Adult Protective Services

General Adult Population

July 1, 2009 through June 30, 2014

July 2016

Office of Aging and Disability Services

Adult Protective Services

General Adult Population

July 1, 2009 through June 30, 2014

Table of Contents

Introduction

Maine’s APS Program

Intake

Supervisor Review

Investigations

Disposition of Investigations

APS Client Characteristics

Risk Factors

Perpetrators

The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, age, or national origin, in admission to, access to or operations of its programs, services, or activities or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Acts of 1964 as amended, Section 504 of the Rehabilitation Act of 1973 as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act. Questions, concerns, complaints, or requests for additional information regarding the ADA may be forwarded to the DHHS’ ADA Compliance/EEO Coordinator, State House Station #11, Augusta, Maine 04333, 207-287-4289 (V) or 207-287-3488 (V), TTY Users Dial 711 (Maine Relay). Individuals who need auxiliary aids for effective communication in programs and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinator. This notice is available in alternate formats, upon request.

Office of Aging and Disability Services Maine Department of Health and Human Services

Introduction

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

Under Title 22MRSA Chapter958-A, the Legislature has assigned to the Department of Health and Human Services (DHHS) responsibility to:

  • Protect incapacitated and dependent adults from abuse, neglect and exploitation and protect incapacitated and dependent adults in circumstances that present a substantial risk of abuse, neglect orexploitation;
  • Prevent abuse, neglect or exploitation of incapacitated and dependent adults;
  • Enhance the welfare of these incapacitated and dependent adults; and
  • Promote self-care wherever possible.

Within DHHS, these responsibilities rest within the Adult Protective Services (APS) unit within the Office of Aging and Disability Services (OADS). OADS was formed in August 2012 with the merger of two offices, the Office of Adults with Cognitive and Physical Disabilities (OACPDS) and the Office of Elder Services (OES).

Although the combined APS unit operates under the same statutory authority, the activities of the APS unit operate under two different sets of regulations, targeting two different populations. The legacy OES APS program operates under 10-149 CMR Chapter 5and targets a general adult population. The legacy OACPDS program operates under 14-197 CMR Chapter 12 and focuses specifically on adults with intellectual disability or autism spectrum disorder (ID/ASD).

Since 2012, OADS has been incrementally integrating the operations of the two APS programs. One program manager, located at the OADS central office, oversees the adult protective services programs for all adults, regardless of age, disability, location, services, etc. At the district offices, all adult protective services activity is managed and overseen by APS supervisorsand OADS program administrators. The former APS Developmental Services staff and APS staff for the general population are co-located at the district offices. Referrals and investigations that require petitions to the Maine probate courts for public guardianship or conservatorship are all handled by the designated APS staff in the district offices. Guardianship and conservatorship representation continues to be delegated to the APS staff for the general adult population and to the Developmental Services caseworker or supervisor for the population served by the Developmental Services program. The same program administrator oversees all public wards and protected individuals.

This Report and Future Reports

This report focuses on adult protective services for the general adult population, covering five years of APS data, SFY 2010 to SY2014, three years prior to the merger of OADS in 2012 and the two years following. These data provide for the first time an in-depth look at this population group.

Historically, OADS has submitted an annual report to the Legislature describing APS activities for the ID/ASD population. Starting July 1, 2014, the two programs began using the same client database, Maine Adult Protective Services Information System (MAPSIS), to record and track all reports of abuse, neglect and exploitation that the supervisor assigns to APS caseworkers for investigation. Key information continues to be entered in the EIS system to enable OADS to report complete information on the disposition of Reportable Events.

Starting with the FY2015 reporting period, OADS will begin reporting a combined APS report. Because OADS still uses two distinct client databases (and the statutory requirement to provide an APS report for the Developmental Services), the report will distinguish the activity of the two legacy populations and will combine key data to show the complete program (i.e. total APS referrals, investigations, substantiations).

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

Maine’s APS Program

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

APS Organizational Structure

Maine Adult Protective Services is organized into eight districts (see map on the next page).The APS program manager, located within the OADS central office, is responsible for overseeing the APSprogram. Direct oversight isprovided by the regional program administrators and the district APS supervisors. A centralized intake unit receives all reports of abuse, neglect and exploitation statewide and directs the report to the appropriate APS supervisor, who is responsible for assigning a report for investigation, when the supervisor determines that an investigation is warranted. More detail on the intake and investigatory process are provided below.

APS Statutory Authority

APS operates within the statutory authority defined for it under the Adult Protective Services Act.[1] Accordingly, APS may only serve adults who are determined to be “incapacitated” or “dependent.”

Dependent Adult. A dependent adult is an adult who has a physical or mental condition that substantially impairs the adult's ability to adequately provide for his or her daily needs. A person is considered a dependent adult if he or she is wholly or partially dependent upon one or more other people for care or support because the person suffers from a significant limitation in mobility, vision, hearing or mental functioning or is unable to perform self-care because of advanced age or physical or mental disease, disorder or defect. A dependent adult includes an adult residing in any setting including a nursing facility, assisted living, or a residential care facility.[2]

Incapacitated Adult. An Incapacitated adult is any adult who is impaired by reason of mental illness, mental deficiency, physical illness or disability to the extent that the individual lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his or her personor effectively manage his or her estate.[3]

The APS program for persons with intellectual disability or autism spectrum disorder serves adults who are receiving developmental services through a DHHS-administered program. As a recipient of developmental services, the alleged victim of abuse is assumed to meet APS program criteria.

In the case of APS for the general population, APS must determine whether the alleged victim meets the criteria for dependent or incapacitated. The alleged victim may or may not be known to OADS, may or may not be receiving services from DHHS, and may or may not meet the criteria for dependency or incapacity that must be met before APS can act. As discussed below, not all reports made to APS involve individuals who meet this threshold. An individual may be a victim of abuse, neglect or exploitation but if the individual is not dependent or incapacitated APS does not have statutory authority to intercede.

APS’ statutory authority is also limited to those cases where danger or significant risk of danger exists. If APS does not find allegations of abuse, neglect or exploitation or circumstances that present a substantial risk of abuse, neglect or exploitation, it may not intercede. These terms are statutorily defined:

Continued on page 5.

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

APS Districts

/ Maine Adult Protective Services is organized into eight districts.


Abuse is the infliction of injury, unreasonable confinement, intimidation or cruel punishment that causes or is likely to cause physical harm or pain or mental anguish; sexual abuse or exploitation; or the intentional, knowing or reckless deprivation of essential needs. Abuse includes acts and omissions.

Neglect is a threat to an adult’s health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these.

Exploitation is the illegal or improper use of an incapacitated or dependent adult or that adult’s resources for another’s profit or advantage.

Danger is defined as a situation or condition of abuse, neglect or exploitation, or the inability to give informed consent when there is no responsible substitute decision-maker. The risk of danger is substantial when it is more likely than not that abuse, neglect or exploitation will occur.

Intake

Intake is the process of collecting facts from a reporter and gathering other readily available information to determine whether the problempresented is appropriate for case assignment. Referrals are received byDHHS’ centralized intake unit or, after hours, by the Adult and Children’sEmergency Services (ACES) staff. Through the intake process, information is gathered from the reporter and others. Referrals may result in one of several outcomes:

A Standard Referral. If the intake unit determines that the referral involves an allegation of incapacity or dependency, and danger or substantial risk of danger, the referral is sent to the appropriate APS supervisor to determine whether an investigation is warranted.

Facility Incident. In some cases, assisted living facilities report resident altercations or injuries of unknown origin. These facility incidents are referred to the Division of Licensing and Regulatory Services (DLRS).

Court study referral. In some cases a report may be referred for a court study to determine whether guardianship is appropriate.

Information and referral. In some cases, intake staff provide information only or refer a caller to a more appropriate service.

Supervisor Reviews

For standard referrals, the APS supervisor or OADS program administrator reviews each referral, collects more information if necessary, and assigns the referral to a caseworker or documents why the intake was screened out. Some of the reasons an intake referral might be screened out include:

  • There is insufficient evidence of danger or incapacity;
  • The individual has been hospitalized, meaning the danger or risk has been resolved;
  • The danger has been reduced or eliminated;
  • The allegations were recently investigated and these allegations involve no new information;
  • The individual is receiving developmental services; and
  • The individual has been referred to other services.

The reporter is notified by phone or in writing about the disposition of his or her report at intake – whether it has been assigned for investigation or, if not assigned, whether there are other resources available.

Investigations

Once assigned, the APS case worker is responsible for conducting an investigation. The investigation includes an assessment of:

Capacity: The caseworker may assess capacity using a “mini-mental status” exam or, alternatively, using a more comprehensive assessment that evaluates the impact of an underlying medical condition, cognition, functional abilities, whether an individual’s choices are consistent with long-held patterns and preferences, whether the individual needs supervision, or whether treatment could enhance functioning.

Ability to Give Informed Consent: The caseworker will assess whether the individual has knowledge and understanding of the specific situation; knowledge and understanding of the decisions that need to be made; an awareness of having choices and the ability to make choices; an awareness of consequences, including the benefits and risks of each choice; and the ability to communicate a decision.

Dependency: The caseworker will assess the individual’s ability to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Danger or Substantial Risk of Danger: The caseworker will assess the danger or risk of danger associated with all allegations.

Disposition after Investigation

Investigations may be closed for a variety of reasons including:

AllegationsSubstantiated: The allegations were found to be true. The case is closed when the danger is resolved or when services are arranged to assure safety.

Allegations Unsubstantiated: The allegations were found to be untrue.

Insufficient Evidence: There is insufficient evidence to substantiate the allegation.

Investigation No Longer Warranted: The danger is eliminated before the investigation is completed (e.g., the individualhas moved to an assisted living facility).

Court Study Completed: A court study to determine whether public guardianship has been completed.

Intake

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

  • Between SFY 2010 and SFY 2014 intakes increased from 5,250 to 6,577, a total of 25.3 percent.
  • “Standard referrals,” intake reports referred to an APS supervisor to determine if an investigation is warranted, are made when the report involves allegations of incapacity or dependency and allegations of danger or risk of danger. The number of standard referrals increased by 5 percent from SFY 2010 to SFY 2012 and by 25 percent from SFY 2012 to SFY 2014.

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

Overview: Intake, Supervisor Reviews, Investigations and Substantiated Cases by State Fiscal Year, 2010 – 2014
Over the five-year period of this report, the number of intakes increased while the number of investigations and substantiated cases held relatively steady. Between SFY 2010 and SFY 2014 intakes increased from 5,250 to 6,577, a total of 25.3 percent. During that same period the number of investigations increased 4.3 percent, from 2,383 to 2,486, and the number investigations with substantiated allegations increased by 2.9 percent, from 905 to 931.
Number of Intakes by APS Client Age Group by State Fiscal Year, 2010 – 2014
Between SFY 2010 and SFY 2014, total intakes increased by 25 percent. The number of intakes for both older adults and younger adults each increasedby29 percentover the same period.
* APS does not request a date of birth for information & referral calls or incident reports.
Disposition at Intake by State Fiscal Year, 2010 – 2014
About three-quarters of all intake reports are referred to an APS supervisor who will determine if an investigation is warranted. These “standard referrals” are made when the report involves allegations of incapacity or dependency and allegations of danger or risk of danger. Some reports are referred for a court study to determine if guardianship is appropriate. Others involve incident reports from an assisted living facility and are referred to the Division of Licensing and Regulatory Services. In some cases, the reporter may receive information or referral to a more appropriate service.
The number of standard referrals increased by 5 percent from SFY 2010 to SFY 2012 and by 25 percent from SFY 2012to SFY 2014. Incident reports fluctuated over the five-year period.
Disposition ofReferrals at Intake by Client Age Group, Average Over SFY 2010 – SFY 2014*

When available, APS records the individual's date of birth for standard referrals and court studies. However, APS does not request the date of birth for information and referral calls or incident reports. Among all initial intakes for which the individual's date of birth could be determined from MAPSIS data, 95% of intakes for younger adults were forwarded on for a supervisor review, as were 99% of initial intakes for older adults. Among initial intakes involving individuals whose date of birth could not be found in MAPSIS, 91% were closed at intake while the other 9% were sent to supervisor review.
*Omitting a total of 10 cases including one “lost” at intake and nine still in intake as of April 2015.

Supervisor Review

Data Highlights

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

  • Supervisors screened out more than half (53%) of cases forwarded for review when younger adults were involved, while they assigned the other 47 percent to investigation. When forwarded cases involved older adults, supervisors screened out only 39 percent, and assigned the remaining 61 percent to investigation.
  • As the number of referrals forwarded for review increased, the number of forwarded cases screened out due to insufficient danger or incapacity also increased. For reviews of cases involving younger adults, the percent of intakes screened out due to insufficient danger rose by 14 percentage points from 55 percent in SFY 2010 to 63 percent in SFY 2014. For case reviews involving older adults, the percent of intakes screened out due to insufficient danger rose by 25 percentage points from 48 percent in SFY 2010 to 60 percent in SFY 2014.

Adult Protective Services SFY 2009 – SFY 2014 1

Office of Aging and Disability Services Maine Department of Health and Human Services

Disposition at Supervisor Review by Age Group, Average Over SFY 2010 – SFY 2014*
Supervisors screened out more than half (53%) of cases forwarded for review when younger adults were involved, while they assigned the other 47 percent to investigation. When forwarded cases involved older adults, supervisors screened out only 39 percent, and assigned the remaining 61 percent to investigation.
Of the small number of cases forwarded with no age recorded in MAPSIS, 88 percent were screened out.** The remaining 12 percent were assigned to investigation.
*Omits two cases identified as “still in review” and omits 59 cases “closed at investigation” that were not assigned to an age group.
**Client age may be missing because the reporter may not have known the individual's date of birth, the individual did not wish to reveal his or her age, the case involved multiple individuals, or due to record-keeping errors.
Reason for Cases Screened Out at Review Stage/Not Assigned to Investigation, Age 18-59, SFY 2010 – SYF 2014
As the number of referrals forwarded for review increased, the number of forwarded cases screened out due to insufficient danger or incapacity also increased. For reviews of cases involving younger adults, the percent of intakes screened out due to insufficient danger rose by 14 percentage points from 55 percent in SFY 2010 to 63 percent in SFY 2014.
Reason for Cases Screened Out at Review Stage/Not Assigned to Investigation, Age 60 and Older, SFY 2010 – SYF 2014
For case reviews involving older adults, as the number of referrals increased, the number of referrals screened out due to insufficient danger or incapacity also increased. For these cases, the percent of intakes screened out due to insufficient danger rose by 25 percentage points from 48 percent in SFY 2010 to 60 percent in SFY 2014.

Investigations

Adult Protective Services SFY 2009 – SFY 2014 1