Commonwealth of Massachusetts

ELDER PROTECTIVE SERVICES PROGRAM

Deval L. Patrick, Governor

The Executive Office of Elder AffairsAnn L. Hartstein, Secretary

Presenter:

Deborah FogartyDirector, Protective Services

Executive Office of Elder Affairs, 5th FloorOne Ashburton Place

Boston, MA 02108

(617) 222-7495

deborah.fogarty@state.ma.us

COMPONENTS OF ELDER PROTECTIVE SERVICES PROGRAM

• Elder Protective Services– 22 Designated Agencies– Intake, Investigation, Intervention

• Elder Abuse Hotline (1-800-922-2275)– During business hours calls are routed to the appropriate PS

Agency, calls are answered and reports taken by Hotline workers after business hours, weekends and holidays

• Guardianship Program– Five contract agencies– 170 guardianship slots for PS clients

• Money Management Program– 25 designated programs– 1482 elders assisted per month

WHAT IS ELDER ABUSE?

• The infliction of physical, emotional, or psychological harm on an older adult

• Elder abuse can also take the form of financial exploitation or intentional or unintentional neglect of an older adult by the caretaker

THE LAW

• Protective Services governed by M.G.L. c. 19A § 14-26

• Regulations 651 CMR 5.00• Reporting: Mandated versus Non-Mandated• Report to local PS agency covering town where

elder resides (www.800ageinfo.com) or after normal business hours Elder Abuse Hotline

1-800-922-2275

GOAL OF PROTECTIVE SERVICES PROGRAM

‘The goal of the Protective Services Program is to prevent, remedy or eliminate the effects of abuse on the elder. While the primary focus

is on ending or alleviating abuse, other critical program goals include: freedom,

safety, least disruption of lifestyle and the least restrictive care component.’

PROGRAM PHILOSOPHIES

• Right to Self-determination– Based on elder’s capacity to consent– Applies to investigation and service provision– Impact on risk

• Least restrictive, appropriate intervention

CAPACITY TO CONSENT

‘The Elder's ability to understand and appreciate the nature and consequences of decisions about Protective Services, including the benefits and risks of and alternatives to any proposed services, and to reach an informed decision.’

TYPES OF ABUSE

TYPES OF ABUSE

• Physical abuse: the non-accidental infliction of serious physical harm or the threat to do so where it is believed the person has the capacity to carry out the threat.

• Emotional abuse: the non-accidental infliction of serious emotional injury. There must be a relationship between the action and reaction.

TYPES OF ABUSE (continued)

Question 1: Sexual Abuse of elders includes:

A. Rape

B. ‘Forcing’ an elder to watch pornography

C. Sexually inappropriate language by a grandson to his grandmother

D. Inappropriate or harmful personal care of an elder by his daughter

E. All of the above

TYPES OF ABUSE (continued)

Question 1: ANSWER

E. All of the above

Sexual abuse: sexual assault, rape,

sexual misuse or sexual exploitation or

threats of abuse. Includes harmful genital

practices.

TYPES OF ABUSE (continued)

• Sexual abuse: sexual assault, rape, sexual misuse or sexual exploitation or threats of abuse.

• Financial exploitation: a non-accidental act or omission by another person, without the consent of the elder, which results in a substantial monetary or property loss to the elder or gain to another individual. May also include gaining control over an elder’s assets.

TYPES OF ABUSE (continued)

• Caregiver neglect: failure or refusal by a caretaker to provide one or more basic necessities essential for physical well-being, which has caused, or will immediately result in, serious physical harm.

• Self-neglect: failure or refusal by an elder to meet one or more basic necessities essential for physical well-being, which has caused, or will immediately result in, physical harm.

STATISTICS(comparison of FY 2005 through FY 2011)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

FY2005

FY2006

FY2007

FY2008

FY2009

FY2010

FY2011

Reports

InvestigationsCompleted

Abuse Confirmed

Number of confirmed cases(for FY 2010 and 2011)

0

500

1000

1500

2000

2500

3000

FY2010 FY2011

Physical

Emotional

Sexual

Financial

Neglect

Self-neglect

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

Question 2: Which of the following may be indicators of Physical Abuse?

A. Unexplained scars or bruising at different stages of healing

B. Imprint injuriesC. Bilateral injuriesD. Injuries not consistent with explanationE. All of the above

SIGNS AND SYMPTOMS (continued)

Question 2: ANSWER

E. All of the above- all are potential indicators of Physical Abuse

SIGNS AND SYMPTOMS

• Physical Abuse

►Bruises, welts, cuts, scratches

►Ligature marks

►Human bite marks

►Bilateral and imprint injuries

►Burns that appear to be from an object (e.g. cigarette)

►Spotty balding from pulling of hair

►Unexplained scars or bruising at different stages

►Injuries not consistent with explanation

SIGNS AND SYMPTOMS

• Emotional Abuse►Emotional trauma►Mental health or self-esteem declines►Fear or anxiety when around others

• Sexual Abuse►Genital, rectal, mouth or breast trauma►Sexually transmitted disease►Trauma, such as PTSD or upset when bathed

SIGNS AND SYMPTOMS (continued)

Question 3: True or False: An 84

year old brittle diabetic not

consistently taking (or being given)

her medications should be reported

for Caregiver Neglect or Self

Neglect.

SIGNS AND SYMPTOMS (continued)

Question 3: Answer

True- although no harm may have

occurred, due to medical conditions

she is at ‘immediate risk of harm.’

SIGNS AND SYMPTOMS

• Caregiver neglect and self-neglect►Malnourished or dehydrated►Personal care poor►Inappropriate clothing

►Untreated injuries or medical conditions►Mismanagement of medications►Infestation of insects, rodents or other pests►Extreme clutter►Inappropriate facilities

SIGNS AND SYMPTOMS

• Caregiver neglect and self-neglect (continued)►Unsafe environment►Lack of utilities►Lack of appropriate services

►Financial mismanagement►Lack of appropriate supervision►Unsafe or dangerous behavior

SELF-NEGLECT

• Prevents elder from remaining safely in the community.

• Competent elder refusing assistance or no caregiver present.

• Underlying causes include: resistance; wanting to remain independent; increase in physical impairments; decline in cognitive functioning; substance abuse; cultural/linguistic issues; availability of services; financial issues; willingness of others to assist.

REPORTING

REPORTING

Mandated Reporters (M.G.L. 19A (15)(a))

Any physician, physician assistant, medical intern, dentist, nurse, family counselor, probation officer, social worker, police officer, firefighter, emergency medical technician, licensed psychologist, coroner,

registered physical therapist, registered occupational therapist, osteopath, podiatrist,

executive director of a licensed home health or homemaker agency, executive director of an

assisted living or a home care corporation and executive director and outreach worker for a Council

on Aging.

REPORTING (continued)

Mandated Reporters:• Subject to $1000 fine for not reporting• Not liable in any civil or criminal action for

filing, provided did not perpetrate, inflict or cause abuse (M.G.L. 19A (15)(d))

• Cannot be discharged, demoted or be the subject of other disciplinary action due to filing of report

• Confidentiality of reporter maintained- identity only released to District Attorney, if applicable

REPORTING (continued)

Non-Mandated Reporters (M.G.L. 19A (15)(c))

Any other person may make such a report to the department or its designated agency, if any such person has reasonable cause to believe that an elderly person is suffering

from or has died as a result of abuse.

REPORTING (continued)

Question 4: True or False: Reporters

need to have specific, factual information

in order to file a report.

REPORTING (continued)

Question 4: Answer: False- Specific,

factual information is not needed- only a

‘reasonable cause to believe.’

REPORTING

• When to report– Whenever you have a concern or suspicion of a

problem– You do not need to prove abuse exists before

reporting.– If you are not sure whether to report, call to

consult.

• What to report– Be as detailed as possible, including involved

parties, injuries and examples– Describe risk as much as possible.

REPORTING (continued)

• Confidentiality of reporter

• No criminal or civil liability if report filed in good faith (M.G.L. Chapter 19A, Section 15(d))

Profile of PS Clients

• Jurisdiction of Elder Protective Services– Elder defined as 60 years and older– Generally resides in Community– Alleged Victim and Alleged Perpetrator often

have an On-going personal relationship– On-going personal relationship defined as ‘at

least intermittent contact of a non-business nature.’

PARAMETERS OF PS PROGRAM

• Where to call if outside jurisdiction of PS?– Department of Public Health– Disabled Persons Protection Commission– Department of Mental Health– Department of Developmental Services– Local Police Department

• Not sure of jurisdiction- contact PS to consult

INVESTIGATION PROCESS

• After a report in screened in for investigation, a worker must:– Initiate an emergency screening within 5 hours– Initiate a rapid screening within 24 hours– Initiate a routine screening within 5 days

• Investigation must be completed within 30 days, unless extension granted

• Certain reportable conditions, if substantiated, must be reported to the District Attorney, for example death, serious physical abuse or neglect, financial exploitation, and sexual abuse

• Mandated reporters must be notified of outcome within 45 days of filing report

INVESTIGATION PROCESS (continued)

• Investigation consists of– Contact with key information sources, including

elder, family members, friends, professionals and service providers

– Medical, financial and other documentation may be requested

– Evaluation of information, reliability, and inconsistencies

– Assessment of risk and capacity to consent

• Contacts can only be made with elder’s informed consent, unless elder lacks capacity to provide

• If refusal is due to duress, PS must continue with investigation, unless this would place elder at greater risk.

PROTECTIVE SERVICES INTERVENTION

• If allegations are confirmed, interventions may include:– Casework intervention– Counseling– Coordination of services– Advocacy– Court intervention– Mental health services– Medical services and therapies

PROTECTIVE SERVICES INTERVENTION (continued)

– Home care services– Nutrition– Emergency services– Respite care– Legal services– Money management– Alternative housing arrangements– Institutional placement

Other questions or issues?