Adult Protective Services

CHAPTER 2 - INTAKE

SOP 102 :Reporting Requirements - Adult Protective Services 
SOP 106 :Definition of Adult for Investigation - Adult Protective Services 
SOP 108 :Acceptance Criteria for Abuse, Neglect and Exploitation - Adult Protective Services 
SOP 110 :Reports Not Meeting Acceptance Criteria - Adult Protective Services 
SOP 112 :Receiving the Report - Adult Protective Services 
SOP 114 :Failure To Gain Entry - Adult Protective Services

SOP 102: Reporting Requirements - Adult Protective Services

All known or suspected incidents of abuse, neglect or exploitation of an adult as defined in KRS 209.020(4)) are to be reported to and investigated by the Cabinet for Families and Children (KRS 209.030 and 060).  The only exemption to mandatory reporting is the attorney/client privilege.

Per KRS 209.020(7), people who are injured or who are subjected to the infliction of physical pain or mental injury can meet the definition of abuse.  KRS 209.020(15) says that neglect is a situation in which an adult is not able to perform or obtain for himself those services which are necessary to maintain the adult's health or welfare, the deprivation of services by an adult's caretaker which are necessary to maintain the adult's health and welfare, or a situation in which the person deprives his spouse of reasonable services necessary to maintain health and welfare.  Exploitation is the improper use of the adult or the adult’s resources for the advantage or profit of someone as outlined in KRS 209.020(8).

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SOP 106: Definition of Adult for Investigation - Adult Protective Services

The worker shall consider the following definition of "adult" to determine when to accept a report:

A person 18 (eighteen) years of age or older who has a mental or physical dysfunction.  The alleged perpetrator does not have to be a family member, household member or caretaker.
The adult shall be 18 (eighteen) years of age or older who has a mental or physical dysfunction, is not able to manage his own money or resources or carry out the activities of daily living or is not able to protect himself from a neglectful or a hazardous or abusive situation if he does not have the assistance from others, and who may be in need of some type of protective services;

A person of any age who's alleged perpetrator is their spouse.
(KRS 209.020 (4) (a) and (b). gives the Cabinet the authority to investigate a person without regard to age who is the victim of abuse and neglect that is inflicted by a spouse.

A person in an ongoing, cohabiting and intimate relationship who is 18 (eighteen) years of age or older and the victim of alleged abuse by a partner. (Ireland v Davis, Ky. App., 957 S. W. 2nd 310 (1997)).

Referrals not meeting the definition of adult may be reviewed to determine if the information or allegation meets acceptance criteria for General Adult Services referrals, referred to other agencies for assistance or referred to the appropriate law enforcement agency for assistance.

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SOP 108: Acceptance Criteria for Abuse, Neglect and Exploitation - Adult Protective Services

The Department for Community Based Services shall receive and investigate reports, which allege physical abuse, sexual abuse and mental injury of dysfunctional adults who meets the definition of adult in SOP 106: Definition of Adult for Investigation – Adult Protective Services.

Physical and Sexual Abuse - Adult Abuse

Physical and sexual abuse is the infliction of physical pain or injury done by the offender to the person's body.  These are acts, which cause or are intended to cause physical harm and may include, but not limited to:

Forced sexual relations, including  forced sex with others, animals or foreign objects;

Unwanted fondling or touching;

Physical assault, including pushing, kicking, hitting, slapping, punching, choking, strangling, pinching, burning, hair pulling, shoving, stabbing, shooting, beating, battering during pregnancy, striking with an object and complaints of pain as a result of the assault;

Physical restraint against one's will.

Rough handling, i.e.  forced feeding, roughness when transferring individual from bed to chair, or during bathing, etc; and

Inappropriate use of physical or chemical restraints.

Mental Injury (Emotional/Psychological /Verbal Abuse) - Adult Abuse

Mental injury is the infliction of mental anguish caused by actions or verbal assaults against a person's well being that may result in an adverse change in behavior.  The abuse can be spontaneous, protracted or systematic efforts to dehumanize the person while instilling fear and may include, but not limited to:

Threats of violence against victim, self or others;

Threats with a weapon(s), including objects used as a weapon;

Forced isolation or imprisonment;

Destruction or threats to destroy property and/or pets;

Forcing to perform degrading acts;

Controlling activities such as sleep, eating habits, access to money or social relationships;

Verbal assaults and attacks on the person's self esteem, including name-calling, insulting, degrading remarks, custody threats or threats to abduct/abscond with the child(ren); or

Stalking.

Death of the Adult- Adult Abuse

The Department for Community Based Services shall accept reports when the allegations indicate that the individual died as a result of adult abuse.

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Spouse or Partner Abuse 

The Department for Community Based Services shall receive and investigate reports, which allege spouse or partner abuse and neglect who meets the definition of adult in SOP 106: Definition of Adult for Investigation –Adult Protective Services.

Spouse or partner abuse relates to the infliction of physical pain, injury or mental injury by an individual's spouse or cohabiting partner or the deprivation of reasonable services needed for health or welfare.

Spouse or partner abuse may take many forms and varies with respect to the frequency and severity of the violence. Included for investigation may be reports of:

Physical and Sexual Abuse- Spouse or Partner Abuse

Physical and sexual abuse is the infliction of physical pain or injury done by the offender to the person's body.  These are acts, which cause or are intended to cause physical harm and may include, but not limited to:

Forced sexual relations, including  forced sex with others, animals or foreign objects;

 Unwanted fondling or touching;

Physical assault, including pushing, kicking, hitting, slapping, punching, choking, strangling, pinching, burning, hair pulling, shoving, stabbing, shooting, beating, battering during pregnancy, striking with an object and complaints of pain as a result of the assault;

Physical restraint against one's will;

Rough handling, i.e.  forced feeding, roughness when transferring individual from bed to chair, or during bathing, etc; and

Inappropriate use of physical or chemical restraints.

Mental Injury (Emotional/Psychological/Verbal Abuse)- Spouse or Partner Abuse

Mental injury is the infliction of mental anguish caused by actions or verbal assaults against a person's well being that may result in an adverse change in behavior.  The abuse can be spontaneous, protracted or a systematic effort to dehumanize the person while instilling fear and may include, but not limited to:

Threats of violence against victim, self or others;

Threats with a weapon(s), including objects used as a weapon;

Forced isolation or imprisonment;

Destruction or threats to destroy property and/or pets;

Forcing  to perform degrading acts;

Controlling activities such as sleep, eating habits, access to money or social relationship;

Verbal assaults and attacks on the person's self esteem, including name-calling, insulting, degrading remarks, custody threats or threats to abduct/abscond with the child(ren); or

Stalking.

Spouse or Partner Neglect

Spouse or partner neglect is the deprivation of services needed for health and welfare and may include:

Actively prohibiting the spouse or partner from obtaining needed medical care;

Controlling the environment to the extent that it prohibits the person from carrying out activities of daily living.

Death of the Adult- Spouse or Partner Abuse

The Department for Community Based Services shall accept reports when the allegations indicate that the individual died as a result of spouse or partner homicide or homicide followed by suicide if:

The adult victim is reported to DCBS by law enforcement, coroner or other source;

DCBS is in the process of conducting an adult or child protective service investigation; or

DCBS had prior protective service involvement with the family.

Children who witness the homicidal incident of a parent or guardian, or were victims of the homicidal incident perpetrated by a caretaker shall be reported to Child Protective Services.  Refer to SOP 168: Death of the Adult – Adult Protective Services.

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Acceptance Criteria for Self Neglect

The Department for Community Based Services shall receive and investigate reports, which allege self-neglect of a dysfunctional adult who meets the definition of adult in SOP 106: Definition of Adult for Investigation –Adult Protective Services.

Self-neglect is a situation in which the adult is unable to perform or obtain services, which are necessary to maintain health or welfare.  These may include, but are not limited to situations alleging that the adult’s health or welfare has suffered or declined as a result of:

Unmet personal or medical needs, such as bedsores, malnourishment, dehydration, inappropriate clothing, poor hygiene, using medicines incorrectly, lack of food or inadequate food;

Refusing or being unable to access medical or mental health care/treatment;

Living in an unsafe environment, such as fire/safety hazard, roach/rat/insect infested dwelling, condemned building;

Living alone and in life-threatening conditions;

Being unable to manage own resources; or

New onset of confusion and/or disorientation.

Death of the Adult-Self Neglect

The Department for Community Based Services shall accept reports when the allegations indicate that the individual died as a result of self-neglect.

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Caretaker Neglect 

The Department for Community Based Services shall receive and investigate reports, which allege neglect by a caretaker of a dysfunctional adult who meets the definition of adult in SOP 106: Definition of Adult for Investigation –Adult Protective Services.

Caretaker neglect is the deprivation by a caretaker of services, which are needed to maintain health and welfare.  The caretaker arrangement can be formal (i.e. contractual, institution) or informal (i.e. voluntary agreement with family member, friend).  The caretaker neglect can be either "passive" (unintentional) or "active" (intentional) in nature by the caretaker as related to the provision of services (i.e. food, clothing, shelter, social contact, personal needs, medical care) and may include, but are not limited to:

Lack of adequate food or health related services due to the caretaker's inadequate skills or knowledge;

Abandonment or lack of supervision;

Unmet personal or medical needs, such as bedsores, malnourishment, dehydration, inappropriate clothing, poor hygiene, uses medicines incorrectly, lack of food or inadequate food;

Withholding or deprivation of food/water or health services;

Over medication or under medication;

Forcing isolation;

Not obtaining needed mental health or medical services/treatment or

Permitting unnecessary pain.

Death of the Adult- Caretaker Neglect

The Department for Community Based Services shall accept reports when the allegations indicate that the individual died as a result of caretaker neglect.

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Exploitation

The Department for Community Based Services shall receive and investigate reports, which allege exploitation of dysfunctional adults who meets the definition of adult in SOP 106: Definition of Adult for Investigation –Adult Protective Services.

Exploitation is the improper use of an adult or the adult's resources for the profit or advantage of another person.  This includes financial, material and sexual exploitation, which can be accomplished by force, through misrepresentation, threats, coercion or deception.  These may include but are not limited to:

Misuse of assets (i.e. unusual bank account activity, unpaid bills by payee or other responsible party);

Excessive charges for food, shelter, care or services;

Unauthorized or fraudulent use of monies;

Personal belongings or household items missing; and

Taking sexual advantage of mentally or physically impaired individuals.

Death of the Adult - Exploitation

The Department for Community Based Services shall accept reports when the allegations indicate that the individual died as a result of exploitation.

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SOP 110: Reports Not Meeting Acceptance Criteria - Adult Protective Services

The Department of Community Based Services is not required to investigate reports of adult maltreatment which do not meet the statutory definition of adult abuse, neglect or exploitation per KRS 209.  Referrals not requiring mandatory APS investigation may be reviewed to determine if they can be accepted for General Adult Services referrals, referred to other agencies for assistance or referred to the appropriate law enforcement agency for assistance.

When a report does not meet the criteria for investigation, the worker shall document the reason for not accepting it in TWIST in the Intake Determination Summary Screen.

The following criteria may be used in not accepting a report for an adult protective service investigation:

Victim of report is under the age of eighteen (18) and not married to the alleged perpetrator.  A referral may be made to Child Protective Services, as appropriate;

Victim of report is cohabiting and under the age of eighteen (18).  A referral may be made to Child Protective Services as appropriate;

Insufficient information to locate the adult or explore leads to locate.  Worker is to attempt to obtain this information from the reporting source or other appropriate agencies;

A specific act of abuse, neglect or exploitation is not alleged;

Referral source reports generalized feelings of concern regarding the welfare of the adult, but does not state specific allegations that reflect abuse, neglect or exploitation;

Referral source reports that an adult is improperly dressed for some activities, but the clothing deficiency does not result in harm to the well being of the adult;

Referral source reports that the caretaker provides nutritious food irregularly or in insufficient amounts, but there is not an impairment in the health of the adult;

Referral source reports inadequate hygiene conditions that, although not optimal, do not adversely affect the well being of the adult;

Threats or attempts to commit suicide;

Reports of exploitation when the alleged victim is deceased;

Client's right to self-determination and lifestyle issues with no allegation of abuse, neglect or exploitation;

Report alleging only a "verbal argument" between married or cohabiting partners; or

If the report concerns a situation or specific incident investigated in the past thirty (30) days and found to be unsubstantiated and no new or additional information or change in the adult's circumstances is communicated by the referral source.

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SOP 112: Receiving the Report - Adult Protective Services

When receiving a report of suspected adult abuse, neglect, exploitation or spouse abuse, the Social Services worker (SSW) shall make every effort to obtain information to comply with KRS 209.030(3) and other information that may assist in determining if the adult may be in need of protective services or is in a state of emergency and/or immediate need of protective services.

A report may be made orally or in writing to the Department for Community Based Services. Anonymous reports shall be accepted if they meet all other criteria.

Information Obtained From The Reporting Source

The worker is to make every effort to obtain from the reporting source the following information:

Name and address or location of the alleged adult victim;

Any person responsible for the care of the adult, if applicable;

Age of the adult;

Nature and extent of the abuse, neglect, or exploitation, including any evidence of previous abuse, neglect, or exploitation;

Date and time of specific incident;

Identity of the alleged perpetrator;

Information that may assist in determining if the adult may be in a state of emergency and in immediate need of protective services; and

Information relevant to the safety of the adult and worker assigned to investigate.

The Social Service Worker may advise the referral source that additional information is needed before a report may be accepted.  If the referral source refuses to provide the information or does not have sufficient information to identify or locate the alleged victim, the referral source is to be informed that the Department will not generate a report.  The referral source is to be provided with information regarding community resources that may be of assistance.  The referral source is informed if the allegations are to be accepted for investigation. 

Information From Other Agencies, Databases and Individuals

The worker is to contact other agencies, individuals, or databases (i.e.. Kentucky State Police/Law Information Network of Kentucky (KSP/LINK) Domestic Violence File, Child Abuse and Neglect Central Registry and Adult Protection Historical File) for the purpose of securing additional information which may be relevant in conducting the investigation.

Completion of the DCBS-115, Suspected Abuse/Neglect, Dependency or Exploitation Reporting Form and DCBS-284, Reporting Form

When the report is received and the required information secured, the SSW will complete the necessary screens in TWIST to produce the DCBS-115. The worker shall submit all intakes to the supervisor or designee for assignment. A DCBS 284 shall be completed as necessary. (See forms section)

A copy of the DCBS-115 shall be sent to the appropriate law enforcement agency (e. g. city police, county police, state police, or sheriff’s office) in compliance with KRS 209.030(4).  It is not necessary to report the allegations to a law enforcement agency if law enforcement is the original reporting source;

The DCBS-115 may be sent to the Commonwealth Attorney, County Attorney and the Attorney General’s Office for prosecution;

A DCBS-284 shall  be forwarded to the Office of Inspector General, Division of Long Term Care when a client is abused neglected or exploited in:

  1. A licensed health care facility;

  2. An illegal health care facility;

  3. A licensed home health agency; or

  4. An illegal home health agency.

If a facility is receiving Medicaid funds, the DCBS -284 shall be forwarded to the Attorney General’s Office, Medicaid Fraud and Abuse Control Division when the investigation is substantiated or likely to result in a substantiated finding.

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SOP 114: Failure To Gain Entry - Adult Protective Services

If an adult, a caretaker, or a facility does not allow the worker to enter the premises to conduct the investigation, the worker shall inform supervisory staff. With the approval of the Service Region Administrator or designee, the worker may seek a search warrant or pursue other legal remedies if allegations indicate the need.  If possible the worker is to consult with the Office of General Counsel prior to seeking a search warrant.  If issued, a search warrant shall be served by a law enforcement officer and not by a DCBS employee.

If the adult resides in a private residence, the SSW shall:

Attempt to persuade the adult or the caretaker of the Cabinet's statutory responsibility to investigate and offer to furnish a copy of the statute;

If that fails, seek the assistance of law enforcement to gain entry; and

If entry is not obtained, notify supervisory staff to determine if probable cause exists to pursue a search warrant or other legal remedies.

If the adult resides in a licensed health care facility, the SSW shall:

Attempt to inform the facility representative or operator that KRS 209.030(5) requires the Cabinet to conduct an investigation and offer to furnish a copy of the statute;

Seek assistance of law enforcement; and

 If entry is denied, inform supervisory staff to determine if probable cause exists to pursue a search warrant or other legal remedies.

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