Adult abuse reporting and prevention : Georgia's uniform guide for elderly and/or disabled adults

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ADULT ABUSE REPORTING and REVENTION

GEORGIA'S UNIFORM GUIDE for Elderly and/or Disabled Adults

This guide was produced by the DHR Elder Abuse Prevention Work Group. This is an effort to reduce the incidence of elder and/or disabled adult abuse through education about the problem of, some solutions for. and the proper responses to the growing problem of adult abuse.

August 1997

iiiDHR

TABLE OF CONTENTS

FOREWORD ....................................................... I
ACKNOWLEDGEMENT ............................................. 2
INTRODUCTION ................................................... 4
LAWS AND REGULATIONS ......................................... 5 Social Security Act .............................................. 5 Long-term Care Facility Resident Abuse Reporting Act ................. 5 Ombudsman Act ................................................ 5 Georgia's Disabled Adults and Elder Persons Protection Act ............. 5 Chart I-MANDATED REPORTERS .............................. 6
GENERAL INFORMATION .......................................... 7
PREVENTION OF ABUSE, NEGLECT, AND/OR EXPLOITATION ......... 9 Information and Education ........................................ 9 Putting the Information into Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
$Financial and/or R Medical Support .............................. 11
Social Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Legal Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Summary ..................................................... 12
DEFINITIONS AND TYPES ......................................... 12 Physical Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Determining Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Indicators of physical abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Psychological Abuse ........................................... 16

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Indicators of psychological abuse ........................ 17

Neglect ...................................................... 18

Self-neglect .............................................. 19

Caregiver neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Indicators of neglect ................................... 20

Sexual Abuse and Exploitation ................................... 22

Indicators of sexual abuse .............................. 24

Indicators of sexual exploitation . . . . . . . . . . . . . . . . . . . . . . . . . 25

Financial Exploitation .......................................... 26

Indicators of exploitation ............................... 27

Consumer Fraud ............................................... 28

Abuse in Institutions ............................................ 30

Indicators of abuse, neglect or exploitation in institutions ..... 31

Chart 2

TYPES & CHARACTERISTICS OF ABUSE AND NEGLECT

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CONTRIBUTING FACTORS TO ADULT ABUSE ....................... 33 Chart 3 - CONTRIBUTING FACTORS ...................... 34
Personal Traits of the Abuser ..................................... 35 Cycle of Violence: Transgenerational Family Violence ............... 36 Dependency .................................................. 36 Social Isolation ................................................ 37 Stressors ..................................................... 37

THE VICTIMS OF ABUSE, NEGLECT, AND EXPLOITATION ..... -...... 38 Victim Characteristics .......................................... 38

THE ABUSER AND CAUSES ........................................ 40 Chart 4 CHARACTERISTICS OF ABUSERS .................... 41

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Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Caregiving ................................................... 42
Chart 5 SIGNS OF POTENTIAL ABUSE BY CAREGIVERS ....... 42
SCREENING FOR POSSIBLE VICTIMS ............................... 44 Role of Service Providers ........................................ 44 Engaging the Client ............................................ 45 Interview Techniques ........................................... 46 Communication ............................................... 46 Approaches for Effective Communication with a Confused Person .. 47 ............................................................ 48 Suggested Screening Questions ................................... 48 Interviewing the Caregiver ....................................... 51
REPORTING ABUSE ............................................... 53 Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Long-Term Care Settings ........................................ 57 Mental Health Settings .......................................... 59 Chart 6 ABUSE, NEGLECT AND EXPLOITATION REPORTING & INVESTIGATIONS BY SETTING ....................... 62
AGENCY RESPONSIBILITIES ...................................... 63 Department of Human Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Division of Family & Children Services . . . . . . . . . . . . . . . . . . . . . . . . 63 , Adult Protective Services (APS) ......................... 63 Division of Aging Services .................................. 66 Division of Public Health ................................... 67 Division of Rehabilitation Services ........................... 67 Division of Mental Health, Mental Retardation & Substance Abuse .. 67

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Office of Regulatory Services ................................ 68 Other Agencies ................................................ 68
Area Agency on Aging (AAA) ............................... 68 Family Violence Shelters and Programs ........................ 69 Elder Fraud Unit (Governor's Office of Consumer Affairs) ......... 69 State Commission on Family Violence ......................... 69 State Health Care Fraud Control Unit .......................... 70 Law Enforcement ......................................... 70
PROTECTIVE RESOURCES ......................................... 71 Residents' Rights .............................................. 71 Nursing Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Personal Care Homes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Where to Make a Complaint about a Nursing Facility or Personal Care Home .............................................. 71 Legal Issues Related to Adult Abuse ............................... 72 Legally Recognized Directives ............................... 72 Living Will .......................................... 73 Durable Power of Attorney for Health Care ................ 73 Do Not Resuscitate Orders .............................. 74 Representative Payee .................................. 77 Power of Attorney and Durable Power of Attorney .......... 77 Temporary Protective/Restraining Orders (TPOs/TROs) ........... 78 Involuntary Commitments (Pick-Up Orders) .................... 79 Guardianships ............................................ 79 Assistance Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Adult Medicaid ........................................... 81 Application .............................................. 81 Qualified Medicare Beneficiary (QMB) ................... 81 Specified Low Income Medicare Beneficiary (SLIMB) ....... 81 Qualified Working Disabled Individual (QWDI) ............ 81

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Public Law Medicaid .................................. 81 Community Care Services Program (CCSP) ................ 82 Adult Medically Needy Spend-Down ..................... 82 Nursing Home Medicaid ............................... 83 Hospice ............................................. 83 Mental Retardation Waiver Program (MRWP) .............. 83 Independent Care Waiver Program (ICWP) ................ 83 Eldercare Locator ......................................... 83 Elderly Legal Assistance Program (ELAP) ..................... 84 The Long-Term Care Ombudsman Program .................... 85
GLOSSARY ...................................................... 87
GLOSSARY OF ACRONYMS ....................................... 90
APPENDIX ....................................................... 96 Disabled Adults and Elder Persons Protection Act .................... 96 Long-term Care Facility Resident Abuse Reporting Act ............... 103 Long-Term Care Ombudsman Program Act ........................ 107 Unfair and Deceptive Practices Toward the Elderly Act ............... 113 DHR Memorandum ofUnderstanding ............................. 117 Resources Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Community Based Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Resource Form ........................................... 127

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FOREWORD

There are many faces of adult abuse* ...

..-a 43-year-old paraplegic attacked by his stepson with a hammer which broke his shoulder:
~a wealthy, frail and elderly woman exploited by a "caregiver" who posed as a nurse and depleted the woman's assets~
~a 62-year-old man with Alzheimers left locked alone in an apartment for days~
~an 86-year-old man, abandoned without income or family, living in a "crack house" and begging for food.

You may know of similar situations that need investigation and assistance. By using the information in this guide, which discusses identification, indication, investigation and the reporting of Adult Abuse, you can help prevent and possibly stop incidences of abuse.

The DHR Elder Abuse Prevention Work Group, the developers of this guide, represent the Division of Aging Services, the Division of Family and Children Services; the Division of Mental Health/Mental Retardation & Substance Abuse; the Office of Regulatory Services; the Division of Public Health and the Division ofRehabilitation Services all within the Department of Human Resources. The guide was developed for employees of the Georgia Department of Human Resources and staff members of all agencies which subcontract with the Department or any of its Divisions or Offices. The purpose of this guide is to help employees



identify suspected abuse, neglect or exploitation of any adult in Georgia~



report suspected abuse to the appropriate authority~ and



assist DHR "customers" with other needed referrals.

You are urged to utilize the text and charts ofthis Guide in local public awareness/community education efforts, as well as, in staff development.
* Adult abuse. for the purposes of this guide, refers to abuse, neglect and exploitation of the
elderly and/or disabled adults.

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ACKNOWLEDGEMENT
In November of 1993. the Director of the Division of Aging Services was asked by the Office of the Commissioner of the Department of Human Resources to convene a work group comprised of representatives of all the Divisions and Offices of the Department of Human Resources for the purposes of gathering and evaluating information on elder abuse activities within the Department. the State of Georgia and from around the country. This group diligently worked and identified three areas needing action by the Department.
The first area identified for action was coordination among the various Divisions and Offices of the Department of Human Resources which are impacted by the problem of abuse of Elder and Disabled Adults. The work group completed a Memorandum of Understanding signed by the Directors of the Division of Aging Services. the Division of Family and Children Services. the Division of Mental Health, Mental Retardation and Substance Abuse. the Division of Public Health. the Division of Rehabilitation Services. and the Office of Regulatory Services. Also signing to indicate his knowledge of and cooperation with the work of the Department and this group in this area was Mr. Barry Reid. the Administrator of the Governor's Office of Consumer Affairs. (See Appendix)
The Memorandum of Understanding (MOU) expresses the duties and responsibilities of the represented organizations as they relate to elder and disabled adult abuse prevention and reporting. The group proceeded with the next two identified work products: a statewide education brochure about elder and disabled adult abuse reporting and prevention and finally, this uniform guide outlining the proper protocol to follow in elder and disabled adult abuse reporting and prevention.
The DHR Elder Abuse Prevention Workgroup acknowledges the Commissioner of the Department of Human Resources, Tommy Olmstead, who executed a Declaration of Affirmation to indicate his support of the MOU and the work that this group has done and we also acknowledge each Division and Office Director for giving their affirmation of the work by this group and permitting the necessary staff to participate.

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Acknowledgement and the greatest appreciation is given to the hard work and effort put forth by the members of the Department of Human Resources Elder Abuse Prevention Workgroup. The following members have worked tirelessly over the past three years to assist the Division of Aging services educate the Department, the Aging Network. Professionals, Seniors and their family members, friends and caregivers about Adult Abuse, and the prevention and reporting of Adult Abuse.
Mary Martha Allen, Division of Family and Children Services Barbara McBrayer-Brice, Division of Aging Services Tom Dennis, Division of Rehabilitation Services Marta Fernandez, Division of Mental Health Mental Retardation and Substance Abuse Barbara Fraser, Division of Aging Services Cathy Griffin, Division of Mental Health Mental Retardation and Substance Abuse Jane McCombs, Division of Public Health Peggy Thomas, Office of Regulatory Services Natalie Thomas, Chair, Division of Aging Services

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INTRODUCTION

Most Americans are shocked by the abuse. neglect and exploitation of adults who are elderly and/or disabled. However. studies suggest that abuse, neglect and exploitation are widespread phenomena affecting people across all classes of society. Abuse can occur in any setting including long-term care facilities such as nursing homes and personal care homes. Despite this prevalence. adult abuse is still considered this nation's "hidden problem." This abuse is one of the most underreported social problems in the United States. The five most prominent explanations for this are:

l. Interference with family life by outsiders usually is not tolerated.

2. Isolation of victims--people are often isolated and often not seen by non-family members.

3. Elderly victims are reluctant to report abuse by relatives.

4. Professionals often do not recognize the signs of abuse, neglect, or exploitation.

5. Professionals fail to report incidents even in states with mandatory reporting.

Because abuse, neglect and exploitation are usually hidden, it is difficult for the professional community to address these problems effectively. This information guide is designed to help us in recognizing abuse, neglect, and exploitation of the elderly and disabled adult and attempting to ensure that these victims receive proper assistance. With an enhanced awareness of these issues, we can more effectively ensure the protection of our citizens who are older and/or disabled.

Even the most cursory glance at the information presented here provides the reader with an appreciation of the complex problem of adult abuse. Problems of aging include many major issues such as expanding health care costs; the difficulty in funding Social Security; and a growing number of elders dependent on a smaller number of younger adults for financial support and care. These issues can create intergenerational conflict which may contribute to abuse and neglect. In addition to abuse and neglect perpetrated by others, self-neglect is becoming more prevalent. Many of the same problems which face the elderly population are shared by those younger adults who are disabled by mental illness, developmental disabilities, and other physical or emotional problems.

Georgia law mandates certain professionals to report suspected abuse, neglect or exploitation of

adults. The major goal of this guide is to provide basic information about indicators of adult abuse,

neglect, or exploitation. A report to the proper authority can marshal resources to ensure the safety

and well-being of the individual while protecting him or her from further abuse. neglect or

exploitation.



If you suspect abuse ... Report it!

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LAWS AND REGULATIONS
Various laws in Georgia protect elderly and disabled adults from abuse. neglect, exploitation. and fraud. The laws protect them whether they are living in their own home. with relatives. in personal care homes. nursing homes. or are homeless. Major laws are as follows:
Social Security Act
In 1975. Title XX of the Social Security Act provided a legal base for Adult Protective Services at the Federal level. The purpose clause addressed "preventing or remedying abuse. neglect and exploitation of adults unable to protect their own interests." It described Adult Protective Services as "services to protect individuals 18 and over who are harmed or threatened with harm through action or inaction by another or through their own actions due to ignorance, incompetence, or poor health: In 1981, Title XX of the Social Security Act was amended with passage of the Omnibus Budget Reconciliation Act. This created the Social Services Block Grant and provided funds to the states for social services including Adult Protective Services.
Long-term Care Facility Resident Abuse Reporting Act
The Georgia General Assembly enacted the Long-term Care Facility Resident Abuse Reporting Act in 1980 to require reporting of incidents of abuse and exploitation of residents of nursing homes, intermediate care homes and personal care homes. (See Act in Appendix)
Ombudsman Act
In 1979. Georgia passed the Long-term Care Ombudsman Program Act, pursuant to the Older Americans Act of 1965, as amended. This law gives ombudsmen access to residents in long-term care facilities and the authority to investigate concerns on behalf of residents and to act as their advocates. ( See Act in Appendix)
Georgia's Disabled Adults and Elder Persons Protection Act
In 1981. Georgia passed the Disabled Adults Protection Act to assure the availability of protective services to all elderly and/or disabled adults in need of that service, who are not residents of longterm care facilities (hereafter, LTCFs). The Act was amended and renamed in 1997. (See Act in Appendix)

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Chart I-MANDATED REPORTERS

Specific professionals are required by law to report suspected or actual abuse, neglectand/or exploitation of elderly and/or disabled adults. This chart lists the
mandated reporters.

Reporters for Elderly and Disabled Adults Not in LTCFs

physician intern psychologist podiatrist

osteopath resident dentist nursing personnel

For persons living in the community. Georgia law requires mandatory reporting of suspected abuse. neglect or exploitation by any of the professionals listed to the left. All other persons are encouraged to report suspected abuse to protective and regulatory agencies.

and other hospital. medical. social work. daycare. and law enforcement personnel

Reporters for Residents of LTCFs:

administrator manager

physician

nurse/ nurse's aide

dentist

medical examiner

osteopath

optometrist

chiropractor podiatrist

social worker coroner

clergyman

police officer

pharmacist

physical therapist

psychologist orderly

and

other employees in a hospital, skilled

nursing home. intermediate care facility,

or personal care home

Georgia law requires mandatory reporting of suspected abuse or exploitation of a resident of a long-term care facility by these professionals listed.

and any employee of a public or private agency providing professional services to long-term care residents or responsible for inspecting long-term care facilities

NOTE: Persons who report in good faith are immune from liability. Confidentiality is important and respected.

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GENERAL INFORMATION

In the late 1970's. the problem of elder abuse began to surface as a national concern. By the early 1980's. the United States Congress, through its Select Committee on Aging, brought this issue to the forefront and enhanced public awareness of this problem. Nonetheless. elder abuse. neglect. and exploitation remain some of the most unrecognized and under-reported problems in this country. Thus. the incidence of abuse. neglect. and exploitation is not specifically known. According to an American Medical Association profile of adult abuse and a 1994 survey conducted by the National Center on Elder Abuse:

l. Adult abuse exists with a frequency rate only slightly less than child abuse.

2. It is estimated that 10% of the older population is abused and approximately one in 10 Americans 65 years of age and older suffer from some form of abuse.

3. One in 25 older adults will likely be the victim of moderate to severe abuse at the hands of his/her children or other caregivers.

4. Only one out of 14 incidents of elder abuse. excluding self-neglect. actually comes to the attention of law enforcement or protective services agencies while one of every three incidents of child abuse comes to the attention of law enforcement or protective services agencies.

5. Most victims of adult abuse and their caregivers are not well informed about available services which could help the caregiver cope with some of the stresses inherent in care g1vmg.

6. Abuse can occur in any setting including long-term care facilities such as nursing homes and personal care homes.

Adult abuse. neglect and exploitation will be an even greater national problem in the next century:



In Georgia. the county Departments of Family and Children Services provided Adult

Protective Services to 18,000 elderly and/or disabled adults in 1996. Of these, 66 percent

were over age 60. An average of 1,000 new cases are opened every month. In cases where

services were provided to older adults, the majority of cases involved self-neglect.



There are anestimated 7,353,225 people in Georgia. Ofthis number, approximately 982.554

are 60 years of age or older. Georgia ranks 13th in the nation for the number of persons 60

years of age and older, 49th in the nation for the percentage of persons 60 years of age and

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older. but ranks 6th in the nation in the percent ofthose 60 and over with mobility and/or self-care limitations.



The 1990 U.S. Census reported that 17.3% of the population or 6.955,299 persons 60 years

and older had mobility and/or self-care limitations and were not institutionalized. therefore.

requiring some assistance of another person.



The General Accounting Office of the Federal Government estimates that many of those

dependent elders suffer from mental or physical disabilities, or both. Studies indicate that

the more dependent a person is the greater his or her vulnerability to abuse. The theory

supporting this research attributes an increase in abuse to the most dependent individuals to

the heightened stress level ofthe caregiver as the dependent person's need for care increases.



Currently. there are close to 42 million people age 60 and over in this country. It is estimated

that this population will increase to 72 million by 2020. with the fastest growing group being

those over the age of 85.



During the 1980s the number of older persons increased twice as fast as the rest of the

population. Thus. because ofthe immense growth of this population, the potential for abuse,

neglect. and exploitation is enormous.



Researchers estimate that one-half to one million older persons are battered, sexually abused.

financially exploited and/or psychologically abused each year in this country. Another one

million may be severely neglected.



In 1994 the National Center on Elder Abuse reported that 35% of substantiated elder abuse

cases involved adult children and 13.4% involved spouses.



More than half of all reported elder abuse and neglect is caused by family members: spouses

(13.4%), children (35%) and other relatives (13.4%).



The Older Women's League (OWL) estimates 1.4 million women ages 45 to 65 are abused

physically by their spouses and more than one million women aged 65 and older are victims

of abuse each year.

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PREVENTION OF ABUSE, NEGLECT, AND/OR EXPLOITATION

The likelihood of abuse. neglect and exploitation increases with aging and dependency. Although each individual may have different needs. there are resources which are certainly helpful in reducing the risk of abuse and dealing with abusive situations.

ll::n Information and Education

It is vital to gather as much information as possible about what abuse is. how to recognize it and how to report it. It is true that information is power. Sources of information and education resources include but are not limited to:



Division of Aging Services



Adult Protective Services



Area Agencies on Aging



Public Library



National Resource Center on Elder Abuse



AARP



Bookstores



Red Cross



Hospitals



Support Groups



Long Term Care Ombudsman Program (for nursing homes & personal care homes)



Division of Mental Health Mental Retardation & Substance Abuse



Office of Regulatory Services

Information is available in a number of forms. Not all forms are available at all ofthe above sources, but with a little effort. it is possible to find out everything one might want or need to know about adult abuse. Some of the forms of information include:

. .. . . .. .. .. ..

Fact Sheets Statistics Brochures Books Videos Community Education Sessions Speakers Trainings

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Information and education are available and necessary for everyone who might encounter adult abuse including but not limited to:

Disabled Adults Students Churches Family Members Homemaker Services Staff

Seniors Law Enforcement Staff of Nursing Homes Care Managers Respite/Adult Day Care Staff

Caregivers Public Agencies Staff of Personal Care Homes Senior/Nutrition Center Staff Home Health Agency Staff

~ Putting the Information into Action
Once one is armed with information and education, putting that information to good use is the next logical step. There are various steps one can take to avoid circumstances which might lead to abuse. Look below for some ideas that you can present to adults and their caregivers to prevent abuse.
+ Arrange some time away when providing the majority of care for another person.
+ Make lists, charts or notes about what is required to provide care for a specific medical or
psychological condition.
+ Join a support group.
+ Make a directory of the available resources in your area.
+ Make a list of all of the important people or telephone numbers that you may need to access.
+ Create a support network for yourself from family, friends, neighbors, club members, church
members and others.
+ Ask questions about anything that seems unfamiliar or that you don't understand.
+ Give yourselfa reflection period before making any major decisions involving money, health
care, finances or resources.

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$Financial and/or R Medical Support
At times. medical or financial support may be the key to avoiding abusive situations. Depending upon the individual's needs and qualifications. some of the following avenues should be explored.
C!>. Applying for Medicaid. Medicare. or Supplemental Insurance
C!> Seeking medical and/or behavioral counseling or therapy
C!> Obtaining home health services ~" Obtaining periodic medical checkups
cy Applying for available public benefits such as: Food Stamps and commodities. Supplemental Security Income, retirement or pension benefits
cy Getting a physician to enroll in the free pharmaceutical program
cy Discussing medical bills or problems with medical bills with insurance counselor programs such as HICARE (Health Insurance Counseling Assistance & Referral for the Elderly)
cy Seeking consumer credit counseling or relief
cy Planning with a financial adviser or certified financial planner

~ Social Services

Social Services can sometimes provide the extra hand needed to fill gaps left by absent caregivers or persons unable to do as much for themselves as they once did. Examples include:



Homemakers for housecleaning assistance Personal aid assistance for personal care such as bathing, dressing, grooming or meals



Sitters or respite care for relief or to avoid being left alone Home Delivered Meals or Congregate Meals Senior Citizens Centers

Adult Day Care

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~Legal Services Jl:n

Legal services might provide assistance in explaining certain legal rights and obligations. Legal services can also assist in putting in place certain legal documents to make it easier to transact business and protect certain resources and rights. Such services could include:



Advance directives such as living wills, and durable powers of attorney for health care



Financial Powers of attorney



Planned Guardianships



Trust arrangements



Caregiver contracts

Summary

Using available resources can help achieve a marked reduction in the incidence of adult abuse. Many of the resources and options mentioned in this section are discussed in detail throughout this guide.

DEFINITIONS AND TYPES

Although federal definitions provide guidelines for identification, these problems are currently defined by individual state laws and definitions. The following are definitions, types and indicators of abuse. neglect, and exploitation which may occur when dealing with the elderly and/or disabled adults. The presence of only one indicator may not mean that an individual is a victim of adult abuse. However. the presence of a combination of indicators should serve as a red flag to alert you to the possibility of adult abuse.

Physical Abuse - Definitions

Adult Abuse:

the willful infliction of physical pain, physical InJUry, mental anguish,

unreasonable confinement. or the willful deprivation of essential services to a disabled adult.

Abuse in a Long-term Care Facility:

any intentional or grossly negligent act or series of acts

or intentional or grossly negligent omission to act which causes injury to a resident, including, but

not limited to assault or battery, failure to provide treatment or care, or sexual harassment of the

resident.

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Case Scenario - Physical Abuse in the Community
A "Meals on Wheels" driver was delivering a meal to an elderly woman. He observed the woman sitting in a chair with her hands tied together and another length of rope between her arms tied to the leg ofan old-fashioned dresser. She looked dirty, had uncombed hair and wore a stained dress. Her face was bruised on one side and her arms appeared to have cuts.
The man who accepted the meal said he was a friend ofthe woman's son and was just staying in the house for a few days because he had been evicted from his apartment. He said he didn't know anything about the woman's care-- just that her son had said to keep her tied and the door locked so she couldn't get out. He had no information about the son or when he might return.
Possible Resolution
The driver reports his observations to the site manager who makes a referral to Adult Protective Services at the County Department of Family and Children Services (DFCS) in the county where the home is located. Adult Protective Services will investigate the situation and interview the woman. An assessment will determine her need for services and her ability to recognize her need for assistance. Services will be provided, ifthe woman agrees to accept services. Steps to provide the necessary services will be made if it is detemrined that the woman is not capable of deciding whether or not she is in need of services.

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Determining Abuse
Physical abuse is easier to detect than are the other types of mistreatment. While the elderly and disabled may be more injury prone, certain types of injuries may be indicative of suspected abuse. Bruises, cuts, scratches. or bums to the thighs, calves, genitals, buttocks, cheeks, or back are more likely a result of abuse than are injuries to bony areas (elbows, knees, hands) which are often incurred accidentally. However, bruises to any part of the body of a person who is immobile are suspect because of the reduced likelihood that they are self-inflicted.
Typically the person most at risk of physical abuse is a woman age 75 or older, who has at least one physical or mental impairment and is dependent on relatives for her care.

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~ Indicators of physical abuse may include:



Bruises

Bilateral bruises (bruises on both sides of the body) are rarely accidental. Bilateral bruising to the arms may indicate that the individual has been shaken, grabbed, or restrained.

"Wrap around'' bruises are unlikely to be accidental. These are bruises which encircle the individuars arms, legs or torso. They may indicate that the person has been physically restrained.



Welts, cuts, lacerations, punctures, fractures, burns, black eyes



Signs of hair pulling, e.g., hemorrhaging below the scalp



Unexplained venereal disease or other unexplained infections



Abrasions on arms, legs or torsos that resemble rope or strap marks may indicate

inappropriate physical confinement, e.g., rope burns



Weight loss or dry skin caused by malnutrition and/or dehydration



Hyperthermia or hypothermia



Signs of over medication or under medication



Decubitus ulcers (pressure sores or bedsores) that are not cared for



Conflicting explanations of injuries



Unexplained injuries or explanations which do not fit the observed injuries



A history of similar injuries, and/or numerous or suspicious hospitalizations



Unwillingness to discuss problems



Depression

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Psychological Abuse
Psychological abuse is sometimes difficult to determine at first glance but one indicator which may aid in the detection is behavioral change in the victim after the alleged incident. These changes may appear as mood changes (laughing or crying excessively), interpersonal changes (refusal to talk or talking incessantly), and changes in sleep, dietary, or hygiene routines. as well as more obvious behaviors such as flinching or cowering when the alleged abuser or others approach.
Case Scenario -Psychological Abuse
Ms. Jenkins went to the health clinic for her six month follow-up appointment. When she met with the nurse, Ms. Jenkins was not her usual talkative self. This nurse had been following Ms. Jenkins' care for the past five years. Upon further review, the nurse noticed that Ms. Jenkins appeared nervous, avoided eye contact and seemed extremely reserved. After much coaxing, Ms. Jenkins confided to the nurse that three months ago she had been forced to move in with her daughter, son-in-law and their five children. Ms. Jenkins was living in the room with her 13- and 15-year old grandchildren, who were extremely upset that she was there.
Ms. Jenkins burst into tears as she told the nurse that ever since she moved in she has overheard her daughter and son-in-law arguing about the new living arrangement. Ms. Jenkins, who normally went to the senior center and to her church activities, admitted that, in an attempt to stay out of everyone's way, she hardly ever left her room now. Ms. Jenkins had lost 15 pounds in the past six months and her blood pressure was considerably higher than during her previous checkup.
Possible Resolution
The nurse discusses with Ms. Jenkins that she seems to be unhappy with the new living arrangements and that her situation is beginning to affect her physically. When Ms. Jenkins admits that she needs help, she agrees to allow the nurse to speak with the daughter and to contact the Area Agency on Aging for possible alternate housing and counseling resources. Ms. Jenkins is then scheduled for a follow-up visit at the health clinic for the following month.

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~ Indicators of psychological abuse may include:



Emotional distress such as crying, depression, or despair



Difficulty sleeping, nightmares. insomnia, sleep deprivation



Emotional numbness, withdrawal or detachment



Anxiety, agitation



Unrealistic view by the individual about his or her care (e.g., claiming that his or her care is

adequate when it is not, or insisting that the situation will improve)



Confusion



Change in appetite unrelated to medical condition



Paranoia



Self-destructive behavior (i.e., pulling out one's own hair or other deliberate self -injury)

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Neglect

Neglect:

the absence or omission of essential services to the degree that it harms or threatens

with harm the physical or emotional health of an elderly and/or disabled adult. Neglect is often

obvious because of the individual's personal condition or physical surroundings.

Case Scenario - Self-Neglect
A woman called the County Health Department to complain about her neighbor's property,
which was overgrown with weeds and had garbage in the yard. The caller said there were lots of cats and dogs in the house and around the yard, the place was an eyesore, garbage had piled up, and that the stench was terrible. She stated that her neighbor, Mr. Teal, appeared to be about 65 years old and
did not take care of himself. She said he was dirty and so was his horne. The neighbor reported that Mr. Teal walked with a cane, had a noticeable limp, and a withered right arm. The neighbor had offered to help him, but he refused assistance. She thought he might be eating cat or dog food.
Possible Resolution
The County Health Department Environmentalist inspects the home to investigate the
situation. He consults with a public health nurse and makes an immediate referral to the local County Department of Family & Children Services, Adult Protective Services. A case worker will visit the home, investigate the situation, offer services, and coordinate with the County Health Department.

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Self-neglect occurs when an individual fails to provide adequately for his or her own needs. This
usually happens when an elderly and/or disabled person is attempting to maintain an independent lifestyle without the ability to do so. This is the most frequent type of abuse case reported. It is also the problem most often encountered by law enforcement and other agencies.
Caregiver neglect or secondary party neglect occurs when an individual, either a professional or unpaid caregiver, fails to provide
proper care for someone else. Effects of neglect can be both physical and psychological.

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~ Indicators of neglect may include:

Signs ofNeglect in an Individual's Home



Absences of necessities including food, water, and/or heat



Lack of shelter



Inadequate living environment evidenced by lack of utilities, sufficient space. and/or

ventilation



Housing unsafe structurally, e.g., sagging walls, floors or roofing



Faulty wiring, inadequate sanitation



Human or animal waste on floors or furniture



House filled with trash and/or empty liquor bottles



Urine-soaked linens and strong odors



Uncollected mail or newspapers



Animal and/or insect infestations



Empty or unmarked medicine bottles or outdated prescriptions

Signs ofNeglect Observed in an Individual



Lack of clothing appropriate to the temperature and other conditions



Absence of needed eyeglasses, hearing aids, dentures, or other prostheses



Soiled clothing



Lack of needed medical care



Dirty body and/or encrusted fingernails



Untreated bed sores, sores or wounds of any kind

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Skin rashes



Dehydration evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy or lack

of energy and mental confusion



Untreated medical or mental conditions including infections, soiled bandages, unattended

fractures



Lack of needed supervision



Individual left alone or ignored for long periods of time

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Sexual Abuse and Exploitation

Sexual abuse of a disabled or older person has received little public or professional recognition. Abuse exists when the victim is forced. tricked, threatened, or otherwise coerced into sexual activity without his or her consent or when the individual is incapable of giving consent. Sexual abuse and exploitation can occur in any setting. Sexual abuse should be considered as a possibility in two situations:

I. When a disabled or older person reports unwanted sexual contact. 2. When symptoms commonly associated with sexual victimization are present. (See Indicators
further in this section.)

The following factors should be considered when evaluating a potential case of sexual abuse or exploitation:



It occurs between men and women of all racial, ethnic and economic levels.



The perpetrator is often a spouse or an adult child.



Paid or unpaid caregivers may be responsible for sexual abuse.



Social isolation and dependence may increase the risk for mistreatment.



Victims often experience several forms of maltreatment at the same time.

Sexual abuse includes one or more of the following activities:



Physical attacks on sexual parts of the body



Rape by a person or with objects



Sodomy



Incest



Sexual touching, fondling or kissing



Exposing oneself to the victim



Sexual harassment



Being treated as a sex object



Being forced to view pornographic materials



Inappropriate sexual comments

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Case Scenario -Sexual Abuse in a Nursing Home
A 94-year-old woman with dementia was a resident in a nursing home. She was examined after having been admitted to the hospital for treatment of a severe urinary tract infection. Evidence was found to indicate that she had been recently sexually assaulted. Because of her dementia, the woman was unable to say what had happened to her.
Possible Resolutions
A hospital social worker reports the incident to law enforcement, the nursing home, and to the Special Services Section/Intake and Referral Unit of the Office of Regulatory Services which is responsible for investigating reports of abuse in nursing homes. The nursing home contacts the Long-term Care Ombudsman who visits the resident, either at the hospital or the nursing home. The Ombudsman visits the resident to determine the resident's wishes and follows up to see that appropriate reports and investigations are done by the nursing home. The Ombudsman follows up with the resident to see that her needs are being met and follows up on the results of the investigation by the Office of Regulatory Services and law enforcement.

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~ Indicators of sexual abuse may include:



Physical injury to genitals, anus, breasts or mouth



Bilateral bruising of the inner thighs



Genital or urinary pain, irritation, itching, infection, bleeding or scarring



Sexually transmitted diseases or genital infections



Inappropriate, unusual or aggressive sexual behavior



Tom, stained or bloody underclothing



Difficulty walking or sitting



Frequent, unexplained physical illness



Extreme upset when changed, bathed or examined

Psychosocial or behavioral symptoms may include:



Intense fear reaction to people



Mistrust of others, nightmares



Sleep disturbances



Fear of going to bed



Phobic behavior



Regressive or aggressive behaviors



Depression



Suicidal thoughts

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Sexual exploitation involves sexual abuse where the offender gains advantage or profit from illicit activity such as prostituting the victim, or using the victim to produce pornography.
~ Indicators of sexual exploitation may include:



Reports of being subjected to verbal sexual harassment- receiving obscene telephone calls



Reports ofbeing forced to masturbate in view of an abuser,



Reports of being made to watch others engage in sexual activity,



Reports of being made to engage in sexual activity with someone, animals, object



Reports of being made to pose for sexually explicit photographs.

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Financial Exploitation

Financial Exploitation:

the illegal or improper use of an elderly and/or disabled adult's

resources for another's profit or advantage. Exploitation relates to misuse of property or financial

resources. Exploitation often is discovered only by extensive conversation with the victim or

someone outside the victim's residence who may have information about the victim's income and/or

resources. Allegations of exploitation frequently require extensive investigation.

Case Scenario -Financial Exploitation in the Community

A bank teller told his bank manager that several large checks totaling nearly $4,000 had been cashed from one of his elderly customers for lawn maintenance. The payee, amounts, and endorsements appeared to be signed in the same handwriting (not the customer's) but the checks appeared to be signed by his customer. The manager, acquainted with the customer, knew that she was in her 70's, walked with the assistplce ofa walker and seemed unsteady on her feet and knew that her yard was very small.
When the bank manager called the customer to ask about the cashing of her checks, she said that she had been paying a young man to keep her lawn up for her since last summer. Several times recently the young man. had asked her for some "advance" money because he needed new equipment and a new truck to keep his business going. He told her he would take care of her yard on an ongoing basis as a means of repayment.
She said she advanced the young man about $50 once and another time it was about $200. She said there were other money advances, but she couldn't remember the exact amounts. She stated that she couldn't see well enough to make the entries or read her bank statements, so she asked the young man to fill out the checks. She stated that there had always been plenty of money in the bank to cover her needs each month so she wasn't concerned about the balance.~'

\ ~ ~ -, ' 'i

Possible Resolution

'"(

The bank officer reports the woman's situation to the local County Department of Family & Children Services, Adult Protective Services who will investigate the situation and offer assistance to the woman. APS will contact law enforcement if financial exploitation is substantiated. Law enforcement will determine ifcriminal charges can be filed. Ifthe woman chooses to take civil legal action against the lawn maintenance person, she could contact the local Elderly Legal Assistance Program provider or a private attorney fot further assistance.

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~ Indicators of exploitation may include:



Missing personal belongings (jewelry, silver, coins, furniture and/or other valuables)



Eviction notice arrives when a person thought he or she owned the house



Property deed no longer in individual's name



Forced admission to a long-term care facility for the purpose of taking possession of his or

her property and possessions



Unexplained bank account withdrawals or transfers



Bank statements and canceled checks no longer coming to an individual



Unpaid bills but adequate income



Utilities shut off for nonpayment



Unusually large or frequent gifts or payments for services



Suspicious signatures on checks or other documents



Power of attorney given or Will drawn up that the individual did not understand when signed



Lack of understanding about or proof of financial arrangements



Stolen Social Security checks



Extraordinary interest by family in individual's assets



"New friends" expressing interest in the individual's finances, will, or bank account



Questionable explanations given about the individual's finances

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Consumer Fraud

Consumer fraud is another form of exploitation. Older and disabled adults are easy targets for con artists. Seniors own more than half of all financial assets in America and often have saved for retirement. But, at the same time, they are vulnerable because they grew up in an era when business was transacted on a handshake. Research has shown that older adults are quicker to believe promises and slower to take steps to protect their legal rights. Since many older adults are on fixed incomes, most often Social Security, it is nearly impossible for them to replenish bank accounts emptied as a result of fraud. The three most common practices con artists use to defraud are telemarketing. mailing and door-to-door sales. Common consumer scams include:



Home improvement schemes such as driveway repairs, house painting or roofing



Living trusts which falsely advertise that probate or inheritance taxes can be avoided and

have "peace of mind" benefits which seem too good to be true



Auto repairs



Health care and insurance fraud



Contests where a prize has been won but money must be sent in in order to collect it

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Case Scenario - Consumer Fraud
Eighty-nine year old Ms. Tugglesworth called her friend to tell her that a nice young man had stopped by and offered to fix a weak spot that he had seen on her roof while passing by. Ms. Tugglesworth said that she didn't know her roof had a weak spot, she would not have seen it or recognized it. She agreed to the young man's terms. He was supposed to start the job first thing the next morning, at which time Ms. Tugglesworth was to pay him $3,500.00 in full.
Possible Resolution
Ms. Tugglesworth's friend cautions her about hiring the young man without checking him out first. Thanks to her friend, Ms. Tugglesworth finds out that she can make a complaint to the Better Business Bureau and the Elder Fraud Unit ofthe Governor's Office of Consumer Affairs. After calling and receiving advice from both offices, Ms. Tugglesworth tells the young man that she has changed her mind about hiring him to do the repairs. Instead she calls the Area Agency on Aging for some referrals for home repair assistance.

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Abuse in Institutions
Abuse occurring in institutional settings, such as nursing homes, personal care homes, and hospitals can be caused by staff, families and visitors, and other residents/patients. Patient and resident rights are protected by law.
Case Scenario- Nursing Home
The Long-Term Care Ombudsman received a call from the daughter of a nursing home resident who said that the nursing home staff had informed her that her father had a broken hip and had been admitted to the hospital. When the daughter went to the nursing home to investigate the incident, she discovered that her father had actually fallen two days before being sent to the hospital. The daughter called the Long-term Care Ombudsman and requested that the incident be investigated.
Possible Solutions
The LTCO advises the daughter to contact the Special Services Section/Intake and Referral Unit of the Office of Regulatory Services which is responsible for investigating reports of abuse in nursing homes. The LTCO visits the resident to determine what happened and to discuss with the resident what he wanted done. The LTCO then checks with the nursing home to see if the facility has properly reported and investigated the incident. The LTCO follows up with the resident, the daughter and nursing home staff.

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~ Indicators of abuse, neglect or exploitation in institutions



Neglecting to provide care and treatment



Stealing anything from the resident, including money, clothing or other belongings



Not having enough staff to care for the residents or patients



Alcohol and/or drug abuse on the part of employees



Yelling at or threatening the resident or patient



Improperly using physical and chemical restraints such as leaving a resident or patient tied

or restrained to a bed or chair



Pushing, grabbing, shaking, shoving, pinching, slapping or hitting a resident or patient



Leaving a resident in wet clothing or on wet sheets



Leaving residents dressed in soiled or tom clothes



Ignoring or removing a call bell



Retaliating against a resident or patient including threatening to discharge him or her



Refusing to allow a resident to go to an activity or to go outside or isolating him or her



Misusing patients' and residents' funds

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Chart 2
TYPES & CHARACTERISTICS OF ABUSE AND NEGLECT

Adult abuse, neglect, or exploitation refers to any of the several forms of mistreatment of an older person or disabled adult. This chart summarizes these forms of mistreatment.

Type

Characteristics

Physical

Acts resulting in bodily harm and injury, use of physical restraints, sexual assault

Substance

Misuse of drugs, over medication, narcotics abuse, excessive use of alcohol

Psychological

Verbal assault, threats, intimidation, namecalling, isolation from others

Financial/Material

Theft or misuse of money or property

Violation of Rights

Forced removal from own home, inappropriate placement in nursing home or other facility

Neglect

Failure to provide adequate food, shelter, clothing, needed personal care, medical care and appropriate supervision

Sexual

Forced or coerced sexual activity without consent

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CONTRIBUTING FACTORS TO ADULT ABUSE

There does not appear to be any single explanation for any one form of adult abuse and theories cannot fully determine causes.

The prevailing theories of the "why" of adult abuse are based on the following assumptions:



Adult abuse and neglect, including self-neglect, are neither normal nor to be condoned.



Neglect is the most common form of elderly and disabled adult mistreatment.



Multiple causes or conditions may be present that must be addressed.

The most commonly accepted risk factors for adult abuse are:

1. A history of substance abuse or mental pathology in either victim or caregiver 2. A previous history of abuse in the caregiving context 3. Financial dependence of the caregiver on the victim 4. Chronic illness or impairment affecting the victim who lacks informal support 5. The victim's need for care which exceeds the capacity of the caregiver to help
See Chart 3 on the following page for a summary of these .~......~.......,

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Chart 3 -CONTRIBUTING FACTORS

The contributing factors for adult abuse and neglect are related to the individual being cared for, the abuser and the environment. This chart summarizes the factors which
contribute to adult abuse.

PERSON/PLACE

FACTORS WHICH CONTRIBUTE TO ABUSE

ELDERLY/ DISABLED PERSON

Female Drinking Problem History of Abuse Provocative Behavior

Dependence Impairment Excessive Loyalty Isolation

ABUSER

Substance Abuse History of Abuse Economic Dependence MentaVemotional Illness

Isolation Blaming Overly Critical Stress

ENVIRONMENT

Lack of Support Sudden/Unwanted Change

Home Problems Ageism

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A case of adult abuse. including self-neglect. may include one or any combination of these traits. The causal factors consistently cited in research include:



Personal Traits of the Abuser



Cycle of Violence: Transgenerational Family Violence



Dependency



Social Isolation



Stress

Personal Traits of the Abuser

Studies indicate that the following, which may be traits of the caregiver or the self-abusing victim. predispose abusive behavior:

1. Substance (Drug/Alcohol) Abuse is involved in a large number of cases. Alcohol is involved in a large number of cases and it is unclear whether alcohol is the stimulus, the effect or the frequent companion to adult abuse. Substance abuse:



Lowers inhibitions against violent conduct



Gives an excuse for violent behavior



Causes exploitation of money/belongings



Results in neglect of duties of caregiver, and



Reduces activities of daily living

2. Mental Health problems related to adult abuse including the following:



Psychotic Conditions



Emotional problems



Past hospitalizations for psychiatric conditions



Schizophrenia



Dementia or mental retardation



Inadequate capacity to care for self/others

3. Sociopathic Behavior results in disregard of conventional mores or violation of cultural standards. As a result of this behavior an individual shows:



Remarkable lack of conflict, guilt, anxiety and insecurity



Inability to control impulses



Inability to form meaningful relationships

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Violent behavior is often learned in the home as a means to deal with feelings. Persons who have witnessed or have been victims of family violence may deal with their problems in a like manner. The cycle ofviolence has elements of retaliation and imitation. Adult children who were mistreated as kids may be abusive to their elderly parents as a form of "pay back."
The threat ofviolence can sometimes be as damaging as the physical act of violence.
Domestic violence increases in frequency and severity over time and the need for medical attention often increases with each episode.
Dependency
The abuser and the victim may have few alternatives to the abusive domestic situation due to economic/financial dependence and/or physical/emotional dependence.
There may be a mutual web of dependency where the adult child/caregiver provides care to the elderly or disabled adult, who provides him/her with money, emotional support and a place to live. In studies, dependency of the abuser on the victim is shown to be a major factor in physical abuse. In one study, 64 percent of abusers were financially dependent on the victim and 55 percent dependent for housing. Often abusers become frustrated due to powerlessness in controlling their finances or improving their financial independence.
The victim's medical, functional or cognitive disability increases dependency and vulnerability, increasing the risk for abuse or neglect. Caregiving responsibilities create stress and the caregiver may become more frustrated as the person being cared for becomes more dependent for financial, emotional, and physical support. The adult child/caregiver may not have wanted the role, had a poor relationship with the person in the past and now exhibits resentment. The caregiver may be unprepared or ill-suited for the caregiving task.

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Social Isolation
Social isolation is relevant in adult abuse. whether it is a cause or an effect. Aging and disability are often accompanied by decrease in productivity. loss of independence and mobility, and loss of contact with others.

Isolation is often associated with neglect. but also is related to forms of violence. Isolation reduces the risk that abuse will be discovered. Violence and exploitation may be hidden when a caregiver denies the adult his or her right to see and/or talk to friends or other family members.

Stressors

The greater the stress on the caregiver and the greater the dependency of the disabled adult for activities of daily living. the greater potential for abuse.

Stress often triggers abusive behavior that results in physical violence, neglect and/or financial exploitation. Some ofthe key stressors include:



Economic hardship: the abuser has no income of his/her own



Lack of respite: the stressed caregiver is not aware of resources/respite, is ill prepared for

the caregiving task and feels trapped



Guilt: caregivers feel guilty about their own inadequacies and frustrations in the caregiving

role



Anxiety and fatigue: caregivers neglect their own needs and health, resulting in increased

stress



Difficult behaviors of the disabled adult: behaviors such as excessive demands,

wandering, insomnia, and noncompliance may produce stress and contribute to abuse

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THE VICTIMS OF ABUSE, NEGLECT, AND EXPLOITATION

Individuals who recognize the characteristics which describe victims of abuse. neglect. and

exploitation have a better ability to evaluate and report suspected abuse. Abused individuals may

not report the abuse because they feel ashamed or embarrassed or have low self-regard. They may

not want to report their own child. grandchild, or caregiver. They may fear more abuse if they report

it. Some may not be able to think clearly or may not realize that help is available.



While the characteristics listed below are only indicators and are not all-inclusive, they should cause you to question whether abuse, neglect, or exploitation has been or is occurring. If you suspect abuse, neglect, or exploitation, call the appropriate agency. The agency will determine whether what you have observed constitutes abuse.

Victim Characteristics

1. Female: There are more abused, neglected, and exploited women simply because there are more women than men. Older women are also less likely to resist abusive behavior and are more vulnerable to sexual molestations.

2. Advanced age: As people age, they often lose the capacity or strength to resist or defend themselves.

3. Dependency: Adults who depend on others for their care are more vulnerable.

4. Substance abusers: Alcoholics and substance abusers are very susceptible to abusive behavior and are frequently self-neglectful. Mis-medicating, whether intentional or not, and whether by prescription, over-the-counter, or street drugs, often places a person at greater risk.

5. Intergenerational conflict: Sometimes past problems between parent and adult child become intensified by an increasing dependency on the adult child by a parent or the adult child's dependency on a parent.

6. Internalized blame: The victim takes responsibility for the abuse, neglect, or exploitation and fails to acknowledge that it is the fault of the abuser.

7. Excessive h)yalty: If the victim has a strong sense ofloyalty to the caregiver, he/she will probably not seek help.

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8. Past abuse: An individual may have a history of abusive relationships as either the abuser or a victim.
9. Fear: Some persons tolerate abuse without seeking relief because they are afraid of retaliation. worsening the situation, losing care or being institutionalized.
I0. Isolation: Because of physical impairments that lead to social isolation. abuse goes undetected.
ll. Impairment: The greater the individual's need for care. the greater the demand on the caregiver. If the person's disability includes mental impairment. it may increase the caregiver's stress.
12. Difficult behavior: Some elderly and/or disabled adults can be very demanding. unpleasant. and ungrateful, as well as physically and verbally aggressive towards their caregivers.

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THE ABUSER AND CAUSES
There are no simple answers to the causes of adult abuse. Although the importance of understanding the specific types of adult mistreatment cannot be emphasized enough. it is also important to develop a clear picture about the identity of those who are the abusers in these types of mistreatment and the factors contributing to its occurrence. Chart 4, on the following page. lists some characteristics of abusers.

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Chart 4
CHARACTERISTICS OF ABUSERS

This chart provides a clearer picture about the identity of abusers

Substance Abuse distorts judgment and perception resulting in poor care or acting out negative feelings towards the victim.

Stress from dealing with emotional. economic. or care giving issues may cause the caregiver to become distraught.

Symptoms of Senility, Confusion, or Mental Illness may impair ability to care for the victim and ability to understand the potential risk for the victim.

History of Abuse (child abuse or domestic abuse) which may result in deliberate retaliation, learned abusive behavior, or unconscious hostility.

Inexperience may result in a well-intended caregiver who does not know how to care for a dependent adult.

Uncaring Attitude is likely to make the caregiver callous and unable to care for the individual properly.

Financial Dependency may cause resentment, greed, hostility and/or mistreatment.

Lack of Understanding of physical and emotional problems and needs of the person in his/her care may result in mistreatment.

Isolation results when a caregiver lacks contacts outside the home and has no one to discuss problems with or provide occasional respite.

Unrealistic Expectations by the caregiver could result in abuse or inappropriate care.

Blaming the Victim for problems and directing the anger toward the victim may lead to mistreatment.

Overly Critical caregivers may become impatient and often do not make good caregivers.

Patterns of Coercive Control that one exercises over another may perpetuate abuse.

Need to Dominate through physical and/or sexual violence, threats, emotional insults and/or economic deprivation may result in abuse.

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Environment
Environmental conditions for both the abuser and the victim of abuse should be considered as a cause of adult abuse. Some specific factors to consider include:
1. Overcrowding: The stress oftoo many people in a crowded environment often leads to frustration and conflict.
2. Isolation from others: A lack of interaction with other family members or others from outside the home often leaves both the victim and caregiver isolated and feeling invisible.
3. Family Problems: Some families already have problems or stressful lifestyles and the added burden of caregiving only makes matters worse. The stress or anger from problems may be blamed on the victim, creating additional resentment and/or resulting in poor. abusive care.
4. Lack of community support or resources: Some families need respite care, help with finances to care adequately for dependent person, and other support.
5. Inadequate staffing in hospitals, nursing homes and personal care homes: Lack of support and supervision for institutional staff may result in abuse and neglect.
Caregiving
Abuse by formal caregivers such as institutional staff and informal caregivers such as family members is very prevalent. Most families provide good care and adult abuse is not present. However. caregiving may create stresses which can result in abuse of the person for whom care is given. Chart 5 provides a list ofthe signs of potential abuse by caregivers.

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Chart 5
SIGNS OF POTENTIAL ABUSE BY CAREGIVERS
Expresses extreme anger, frustration, or exhaustion Isolates the individual from the outside world. friends, or relatives Lacks caregiving skills Isolates the individual emotionally by not speaking to, touching or comforting himlher Threatens the individual with physical abuse, withdrawal of care, loss of relationships, desertion
or nursing home placement Exhibits signs of mental health problems or impaired judgement including poor self-control.
hostility. agitation, or volatility Appears drunk or high; abuses alcohol or drugs Speaks for the individual Dominates an interview Refuses to allow the individual to be interviewed alone Does not recognize the needs of the disabled individual Exhibits exaggerated defensiveness Denies problems or negative emotions Handles the individual roughly or in a manner that is threatening, manipulative, sexually
suggestive or insulting

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SCREENING FOR POSSIBLE VICTIMS
For a variety of reasons. most victims are reluctant to admit that abuse. neglect or exploitation has occurred. Reasons include reluctance to blame a family member or caregiver: fear of retaliation: fear of placement in a nursing home; or fear of loss of support services. Usually the active involvement of a third person is required before the case can be brought to the attention of concerned professionals. You are that third person. Professionals and staff in the fields of health, safety and social services need to be alert to indicators of abuse and take steps toward intervention.
Role of Service Providers
Studies have found that victims and perpetrators rarely seek outside help for the abuse, neglect or exploitation that is occurring. However, there are indicators that in many cases, either the victim or the abuser requests "assistance' from an agency. All service providers need to screen for and be able to recognize and respond to indicators of abuse, neglect and exploitation. Screening for abuse, neglect and exploitation is an important responsibility for service providers and especially for the Department of Human Resources' staff and contractors. The screening should be targeted at obtaining an accurate picture of the client in the context ofhis/her home environment.
..-..-

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Engaging the Client

There is a balance between fact finding and engaging -establishing a relationship with- disabled or elderly persons, the caregiver, and relatives. This balance will help you in gathering the necessary infonnation from and about the person. as well as beginning the development of the essential helping relationship.

You must express a sincere desire to help while allowing the person to express feelings about the situation. Your initial contact with the elder or disabled adult, caregivers, and others must show clearly your concern and a desire to help. You should expect possible reactions of anger and resistance. If these reactions occur. don't take them personally and try not to respond defensively.

Wa.vs to Engage the Client, Caregiver, Family



Show active listening



Give them a sense of control



Detennine their view/perspective



Show genuine concern



Show appreciation of their strengths



Respond honestly to questions



Encourage open/honest discussion of feelings



Be sensitive to their needs/feelings



Be respectful of their beliefs or customs



Provide information



Maintain frequent contact



Provide some help

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Interview Techniques

In order to get answers. you must ask the right questions in the most appropriate way. You can request information in two very different ways--directly or indirectly.

Directly:

"Does your caregiver (son) check on you each dayT'

Indirectly: "Could you tell me about your caregiver (son)?" The non-directive question \\<ill not only give you facts. it may give you some "feelings" as well. The best approach is one which balances both interview techniques.

The "one-word lead" is another helpful interviewing technique: When a client makes a statement that is unclear, unfinished or ambiguous. the "one-word lead" may be a useful technique. For example. if the client says, "Yes. all my family help me except Roy," you might simply say, "Roy?" Such a response asks for more information about the relationship without offering any boundaries. Even with a client who tends to verbally wander, the one-word lead can be a tool to help focus.

Communication
Communicating with a person with dementialAlzheimer's Disease can be difficult. Confusion and communication problems, especially in the elderly, can also be caused by inappropriate medication, impaired hearing. poor nutrition and depression. Do not assume that someone is unable to answer questions credibly regarding the situation/conditions/feelings, simply because he or she is old or confused.

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Approaches for Effective Communication "H'ith a Confused Person



Conduct interview in a quiet place free of distractions.



Make direct eye to eye contact and remain face-to-face.



Speak loudly and clearly, but avoid a high pitched voice.



Begin each sentence addressing the person by name.



Ask only one simple question at a time.



Use short words and simple sentences.



Use hand gestures. Point to body parts and objects.



Use simple drawings or pictures.



Speak slowly and wait for a response. If the response doesn't come in a minute or so, repeat

the question exactly as before.



Pay close attention to the person's emotional and non-verbal responses when asked

questions.

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Suggested Screening Questions
Service providers. DHR. and DHR contractor staff should routinely incorporate questions related to elder abuse and neglect into conversations with clients. Remember. these questions are merely examples. You should ask the questions in your own words and in the order that is appropriate based on the responses you get. Be careful not to make clients feel that they are being interrogated. Don"t assume that because you don't get a revealing response to one ofthe basic questions. that you should not ask more specific questions. When appropriate. answers should be followed up to determine how and when the mistreatment occurs. who perpetrates it, and how the person feels about it and copes with it. Try to determine how serious the danger is and what the person thinks can be done to prevent the mistreatment from recurring.
Questioning needs to progress from generalities to specifics. It's best to start with basic questions such as
What is your name, age, address?
How long have you lived there?
Do you live alone or does someone live with you? If so, who?
If you had a crisis, who would you call for help?
Proceed to general questions that give a sense ofthe overall well-being ofthe client such as
Do you get enough income to pay your bills?
Is someone else dependent on you for money? If yes, who?
Do you need any help taking care of yourself?
Do you pay your own bills? Can you keep up with taking your own medicines?
How do you usually spend your day?

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Have you had any injuries, hospitalizations, or emergency room visits recently? Describe them.
Do you have enough privacy in your home? Are you alone often? Are you sad or lonely? Finally, ask more specific questions to screen for the various types of abuse or neglect such as Are you uncomfortable with anyone close to you or anyone living with you? Who makes decisions about your life, such as how or where you will live? Does anyone in your family drink too much or have problems with drugs or
medicine? Has anyone ever failed to help you take care ofyourself when you needed help? Has anyone close to you ever hurt you? Has anyone touched you without your consent? Have you been forced to do things you did not want to do? Give an example. Has anyone threatened to place you in a nursing home? Has anyone cursed at you or threatened you? Has anyone kept you at home against your will? Has anyone refused to give you food, water, or your medications? Has anyone beaten or threatened to beat you?

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Are you afraid of anyone in your home or anyone close to you?
Has anyone taken anything of yours without asking?
Have you signed any documents that you didn't understand?
Adaptedfrom Elder Mistreatment Guidelines for Health Care Professionals: Detection. Assessment & Intervention. Mount Sinai/Victim Services Agency Elder Abuse Project. New York, 1988.

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Interviewing the Caregiver
II'Talk li'ith the caregiver and attempt to determine the extent to which the elder or disabled adult .is dependent on him/her. These are examples ofthe types o[questions to ask:
What is the dependent adult's and caregiver's medical condition? What kind of medications do they take? Is the dependent adult able to handle his or her medication independently? What other kinds of daily care does he or she require? What can he or she do for himself or herself? What does the dependent adult expect the caregiver to do for him or her?
II'It is important to understand the caregiver's situation and to determine if he or she needs
assistance with caregiving. Possible questions to ask include:
How do you manage the caregiving role? What difficulties have you had? How do you cope with the responsibility of caring for the person? How much longer can you continue to provide care at this level? Do you have outside help or respite care? What other responsibilities do you have? Are you working outside the home? Are you responsible for the person's fmances? What kinds of arrangements have you made with him or her, or the designated power of attorney agent, representative payee, or guardian?

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Whether or not your screening identifies potential abuse, you should always consider if



the individual seems capable of making an informed decision;



the situation is a life-style issue in terms of the person's personal preference:



there are any family members available who would be a source of support or assistance;



there is a natural support system in the community (neighbors, church members, or friends)

available to help the individual;



there is a professional support system (home health, homemaker services, meals on wheels,

or transportation) available to help the individual;



the elder or disabled adult is willing for you to make referrals to community resources.

Remember, to report suspected abuse, neglect or financial exploitation, you do not have to prove that mistreatment has occurred. You only need a reasonable cause to suspect that it has.

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REPORTING ABUSE
The following case examples are provided to illustrate possible abuse situations you may encounter in your day-to-day work. Abusive situations may occur in the community. in a long-term care facility. or a mental health setting. The cases described will not cover every possibility. but should describe typical situations and the appropriate actions to take when abuse occurs in that setting. Chart 6 summarizes the process for reporting, investigating and taking action in case of adult abuse. neglect or exploitation.
Community Settings
When abuse. neglect or exploitation is suspected for an individual who lives in his own home (house. apartment. condo. etc.) or with relatives, a report should be made to Adult Protective Services in the County Department of Family & Children Services where the person resides.

Case Scenario 1- Physical Abuse

Mrs. Jacobson, an older woman, walking with a walker, went in for a flu shot. The Public Health Nurse noticed that she seemed fearful and when asked questions, Mrs. Jacobson looked to her daughter before answering. The nurse took Mrs. Jacobson to a private area to give the flu shot and asked the daughter to wait outside. Since Mrs. Jacobson's blouse had tight sleeves, the nurse asked her to remove it for the shot. The nurse noticed the following:



bruises on the upper left arm that resembled finger grips



a bruise on the right shoulder



scattered black, blue, green, and yellow bruises on the chest and back in different stages of

healing

When asked about the bruises, Mrs. Jacobson stated that she had fallen. When questioned further, she said she had fallen only that one time. When asked who helped her at home. she said that her daughter moved back in with her after a divorce, had no job and they depended on each other. When asked if she needed more help in the home, she seemed reluctant to answer. When asked if this could be discussed with her daughter, Mrs. Jacobson seemed very apprehensive and emphatically said. "No."

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Possible Resolutions
The public health nurse suspects abuse and reports it to the local County Department of Family and Children Services (DFCS), Adult Protective Services, who will investigate the situation and offer assistance to Mrs. Jacobson.
Case Scenario 2- Caregiver Neglect
For the first time in several months. the mail carrier saw Mr. Brown on the porch in the wheelchair. When she noticed that he had lost weight and was wearing dirty clothes, she stopped to talk to him. When asked where he had been, Mr. Brown said he could no longer get out of bed by himself but that his girlfriend helped him into the wheelchair before she left for work. The mail carrier asked if he needed help at home and offered to call the Community Care Services Program that had helped her elderly aunt.

When the Community Care Management Team member contacted Mr. Brown for program services. she learned that:



Mr. Brown was discharged from a rehabilitation center I0 months earlier and had exhausted

his private insurance coverage;



his wife had left him after his accident and his girlfriend had been taking care of him;



he had spent all his savings and his girlfriend cashed his monthly check;



the girlfriend said there was no money left to provide additional help;



he has had neither home health nor nursing services for months;



he was weak and could not transfer independently from bed to wheelchair although he had

been able to do so when initially discharged from the rehabilitation center;

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his home was not wheelchair accessible;



he was alone in the house most ofthe day; and,



he had not eaten that day.

Possible Resolutions

The Community Care Services Program after telephone contact with Mr. Brown determines that he appears eligible for CCSP services and schedules a home visit for a full assessment. The Care Management Team member refers Mr. Brown to the local Adult Protective Services who will investigate the situation and offer assistance; to the County Department of Family and Children Services (DFCS) to determine his eligibility for Food Stamps and possibly Medicaid; and to the Division of Rehabilitation Services for employment services. A referral can be made to the Social Security Administration for possible applications for Social Security Disability or Supplemental Security Income.

Case Scenario 3- Financial Exploitation
The rehabilitation teacher worked with Mrs. Rust who was severely visually impaired. Mrs. Rust told the rehabilitation teacher that her niece said that she did not need to learn to write checks and keep bank records because the niece handled her finances. At the next visit, the rehabilitation teacher found that Mrs. Rust's electricity was off. She also noticed that the food in the refrigerator had spoiled. Mrs. Rust tearfully reported that her niece was supposed to pay the bills. The rehabilitation teacher contacted the niece who angrily refused to discuss Mrs. Rust's finances.
Possible Resolutions
The rehabilitation teacher reports Mrs. Rust's situation to her supervisor and to Adult ;:.,. Protective Services in the county where Mrs. Green lives. Adult Protective Services will investigate the situation and offer services as needed.

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Case Scenario 4- Physical Abuse
A Community Care Services Program personal support aide visited Mr. White who was an older man in a wheelchair. She reported to her RN supervisor that while giving Mr. White a bath. she noticed sores which appeared not to have healed. The nurse made a home visit and learned that Mr. White's son had recently moved into the home. She noticed what appeared to be cigarette bums on Mr. White's arms. Mr. White was a smoker. but the multiple bums looked suspicious. For example he had sores around his neck and some looked infected. The nurse asked Mr. White if he had seen a doctor for treatment of the sores. Mr. White said, "No:' She asked if he needed help getting an appointment with his doctor, and Mr. White responded that he didn't want to get anybody in trouble.
Possible Solutions
The nurse reports her observations to Adult Protective Services in the county where Mr. White lives. Adult Protective Services will investigate the situation and offer services as needed. The nurse advises the CCSP care manager that she has referred Mr. White to Adult Protective Services.
Case Scenario 5- Self-Neglecting Medical Treatment
A rehabilitation counselor visited Mr. Black's residence because Mr. Black failed to keep his appointment at the clinic. Mr. Black was an amputee who was to attend the local amputee clinic and receive physical therapy and prostheses. Mr. Black lived with his brother who stated that Mr. Black
refused to take his medicine, go to the doctor, or allow his stump which appeared infected, to be cleaned.
Possible Solutions
The counselor calls Adult Protective Services in the county where Mr. Black lives. Adult
Protective Services investigates the situation and offers services, but Mr. Black emphatically refuses.
The assessment includes functional and mental capacity and Mr. Black seems to have the capacity
to understand the consequences of his decisions and actions. A mental health professional visits Mr. Black and assesses him competent. The caseworker continues to visit Mr. Black to urge him to seek treatment. The rehabilitation counselor also continues to work with Mr. Black to him to accept
assistance.
r 1

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Long-Term Care Settings

When abuse. neglect or exploitation is suspected in a nursing home or personal care home. reports should be made to the DHR Office of Regulatory Services which is responsible for investigating reports of abuse.

Case Scenario 1- Physical Abuse in a Personal Care Home

A Long-Term Care Ombudsman (LTCO) received a call from the manager of a personal care home who reported that while a resident's husband was visiting his wife. Lucy Green. a staff member observed Mr. Green strike his wife on the right side ofthe head. When the staff member rushed into the room to prevent further attacks, Mr. Green reluctantly stopped. He stated that he used this method to get Mrs. Green to eat and behave and had done so since she developed Alzheimer's Disease. Further conversation with the administrator indicated that Mrs. Green was a 67 year old woman. diagnosed with Alzheimer's Disease, who was pleasant but responded to questions with unrelated and sometimes meaningless words. The manager told the ombudsman that she wanted to stop the abuse.

Possible Resolution

If Mr. Green is still on the premises and there is immediate danger, the manager should call

the police. The resident can be protected under the Family Violence Act in which case police

officers can make an arrest without a warrant as long as the perpetrator is obviously aggressive. The

manager can obtain a Temporary Restraining Order (TRO) to keep Mr. Green away from the facility.

The ombudsman directs the manager to call the Personal Care Home Unit of the Office of

Regulatory Services (ORS) to report the abuse. When the abuser is not an employee of a facility.

ORS will refer the case to the police or Adult Protective Services. ORS may also request that the

ombudsman assist the facility in finding ways to address the situation.

If the police are called, they will determine if a crime has occurred. They may or may not

arrest Mr. Green.

The LTCO will visit Mrs. Green in the facility and attempt to determine what occurred. If

Mrs. Green cannot tell the ombudsman what happened or what she wants, the ombudsman will work

with the manager to assure that all appropriate referrals have been made. The ombudsman can seek

authorization from the State Long Term Care Ombudsman's office to act on behalf of the resident

to assure that the resident is protected from further harm.

"-

Ifthe facility in this example were a nursing home, reports ofabuse, exploitation and neglect would be reported to the Special Services Sectionllntake and Referral Unit of the Office of Regulatory Services.

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Case Scenario 2-Physical Abuse in a Personal Care Home
A personal care home resident with a mental illness diagnosis confided to a LTCO making a routine visit that she was afraid of the home manager who slapped her when she was "bad.
Possible Resolutions
The LTCO asks the resident if she would like to have the situation at the personal care home investigated. The resident refuses and asks the LTCO not to file a complaint because she fears being beaten up more and kicked out of the home. The LTCO urges the resident to allow her to report the abuse. but the resident still refuses. The ombudsman talks to other residents in an attempt to find others who report being abused or observing the staff abuse residents. The LTCO then visits the home frequently and makes every effort to convince the resident in question to allow her to report the abuse. The LTCO also checks to see whether the resident wishes to be relocated to another personal care home.
The LTCO will work with the home provider to determine how the provider treats residents and to suggest better ways for staff to respond to residents' behavior.
Case Scenario 3 -Personal Care Home/Financial Exploitation
A personal care home resident, Mrs. Jones, 80 years old, called the LTCO to complain that her granddaughter "dropped" her off at the personal care home without belongings or clothing while pretending to take her grandmother on an afternoon drive. In response to the Ombudsman's questions, Mrs. Jones also reported that her granddaughter was now living in her house and had forced her to sign a paper which gave the granddaughter control of Mrs. Jones's money.
Possible Resolutions
The LTCO investigates the resident's charges and finds them to be valid. With the resident's permission. the LTCO refers the resident's financial concerns to the Elderly Legal Assistance Program and makes a report to the Office of Regulatory Services (ORS), Personal Care Home Section, which investigates abuse in personal care homes. ORS documents the report, investigates and asks the ombudsman to follow up with the resident. The ombudsman works with the resident to determine what she wants and whether it is feasible for the resident to return to her home if that is her wish.

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Mental Health Settings
When abuse. neglect or exploitation is suspected in a mental health treatment facility. reports should be made to the DHR Division of Mental Health, Mental Retardation and Substance Abuse.
Case Scenario ]-Financial Exploitation
A 78-year-old man, Roland Tuck, was admitted to a mental institution in Georgia as a transfer in from another state where he had been hospitalized. His nephew, Mr. Tucks representative. had just moved to Georgia. The nephew told the staff that Mr. Tuck was dependent and without financial resources. However, Mr. Tuck frequently talked with the hospital staff about his wealth, derived from offshore drilling. He also mentioned that his nephew was mismanaging his money. At first, because of his age and mentality, it was concluded that the client was delusional. Mr. Tuck continued to ask the case manager to please check on his story. The case manager decided to investigate and learned that Mr. Tuck was indeed wealthy.
Possible Resolutions
The case manager refers Mr. Tuck to the Elderly Legal Assistance Program (ELAP) for evaluation of the claims of possible mismanagement of his funds by the guardian. If such evidence is found. the ELAP may be able to assist Mr. Tuck in filing a suit to try to get some of his money back from the nephew. The ELAP may also be able to assist Mr. Tuck in putting protections in place to keep the nephew from having access to Mr. Tuck's money without Tucks knowledge and perrmss10n.

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Case Scenario 2- Sexual Abuse
An Adult Protective Services worker contacted the Division of Mental Health. Mental Retardation and Substance Abuse after receiving a call from a community service board case manager. The case manager reported that Jack Gold, who is severely mentally retarded. had been admitted to a state hospital for stabilization. After he was discharged. the case manager noticed the Mr. Gold's tongue was protruding from his mouth and he was "walking strangely."
The case manager talked with Mr. Gold who told her that he had taken a shower with four other male patients in the hospital and one "put his privates in my mouth and another one put his privates in my rectum.,.
Possible Resolution
Mr. Gold was taken by the case manager to a private doctor for an examination and sexual abuse was confirmed. The case manager informed the state hospital. The patient advocate investigated and called the Georgia Bureau of Investigation, which has authority and jurisdiction in these kinds of cases. to assist in the investigation.
Case Scenario 3- Physical Abuse
Bill, a young mentally-ill man in a regional mental hospital reported to a staff member that his arm hurt. Apparently, Bill had recently become unusually agitated and violent. It was determined that a staff person. instead offollowing the usual procedure oftalking to the patient, had became overly aggressive and used physical intervention. As a result, Bill received a fractured arm.
Possible Resolution
In an internal investigation of the incident, an incident report was filed with the hospital's Quality Assurance Committee, which also conducted an investigation. Determinations were made that the staff member was overly aggressive and at fault in causing the injury. Termination of employment was recommended to the Director, and the staff person was fired. No licensure issues exist because the staff member was a technician.
Case Scenario 4- Neglect
Helen Silver, an elderly, mentally-ill female fell while in a mental hospital. She reported the incident to hospital staff and later told staff she did not want to get out of bed because her "foot hurt." Nothing was done about the reported injury until Ms. Keller, the patient's sister talked to the

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unit director. Ms. Keller felt the injury was ignored because her sister sometimes complained about various ailments and because she was mentally-ill. After x-rays it was determined that Miss Silver had a broken bone in her foot. The injury was finally treated and Ms. Keller reported they would not file a suit against the hospital because she felt such actions would result in retaliation (or lack of care) against her sister.
Possible Resolution
Ms. Keller did not feel comfortable going to the unit advocate or hospital patient advocate for fear of retaliation, so she contacted the Division Advocate at the Division of MH/MR/SA. The Division Advocate called the hospital advocate and requested that an investigation be conducted.

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Chart 6 ABUSE, NEGLECT AND EXPLOITATION REPORTING & INVESTIGATIONS BY SETTING
This chart summarizes the reporting, investigating and action taking process for all State Agencies referred to in this guide.

Home or Residence
Personal Care Home
Nursing Home
MWMRISA Facilities
Hospitals Home Health Services Home Care Providers Consumer Fraud

County Dept. of Family & Children Services; Adult Protective Services
Office of Regulatory Services Personal Care Home Unit PH .. : (404) 657-4076 Fax: (404) 657-8935
Office of Regulatory Services Long-Term Care Section, Complaint Intake Ph.: (404) 657-5726 or
657-5728 Fax: (404) 657-5731
Division of MH/MRISA Office of Constituent Services Ph.: (404) 657-2152 Fax: (404) 657-2256

A visit to the elderly or disabled adult. Contact with the reporter and others having knowledge of the facts.
Investigates violations of the State Licensure and Federal Certification Regulations and reports of abuse, neglect or exploitation. May request assistance from DFCS, Ombudsman or Law Enforcement.
Investigates violations of the State Licensure and Federal Certification Regulations and reports of abuse, neglect or exploitation. May request assistance from DFCS, Ombudsman or Law Enforcement.
Investigates reports relating to residents of MHIMRISA facilities and participants in service programs. May involve ORS, Regional Board, DFCS and Law Enforcement

Reports substantiated abuse, neglect or exploitation to law enforcement. Completes assessment and provide ongoing services to consenting clients.
Corrective Action plan with facility and/or reports to law enforcement on substantiated cases. May request assistance from DFCS, Ombudsman or Law Enforcement.
Corrective Action plan with facility and/or reports to law enforcement on substantiated cases. May request assistance from DFCS, Ombudsmen or Law Enforcement.
Corrective Action plan with facility and/or reports to Law Enforcement on substantiated cases.

Office of Regulatory Services Health Care Section Complaint Intake Ph.: (404) 657-5728
Home Health Hotline 1-800-326-0291
Governor's Office of Consumer Affairs Ph.: (404) 657-7544 or
1-800-805-7544

Investigates reports of abuse occurring within any of the listed facilities or services. May involve other offices within DHR and/or Law Enforcement.
Investigates reports of Elder Consumer Fraud in the areas of telemarketing fraud, home repair scams, phony charities and other rip-offs.

Corrective Action plan with facility and/or reports to law enforcement on substantiated cases.
Legal action when possible.

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AGENCY RESPONSIBILITIES
In Georgia a number of agencies have authority and responsibility to receive and respond to complaints and allegations of abuse. Each of these agencies is discussed below.
Department of Human Resources
The mission of the Georgia Department of Human Resources (DHR) is to assist Georgians in achieving healthy. independent and self-sufficient lives. DHR carries out its mission by means of financial assistance, social services, health, regulatory and rehabilitation programs. DHR was created in 1972 to form a coordinated network of helping agencies close to home.
Division of Family & Children Services
The Division of Family & Children Services is responsible for Temporary Assistance for Needy Families (TANF), Food Stamps, Child Support Enforcement and collection, Medicaid, and Social Services. County DFCS administer social service programs and fmancial assistance to families with problems caused by poverty, neglect or lack of education. There is a DFCS office in each county. Caseworkers provide protective services for children, the elderly and disabled adults.
Adult Protective Services (APS)
APS responds to reports of domestic abuse, neglect or exploitation of disabled or elderly adults who are not residents of long-term care facilities. APS investigates all reports. APS is not an emergency response agency. In cases of emergency, one should contact 911, the police or a medical facility. APS is not the initial response agency for street crimes, confidence game crimes or other types of conduct by strangers. Each county DFCS Office has adult protective services staff who investigate complaints of adult abuse, neglect and exploitation of persons who do not live in long term care facilities.
Although APS acts to protect adults like Child Protective Services acts to protect children, APS recognizes that adults have a right to self-determination.

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The following information may help you understand what Adult Protective Services is all about.

I. APS attempts to protect individuals 18 years of age and older who are:



Unable to protect their own interests:



Harmed or may be threatened with harm through either action or inaction of their

own or by someone else: and/or



Disabled and need to be protected from abuse, neglect or exploitation.

2. APS staff investigate all reports of suspected abuse, neglect, or exploitation. The investigator also evaluates the need for services and attempts, only with the adult's consent, (An adult is considered to be capable of making his or her own decisions unless the Probate Court has ruled otherwise) to:



Prevent or remedy the abuse, neglect and/or exploitation;



Help the person manage his or her own affairs, if possible;



Arrange a safe environment away from the threatened harm or danger; and/or



Help protect the rights and resources of those unable to protect themselves.

3. To receive ongoing APS services, at least the following must be true:



The person must be at least 18 years old;



The person must be either alone or without anyone else who can and is willing to

assist in resolving the problem;



The person must be either physically and/or mentally incapable of protecting him or

herself; and



The person must be in danger or threat of harm or injury.

4. While APSis in place to assist those individuals who accept assistance in stopping abuse, neglect or exploitation, DFCS cannot force adults who appear competent and capable of making their own decisions to accept help.

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5. APS works to keep individuals. who are able. as independent and unrestricted as is safely possible.

6. When Adult Protective Services substantiates that an individual has been abused. neglected or exploited by another, the law requires that a report is made by them to law enforcement (police, sheriffs department) for that area. This is done even without the individual's consent.

7. APS pursues guardianship only as a last resort intervention and the Director of the County DFCS is appointed guardian of person only as last resort-not as the first option.

8. It is not true that APS will automatically petition for guardianship of every elderly or disabled person who is without family and is ill or neglected or otherwise abused.

9. In the instance where APS does pursue guardianship to protect a person, APS is not authorized by law to be guardian over a person's property--only over the person. The court in this instance would have to appoint someone else to be guardian over the person's property.

APS investigates all reports. This must include: a home visit or a visit to the subject; an investigation of the allegations; a comprehensive assessment and contacts with others who have knowledge of the situation.

The intervention strategy pursued is based on the individual's unique situation, adheres to APS Program Guiding Principles, and seeks a remedy for preventing further serious harm. An Initial Determination of the need for ongoing APS is to be made within 30 days of the acceptance of the APS referral. Intervention is based upon the following:

1. If the Client is at risk, then the client is in need of ongoing APS.

2. If the Client is not at risk, then the client is not in need of ongoing APS.

3. If the Client is considered or believed to be at risk, the caseworker must continue the

assessment in order to make a decision.

"

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THE FOLLOWING THREE CRITERIA TOGETHER DESCRIBE A PERSON-AT-RISK AND IN NEED OF ONGOING ADULT PROTECTIVE SERVICES.
ENDANGERMENT: The conditions causing endangennent (hann or threat of hann) may be behavioral or situational and may be chronic, acute or intennittent. Sources of endangennent may also be elements of personal or social vulnerability. Endangennent may be from abuse by other persons. medical neglect, exploitation or environmental factors such as deteriorating housing.
PERSONAL VULNERABILITY: An individual is personally vulnerable if he or she is unable to care for self in aspects of everyday living because of mental or physical impainnent. Personal vulnerability exists when a person is not able to manage in some fundamental element(s) ofeveryday living such as self-care (e.g.: dressing, ba~ng, taking medications. etc.). or home management (e.g.: food preparation, household upkeep, shopping, bill paying, etc.) The same factors that cause endangennent may also cause personal vulnerability.
SOCIAL VULNERABILITY: An individual is socially vulnerable if he or she needs assistance but has no one who can effectively and reliably assist in meeting needs. Social vulnerability also exists if the person available to help (friend, relative, provider) is neglecting, exploiting or abusing the disabled adult. The same factors that create endangennent and personal vulnerability may also cause social vulnerability.

Division of Aging Services

The Department of Human Resources (DHR) is designated by the Governor as the state focal point for all matters relating to older persons' needs within Georgia. The Division of Aging Services (DAS) is Georgia's State Unit on Aging and administers a statewide system of services for older Georgians through regional contractors, Area Agencies on Aging. The comprehensive and coordinated system of agencies and organizations designed to meet the needs of older Georgians is called the Aging Network. Ceratin Division staff and aging Network members are mandated reporters. See Chart 1-Mandated Reporters. The network includes:



The Area Agencies on Aging (AAAs), public or nonprofit private agencies or organizations

designated by the Division of Aging Services; and,



Numerous community-based service providers which directly serve Georgia's older

population through subcontracts with AAAs such as the Long-Tenn Care Ombudsmen and

Elderly Legal Assistance Program providers.

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In addition. the Division also administers the Community Care Services Program. The

providers offer in-home health services for persons who would otherwise have to reside in

a nursing home.

Division of Public Health
The Division ofPublic Health (DPH) promotes the well-being of Georgians of all ages by providing health care. health education. screening, inspections and disease monitoring. There is a Public Health Department in each county. It provides family and child health services through county health departments responsible for protecting public health and safety and preventing or reducing disease and disability. Certain Division staff and employees are mandated reporters. See Chart 1Mandated Reporters.

Division of Rehabilitation Services
The Division of Rehabilitation Services (DRS) provides opportunities for work and personal independence for people with disabilities. Services are provided through District Offices throughout Georgia. Certain Division staff and employees are mandated reporters. See Chart 1- Mandated Reporters.

Division of Mental Health, Mental Retardation & Substance Abuse

The Division of Mental Health. Mental Retardation and Substance Abuse (DMHMRSA) contracts with Regional Mental Health Boards and private nonprofit agencies to provide treatment for mental illness, mental retardation and substance abuse. The Division serves people of all ages with the most severe problems. These problems are likely to be long-term and those suffering from them have no other sources of help. The Division also oversees the state hospitals. Services are provided across the state through eight regional psychiatric hospitals. two mental retardation institutions, and through contracts with 28 community service boards, boards of health and various private providers. Community services include:



outpatient diagnosis;



evaluation;



medication monitoring;



counseling and education;



day programs to help people learn daily living and work-related skills;



residential services such as group homes;

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supervised apartments and foster families. and residential treatment for substance abuse:



family support services:



crisis intervention; and



case management to help people find the services they need and ensure services work in

concert.

Certain staff and employees are mandatory reporters. See Chart 1- Mandated Reporters.

Office of Regulatory Services

The Office of Regulatory Services (ORS) is responsible for inspecting, monitoring, licensing, registering, and certifying a variety of health and child care facilities; and for administering programs for receiving and investigating complaints about such facilities. It works to ensure that facilities and programs operate at acceptable levels, as mandated by state statutes and by rules and regulations adopted by the Board of Human Resources. ORS also certifies various health care facilities to receive Medicaid and Medicare funds.

ORS inspects and licenses child day care centers, child group day care homes, child residential care facilities, private adoption agencies and family violence shelters. It registers family day care homes.

ORS regulates acute, long-term and out-patient care facilities; including nursing homes, intermediate care homes, personal care homes, hospitals, and home health agencies. In Georgia the Office of Regulatory Services is the state agency responsible for receiving and investigating complaints of abuse within these facilities.

Other Agencies

Area Agency on Aging (AAA)
Each AAA serves a region which has been designated as a Planning and Service Area (PSA) that includes a number of counties in Georgia. Together the AAAs serve all of the counties in Georgia. Each AAA plans and coordinates social services, nutrition and other programs for residents age 60 and over in the counties within that PSA. AAAs are local focal points of the Aging Network. They serve the interests of the elderly, their family members, friends and service provider agencies. Although most A.AAs are not direct service providers, Area Agencies, who contract with providers, can connect people with the appropriate service provider agencies. Area Agencies on Aging are responsible for the regional coordination of the Community Care Services Program (CCSP) and receive funding from a variety of sources to fund social services in their region. Contact the AAA

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for specific information on the services and programs that are available in a certain county. See the Appendix for a list of services which might be available through Area Agencies on Aging.
Family Violence Shelters and Programs
The Family Violence Shelters and Programs provide emergency shelter, support groups. crisis line. and referrals to victims of family violence. Some counseling may also be available. A toll-free number. 1-800-33HAVEN (334-2836) can be used to automatically connect the caller to the nearest shelter/program in Georgia.

Elder Fraud Unit (Governor's Office of Consumer Affairs)
The Governor's Office of Consumer Affairs has a special division which concentrates its efforts on protecting Georgia's elder citizens from consumer fraud, telemarketing scams and bogus home repairs. This division is the Georgia Elder Consumer Abuse Program (GECAP) and is handled by the Elder Fraud Unit. The division has a toll-free number 1-800-805-7544.
State Commission on Family Violence
In 1992 the Georgia General Assembly passed legislation to create the State Commission on Family Violence to develop a coordinated response and comprehensive plan to address family violence in Georgia. Family violence includes domestic abuse, child abuse, and elder abuse. The law creating the State Commission on Family Violence specifically charged the Commission with the task of establishing a Community Task Force on Family Violence in each judicial circuit. There are 45 judicial circuits in Georgia. By fall of 1996 there were 35 task forces operating in Georgia. Each task force can provide the framework to improve the local community and justice system response to domestic violence and abuse. Task force activities may include developing protocols, victimwitness assistance programs, community awareness campaigns, education for law enforcement and others, resource directories, emergency assistance and shelter, support groups, treatment programs, and family counseling centers.
The Chief Judge ofthe Superior Court in the Judicial Circuit may convene the meeting to form the task force or may appoint a designee in that Judicial Circuit to convene the meeting.

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The American Bar Association Commission on Domestic Violence. (800) 285-2221 has publications and information about violence and abuse.
For more information contact the Georgia Commission on Family Violence.
State Health Care Fraud Control Unit
This unit is a jointly operated initiative of three state agencies: the Department of Law. the Georgia Bureau of Investigation (GBI) and the Department of Audits and Accounts. The unit was created to serve the public, to uphold and enforce the law, to investigate and prosecute Medicaid fraud. and to protect vulnerable patients in Medicaid-funded facilities from abuse.
This unit has statewide jurisdiction, and has the capacity to fully investigate and prosecute its O\\<TI cases in all parts of the State of Georgia. The members of the unit will operate as a multidisciplinary team. The team, when fully staffed, will consist of five prosecuting attorneys, a nurse/paralegal, and two legal secretaries who will constitute the Legal Division. In addition the
unit will have an Investigative Division consisting of a GBI Special Agent in charge, two GBI
Assistant Special Agents in charge, sixteen GBI Agents, two GBI Intelligence Analysts, four auditors. and administrative support staff.
The unit is located at 2100 East Exchange Place, Building One, Suite 200, Tucker, Georgia 300840449. The telephone number for the Investigative Division is (770) 414-3640 and for the Legal Division, (770) 414-3660.
Law Enforcement
When the aged or disabled person is likely to incur immediate and serious physical harm, a law enforcement officer should be contacted. When an individual is a danger to himself or others, law enforcement can, upon its own initiative or through a Court Order, involuntarily detain the person and take them to an appropriate facility for evaluation.
Once an investigating agency initiates an investigation of certain types of abuse, law enforcement may be called to conduct a parallel investigation or may be subsequently contacted after the abuse has been substantiated. Georgia law provides that under the Family Violence Act, police officers can make an arrest without a warrant as long as the perpetrator is obviously aggressive. Law enforcement officers are also mandated reporters of abuse, neglect and exploitation.

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PROTECTIVE RESOURCES

Residents' Riehts Nursing Homes

'fit

The Long-Term Care Residents' Bill ofRights in Georgia is a state law which provides a list of rights

that nursing home residents have such as the right to privacy; the right to enter and leave the home

as one chooses; the right to choose or refuse medical treatment; and rights as to transfer or discharge.

The complete list of rights must be posted in the facility and provided to resid~nts upon admission

to the facility.

-

Personal Care Homes

Residents in personal care homes have rights provided by State law which are listed in the Rules and Regulations for Personal Care Homes. These rights include the right to be free from physical and chemical restraints, the right to privacy, and the right to consent to or refuse medical treatment. The list of these rights must be provided upon admission to a personal care home. Whenever there is a question regarding residents' rights, the Long-Term Care Ombudsman Program may be contacted for information and assistance.

~Where to Make a Complaint about a Nursing Facility or Personal Care Home

When there are complaints or concerns about the care or treatment of residents in nursing homes or personal care homes, these options are available.

1) Discuss the problem with Facility Staff: A number of problems with resident

care and the exercise of residents rights* can best be addressed by first discussing the

concern with facility staff. If a concern about a resident's rights issue is not resolved

through informal discussion with staff, residents or their legal representatives can

pursue the grievance procedure explained in The Long-Term Care Residents' Bill of

Rights.

"-

2) Make a complaint to the Long-Term Care Ombudsman Program: T h e community ombudsman program where the nursing home is located works to investigate and resolve complaints that affect long-term care residents. If there are concerns involving discharge or serious violations of residents' rights in nursing or

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personal care homes. the ombudsman can assist the resident in requesting a hearing before an Administrative Law Judge. The community ombudsman program can be contacted through the Area Agency on Aging or by calling the State Ombudsman Program at (404) 657-5319.
3) Make a complaint to the Regulatory Agency: If abuse of a nursing home resident is suspected. or there is a serious problem with resident care. complaints should be made by phone or in writing to the Intake Unit of the Long-Term Care Section. Office of Regulatory Services, Georgia Department of Human Resources, (404) 657-5728. If the problem occurs in a personal care home, the complaint should be made to the Personal Care Home Program within the Long-Term Care Section. (404) 657-4076.
* Residents' rights for nursing home residents can be found in the Georgia Long-Term Care
Facilities Residents' Bill ofRights. Chapter 290-5-39. Regulations which detail how the Law will be applied are written from State law. See Appendix. Residents' rights for personal care home residents are explained in the Rules and Regulations for Personal Care Homes, Chapter 290-535.18. A copy of these rights may be obtained from the Office of Regulatory Services, Georgia Department of Human Resources by calling (404) 657-5700.
te. Legal Issues Related to Adult Abuse

Legally Recognized Directives

'

Sometimes family members disagree with a loved one's decisions about his or her health care. Allowing an individual to give advance directions concerning his or her health care lets each person control the direction of his or her own health care and eliminates that burden from other family members who may disagree with each other. Traditionally advance directives include the Living Will. the Durable Power of Attorney for Health Care, and the Do Not Resuscitate Order. Advance directives are a means of providing you with the mechanism for carrying out decisions that you have made about your health care choices before you become incapacitated and can no longer make these decisions known. It is important for you to make these decisions while you are still able to make them.

Any advance directive choice can be revoked at any time by the individual who made it. If the choice is expressed in a document, either write "VOID" on the original document and retrieve all the copies, or tear up, burn or otherwise destroy the original document, and retrieve all of the copies. If the choice has been communicated orally, then either orally revoke the decision, or put the revocation in writing. Make sure that the revocation is sent to all physicians, health care facilities,

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and individuals to whom it was given. Information about advance directives and other options are discussed below:
Living Will
A Living Will is a document which allows a competent person 18 years of age and older to state in advance whether or not they want to be kept alive by artificial means. While this document is not used for emergency situations, it informs the medical community, as well as the individual's family, of the individual's decision regarding this matter in the following instances:
I) Persistent vegetative state with no reasonable expectations of ever recovering or regaining cognitive functions;
2) Terminal condition which will result in death; or
3) Comatose state with no reasonable expectation of ever regaining consciousness.
In addition the Living Will can be used to indicate a preference for receiving artificial nourishment (food) and/or artificial hydration (water).
Durable Power ofAttorneyfor Health Care
A Durable Power of Attorney for Health Care (DPOA-HC) allows individuals to choose another person or persons to act as agent(s) in making sure their health care decisions are carried out. This document differs from the Living Will in the respect that it allows decisions in every area of health care, including, but not limited to, the decision to terminate or not to extend life.
The agent(s) that the person chooses is(are) under no obligation to act under the DPOA- HC; however, if the person(s) chooses to act, the action must be iil accordance with the desires expressed in the document.
Decisions made through the DPOA-HC can include, but are not limited to, the following health care items:
1) Medicines used for treatment; 2) Cardiopulmonary resuscitation (CPR); 3) Injections; 4) Laboratory tests; 5) Surgical procedures; 6) Amputation of limbs;

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7) Blood transfusions: 8) Artificial feeding and hydration; 9) Naming a choice ofperson(s) to become one's guardian if necessary; and 10) Making decisions about prolonging one's life by artificial means.
Opinions differ as to whether a person needs both a Living Will and a Durable Power of Attorney. If someone is not sure what is best for him or her have them discuss the matter in further detail with someone they trust. such as a family member, family doctor, or an attorney. What is certain however. is that there are documents available to assist in expressing health care decisions.
If these decisions are not made by the individual while he or she can, someone else may be forced to make them.
Do Not Resuscitate Orders
_ These orders allow an adult the right to instruct physicians and other health care personnel to refrain from cardiopulmonary resuscitation (CPR).
1) CPR is defined by law as only those measures used to restore or support cardiac or respiratory function in the event of a cardiac or respiratory arrest.
2) An adult person with decision-making capacity has the right to consent orally or in 'Writing to an order not to resuscitate and its implementation at a present or future date, even though that person may lose his or her mental capacity in the future.
3) Decision-making capacity is defined by law as the ability to understand and appreciate the nature and consequences of an order not to resuscitate, including the benefits and disadvantages of such an order, and to reach an informed decision regarding the order.
4) Ifthe doctor believes that CPR is medically futile, regardless of the presence of a DNR Order from the patient or family, the doctor may declare the patient a "Candidate for Non-resuscitation" and enter his or her own DNR Order.
"Candidate for Non-resuscitation" means a patient who, based on a determination to a reasonable degree of medical certainty by an attending physician with the concurrence of another physician:
a) Has a medical condition which can reasonably be expected to result in the imminent death of the patient;

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b) Is in a noncogrutive state with no reasonable possibility of regaining cognitive functions; or

c) Is a person for whom CPR would be medically futile (ineffective) in that such resuscitation will likely be unsuccessful in restoring cardiac and respiratory function or will only restore cardiac and respiratory function for a brief period of time so that the patient will likely experience repeated need for CPR over a short period of time or that such resuscitation would be medically futile for other reasons.

Orders surrounding the administration of cardiopulmonary resuscitation (CPR) are recognized by a number of names:



DNR



Do Not Resuscitate



Order Not to Resuscitate



No Code

Every adult is presumed to have the capacity to make a decision regarding CPR and every patient will be presumed to consent to the administration of CPR unless there is consent or authorization for the issuance of an order not to resuscitate.

Persons authorized to issue an order not to resuscitate:



attending physician which authorizes a physician, health care professional,

or emergency medical technician to withhold or withdraw CPR



an adult person with decision making capacity (even if they lose capacity in

the future)



appropriate authorized person: agent under a Durable Power of Attorney for

Health Care; spouse; guardian of person; son or daughter 18 years of age

or older; parent; brother or sister 18 years of age or older (in good faith)



parent for a minor child



as last resort, an attending physician may issue an order not to resuscitate if:

he or she has the concurrence of a second physician in writing that the patient

is a candidate for nonresuscitation; an ethics committee or similar group

which concurs in the opinion of the attending and the concurring physician;

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and the patient is receiving inpatient or outpatient treatment from. or is a resident of. a health care facility other than a hospice or a home health agency.
Carrying out a DNR order when the patient is not in a hospital, nursing home or licensed hospice is now legal as long as the order is evidenced in a writing containing the patient"s name, date of the form. printed name of the attending physician, and signed by the attending physician on a form similar to the one in the law. An example follows:
"DO NOT RESUSCITATE ORDER
NAME OF PATIENT:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ THIS CERTIFIES THAT AN ORDER NOT TO RESUSCITATE HAS BEEN ENTERED ON THE ABOVE-NAMED PATIENT.
SIGNED:-----------ATTENDING PHYSICIAN
PRINTED OR TYPED NAME OF ATTENDING PHYSICIAN:._ _ _ __
ATTENDING PHYSICIAN'S TELEPHONE NUMBER._ _ _ _ _ __ DATE:._ _ _ _ _ _ _ _ _ _ _ _ _ _"
The patient must also be wearing an identifying bracelet on either the wrist or the ankle or an identifying necklace. The bracelet or necklace shall be substantially similar to the ID bracelets worn in hospitals and must be on an orange background with the following information provided in boldface type:
"DO NOT RESUSCITATE ORDER
Patient's name=----------------------Authorized person's name and telephone number, if applicable:_____ Patient's physician's printed name and telephone number:_______ Date of order not to resuscitate:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _,

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Liability for persons carrying out a DNR order:
No authorized person is subject to any criminal or civil liability for carrying out a DNR order in good faith as long as it was carried out in compliance with the standards and procedures set forth in the law.
The law does not force doctors or hospitals to carry out the decision in advance directives. If a doctor informs you that he or she has decided not to carry out the request in an advance directive. the next of kin or legal guardian has the right to elect that the patient be transferred to a different doctor or if necessary. a different hospital.
Even if one loses mental capacity after making an Advanced Directive, the directive will continue to be legally effective. A person's decision will not be changed unless someone can prove that he or she really had a change of mind about the directive or that he or she lacked the necessary capacity at the time the directive was created.
Representative Payee
Sometimes when it is necessary to protect the beneficiary's interests, the Social Security Administration will select or allow to be selected either an individual or an organization to receive benefit payments for the use and benefit of the beneficiary. It is required that there be convincing evidence of an adult beneficiary's incapacity to manage his or her funds before a representative payee is appointed. When a beneficiary is disabled due to drug or alcohol addiction, he or she is required by law to have a representative payee.
Power ofAttorney and Durable Power of Attorney
A Power of Attorney allows an individual to appoint another person or persons as agent(s) to conduct business that he or she could legally conduct if he or she were not disabled or otherwise unavailable. A Power of Attorney can be limited to a certain act or acts, or it can be a full power to extend to every aspect of business that an individual could conduct. The authority of a Power of Attorney ends upon the individual's death.
Sometimes Powers of Attorney end upon a person becoming mentally incapacitated because the person no longer has the capacity to change his or her mind about the Power of Attorney. A Durable Power of Attorney continues to be effective even if a person becomes mentally incapacitated. The Durable Power of Attorney must expressly state within its text that it is durable and is authorized to extend past the principal's mental incapacitation.

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A Power of Attorney is a formal and important document and must be properly witnessed. Powers of Attorney can be revoked at any time prior to mental incapacitation and it is best that a Power of Attorney provide for v.Titten revocation.
Powers of Attorney do not currently have to be notarized unless they involve the lease, sale or mortgage of real property (land); then they are required to be notarized. Once signed, Powers of Attorney are immediately effective and the agent is authorized to act unless the document specifically states that it only becomes effective on a certain date or when a certain event occurs.

Forms for the Financial Power of Attorney, as well as the Living Will and Durable Power of Attorney for Health Care can be obtained from the Division of Aging Services, office supply stores, bookstores, some banks and some courts. Otherwise, one must see an attorney to have one prepared to meet specific needs.

Temporary Protective/Restraining Orders (TPOs/TROs)

The Superior Court may, upon a proper presentation of facts by affidavit or verified complaint, issue a Temporary Protective Order, or a Temporary Restraining Order, in an attempt to prevent immediate and irreparable injury, loss, or damage to a person in need of protection, such as to prevent further acts ofFamilyViolence. The Order will specifically state what act or acts are to be restrained but can include the following:



Directing a party to refrain from such acts;



Granting to a spouse possession of the residence or household;



Excluding the other spouse from the residence or household;



Requiring a party to provide suitable alternate housing for a spouse and his or her children;



Ordering the eviction of a party from the residence or household;



Ordering assistance to the victim in returning to the residence or household;



Ordering assistance in retrieving personal property of the victim if the other party's eviction

has not been ordered;



Ordering either party to make payments for the support of a minor child as required by law;



Providing for possession of personal property of the parties;

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Ordering a party to refrain from harassing or interfering with the other:



Awarding costs and attorney" s fees to either party: and



Ordering either or all parties to receive appropriate psychiatric or psychological services as

a further measure to prevent the recurrence of family violence.

Involuntary Commitments (Pick-Up Orders)

Involuntary Commitment (I 013) Process:

An Involuntary Commitment (I 0 I3) can be granted by a local county Probate Court based on the testimony of two (2) persons. They must attest to the fact that a persons is a danger to himself or others. A I0 I3 may also be granted based on information provided by a licensed physician, licensed psychiatrist or licensed clinical social worker. A peace officer is often called to take someone to the emergency room for a medical determination of involuntary status. The I0 13 would allow the person to be involuntarily hospitalized until he/she becomes stable. or signs an agreement to be held on a voluntary basis.

Guardianships

A "guardianship'' may be established to take care of an adult who is not capable of making personal and/or financial decisions for himself or herself. Under a guardianship, a person or an institution, called the "guardian," has the legal authority and duty to handle the personal and/or financial affairs of an incapacitated adult. called the "ward." For example, the guardian may decide where the ward will live. consent to medical treatment, or pay bills for the ward. In Georgia, the county Probate Courts establish guardianships and appoint guardians.

A guardianship is a serious matter. It can have positive and negative effects on both the guardian and the ward. For the guardian, guardianship is a great responsibility, which can be more of a burden than expected. For the ward, guardianship takes away his or her constitutional and civil rights and publicly labels him or her as incapacitated or incompetent.

Guardianship law in Georgia is currently under review and changes will be made periodically. To find out more about guardianships, contact the Probate Court in your county, an Elderly Legal Assistance Program provider, or a private attorney.

A guardianship is the most restrictive means of controlling another individual. It should be used only when there is no other option to care for that individual's needs and best interests. Guardianships can be temporary or permanent. They are available in emergency situations and can be put into place in less than a week. Otherwise, the process takes approximately 30-45 days.

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When someone is appointed guardian over another person, the guardian is informed that the Ward:



Is entitled to respect from the guardian;



Has a right to expect the guardian to be reasonably accessible

and available to him/her;



Has a right to communicate freely and privately with persons

other than the guardian, unless the Court has specifically ordered

otherwise; and



Has a right to have his property used for his support, care,

education and well-being only, and not the guardian's.

At the same time, however, the Ward will lose the ability and the authority to do certain things, such as:



Marrying another person;



Entering into a contract with a person or transacting any type of

business:



Consenting to and refusing medical treatment;



Choosing where he or she wants to live; and



Buying or selling property.

With all of the rights that the Ward loses, the Ward always retains the right to bring an action against the guardian.

Being appointed guardian over another person is a very important responsibility. To abuse that responsibility is to abuse that other person. Such action is not taken lightly and can be dealt with by the courts quite severely, including making the person repay money to the Ward, and in certain instances, imprisonment of the guardian.

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Assistance Programs
Adult Medicaid:
Medicaid is a federal insurance program, the cost of which is shared by the federal government and the state government. In Georgia the agency that administers the Medicaid program is the Department of Medical Assistance (DMA). Medicaid provides medical coverage for certain individuals and families who have low-income and limited assets or resources. In addition to having a low income. a recipient must also meet other criteria.
There are numerous categories of Medicaid but all of them are not generally relevant to older Georgians. Adult Medicaid Programs generally require that the recipient be 65 or older. blind. totally disabled for at least 12 months, or permanently disabled. The following categories of Medicaid. other than SSI Medicaid, may be available to older Georgians.

Application For Medicaid

Apply for Medicaid at the local office ofthe Department of Family and Children Services (DFCS) in the county of residence. Contact the local DFCS for specific eligibility criteria and specific services covered by Medicaid.

Qualified Medicare Beneficiary (QMB): Provides limited Medicaid to certain
older and disabled Medicare beneficiaries whose income and resources don't exceed a certain level. This class of Medicaid pays Medicare premiums, deductibles and co-insurance
amounts.

Specified Low Income Medicare Beneficiary (SLIMB): Provides limited
Medicaid coverage for those persons whose income is slightly higher than the allowable amount for the QMB program. This coverage pays for the Part B Medicare premium only. The beneficiary will be responsible for Medicare's co-insurance and deductibles under this program.

Qualified Working Disabled Individual (QWDI): Provides Medicaid to certain disabled persons who lose eligibility for SSI cash benefits because of increased employment income.



Public Law Medicaid: Provides Medicaid for some people who lost their SSI!Medicaid

because they received an increase in their Social Security check amount.

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Community Care Services Program (CCSP): Provides Medicaid to persons
who receive services through the Community Care Services Program for 30 days or more. The Community Care Services Program (CCSP) of the Department of Human Resources is designed to assist older Georgians who continue to live in the community rather than enter a nursing home. Some elderly and/or disabled persons need help to remain reasonably independent in their own homes but do not need the care provided in a nursing home. The Community Care Services Program was developed to give older Georgians a greater choice
in deciding where they live and what assistance they need.



Services Provided:

The CCSP provides a full range of home and community-based services which include:



Assessment,



Case Management,



Adult Day Health,



Alternative Living Services,



Home Delivered Meals,



Home Delivered Services,



Personal Support Services,



Respite Services and Emergency Response Services.



Eligibility:

1)

Be certified for intermediate or skilled nursing home care;

2)

Be assessed by the Care Management Team and be determined to have health and

personal needs which can be adequately met in the community within established

cost limits; and

3)

Be an eligible Medicaid recipient.



How To Access CCSP:

To apply for CCSP or to refer someone, contact the Area Agency on Aging in your area.

Adult Medically Needy Spend-Down: Provides Medicaid to those persons who
ordinarily would be over the income limit for Medicaid but for the fact that they have high

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medical bills that are not covered by insurance. The medical bills cancel out the income that exceeds the defined limit. Sometimes this Medicaid coverage only lasts for a month or more until the person accumulates more medical bills.

Nursing Home Medicaid: Provides Medicaid to persons living in a Medicaid
participating facility upon certification by a physician and the Georgia Medical Care Foundation (GMCF) that nursing home care is needed. This class of Medicaid allows a higher income and resources level than the other classes ofMedicaid. Most of the income of the individual receiving Nursing Home Medicaid must go to the nursing home to pay the bill before Medicaid will step in to pay the remainder. The individual will be permitted to keep a certain amount for a personal needs allowance, and in certain circumstances an amount to pay medical expenses not covered by Medicaid.



Hospice: Provides Medicaid to those who receive Medicaid hospice services either at

home or in a nursing home.

Mental Retardation Waiver Program (MRWP): Provides in home and community-
based services to Medicaid eligible mentally retarded and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program. Individuals must be deemed appropriate for Nursing Home/ institutional care by a physician and the GMCF.

Independent Care Waiver Program (ICWP): Provides in home care to individuals
who are severely physically disabled or who have Traumatic Brain Injuries. They need more care than that provided by the CCSP. ICWP recipients must be deemed appropriate for nursing home care by a physician and the GMCF.

Z Eldercare Locator
The Eldercare Locator is a national service that helps families and friends obtain information about community services for older adults, whether nearby in their community or in another state. " Eldercare uses a toll-free telephone service to connect family and friends with local agencies who provide such services as home delivered meals, transportation, adult day care, senior center programs, and others.

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Contact Eldercare Locator at 1-800-677-1116, between 9 a.m. and 5 p.m., Eastern Standard Time. with the name, address and zip code of the older adult, as well as a brief description of the problem or type of assistance the older adult needs.

Elderly Legal Assistance Program (ELAP)

The Older Americans Act provides funding for legal services for older people. The Division of Aging Services gives funds to the Area Agencies on Aging and requires that every county in the AAA planning and service area should have access to legal assistance for persons 60 years of age and older.

There are 17 Elderly Legal Assistance Program (ELAP) providers in Georgia. Together they provide legal services in many areas of the law. The broad purpose of the ELAP is to assist older individuals m.



Understanding their rights;



Exercising choice;



Benefiting from services, opportunities and entitlements, and maintaining rights

promised and protected by law; and



Providing access to the system of justice by offering advocacy, advice and

representation to persons 60 and older.

Each program is required to provide access to an attorney. This does not mean that the first person one meets with will be an attorney. However, if the situation falls within the matters handled by the Elderly Legal Assistance Program, and the case requires the assistance of an attorney, one must be provided.

The assistance provided by the ELAP providers is given at no cost to the elder person. While services are provided regardless ofthe person's income or resources, the Older Americans Act targets the elderly who are in the greatest social and/or economic need.

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Due to limited resources. ELAP providers cannot assist everyone who comes to them for assistance. There are times when the types of cases accepted by a program may change due to a change in the program s funding or resources. However. the following case areas currently have priority for assistance and will be considered for acceptance first:
Social Security SSI Food Stamps Veterans Benefits Pensions Medicaid/ Medicaid Discharge Medicare/QMB/SLIMB Nursing Home/Personal Care Home Issues Railroad Retirement COBRA Landlord/Tenant Home Foreclosure HomeRepairFraud Utility Shut Offs/Energy Issues Defense of Guardianship Elder Abuse, Neglect and Exploitation Financial Exploitation Americans With Disabilities Act Issues Consumer Problems Age Discrimination
The ELAP provider will consider each client's individual circumstances when making a determination to accept the case. The merit of the case will also be considered. This means that the legal provider will examine the facts of your case to see if the law or the evidence support your position. The provider will also consider the likelihood of success. Sometimes, depending on the subject matter, cases not mentioned on the above list can be handled by an ELAP provider.
The Long-Term Care Ombudsman Program
Another program sponsored by the DHR Division of Aging Services and funded through the Area Agencies on Aging is the Long-term Care Ombudsman Program. Long-term Care Ombudsmen investigate problems for persons in nursing homes and personal care homes, help protect residents' rights. and try to resolve residents' problems and complaints. The purpose of the Long-Term Care Ombudsman Program is to advocate for residents of long-term care facilities (nursing homes and personal care homes) to improve residents' quality of life. An ombudsman (meaning "citizen

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representative") acts on behalf of persons who need assistance in advocating their own cause. Representatives ofthe Long-Term Care Ombudsman Program perform this advocacy role on behalf of individuals who are residents of long-term care facilities.
Ombudsmen advocate by investigating and resolving problems and grievances of residents. by pro.viding information to the public, and by encouraging long-term care facilities and governmental entities to improve their services to long-term care residents. For example. ombudsmen work to resolve residents' complaints about everything from cold food and lost laundry, to concerns about resident funds. and violations of residents' rights. They advocate for alternatives to the use of physical restraints, provide information to facility staff regarding prevention of resident abuse. and advocate for residents' rights before staff, community groups, and legislative and administrative bodies.
In Georgia, there are eighteen (18) local ombudsman programs serving all of the state's nursing facilities and personal care homes. You may reach the ombudsman program serving your area through the local Area Agency on Aging or by calling the State Long-Term Care Ombudsman Program at (404) 657-5319. In addition, the telephone number of the state and local ombudsman programs must be posted in a prominent place in each nursing facility and personal care home.

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GLOSSARY
Abuse is the willful infliction of physical pain, physical injury, mental anguish. unreasonable confinement or the willful deprivation of essential services to a disabled adult.
Adult Abuse refers to abuse, neglect or exploitation of elderly and/or disabled adults.
Ageism refers to prejudice based on age.
Assessment means to evaluate and make .a determination about the need, importance. value. etc.
Caregiver means a person who has responsibility for the care of a disabled adult as a result of family relationship, contract, voluntary assumption of that responsibility, or by operation oflaw.
Coercive is forcing an act or choice.
Cognitive Disability means to lack full mental capacity.
Confidence Game Crimes are those related to obtaining money by swindles. false promises or assurances. trickery or deceit.
Cycle of Violence refers to a situation where a victim of violence at some point becomes the one committing a violent act to another victim who then becomes the actor of violence upon still someone else.
Dependency means a reliance on something or someone.
Disabled Adult means a person 18 years of age or older who is mentally or physically incapacitated.
Dominate means to rule or control.
Elderly means a person 60 years of age or older for programs funded by the Older Americans Act but may mean 65 years of age or older for certain Georgia laws.
Financial Exploitation is the illegal or improper use of a disabled adult or that adult's resources, for another's profit or advantage.
Functional Disability refers to lacking full physical capacity.

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Guardian is a person appointed by the Probate Court to manage the affairs of another individual: in this case. an incapacitated adult.
Guardian of person means the guardian makes personal decisions on behalf of the other person. such as where that person lives and the places that person can go.
Guardian of property means the guardian makes decisions, with the court's approvaL concerning the persons assets, finances, resources and business affairs.
Guardianship is the appointment of legal authority by the Probate Court to one person over another in order to protect his or her personal well-being and/or financial well-being because the court has determined the person is not able to handle these matters him or herself.
Impairment means damaged or diminished.
Incapacitated means lacking in full or complete physical or mental ability.
Intergenerational refers to among or between different generations.
Intermittent is coming and going at different times.
Investigation refers to the process of determining facts related to an incident or situation.
Long-Term Care Ombudsman is a Swedish term meaning "citizen advocate" and refers to those individuals certified by the State Long-Term Care Ombudsman Program to be adfocates for residents of nursing homes and personal care homes.
Mismedicating is giving or receiving over or under the prescribed or recommended dosage of medicine.
Mutual Web of Dependency means that both parties or people are dependent upon each other in a particular relationship.
Neglect means the absence or omission of essential services to the degree that it harms or threatens with harm the physical or emotional health of a disabled adult.
Prostheses refers to artificial devices used to replace parts of the body such as legs, arms, hands, etc.
Resident in a Long-Term Care Facility means a person who resides in a nursing home or a personal care home.

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Respite means a period of rest or relief. Resuscitation means to revive. Retaliation is to get revenge. Self-neglect occurs when an individual fails to provide adequately for his or her own needs. Transgenerational means across all generations, i.e., children, parents. grandparents. etc. Vulnerable means open to and capable of being attacked, wounded or hanned. Ward is the incapacitated person for whom the guardian is appointed.

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GLOSSARY OF ACRONYMS

AAA- Area Agency on Aging
AARP-American Association of Retired Persons
ADA-American Bar Association
AID-Aged and/or Physically Disabled
ADC-Adult Day Care
AD/DO-Aged and/or physically disabled and developmentally disabled and/or chronically mentally ill
ADEA-Age Discrimination in Employment Act
ADH-Adult Day Health
ADL-Activities of Daily Living
ADR-Adult Day Rehabilitation (now ADH in CCSP)
ADRDA-Alzheimer' s disease and related Disorders Association

AIDS-Acquired Immunodeficiency Syndrome
AJF-Atlanta Jewish Federation
ALA-American Lung Association
ALAS-Atlanta Legal Aid Services
ALS-Altemative Living Services
AMA-Arnerican Medical Association
AINIE- Abuse, neglect or Exploitation
ANA-American Nurses Association
AoA-Administration on Aging
APHA-Arnerican Public Health Association
APS-Adult Protective Services
APTA-American Physical Health Therapy Association

ARC-Atlanta Regional Commission
ASA-American Society on Aging
BP-Blood Pressure
CAA-Community Action Agency
CAl-Client Assessment Instrument
CAP-Community Action Program
CAT-Computerized Axial Tomography (CAT Scan)
CAU-Clark-Atlanta University
CBS-Community Based Services
CCSP-Community Care Services Program
CDC-Centers for Disease Control
CHF- Congestive Heart Failure
CM-Case/Care Manager
CM-Congregate Meal

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COA-Council on Aging
COBRA-Consolidated Omnibus Budget Reconciliation Act
CON-Certificate ofNeed
COPD-Chronic Obstructive Pulmonary Disease
CPR-Cardiopulmonary Resuscitation
CSH- Central State Hospital
CSRA-Central Savannah River Area
CSS-Catholic Social Services
CT-CAT Scan
CVA-Cerebrovascular Accident
CW-Case Worker
DAS-Division of Aging Services
DCA-Department of Community Affairs
DD-Developmentaily Disabled

DFCS/DFACS -Division of Family and Children Services ofDHR; in each county the office of Family and Children Services is called the county '"Department of Family and Children Services
DHHS-Department of Health .and Human Services
ORR-Department of Human Resources
DMA-Department of Medical Assistance
DMA-6-Department of Medical Assistance form for physician's recommendation of long term care placement/services
DNR-Do Not Resuscitate
DO-Doctor of Osteopathy
DOE-Department of Education
DOL-Department of Labor
DOT-Department of Transportation

DRG-Diagnosis Related Group
DSM-Diagnostic and Statistical Manual of Mental Disorders
EDT-Electronic Benefits Transfer
EDP-Electronic Data Processing
EDS-Electronic Data Systems
EEG-Eiectroencephalogram
EEOC-Equal Employment Opportunity Commission
EKG-Electrocardiogram
ELAP-Elderly Legal Assistance Program
ELSP-Elderly Legal Services Program
ERD- End Stage Renal Disease
EOA-Economic Opportunity Atlanta; Economic Opportunity Authority

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ERISA-Employment Retirement Income Security Act
ER8-Emergency Response System
EU-Emory University
FY- Fiscal Year (SFYState Fiscal Year; FFYFederal Fiscal Year)
GAHSA-Georgia Association of Homes and Services for the Aging
GAO-General Accounting Office
GAO-Georgia Advocacy Office
GBI - Georgia Bureau of Investigation
GG8-Georgia Gerontology Society
GHCA-Georgia Health Care Association
G I-Gastrointestinal
GLSP-Georgia Legal Services Program
GMA-Georgia Medical Association

GMCF-Georgia Medical Care Foundation
GMHI-Georgia Mental Health Institute
GNA-Georgia Nurses Association
GPO-Government Printing Office
GSA-Gerontological Society of America
GSU-Georgia State University; Georgia Southern University
GT-Gastrointestinal Tract
GT-Georgia Tech Univeristy
HA-Homemaker Aide
HBCU-Historically Black Colleges and Universities
HCB8-Home and Community Based Services
HCFA-Health Care Financing Administration
HDM-Home Delivered Meal
HD8-Home Delivered Services

HHA-Home Health Aide
HHC-Home Health Care
HH8-Department of Health and Human Services
HICARE- Health Insurance Counseling Assistance and Referral for the Elderly
HIV-Human Immunodeficiency Virus
HMO-Health Maintenance Organization
MUD-Department of Housing and Urban Development
!&A-Information and Assistance
I&R-Information and Referral
IADL-Instrumental Activities of Daily Living
ICF-Intermediate Care Facility
ICF-MR-Intermediate Care Facility for the Mentally Retarded

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ISTE-Intermodal Surface Transportation Act of
1991
JCAHCO-Joint Commission on the Accreditation of Health Care Organizations
JD-Doctor of Jurisprudence (Law School Graduate)
JFCB-Jewish Family and Children's Bureau
JlpA-Job Training
Partnership Act
LAA-Latin American Association
LCE-Legal Counsel for the Elderly (AARP)
LIHEAP-Low Income Heat and Energy Assistance Program
LOS-Length of Stay
LPN-Licensed Practical Nurse
LTC- Long Term Care
LTCF-Long Term Care Facility
LTCO-Long Term Care Ombudsman

MAG-Medical Association of Georgia
MAO-Medical Assistance Only
MARTA-Metropolitan Atlanta Rapid Transit Authority
MCO-Managed Care Oganization
MD-Doctor of Medicine
MHIMRJSA-Division of Mental Health, Mental Retardation and Substance Abuse
MI-Myocardial Infarction
MIS-Management Information Systems
MOW-Meals on Wheels
MPH-Master of Public Health
MPOT-Medical Plan of Treatment
MR-Mentally Retarded
MRI-Magnetic Resonance Imaging
MRT-Medically Related Transportation

MSW-Masters of Social Work
NAIC-National Aging Information Center
NAAAA-National Association of Area Agencies on Aging
NARFE-National Association of Retired Federal Employees
NASUA-National Association of State Units on Aging
NCA or NCBA- National Center on Black Aged
NCCNHR-National Citizens' Coalition for Nursing Home Reform
NCJW-National Council of Jewish Women
NCOA-National Council on the Aging
NCSC-National Council of Senior Citizens
NET-Non-Emergency Transport
NF-Nursing Facility
NGA-Notice of Grant Award

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NH-Nursing Home
NIA-National Institute on Aging
NIH-National Institutes of Health
NIMH-National Institute of Mental Health
NMI-Nuclear Magnetic Imaging
NMR-Nuclear Magnetic Resonance
NPO- Nothing By Mouth
NRTA-National Retired Teacher's Association (merged with AARP)
NSC-Neighborhood Service Center
NSCLC-National Senior Citizens Law Center
NSf-Nutrition Screening Initiative
OAA-Older Americans Act
OASDHI-Old Age Survivors, Disability, and Health Insurance (Social Security, Medicare, etc.)

OBRA-Omnibus Budget Reconciliation Act
OBS-Organic Brain Syndrome
OEO-Office of Economic Opportunity
OoA-Office of Aging (now known as the Division of Aging Services)
OPB-Office of Planning and Budget
ORS-Office of Regulatory Services
OT-Occupational Therapy /Therapist
OWL-Older Women's League
PA-Physician Assistant
PCA-Personal Care Aide
PCH- Personal Care Home
PH-Public Health
PID- Pelvic Inflammatory Disease
PMAO-Potential Medical Assistance Only

PNF-Provider Notification Form
PPO-Preferred Provider Option; Preferred Provider Organization
PRN-as needed
PSA-Planning and Service Area
PSA-Personal Support Aid PSS-Personal Support Service
PT-Physical Therapy/Therapist
RC-Respite Care
RD-Registered Dietician
RN-Registered Nurse
RT-Respiratory Therapist
RSDI-Retirement, Survivors, Disability Insurance
RSVP-Retired Senior Volunteer Program
SAF-Service Authorization Form
SCLP-Senior Citizens Law Project

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SCSEP-Senior Community Service Employment Program

SEAAAA-Southeastern Association of Area Agencies on Aging

SGS-Southem Gerontological Society

SHPA-State Health Planning Agency

SNC-Skilled Nursing Care

SNF-Skilled Facility

Nursing

SS-Social Security

SSA-Social Security Administration

SSBG-Social Block Grant

Services

SSI-Supplemental Security Income

SSN-Social Number

Security

ST-Speech Therapy/Therapy

STD- Sexually Transmitted Disease

SUA-State Unit on Aging

TANF-Temporary Assistance to Needy Families (formerly AFDC- Aid to Families with Dependent Children)
TBI- Traumatic Brain Injury
TIA-Transient Ischemic Attack
TPO-Temporary Protective Order
TRO-Temporary Restraining Order
UGA- the University of Georgia
UMTA-Urban Mass Transit Act
UR-Utilization Review
UTI- Urinary Tract Infection
VA-Veterans Administration
VISTA-Volunteers in Service to America
VNA-Visiting Nurses Association
VR-Vocational Rehabilitation

VRI- Vancomycin Resistant Infections
WIC-Women, Infants and Children
WHCOA-White House Conference on Aging

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APPENDIX
Disabled Adults and Elder Persons Protection Act: O.C.G.A. 30-5-1 et seq
[30-5-1) This chapter shall be known and may be cited as the "'Disabled Adults and Elder Persons Protection
Act:

[30-5-2] Legislative purpose.

The purpose of this chapter is to provide protective services for abused, neglected, or exploited disabled adults and elder persons. It is not the purpose of this chapter to place restrictions upon the personal liberty of disabled adults or elder persons, but this chapter should be liberally construed to assure the availability of protective services to all disabled adults and elder persons in need of
them. (Ga. L. 1981. p. 1320. 2.)

[30-5-3] Definitions.

As used in this chapter. the term:

( 1) "Abuse" means the willful infliction of physical pain, physical injury. mental anguish. unreasonable confinement, or the willful deprivation of essential services to a disabled adult or elder person.

(2)

"Caregiver" means a person who has the responsibility for the care of a disabled

adult or elder person as a result of family relationship, contract, voluntary

assumption of that responsibility, or by operation of law.

(3)

"Court" means the probate court for the county of residence of a disabled adult or

elder person the county in which such person is found. In any case in which the

judge of the probate court is unable to hear a case brought under this chapter

within the time required for such hearing, such judge shall appoint a person to

serve and exercise all the jurisdiction of the probate court in such case. Any

person so appointed shall be a member of the State Bar of Georgia and be

otherwise qualified for his duties by training and experience. Such appointment

may be made on a case-by-case basis or by making a standing appointment of one

or more persons. Any person receiving such standing appointment shall serve at

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the pleasure of the judge making the appointment or said judge's successor in office to hear such cases if and when necessary. The compensation of a person so appointed shall be as agreed upon by the judge who makes the appointment and the person appointed. with the approval of the governing authority of the county for which such person is appointed, and shall be paid from the county funds of such county. All fees collected for the services of such appointed person shall be paid into the general funds of the county served.

(4)

"Department" means the Department of Human Resources.

( 5)

"Director" means the director of the county department of family and children

services. or the director's-designee, in the county in which the disabled adult or

elder person resides or is present.

( 6)

"Disabled adult" means a person 18 years of age or older who is not a resident of

a long-term care facility, as defined in Article 4 of Chapter 8 of Title 31, but who

is mentally or physically incapacitated.

(7)

"Disabled adult in need of protective services" means a disabled adult who is

subject to abuse, neglect, or exploitation as a result of that adult's mental or

physical incapacity.

(7.1) Elder person" means a person 65 years of age or older who is not a resident of a long-term care facility as defined in Article 4 of Chapter 8 of Title 31.

(8)

"Essential services" means social. medical, psychiatric. or legal services necessary

to safeguard the disabled adult's or elder person's rights and resources and to

maintain the physical and mental well-being of such person. These services shall

include. but not be limited to, the provisions of medical care for physical and

mental health needs, assistance in personal hygiene, food, clothing, adequately

heated and ventilated shelter, and protection from health and safety hazards but

shall not include the taking into physical custody of a disabled adult or elder

person without that person's consent.

(9)

"Exploitation" means the illegal or improper use of a disabled adult or elder

person or that person's resources for another's profit or advantage.

(1 0) "Neglect" means the absence or omission of essential services to the degree that it harms or threatens with harm the physical or emotional health of a disabled adult or elder person.

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( 11) "Protective services" means services necessary to protect a disabled adult or elder person from abuse. neglect. or exploitation. Such services shall include. but not be limited to, evaluation of the need for services and mobilization of essential services on behalf of a disabled adult or elder person. (Ga. L. 1981, p. 1320. 3.)

[30-5-4] (a)

Reporting of need for protective services, manner and contents of report; immunity from liability of persons who make reports, testify, etc., under this chapter.
(1) Any physician, osteopath, intern, resident, other hospital or medical personnel, dentist, psychologist, podiatrist, nursing personnel, social work personnel. daycare personnel, or law enforcement personnel having reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means. or has been neglected or exploited by a Caregiver shall report or cause reports to be made in accordance with the provisions of this Code section. Except as provided in this paragraph, any employee of a financial institution, as defmed in Code Section 7-14. having reasonable cause to believe that a disabled adult or elder person has been exploited shall report or cause reports to be made in accordance with the provisions of this Code section; provided, however, that this obligation shall not apply to any employee of a financial institution while that employee is acting as a fiduciary, as defined in Code Section 7-1-4, but only for such assets that the employee is holding or managing in a fiduciary capacity. When the person having reasonable cause to believe that a disabled adult or elder person is in need of protective services performs services as a member of the staff of a hospital, social agency, fmancial institution or similar facility, such person shall notify the person in charge of the facility, and such person or that person's designee shall report or cause reports to be made in accordance with the provisions of this Code section.
(2) Any other person having a reasonable cause to believe that a disabled adult or elder person is in need of protective services may report such information to an adult protection agency providing protective services, as designated by the department or, in the absence of such agency, to an appropriate law enforcement authority or district attorney. If a report of disabled adult or elder person abuse is made to an adult protection agency or independently discovered by the agency and the agency has reasonable cause to believe such report is true [substantiated], then the agency shall immediately notify the appropriate law enforcement authority or district attorney.

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(b) (c)
[30-5-5] (a)

The report [to the County DEPARTMENT OF FAMILY AND CHILDREN SERVICES (DFCS)] may be made by oral or written communication. The report shall include the name and address of the disabled adult or elder person and should include the name and address of the disabled adult or elder person and should include the name and address of the disabled adult's or elder person's Caretaker [Caregiver], the age of the disabled adult or elder person. the nature and extent of the disabled adult's or elder person's injury or condition resulting from abuse, exploitation, or neglect. and other pertinent information. All such reports prepared by a law enforcement agency shall be forwarded to the Director within 24 hours.
Anyone who makes a report pursuant to this chapter, who testifies in any judicial proceeding arising from the report, who provides protective services, or who participates in a required investigation under the provisions of this chapter shall be immune from any civil or criminal liability on account of such report or testimony or participation, unless such person acted in bad faith or with a malicious purpose. Any financial institution, as defined in Code Section 7-1-4, including without limitation officers and directors thereof, that is an employer of anyone who makes a report pursuant to this chapter in his or her capacity as an employee, or who testifies in any judicial proceeding arising from a report made in his or her capacity as an employee, or who participates in a required investigation under the provisions of this chapter in his or her capacity as an employee, shall be immune from any civil or criminal liability on account of such report or testimony or participation of its employee, unless such financial institution knew or should have known that the employee acted in bad faith or with a malicious purpose and failed to take reasonable and available measures to prevent such employee from acting in bad faith or with a malicious purpose. The immunity described in this subsection shall apply not only with respect to the acts of making a report, testifying in a judicial proceeding arising from a report, providing protective services. or participating in a required investigation, but also shall apply with respect to the content of the information communicated in such acts.
Investigation of reports of need for protective services; petition for court order prohibiting interference with investigation or provision of protective services; hearing on petition: consent to provision of protective services.
Any director receiving a report that a disabled adult or elder person is in need ofprotective services shall conduct or have conducted a prompt and thorough investigation to determine whether the disabled adult or elder person is in need of protective services and what services are needed.

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The investigation shall include a visit to the person and consultation with others having knowledge of the facts of the particular case. Within ten days after receipt of the report. the director shall acknowledge receipt of the report. in writing. to the person making the report.

(b) Any person conducting an investigation required by this Code section who is unable to gain access to the disabled adult or elder person as a result of interference by another person may petition the court for an order authorizing the investigation and prohibiting interference therewith. which petition shall allege specific facts in support thereof. A hearing upon such petition and notice thereof shall be carried out pursuant to subsection (_f) of this Code section. If as a result of the hearing the court finds probable cause to believe that the person named in the petition is a disabled adult in need of protective services or an elder person needing protective services and that any other person is interfering with the investigation required under this Code section, the court may issue an order authorizing that investigation and prohibiting interference therewith by any person.

(c)

If as a result of an investigation conducted under this chapter the

director determines that a disabled adult or elder person is in need of

protective services, the director shall immediately provide or arrange for

protective services for any disabled adult or elder person who consents

thereto.

(d) Any person providing protective services as authorized by subsection (c) of this Code section who determines that another person is interfering with the provision of such services may petition the court for an order authorizing such services and prohibiting interference therewith. Such petition shall allege specific facts in support thereof, including, but not limited to, the results of any investigation required to be made under this chapter. A hearing upon such petition and notice thereof shall be carried out pursuant to subsection (f) of this Code section. If as a result of the hearing the court fmds by clear and convincing evidence that the person named in the petition is a disabled adult in need ofprotective services or an elder person needing protective services and that any person is interfering with the provision of such services, the court may issue an order authorizing the provision of such services and prohibiting the interference therewith by any person.

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(e) (f)
(g)
(30-5-6) (a) (b)

Protective services may not be provided under this chapter to any person \Vho does not consent to such services or who, having consented. withdraws such consent. Nothing in this chapter shall prohibit the department from petitioning for the appointment of a guardian for a disabled adult or elder person pursuant to Chapter 5 of Title 29.
A hearing on any petition filed under this Code section shall be held no sooner than five and no later than ten days after such petition is filed. unless a continuance is granted. At least three days prior to such hearing. notice thereof shall be served on the petitioner and notice and copy of the petition shall be served on the person alleged to be a disabled adult in need of protective services or elder person needing protective services and on such person or persons named in the petition as interfering with the investigation or with the provision of protective services, as applicable. Notice shall be served either in person or by first class mail. Any person willfully violating any order issued pursuant to this Code section shall be in contempt of the court issuing such order and may be punished accordingly by the judge of that court.
The expenses of the court and the hearing officer for any hearing conducted under this Code section shall be the same as those provided in Code Section 37-3-122 and shall be paid as provided therein.-- A disabled adult or elder person shall be deemed to be a patient under Code Section 373-122 only for purposes of determining hearing expenses thereunder. Nothing in this Code Section shall authorize the payment of attorney's fees for any hearing conducted under this Code Section. (Ga. L. 1981, p. 1320. 5: Ga. L. 1984, p. 785, 2.)
Cooperation of local health departments, other agencies, etc., withthe director, power of director to contract for the provision of medical evaluations; regulations for the implementation of this chapter.
The staff and physicians of local health departments, mental health clinics, and other public agencies shall cooperate fully with the director in the performance of the director's duties under this chapter.
The director may contract with an agency or private physician for the purpose of providing immediate accessible medical evaluations in the location that the director deems most appropriate.

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(c) The Board of Human Resources shall adopt regulations to ensure the effective implementation ofthis chapter. (Ga. L. 1981. p. 1320. 6.)

[30-5-7]

Confidentiality of records pertaining to abuse, etc., of disabled adults and elder persons.

All records pertaining to the abuse, neglect. or exploitation of disabled adults or elder persons in the custody of the department shall be confidential; and access thereto by persons other than the department, the director, or the district attorney shall only be by valid subpoena or order of any court of competent jurisdiction. (Ga. L. 1981. p. 1320. 7.)

(30-5-8)

Criminal provisions.

(a)( 1) It shall be unlawful for any person to abuse. neglect, or exploit any disabled adult or elder person.
(2) Any person violating the provisions of this subsection shall be guilty of a misdemeanor.
(b)( 1)It shall be unlawful for any person or official required by paragraph (1) of subsection (a) of Code Section 30-5-4 to report a case of disabled adult or elder person abuse to fail knowingly and willfully to make such report.
(2) Any person violating the prov1s1ons of this subsection shall be guilty of a misdemeanor.
[30-5-9]
Nothing in this chapter shall be construed to limit the application of Code Section 34-7-1 to the employment relationship between a disabled adult or elder person and his or her employer or to create a new cause of action as a result of the employment relationship.

Section 3. This Act shall become effective on January 1, 1998.
Section 4. All laws and parts of laws in conflict with this Act are repealed.

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Long-term Care Facility Resident Abuse Reporting Act:
O.C.G.A. 31-8-80 et seq
31-8-80. Short Title
This article shall be known as the "Long-term Care Facility Resident Abuse Reporting Act."
31-8-81. Definitions
As used in this article, the term:
(1 )"Abuse" means any intentional or grossly negligent act or series of acts or intentional or grossly negligent omission to act which causes injury to a resident, including, but not limited to, assault or battery. failure to provide treatment or care, or sexual harassment of the resident.
(2) "Exploitation" means an unjust or improper use of another person or his property for one's own profit or advantage.
(3) "Long-term care facility" or "facility" means any skilled nursing home, intermediate care home. or personal care home now or hereafter subject to regulation and licensure by the department.
(4) "Resident" means any person receiving treatment or care in a long-term care facility.
31-8-82. Reporting abuse or exploitation; records
(a) Any:
(1) Administrator, manager, physician, nurse, nurse's aide; orderly. or other employee in a hospital or facility;
(2) Medical examiner, dentist, osteopath, optometrist, chiropractor, podiatrist, social worker, coroner, clergyman, police officer, pharmacist, physical therapist, or psychologist; or
(3) Employee of a public or private agency engaged in professional services to residents or responsible for inspection of long-term care facilities who has knowledge that any resident or fonner resident has been abused or exploited while residing in a long-tenn care facility shall immediately make a report as described in subsection (c) of this Code section by telephone or in person to the department. In the event that an immediate report to the

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department is not possible. the person shall make the report to the appropriate law enforcement agency. Such person shall also make a written report to the Department of Human Resources within 24 hours after making the initial report.
(b) Any other person who has knowledge that a resident or former resident has been abused or exploited while residing in a facility may report or cause a report to be made to the department or the appropriate law enforcement agency.
(c) A report of suspected abuse or exploitation shall include the following:
(1) The name and address of the person making the report unless such person is not required-to make a report;
(2) The name and address of the resident or former resident;
(3) The name and address ofthe facility;
(4) The nature and extent of any injuries or the condition resulting from the suspected abuse or exploitation;
(5) The suspected cause of the abuse or exploitation; and
(6) Any other information which the reporter believes might be helpful in determining the cause of the resident's injuries or condition and in determining the identity of the person or persons responsible for the abuse or exploitation.
(d) Uponreceipt of a report of abuse or exploitation, the department may notifY the appropriate law enforcement agency. In the event a report is made directly to a law enforcement agency, under subsection (a) or (b) of this Code section, that agency shall immediately notifY the department.
(e) The department shall maintain accurate records which shall include all reports of abuse or exploitation, the results of all investigations and administrative or judicial proceedings, and a summary of actions taken to assist the resident.
31-8-83. Investigations
(a) The department shall immediately initiate an investigation after the receipt of any report. The department shall direct and conduct all investigations; however, it may delegate the conduct of investigations to local police authorities or other appropriate agencies. If such delegation occurs,

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the agency to which authority has been delegated must report the results of its investigation to the department immediately upon completion.
(b) The investigation shall determine the nature. cause. and extent of the reported abuse or exploitation. an assessment of the current condition of the resident, and an assessment of needed action and services. Where appropriate, the investigation shall include a prompt visit to the resident.
(c) The investigating agency shall collect and preserve all evidence relating to the suspected abuse or exploitation.
(d) All state, county, and municipal law enforcement agencies, employees of long-term care facilities. and other appropriate persons shall cooperate with the department or investigating agency in the administration of this article.
31-8-84. Evaluation of results of investigation; protection of resident
(a) Upon the receipt of the results of an investigation, the department, in cooperation with the investigating agency, shall immediately evaluate such results to determine what actions shall be taken to assist the resident.
(b) The department or an agency designated by the department shall assist and prevent further harm to a resident who has been abused or exploited. The department may also take appropriate legal actions to assure the safety and welfare of all other residents of the facility where necessary.
(c) Within a reasonable time not to exceed 30 days after it has initiated action to assist a resident, the department shall determine the current condition of the resident, whether the abuse or exploitation has been abated, and whether continued assistance is necessary.
(d) If as a result of an investigation a determination is made that a resident has been abused or exploited, the department shall contact the appropriate prosecuting authority and provide all information and evidence to such prosecuting authority.
31-8-85. Immunity for liability
(a) Any agency or person who in good faith makes a report or provides information or evidence pursuant to this article shall be immune from liability for such actions.
(b) Neither the department nor its employees, when acting in good faith and with reasonable diligence, shall have any liability for defamation, invasion of privacy, negligence, or any other

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claim in connection with the collection or release of information pursuant to this article and neither shall be subject to suit based upon any such claims.
31-8-86. Confidentiality
Th~ identities of the resident. the alleged perpetrator, and persons making a report or providing information or evidence shall not be disclosed to the public unless required to be revealed in court proceedings or upon the written consent of the person whose identity is to be revealed or as otherwise required by law. Upon the resident's or his representative's request, the department shall make information obtained in an abuse report or complaint and an investigation available to an allegedly abused or exploited resident or his representative for inspection or duplication, except that such disclosure shall be made withoutrevealing the identity of any other resident, the person making the report, or persons providing information by name or inference. For the purpose of this Code section, the term "representative" shall include any person authorized in writing by the resident or appointed by an appropriate court to act upon the resident's behalf. The term "representative" also shall include a family member of a deceased or physically or mentally impaired resident unable to grant authorization; provided, however, such family members who do not have written or court authorization shall not be authorized by this Code section to receive the resident's health records as defined in Code Section 31-33-1.
31-8-87. Retaliation prohibited
No person or facility shall discriminate or retaliate in any manner against any person for making a report or providing information pursuant to this article or against any resident who is the subject of a report. Nothing in this Code section shall be construed to prohibit the termination of the relationship between the facility and the resident for reasons other than that the facility has been made the subject of a report, that such a report has been made, or that information has been provided pursuant to this article.
31-8-88. Notice of requirements of article
The department shall prepare a written notice describing the reporting requirements set forth in this article. Such notice shall be distributed to all long-term care facilities and hospitals in the state and copies thereof shall be posted in conspicuous locations within facilities and hospitals.

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Long-Term Care Ombudsman Program Act
O.C.G.A. 31-8-50 et llil
31-8-50. Declaration of policy.
The general assembly finds that a significant number of older citizens of this state reside in longterm care facilities in this state and, because of their isolated and vulnerable condition. are more dependent on others for their protection and care. It is the intent ofthe General Assembly to protect and improve the quality of care and life for residents through the promotion of community involvement in long-term care facilities and by establishment of a process to resolve complaints and problems of residents. It is the further intent of the General Assembly that the department, within the available resources and pursuant to its duties under the Older Americans Act of 1965. as amended. ensure that the quality of care and life for such residents is maintained. that necessary reports are made and that, where necessary, corrective action is taken at the departmental level.
31.-8-51. Definitions.
As used in this article. the term:
( 1) "Community ombudsman" means a person certified as a community ombudsman pursuant to Code Section 31-8-52.
(2) "Long-term care facility" means any skilled nursing home, intermediate care home, or personal care home now or hereafter subject to regulation and licensure by the department.
(3) "Resident" means any person who is receiving treatment or care in a long-term care facility who seeks admission to such facility or who has been discharged or transferred from such a facility.
(4) "State ombudsman" means the state ombudsman established under Code Section 31-852.
31-8-52. Establishment of long-term care ombudsman program.
Pursuant to the Older American Act of 1965 (P. L. 89-73, 79 Stat. 219), as amended, and as a condition of receiving funds under that act for various programs for older citize.ns of this state, the Department of Buman Resources has been required to establish and operate a long-term care ombudsman program. In order to receive such funds, the department has already established a position of state ombudsman within the state Office of Special Programs. The state ombudsman shall be under the direct supervision of the commissioner or his or her designee and shall be given the powers and duties hereafter provided by this article. The state ombudsman shall be a person

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qualified by training and experience in the field of aging or long-tenn care or both. The state ombudsman shall promote the well-being and quality of life of residents in long-tenn care facilities and encourage the development of community ombudsman activities at the local level. The state ombudsman may certifY community ombudsman and such certified ombudsman shall have the powers and duties set forth in Code Sections 31-8-54 and 31-8-55. The state ombudsman shall require such community ombudsman to receive appropriate training as detennined and approved by the department prior to certification. Such training shall include an internship of at least seven working days in a nursing home and at least three working days in a personal care home. Upon certification. the state ombudsman shall issue an identification card which shall be presented upon request by community ombudsman whenever needed to carry out the purposes of this article. Two years after first being certified and every two years thereafter, each such community ombudsman. in order to carry out his or her duties under this article, shall be recertified by the state ombudsman as continuing to meet the department's standards as community ombudsman.
31-8-53. Duties of the state ombudsman.
.The state ombudsman shall:
(1) Establish policies and procedures, subject to approval by the commissioner of human resources, for receiving, investigating, referring, and attempting to resolve complaints made by or on behalf of residents of long-tenn care facilities concerning any act, omission to act, practice, policy. procedure that may adversely affect the health, safety, or welfare of any resident;
(2) Investigate and make reports and recommendations to the department and other appropriate agencies concerning any act or failure to act by any government agency with respect to its responsibilities and duties in connection with long-tenn care or residents of long-term care facilities;
(3) Establish a unifonn state-wide reporting system to record data about complaints and conditions in long-tenn care facilities and shall collect and analyze such data in order to identifY significant problems affecting the residents of such facilities;
(4) Promote the development of community ombudsmen activities and provide technical assistance as necessary; and
(5) Make an annual written report, documenting the types of complaints and problems reported by residents, to the director of the Office of Special Programs for his recommendations to the commissioner concerning needed policy and regulatory and legislative changes.

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31-8-54. Duties of community ombudsman.
Pursuant to policies and procedures established by the state ombudsman. the community ombudsman shall:
( 1) Learn about the general conditions affecting residents of long-term care facilities and work for the best interest of these residents;
(2) Receive, investigate, and attempt to resolve complaints made by or on behalf of residents of long-term care facilities;
(3) Collect data about the number..and types of complaints handled; and
(4) Report regularly to the state ombudsman about the data collected and the activities of the community ombudsman.
31-8-55. Entry and investigative authority; cooperation of government agencies; communication with residents.
(a) The state ombudsman or community ombudsman, on his or her initiative or in response to complaints made by or on behalf of residents of long-term care facilities, may conduct investigations in matters within his or her powers and duties as provided by this article.
(b) The state ombudsman or community ombudsman shall have the authority to enter any longterm care facility and shall use his or her best efforts to enter such facilities during normal visiting hours. Upon entering the long-term care facility, the ombudsman shall notify the administrator or, in the absence of the administrator, the person in charge of the facility, before speaking to any residents. After notifying the administrator or the person in charge of the facility, the ombudsman may communicate privately and confidentially with residents of the facility, individually or in groups. The ombudsman shall have access to the medical and social records of any resident if:
(1) The ombudsman has the permission of the resident or the legal representative or guardian of the resident;
(2) The resident is unable to consent to the review and has no legal representative or guardian; or
(3) There is a guardian of the person of the resident and that guardian refuses to permit access to the records necessary to investigate a complaint, and;

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(A) There is reasonable cause to believe that the guardian is not acting in the best interests of the resident; and
(B) A community ombudsman obtains the approval of the state ombudsman.
As used in this Code section, the term "legal representative' means an agent under a valid power of attorney. provided that the agent is acting within the scope of his or her agency; an agent under a durable power of attorney for health care; or an executor, executrix, administrator. or administratrix of the estate of a deceased resident. The ombudsman shall have the authority to inspect the physical plant and have access to the administrative records, policies, and documents of the facility to which the residents have or the general public has access. Entry and investigation provided by this Code section shall be conducted in a manner which will not significantly disrupt the provision of nursing or other care to residents.
c) The state ombudsman or community ombudsman shall identify himself or herself as such to the resident, and the resident shall have the right to communicate or refuse to communicate with the ombudsman.
d) The resident shall have the right to participate in planning any course of action to be taken on his or her behalf by the state ombudsman or community ombudsman, and the resident shall have the right to approve or disapprove any proposed action to be taken on his or her behalf by such ombudsman.
e) The state ombudsman and community ombudsman shall have authority to obtain from any government agency, and such agency shall provide, such cooperation and assistance, services, data, and access to files and records as will enable the ombudsman properly to perform his or her duties and exercise his or her powers, provided such information is not privileged under any law.
f) Where the subject of the investigation involves suspected abuse, neglect, or exploitation of a resident by his or her guardian, the state ombudsman or community ombudsman shall have the authority to communicate with the resident in a private and confidential setting not withstanding any objection by the guardian to such meeting and communication.
31-8-56. Resolution of complaints.
a) Following an investigation, the state ombudsman or community ombudsman shall report his opinions or recommendations to the party or parties affected thereby and shall attempt to resolve the complaint using, whenever possible, informal techniques of mediation, conciliation, and persuasion. With respect to a complaint against a long-term care facility, the ombudsman shall first notify the administrator of the facility in writing and give such administrator a reasonable opportunity to correct any alleged defect. If the administrator fails to take corrective action after

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a reasonable amount of time or if the defect seriously threatens the safety or well-being of the residents. the state ombudsman or community ombudsman may refer the complaint to the appropriate agency.
b) Complaints or conditions adversely affecting residents of long-term care facilities which cannot be resolved in the manner described in subsection (a) of this Code shall. whenever possible. be referred by the state ombudsman or community ombudsman to an appropriate agency.
c) The community ombudsman shall not disclose to the public, either directly or indirectly. the identity of any long-term care facility which is the subject of an investigation unless and until the matter has been reviewed by the office ofthe state ombudsman and the matter has been referred to an appropriate governmental agency for action.
31-8-57. Reporting abuse.
Any person who has reasonable cause to believe that a resident of a long-term care facility is being, or has been. abused, neglected, exploited. or abandoned or is in the condition which is the result of abuse. neglect. exploitation, or abandonment may report such information or cause a report to be made in any reasonable manner to the state ombudsman or community ombudsman, if any.
31-8-58. Confidentiality.
The identity of any complainant, resident on whose behalf a complaint is made. or individual providing information on behalf of the resident or complainant relevant to the investigation of a complaint shall be confidential and may be disclosed only with the express permission of such person. The information produced by an investigation may be disclosed by the state ombudsman or community ombudsman only if the identity of any such person is not disclosed by name or inference in such information, the information may be disclosed only with express permission. If the complaint becomes the subject for judicial proceeding, such investigative information may be disclosed for the purpose of the proceeding.
31-8-59. Notice to residents.
The state ombudsman shall prepare and distribute to each long-term care facility in the state a written notice describing the long-term care ombudsman program and the procedure to follow in making a complaint, including the address and telephone number of the state ombudsman and community ombudsman, if any. The administrator shall give the written notice required by this Code section to each resident and his legally appointed guardian, if any, upon admission. The administrator shall also post such written notice in conspicuous public places in the facility in accordance with procedures provided by the state ombudsman and shall give notice to any resident

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and his legally appointed guardian. if any, who did not receive it upon admission. The failure to provide the notices required by this Code section shall be a ground upon which the department may revoke any permit issued to a long-term care facility under Code section 31-7-1.
31-8-60. Retaliation against resident and interference with ombudsman prohibited; provisions applicable to violations.
No person shall discriminate or retaliate in any manner against any resident or relative or guardian of a resident. any employee of a long-term care facility, or any other person because of the making of a complaint or providing information in good faith to the state ombudsman or community ombudsman. No person shall willfully interfere with the state ombudsman or community ombudsman in the performance of his or her official duties. Code Sections 31-2-6 and 31-5-8 shall apply fully to any violation of this article.
31-8-61. Liability for provision of information.
Notwithstanding any other provision oflaw, no person providing information. including, but not limited to. patient records. to the state ombudsman or a community ombudsman shall be held, by reason of having provided such information, to have violated any criminal law or to being civilly liable under any law unless such information is false and the person providing such information knew or had reason to believe that it was false.
31-8-62. Liability arising from complaints.
Any person who. in good faith. makes a complaint or provides information as authorized in this article shall incur no civil or criminal liability therefor. Any state or community ombudsman who, in good faith. performs his or her official duties, including but not limited to, making a statement or communication relevant to a complaint received or an investigative activity conducted pursuant to this article shall incur no civil or criminal liability therefor.
31-8-63. Rules and regulations.
The department is authorized to adopt and promulgate rules and regulations to implement this article.

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Unfair and Deceptive Practices Toward the Elderly Act:
O.C.G.A. 10-1-850 et seq
10-1-850. Definitions
As used in this article, the term:
(1) "Disabled person" means a person who has a physical or mental impairment which substantially limits one or more of such person's major life activities. As used in this paragraph, "physical or mental impairment" means any of the following:
(A) Any physiological disorder or condition, cosmetic disfigurement, or anatomical loss substantially affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive; digestive; genitourinary; hemic and lymphatic; skin; or endocrine; and
(B) Any mental or psychological disorder. such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities. The term "physical or mental impairment" includes, but is not limited to. such diseases and conditions as orthopedic, visual, speech, and hearing impairment, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, mental retardation, and emotional illness.
(2) "Elder person" means a person who is 60 years of age or older.
(3) "Major life activities" includes functions such as caring for one's self, performing manual tasks. walking, seeing, hearing, speaking, breathing, learning, and working.
(4) "Substantially limits" means interferes with or affects over an extended period of time. Minor temporary ailments or injuries shall not be considered physical or mental impairments which substantially limit a person's major life activities. Examples of minor temporary ailments are colds, influenza, or sprains or minor injuries.
10-1-851. Additional civil penalty for violation of Article 15, 17, or 21 ofthis chapter against elder or disabled persons.
When any person who is found to have conducted business in violation of Article 15, 17, or 21 of this chapter is found to have committed said violation against elder or disabled persons, in addition to any civil penalty otherwise set forth or imposed, the court may impose an additional civil penalty not to exceed $10,000.00 for each violation.

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10-1-852. Determination to impose civil penalty and amount thereof.
In determining whether to impose a civil penalty under Code Section 10-1-851 and the amount thereof. the court shall consider the extent to which one or more of the following factors are present:
(I) Whether the defendant's conduct was in disregard of the rights of the elder or disabled persons;
(2) Whether the defendant knew or should have known that the defendant's conduct was directed to an elder person or disabled person;
(3) Whether the elder or disabled person was more vulnerable to the defendant's conduct because of age, poor health, infirmity, impaired understanding, restricted mobility, or disability than other persons and whether the elder or disabled person actually suffered substantial physical. emotional, or economic damage resulting from the defendant's conduct;
(4) Whether the defendant's conduct caused an elder or disabled person to suffer any of the following:
(A) Mental or emotional anguish;
(B) Loss of or encumbrance upon a primary residence of the elder or disabled person;
(C) Loss of or encumbrance upon the elder or disabled person's principal employment or principal source of income;
(D) Loss of funds received under a pension or retirement plan or a government benefits program;
(E) Loss ofproperty set aside for retirement or for personal or family care and maintenance; or
(F) Loss of assets essential to the health and welfare of the elder or disabled person; or
(5) Any other factors the court deems appropriate.

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10-1-853. Cause of action for damage or injury from offense or violation under this article.
An elder or disabled person who suffers damage or injury as a result of an offense or violation described in this article has a cause of action to recover actual damages, punitive damages. if appropriate. and reasonable attorney's fees. Restitution ordered pursuant to this Code section has priority over a civil penalty imposed pursuant to this article.
10-1-854. State-wide educational initiatives as to consumer crimes against elder and disabled persons, applicable laws, and remedies available.
The administrator [of the Governor's Office of Consumer Affairs] may develop and implement state-wide educational initiatives to infoJ?ll elder persons and disabled persons. law enforcement agencies, the judicial system, social services professionals, and the general public as to the prevalence and prevention of consumer crimes against elder and disabled persons, the provisions of Part I of Article 15 ofthis chapter. the "Uniform Deceptive Trade Practices Act." and Articles 17 and 21 of this chapter, the penalties for violations of such articles, and the remedies available for victims of such violations.
10-1-855. Referral procedures to provide intervention and assistance.
The administrator may establish and maintain referral procedures with the Office of Aging within the Department of Human Resources in order to provide any necessary intervention and assistance to elder or disabled persons who may have been victimized by violations of this article.
10-1-856. Construction with Part 2 of Article 15 of this chapter; confidentiality.
Nothing in this article shall serve to prevent the administrator appointed under Code Section I0-1-395 from investigating and pursuing unfair and deceptive acts or practices committed under Part 2 of Article 15 of this chapter, the "Fair Business Practices Act of 1975." Notwithstanding any other provision of law to the contrary, the names, addresses, telephone numbers, social security numbers. or any other information which could reasonably serve to identify any person making a complaint about unfair or deceptive practices under Part 2 of Article 15 of this chapter, the "Fair Business Practices Act of 1975," shall be confidential. However, the complaining party may consent to public release of his or her identity by giving such consent expressly, affirmatively, and directly to the administrator or the administrator's employees. Nothing contained in this Code section shall be construed to prevent the subject of the complaint, or any other person to whom disclosure of the complainant's identity may aid in resolution of the complaint, from being informed of the identity of the complainant, to prohibit any valid discovery under the relevant discovery rules, or to prohibit the lawful subpoena of such information.

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10-1-857. Complaints, inquiries, investigations and corrective action.
The administrator shall receive all complaints under this article. He or she shall refer all complaints or inquiries concerning conduct specifically approved or prohibited by the Secretary of State. Department of Agriculture, Commissioner of Insurance, Public Service Commission, Department ofNatural Resources, Department of Banking and Finance, or other appropriate agency or official of this state to that agency or official for initial investigation and corrective action other than litigation.

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DHR Memorandum of Understanding
IJjDHR .

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I

1

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Purauant to the following atatutea and rulea: ouur~m AQYL'l'S PBQTI<;'X'ION Ac;T. o.s.q.AI lA!l tbrouqh lQ-57 the Diviaion of Paaily and Children Service throuqh ita county Departenta of Paaily and Children service (OPCS) 1a eharqed aa the adult protection aqency.
t.oNc-:rQII en nc:nxn nexoarr uy11 uroBTxlfC "c:T. o Ic: Ic;." I
llIIQ, The Departaent of Huaan Reaourcea (DKR) haa placed reaponaibilitiaa tor thia Act with the Office ot Requlatory service (ORS)
LQNSj-tPI C"' OJIIPPIIM !'9Ci!'' o~c~;~a. u--n. outiea of
the state and ca..unity oabud...n in receivinq, inveatiqating and atte-sta de to reaolve ~laint ude on behalf of reaident in lonq-tera care tacilitie are the reaponaibility ot the Office of the Lont-tera care oabud..an in the D1viaion ot Aqinq Service.
MJSTBJAt!JIT. NJGLICT 01 AIQII or PA%IIIfl. O.~Q.A. l7l
J.AL Miatreat. .nt, necJlact or aw.e in any ton of any patient ia probibited
DQA8'1'1QNT or lltDW! UIOQICII Btli.U MD IPiJ!LUIQNI rga CI.IDITI BIQII'fl 2tQ4t. 04, !II'RIU POl VXQWlONS AND
PA'I'XIN%1 BJQITI ato---.gz, Procedure for
inveatiqatione of abQ.. and exploitation in DKR/Div1aion operated nurdnq hOM and State fundecl CJl'CNP haae.
I~ . . . . . ~ t'D Dlftlt , . nuLW UD c:lllr.Daa IDnC:UI
On'ICI,. uat.aftaW IDYIC:UI Dlftlt a. nu.JC IDI.ftl Dntlla.
0~ 11DDL UU.ft, JlaDL Ufti.DHJ. UD lftftUIC:I UGIIJ DntiiOII 'oC1'O0 UuuVLaa~a,e,cao..az...nu._ec,ca.e. aIanII,D.~ aDnn~ .tioJ~ x OnII~1,c 11.. D,a c.oaau DaDxIAIWD8DLf~ tDc Cu. . Dv1rft.aJaInIUc c:o au&a.lnx 'tr%.~ z-.
f t f t 'fDD loMIIL1' DDAftD aOLU UD LDIJft~~. 17 ftW. 18 I'D . . .JOIIIJIZLift ~ De. DlhMimft, Dntlla., Oil
onzct '10 coc:&n UD ftADI nu? to XDLa:at ftll JOL%<:1'.
~. .CII,IIIIS_.,,........

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~
A. a~a~l or UOII, DGI.~ oa IDLOiftfiOJI or DUULB ~Vl.!'l
no U. lrO'r RUIDD'fl or LOIIQ ~. . . CUll PACILUIU
'1'!le report will Ita reoei.. a' tile oouty Deputaeat of ruUy C!l114rea lerYioea CDPCI, offioe 1a tile ooaaty ia wllioll tile 4ia.-le4 a4ult reaidea.
l.Tha report aay be aade by oral or vrittan eo. .unieation and hould include the n... and addre of the diabled adult' caretaker, it applicable, the a9e of the di8abled adult, the natura and extant of the diaabled adult' injury or condition reaultinCJ froa abuae, exploitation, or neCJlect, and other pertinent inforaation.
2.Tha office will aend written acknovledqaent to the reporter and conduct a proapt and thoroUCJh inveati9ation to deteraine whether the ~laabled adult ia in need of protective aervicea and what aervicea are needed. The inveati9ation include a viait to the diaabled adult and conaultation with the reporter and other havinq knovledCJ of the facte of the particular ca
J.Tha office vill i . .ediately provide or arranqa for protective eervicea for any dieablad adult who conaanta to aervicea.
4. C:ontac:t the etaff and phyeicianl of local health depart.aanta, aental health clinica, and other ~'~lie a9enciea for their full cooperation in the parforsanca of dutiea aandated under the Dieabled Adult Protection Act.
5.Tha orc:s vill aate reporte to law enforc..ant a9enciee ae
directed by the Diaabled Adulta Protection Act.
s.orc:s ehall cloc:nment. finc:Unqa and provicla an oral and/or
vrittan report of the t1ndift98 within 1S vorkinq day tollovinq eo.plation of the inveeti9at1on. A copy of the written report aball be aent to the DPC:S atate Protective
servicu unit. A copy aball be aent to ou if it ie a retanal froa ou.

c.u, ...-,1 or un, ~ Gil IDLOI'DflOII UL&~U. 'rO

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%IIHIIIIDUU c:ua JaiU UD t . .oar.

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na repon will M r ..ah. . ~ tae Offloa et a..,a1ato27 larYioaa at

Adaille~atl.a l~oae la.tloa

c..,lalat zataae, 11et rl..r

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II.. 21.1711 I 1119 21.1711

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3
l.Tha invaetiqation vill be conducted by the oRS vhen it appear that there ia a violation ot State Liceneure and/or radaral Certification requlationa and to coaply vith tha Lonq-Tarw Care A.buea Raportinq Act, O.C.G.A. chapter 31-1-10. (See aaction C tor Mental Haalth/Mantal RetardationtSu.betance Abuaa (MH/MR/SA) r ..ponaibility in inveatiqation ot OHR operated facilitiee).

2. It the report of abuea, neqlect or exploitation doea not involve a violation of State Liceneure and/or radaral Certification requlationa, tha ORI aay requeet aeaiatance troa
orcs tor concurrent inveatiqation and/or action or troa other
appropriate referral eourcea to dataraina the extant or the eituation and to protect the individual.

J.Tha ORS vill aaka referral to law entorcaaant aqanciea a

appropriate, t.a. aituationa vhara there ia iaediata and

aarioua threat to aataty, when alleqed wal abu 1

involved, vnan aqanciaa invaatiqatinq abuaa are denied ace:

to the facility or aiaappropriation of

t

o the prope

raaidant rty. Tha

a o

uandv

in ill

caeaa of c:riainal requeat c:opi.. of

pertinent police reporta to datenine the extent of the

aituation and to protect the individual.

4.0RS vill refer alleqationa of abuae, neqlect or exploitation
that are reported to ou aa havinq occun"ecl in tacilitiea
operated by the DD Diviaion of rtlf/D/U. to the Office of conatituant Servicaa tor inveatiqation and to reviav inveatiqationa received traa 1111/D/IA and taka further action ae nacaaaary.

!5. Tha orcs vill aaaiat peraona to aue report of abUaa, neqlact

or exploitation in lonqten care tacilitiaa aa naceaaary. If

aituation ia one of 1..-diate danqer DPCI ataff vill notify

ORI and raqueat

i.. of

o.Sui.a

tal

y

reapon4

to

the

cri1i1

lituation

at

the

l.'n\e DPCI will accept traa ou and/or the lonq-ten care
oabuda. .n aa an Adult Protective larvicaa (API) referral a report of abuae, neqlect or exploitation of a diaablecl adult, raaidift9 in a lonqtuw care facility, when the act ia reportecl to c have occurred outaide the facility; or -the alleqed perpetrator 11 not affiliated vith the facility; or the facility vaa not reaponai~le tor auperviaion at the tiaa
the act occurred.

7. orcs will accept traa ou artd/or the lonqten care oatNdnan,
aa an API referral, a report that a di~led adult (reaidinq in e lonq ten care facility) 11 beinq abueed, neqlacted or exploited by a quardian or aay be in need of a quardian to facilitate protective or plac...nt rvicee.

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4
8.Tha ORS will provide notification to the reporter about the outcoaa of the investiqation of the alleqed abuse.
9.Tha ORS will serve as the attica ot record tor all report involvinq nursinq homes, intermediate care homes, personal care homes ineludinq CHR/Division of HH/MR/SA operated facilities. Records of the report, inveatiqation and currant condition vill be recorded in a manner which vill result in efficient data retrieval reqardinq number, type location and disposition of the reports and investiqations.
t C:. 'l'BI ROLl or 'l'BI t.OG'l'DII CUI OXIRIDII JROGilM Ra<:IITIG
U1D IJIVBI'riGA'l'IKG ALLIGA!IO.I or UUII I. LOKG-'l'Dil CUI rACILI'l'III
l.Coaplaintatallaqationa are received in oral or written comaunication by State or Comaunity Lonq-Tera Care oabud..an Pro;raaa. oral complaints are docuaentad by the oabudsaan.
2. The ouudsaan aay rater the complainant to the Oftice of Raqulatory Service to invaatiqate coaplainta involvinq nursinq tacilitie1 or peraonal care ho The oabudsaan al8o intoral the coaplainant, it other than the ralident, of aandatory raportinq requira..nta under the Georqia Lonq-Tara care Abuae Reportinq Act.
J. Reqardle of whether the complainant contact ORS to .Ue the abuae coaplaint, the oabudaaan who hal received the coaplaint vi1it1 the ralidant(l) involved in the a11aqation to determine the ralidents' perception of the alleqed abuae and to determine what action, if any, the reaident wante taken.
4.The oabudaaan, a1 required by federal and state 1tatute1, 11 not permitted to reveal the identity of the coaplainant or the ralidant without their parmi11ion to do 10, or any information which the raeident hal reque1ted by kept confidential, includinq reterrall of abu1e coaplainte. The oabudaaan aay, however, encouraqe the re1ident to uke a coaplalnt to ORS or to permit a referral be aade on behalf of the re1ident.
5.Reterral of coaplaintl to other aqencie1 doel not prohibit the oabud1aan froa continuinq to work with the reaident(l) involved. The ouud...n provide follow-up on coeplainte received by the oabudlaan proqr'u, includinq coaplainta referred to other aqenciea, to detaraine : whether an appropriate invetiqation of the alleqecl abu1e hal taken place, the relident' well beinq, and whether the re1ident ie aati1fied with the outco. . of the inv..tiqation.

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5

D. RZIIOR'l'l o UUIJ, lfJQLJ:C'l' Oa ZDtOI'!'A'l'IO RJ:LATIIfQ TO RIIIDElf'l'l o DZIIAATXBX'l' o ~ aZIOU.CZI/DIVIIIOW OPZRATZD IKitLZD .U.II.Q FACILITIZI, IlfTERXIDIATI CARl PACILITIZI AND PERIOKAL C1RI FACILITIJI POa TBI M.wTALLT DIIa.LBD

The report will be reaaiad by the Offiaa of coastitueat ~ieee, Peraoaal Adoeaay t7Dit, of the Dilsioa of MBKRJA at

Offlaa of coaatitueat le~ioea, teraoaal Adooaey ODit

Dilaioa of Meatal Jaaltl, Meatal aetardatloa

aad l~staaaa Abuse

ouztl loor, Two taaoltrea ltraet,

Atlaata, Gaorqia 30303 'l'alaplloaaa - CC04) 1172112

CI:U'f zu-uJJ

1. Tha Office of Constituent Sarvicaa, Personal Advocacy Unit, will have tha raaponaibility tor reviawinq the reports of abuse, naqlact and exploitation, and asaurinq that an appropriate invaatiqation ia carried out.

2. Thia office will provide ORS, within 30 daya of receipt of an initial report of abuaa, naqlact or exploitation which ia allaqed to have occurred to any raaidant or toraar raaidant whila in a Diviaion/DHR operated lonq tan care facility (skilled nursinq, intaraediate care, or paraonal care hoaa), a status report of tha currant situation.

3. Thia office will provide any other aarvica that 11 autually aqraad to ba appropriate to allow other aqanciaa within DHR to carry out their raaponaibilitiaa.

4. Thia aqraaaant doaa not suparaada other aqraaaanta between oRS and tha Diviaion of Mental Health, Mental Retardation and Subatanca Abuse tor the required or aqraad upon raportinq of abusa or exploitation of other patients in lonq tara care tacilitiaa.

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~f.((/Lif!... 6

I 1- 1:-?C"
Date

OHR Department of Family and Children Service

/.2217~
Date ntal Retardation

..(.~... Dincto
DHR Diviion of PUblic Health
~?~rn~1~.~H,aqAe&_; _Dir/ector OHR Diviion of Aqinq

Ctt(t/ q$'
Date

service

.(f. f-A-
oate

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Community Based Services

Resources Guide

Community-based services are funded primarily through Title III of the Older Americans Act, the Social Services Block Grant, and through state funds. These are social services which are not paid for by Medicaid.

Services Provided

The Community Based Services consist of a range of services provided in clients' homes and/or in community settings. They may include~ Transportation, Home-Delivered Meals, Homemaker Services. Congregate Meals, Senior Center Activities, Adult Day Health, and Respite Care, to name a few.

Eligibility

1) Be age 60 or over; and

2) Be determined to have a need which can be met by the service(s).
Please note that in some areas, there may be waiting lists for some or all of these services, or that some of the services may not be provided at this time.

How to Access other Community Based Services

To apply for these services, or to refer someone else, contact the Area Agency on Aging in your area.

Most of the services (social and nutrition) listed below are available through the Area Agencies on Aging (AAA).

Adult Day Health - services that provide adults with personal care in a protective setting outside their homes during any portion of the day and/or provide health care, medical supervision, and health-related supportive services on an outpatient basis in a congregate setting.
Alternative Living Services- provision of24-hour supervision, medically related personal care and health related support services in residential settings other than the client's home.
Alzheimer's Family Support- services provided to support family members who have one or more members suffering from the effects of Alzheimer's disease.

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Assessment- the process by which trained and designated personnel collect and assess necessary information about a client to determine need and/or eligibility for service based on a service plan developed with the client.
Assisted Transportation - provision of assistance. including escort services, to a person who has difficulties (physical or cognitive) in using regular vehicular transportation.
Case Management- planning, arranging and coordinating appropriate services, including an assessment. and continual monitoring of the client's situation to ensure that needed services are received.
Chore Services- heavy or seasonal work, household tasks, yard work or sidewalk maintenance that do not require the services of a trained homemaker or other specialist.
Congregate Meal - one daily well-balanced (meeting 113 of current recommended dietary allowances) or other appropriate meal provided in a group setting at a community location (i.e., senior center, recreation center).
Continuing Education- services, including consumer education, which provide individuals with opportunities to learn through formal academic courses or informal methods with a view toward either vocational or personal enrichment.
Counseling- an interactive process on a one-to-one or group basis which provides a person direct guidance and assistance in the use of health and social services, and helps an individual in coping with personal problems through the establishment of a supportive relationship.
Elder Abuse Prevention - services provided to increase public awareness for community education and to conduct community education regarding the prevention of the abuse, neglect and exploitation of older persons.
Emergency Response System- an in-home electronic support system that provides two-way verbal and electronic communication to geographically and socially isolated clients. It provides seven-days-a-week, 24 hours-a-day access to a medical control center.
Employment- programs designed to increase employment opportunities for the older worker in the general labor market as well as in special employment programs (i.e., Job Training Partnership Act [JTPA], Title V.).
Friendly Visiting - services that provide regular social contacts through visiting with persons who are socially or geographically isolated.

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Health Screening- services which provide early detection of some diseases and assess physical and emotional adjustment to chronic disability or disease. Services include a general health assessment. limited physical examination, and selected laboratory tests. The older person is referred to a health care provider when abnormalities are detected.
Home-Delivered Meals (Meals-on-Wheels}- provision of one well-balanced hot or other appropriate meal (meeting 1/3 of current recommended dietary allowances) to an older person's home.
Home-Delivered Services -under the Community Care Services Program include skilled home health care services rendered on an intermittent basis to chronically ill or impaired clients in their homes.
Home Health Care - skilled health services provided under medical supervision to individuals who can be cared for at home and who need assistance due to short term illness, chronic illness or disability.
Homemaker - help for light housecleaning, laundry, essential shopping, errands and meal preparation.
Home Management - services that provide adults with counseling and training related to home and personal management.
Housing Assistance- technical help (as contrasted with financial) in obtaining adequate housing to help adults improve their present living arrangements or to relocate to more suitable housing.
Information & Assistance- provision of information about services available to older persons. Activities include contacting individual persons or organizations that provide particular services to arrange for services and following up with the service provider or with the older person to make sure that services are provided.
Legal Information - Elderly Legal Assistance Program (ELAP) staff provide brief and/or immediate advice to an elderly person in response to a specific inquiry or problem.
Legal Services - Elderly Legal Assistance Program (ELAP) staff provide legal advice, consultation and/or representation.

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Nutrition Services -
1) Nutrition Counseling: Individualized guidance and advice for improving nutritional status provided by a health professional to older persons who are at nutritional risk due to health or nutritional prescription, dietary intake, medications use or chronic abuse.
2) Nutrition Education: programs designed to promote better health by providing information on nutrition. physical fitness, or health to participants and/or caregivers in a individual or group setting.
Ombudsman Community Education- presentations on long-term care issues by Long-Term Care
Ombudsmen to community groups or to groups of residents, families or facility staff.
Outreach - a service that identifies older persons who need a particular service and then
encourages them to use those services.
Personal Care - providing personal assistance, standby assistance, supervision or little reminders
for persons having difficulty with one or more of the following: eating, bathing, dressing, toileting and transferring in and out of bed.
Recreation - participation in activities such as sports, performing arts, games and crafts either as
a spectator or as a performer.
Respite Care - various services that provide relief and free time to the primary caregivers of a
functionally disabled older person. These services may include day care, companions and temporary placement, among others. The objective of this category of services is to support family caregivers (children, spouse, etc.) to help older persons remain in the home and community.
Shopping Assistance- helping seniors buy food, clothing, medical supplies, household items, and
recreational goods.
Support Groups -Available for caregivers of individuals with Alzheimers Disease.
Telephone Reassurance- interaction with individuals by telephone to reduce their social isolation
and ensure their health and safety.
Transportation - using a vehicle to help an individual travel from one place to another.

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Resource Form
Adult Protective Services:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Area Agency on Aging:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Department of Family and Children Services:_ _ _ _ _ _ _ _ _ _ _ __ Community Care Services Program:_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Community Service Board:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ County Health Department:___________________ Food Stamps:_________________________
Homeless - Resource: -------------------------------------
Legal Services:_______________________________________________ Long Term Care Ombudsman:____________________________________ Medicaid:______________________________________________ Nutrition Programs:________________________________________ Police Department:__________________________________________
Sheriff's Department: ---------------------------------------TANF:.______________________________________________
Transportation Services: ---------------------------------------United Way:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____

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Other Programs Other Services

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