disability

Interpersonal violence (IPV) occurs at greater rates among men and women
with disabilities (4 to 10 times higher)

Women with disabilities experience abuse for longer periods of time than
women without disabilities

Among abused men with disabilities: 65% experienced physical abuse, 24%
experienced sexual abuse

Among abused women with disabilities: 67% experienced physical abuse, 53%
experienced sexual abuse
Profile: Abuser

Female or male

Elder Abuse- 80% are family members

People with disabilities are abused by family, peers, caregivers

Past history of violent relationship with victim

Suffers from an impairment (drug and/or alcohol abuse, mental illness,
cognitive)

Dependent on victim

Impaired social relationships
Behavioral Characteristics: Victim

Suddenly fears being touched

Sudden onset of nightmares

Changes in sleep patterns, difficulty sleeping

Depression, withdrawal, or mood swings
Behavioral Characteristics: Abuser

Refusal to follow directions or complete necessary personal tasks

Using threats or menacing looks/body language as a form of intimidation

Frequently switches health care providers

Displays unwelcoming or uncooperative attitude during home visits

Using vehicle, money or other resources without consent
What can you do?
BE ALERT
Most suffering done in Silence

The abusers blame their victims…it’s your fault

Threats if the adult reveals the abuse

The adult may be dependent on the abuser for personal care, food, health
care support...may feel there are no options

Unequal distribution of power (people with disabilities generally lack
resources, skills and opportunities often available to other members of
society)

The adult may feel the need to protect the abuser who is also a family
member
Who Should Report Abuse?

All people are encouraged to report abuse

Certain professionals are mandated by law to report suspected cases,
including:

Social services staff

Educators

Licensed professionals

Law enforcement

State, county, local govt.

Formal caregivers
Your Rights & Responsibilities

You can make an anonymous report

Your identity is held in confidence

You are protected from liability

You may be instructed to contact law enforcement in some cases
When Should You Report?

When you suspect abuse
Self-Neglect
Common elements in self-neglect cases include

living in filthy conditions

untended animals

malnutrition

poor hygiene
Priority and Response Time
Priority
Response Time
1.
Life threatening situations
Within 24 Hours
2.
Most neglect and non lifethreatening physical abuse
situations
Within 72 Hours
3.
Most emotional abuse or
financial exploitation abuse
reports
Within 7 Days
Intervention Process
Intake
A screening process to determine if there is reason to
suspect that abuse, neglect, exploitation or self-neglect
has occurred.
Substantiation
Assessment
At the close of the assessment, the caseworker and
supervisor must decide if the allegations of ANE or selfneglect are:
Substantiated
Unsubstantiated
Unable to Substantiate
A systematic, standardized system to respond to reports
of ANE or self-neglect for the purpose of determining
whether abuse occurred, the degree of risk to the adult
of further harm, and if the need exists for immediate
interventions.
Intervention
Providing immediate and/or long term services to reduce or eliminate ANE or self-neglect from reoccurring. Interventions may be needed at any point in the case.
Follow-Up
A systematic method for monitoring substantiated cases to prevent
further abuse or self-neglect by working with the adult in detecting
signs of abuse or self-neglect before the situation becomes lifethreatening.
Casework
Intensive activities to work with the adult to develop and
implement intervention strategies for the purpose of stabilizing
and reducing risk of further harm.
Case Closed
The services of the caseworker are no longer needed.
37
Things You Should Know:

Some cases of abuse are beyond the scope of Protective Services

Victims generally have the right to refuse services

In cases where the adult cannot consent, APS provider will contact
Guardianship & Advocacy for assistance with a temporary
guardianship

Some cases of suspected abuse may be unsubstantiated, or are unable
to be verified
Guiding Principles:
Self Determination

Competent adults have the right to:

Decide how and where to live

Choose whether to accept services and support

Make bad decisions which do not harm others

Determine if this is an old or new behavior pattern for client

Allow room for eccentricity and lifestyle choices which do no harm

Honor rights to privacy
Guiding Principles:
Intervention

Involve the client

Respect the adult’s right to confidentiality

Be direct in discussing the situation

Intervene with the family if possible

Recommend community based services rather than institutional

Recognize that inappropriate intervention may be worse than none at all

The client’s interest comes first
Intervention Services

Medical care and expenses

Law enforcement support

Legal assistance and fees

Housing & relocation services

Minor environmental aid

Respite care, adult day services, in-home care

Counseling

Translation services
Report Suspected Abuse

Adults 18-59 with a disability and adults 60+ who live in a domestic setting
IL Dept on Aging Hotline 1-866-800-1409

Adults 18-59 with a disabilities living in a licensed facility
Office of Inspector General 1-800-368-1463

Adults 60+ who live in a nursing home or licensed facility
IL Dept of Public Health 1-800-252-4343
Long-term Care Ombudsman Program 217-785-3143
TOGETHER
We can Make a Difference!

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