Department for Community Based Services

Standards of Practice Online Manual

19.3 Acceptance Criteria

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter:
Chapter 19-Adult Protective Services (APS)
Effective:
12/2/2015
Section:
19.3 Acceptance Criteria
Version:
4

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Legal Authority/Introduction

LEGAL AUTHORITY:

Staff needs to be aware that there are two (2) definitions of “adult” per KRS 209 and KRS 209A. The Department for Community Based Services (DCBS) receives and investigates reports that allege:

  • Physical abuse, sexual abuse, mental injury, neglect or exploitation of an adult, when the adult meets the definition of adult defined by Kentucky Revised Statue (KRS), Chapter 209 Protection of Adults, which states:
  • "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunction, is unable to manage his own resources, carry out the activities of daily living, or protect himself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services; and
  • Spouse/partner abuse and/or neglect that meets the definition of adult pursuant to:
    • Kentucky Revised Statue, Chapter 209A Spousal Abuse or Neglect, which states: "Adult" means a person without regard to age who is the victim of abuse or neglect inflicted by a spouse; and
    • Ireland v Davis, Ky. App., 957 S.W. 2nd 310 (1997), which states: A person in an ongoing, cohabitating and intimate relationship who is eighteen (18) years of age or older and the victim of alleged abuse by a partner.
  • A spouse/partner abuse victim may also meet the definition of “adult” as defined by KRS 209 and may be served under the provisions of that statute.

Practice Guidance

  • Allegations in an open investigation-When allegations are received on the adult that are not the same as the original allegations, but are received within thirty (30) working days of the original allegations, the SSW may take this as a second incident and include it in the original report.

Procedure

  1. Staff should follow the criteria outlined in the table below to determine whether or not a report meets criteria for investigation.  The format of this section is designed so that staff may view the legal rationale alongside of the agency’s procedures for the criteria.  Legal authority has been shaded in light blue to differentiate it from the SOP procedures.
  2. Please be aware that the following list items are not necessarily all inclusive and may include other acts that the FSOS deems appropriate. 
  3. Reports that do not meet criteria for an investigation will be referred appropriately.
  4.    

  

 I.  Adult Physical or Sexual Abuse

 Legal Rationale:  KRS 209.020 and 922 KAR 5:070

 Acceptance Criteria

 KRS 209.020
(4) "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services;

(8) "Abuse" means the infliction of injury, sexual abuse, unreasonable
confinement, intimidation, or punishment that results in physical pain or injury,
including mental injury;

922 KAR 5:070
(7) The cabinet shall initiate an investigation upon acceptance of a report of:
      (a) Abuse, as defined in KRS 209.020(8), if the report alleges:
      1. Marks that are or have been observed on an adult that another individual allegedly inflicted;
      2. Physical abuse inflicted upon the adult resulting in pain or injury, including a mental injury;
      3. An adult being hit in a critical area of the body, such as the head, face, neck, genitals, abdomen, and kidney areas; or
      4. An act of sexual abuse;

1. The SSW accepts a report of adult physical or sexual abuse that alleges the following acts have occurred:

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

B. Unwanted fondling or touching;

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

D.  Marks that are or have been observed on an adult that were allegedly inflicted by another individual;

E. Rough handling, (for example, forced feeding, roughness when transferring individual from bed to chair, or during bathing); and

F. Inappropriate use of physical or chemical restraints.

 Things to Consider

 

 

 II. Adult Mental Injury

 Legal Rationale:  KRS 209

 Acceptance Criteria

 KRS 209.020
(4) "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services;

(8) "Abuse" means the infliction of injury, sexual abuse, unreasonable
confinement, intimidation, or punishment that results in physical pain or injury,
including mental injury;

1. The SSW accepts a report of adult mental injury that alleges the following acts have occurred:

A. Threats of violence against the adult or others;

B. Threats with a weapon, including objects used as a weapon;

C. Forced isolation or imprisonment, unreasonable confinement;

D. Destruction or threats to destroy property and/or pets;

E. Forcing to perform degrading acts;

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

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

H. Stalking: or

I. Intimidation.

 Things to Consider

 

2. This list is not all inclusive and may include other acts that the FSOS deems appropriate regarding adult mental injury.

 III.  Adult Self-Neglect

 Legal Rationale:  KRS 209.020 and 922 KAR 5:070

 Acceptance Criteria

 KRS 209.020
(4) "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services;

(16) "Neglect" means a situation in which an adult is unable to perform or obtain for
himself or herself the goods or services that are necessary to maintain his or
her health or welfare, or the deprivation of services by a caretaker that are
necessary to maintain the health and welfare of an adult

922 KAR 5:070  
(b) Neglect, as defined in KRS 209.020(16), of an adult that may result in harm to the health and safety of the adult in the following areas:
1. Hygiene neglect, if the adult has physical symptoms that require treatment due to poor care      

3. Food neglect, if an adult shows symptoms of:
      a. Malnutrition;
      b. Dehydration;
      c. Food poisoning; or
      d. Lack of adequate food for a period of time that:
      (i) Results in physical symptoms; or
      (ii) Requires treatment;
4. Environmental neglect, if a serious health and safety hazard is present, and the adult or the adult’s caretaker is not taking appropriate action to eliminate the problem; or
5. Medical neglect, if the adult is not receiving treatment for an injury, illness, or disability that:
      a. Results in an observable decline in the adult’s health and welfare;
      b. May be life threatening; or
      c. May result in permanent impairment;

1. The SSW accepts a report of adult self neglect alleging that the adult’s health or welfare has suffered or declined as a result of:

A. Unmet personal or medical needs, such as bedsores, malnourishment, dehydration, inappropriate clothing, poor hygiene, incorrect use of medication, lack of food or inadequate food;

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

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

D. Living alone and in life threatening conditions;

E. Being unable to manage own resources;

F. New onset of confusion and/or disorientation;

G. Attempts to commit suicide; or

H. Hoarding.

 Things to Consider

 

2. This list is not all inclusive and may include other acts that the FSOS deems appropriate regarding adult self-neglect.

 IV.  Caretaker Neglect

 Legal Rationale:  KRS 209.020 and 922 KAR 5:070

Acceptance Criteria

KRS 209.020
(4) "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services;

(6)"Caretaker" means an individual or institution who has been entrusted with or
who has the responsibility for the care of the adult as a result of family
relationship, or who has assumed the responsibility for the care of the adult
person voluntarily or by contract, employment, legal duty, or agreement;

(16) "Neglect" means a situation in which an adult is unable to perform or obtain for
himself or herself the goods or services that are necessary to maintain his or
her health or welfare, or the deprivation of services by a caretaker that are
necessary to maintain the health and welfare of an adult


922 KAR 5:070
(b) Neglect, as defined in KRS 209.020(16), of an adult that may result in harm to the health and safety of the adult in the following areas:
      1. Hygiene neglect, if the adult has physical symptoms that require treatment due to poor care as a result of:
      a. An act or omission by a caretaker; or
      b. The absence of a caretaker;
      2. Supervision neglect, if the reporting source has observed a physical health and safety risk to an adult resulting from a lack of necessary and appropriate supervision;
      3. Food neglect, if an adult shows symptoms of:
      a. Malnutrition;
      b. Dehydration;
      c. Food poisoning; or
      d. Lack of adequate food for a period of time that:
      (i) Results in physical symptoms; or
      (ii) Requires treatment;
      4. Environmental neglect, if a serious health and safety hazard is present, and the adult or the adult’s caretaker is not taking appropriate action to eliminate the problem; or
      5. Medical neglect, if the adult is not receiving treatment for an injury, illness, or disability that:
      a. Results in an observable decline in the adult’s health and welfare;
      b. May be life threatening; or
      c. May result in permanent impairment;

1. The SSW accepts a report of caretaker neglect that alleges the following acts occurred;

A. Abandonment or lack of supervision;

B. Unmet personal or medical needs, such as bedsores, or incorrect administration of prescribed medication;

C. Failure to provide adequate food or hydration;

D. Adult has physical symptoms the require treatment due to poor hygiene as a result of an act or omission by the caretaker or the absence of the caretaker, and clothing is insufficient to meet the elements;

E. Serious environmental health and safety hazards are present and the adult or the adult’s caretaker is not taking appropriate action to eliminate the problem;

F. A lack of necessary and appropriate supervision has created physical health and safety risks to the adult;

G. Forced isolation, unreasonable confinement;

H. Not obtaining needed mental health or medical services or permitting unnecessary pain.

Resident to Resident Allegations in Alternate Care Settings

The SSW: 

1. Asks the following questions, in addition to the normal intake questions, when a report is received of a resident to resident incident:

  A. Was there a physical or mental injury resulting from the incident?

  B. What is the cognitive status of the residents involved?

  C. Is there a history of incidents involving either of the residents?

  D. What actions were taken by the facility to protect from further incidents?

 

 Things to Consider

 

 

2. The initial focus of resident to resident allegations in alternate care settings is on potential neglect involving the facility.

 V. Adult Exploitation

 Legal Rationale:  KRS 209.020 and 922 KAR 5:070

 Acceptance Criteria

 KRS 209.020
(4) "Adult" means a person eighteen (18) years of age or older who, because of mental or physical dysfunctioning, is unable to manage his or her own resources, carry out the activity of daily living, or protect himself or herself from neglect, exploitation, or a hazardous or abusive situation without assistance from others, and who may be in need of protective services;
(9) "Exploitation" means obtaining or using another person's resources, including
but not limited to funds, assets, or property, by deception, intimidation, or
similar means, with the intent to deprive the person of those resources;

922  KAR 5:070
(c) Exploitation of an adult, as defined in KRS 209.020(9), if the report alleges:
      1. Isolation from friends, relatives, or important information, such as:
      a. Screening telephone calls;
      b. Denying visitors; or
      c. Intercepting mail;
      2. Physical or emotional dependency;
      3. Manipulation;
      4. Acquiescence; and
      5. Loss of resources;

1. The SSW accepts a report of exploitation if there is an indication of: 1 

A. Force, deception or manipulation through

B. Isolation from friends, relatives or important information, such as screening phone calls, denying visitors, or intercepting mail;

C. Compelling physical or emotional dependency; or

D. Excessive charges for food, shelter, care or services;

E. Unauthorized or fraudulent use of monies, resources or assets;

 

 Things to Consider

 

 

 VI.  Spouse/Partner Abuse and Neglect

 ***Prior to applying the criteria below, rule out caretaker neglect or adult abuse if the victim meets the definition of vulnerable adult.

 Legal Rationale:  KRS 209A.020 and case law

Acceptance Criteria

KRS 209A.020
(4) "Adult" means a person without regard to age who is the victim of abuse or
neglect inflicted by a spouse;

(6) "Abuse" means the infliction of injury, unreasonable confinement, intimidation,
or punishment resulting in physical harm or pain, including mental injury;

(9) “Neglect” means a situation in which a person deprives his or her spouse of reasonable services to maintain health and welfare;

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

1. The SSW accepts a referral of spouse/partner abuse or neglect when following factors are alleged: 

A. Unwanted fondling, forced sexual relations, including forced sex with others, animals or foreign objects;

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

C. Unreasonable confinement including the use of physical or chemical restraints or punishment resulting in physical harm or pain;

D. Threats of violence against the spouse/partner, self or others;

E. Threats with a weapon, including objects used as a weapon;

F. Forced isolation or imprisonment;

G. Destruction or threats to destroy property and/or pets;

H. Forcing to perform degrading acts;

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

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

K. Stalking;

L. Intimidation;

M. Actively prohibiting the spouse/partner from obtaining needed medical care;

N. Controlling the environment to the extent that it prohibits the spouse/partner from carrying out activities of daily living.


 

 Things to Consider

 

 

 VII.  General Adult Services

 Legal Rationale:  KRS 209.0365, 387.540 and 922 KAR 5:090

 Acceptance Criteria

KRS 209.035
The cabinet shall promulgate administrative regulations for the provision of general adult services to include uniform criteria for adult intake and appropriate and necessary service provision.

KRS 387.540

3. Interdisciplinary Report

922 KAR 5:090
(7) "General adult services" means a voluntary preventive service aimed at assisting:
      (a) An adult to attain and function at his highest level of self-sufficiency and autonomy; and
      (b) In maintaining the adult in the community.

922 KAR 5:090
Section 2. Criteria for Intake and Assessment. (1) If a social service worker and the adult agree, an individual eighteen (18) years of age or older shall be eligible for general adult services:
      (a) If he is:
      1. Mentally or physically dysfunctional and not in an abuse, neglect or exploitation situation; and
      2. Requesting the service or in a situation where service is requested at the direction of an individual through another individual or agency;
      (b) If an allegation of abuse, neglect, or exploitation is made and the alleged perpetrator is a:
      1. Former spouse;
      2. Former cohabiting partner; or
      3. Partner with a child in common; or
      (c) If he requests a transitioning service from out-of-home care within twelve (12) months of release from the cabinet’s commitment.
      (2) An individual sixty-five (65) years of age or older shall be eligible for general adult services if he is:
      (a) Not mentally or physically dysfunctional; and
      (b) Allegedly being abused, neglected or exploited by a:
      1. Family member;
      2. Household member; or
      3. Caretaker.

 1. The SSW accepts a report for services requested by an adult sixty-five (65) years of age or older, who is not physically or mentally dysfunctional, but is being abused,   neglected or exploited by a family member, household member or caretaker;

2. Accepts an interdisciplinary evaluation report (IDT) from the court for services when an adult is alleged to be partially disabled or disabled as referenced in KRS 387.540 and abuse, neglect or exploitation are not alleged; 

3. Accepts a report for services for any of the following situations if the SSW and the adult (eighteen (18) years of age or older) agree:

  A. Physically or mentally dysfunctional, but is not being abused, neglected or exploited and is requesting services or in a situation in which services are requested at the direction of an individual through another individual or agency;

  B. An alleged victim of domestic violence, and the perpetrator is a former spouse, a former co-habiting partner or a partner who has a child in common with the adult; or 

  C. Transitioning from out of home care and released from commitment within the past twelve (12) months and requesting services for self-sufficiency;

 

 Things to Consider

 

1. When a report is received that does not meet the definition of adult it may be reviewed to determine if the information or allegation meets acceptance criteria for general adult services or is appropriate for referral to other community partners for assistance.  In these cases the General Adult Services path is chosen at intake.

 

 

 

 Criteria for Reports that are not Accepted

 Legal Rationale:  922 KAR 5:070, 922 KAR 5:102

 Acceptance Criteria

922 KAR 5:070
Section 2
(5) If a report does not meet criteria for investigation, the cabinet may refer the reporting source to:
     (a) Community resources;
     (b) General adult services in accordance with 922 KAR 5:090; or
     (c) Domestic violence protective services in accordance with 922 KAR 5:102.

(8) If a report alleging the exploitation of an adult does not meet criteria established in subsection (7)(c) of this section, the report may be referred to an appropriate authorized agency or community resource.

   (9) The following criteria shall be used in identifying a report of adult abuse, neglect, or exploitation not requiring an adult protective service investigation:
     (a) The report does not meet the statutory definitions of:
     1. Adult; and
     2.a. Abuse;
     b. Neglect; or
     c. Exploitation; or
     (b) There is insufficient information to:
     1. Identify or locate the adult; or
     2. Explore leads to identify or locate the adult.

922 KAR 5:102
Section 2
  (9) If a victim of domestic violence does not meet the criteria established in KRS Chapter 209A, the victim may be serviced by referring the victim to:
      (a) Community resources, including domestic violence shelters that meet the standards specified in 922 KAR 5:040;
      (b) General adult services in accordance with 922 KAR 5:090; or
      (c) Adult protective services in accordance with 922 KAR 5:070.

The FSOS may reject the following as a report for adult protective services investigation:

1. The reporting source does not provide sufficient information to determine that the alleged victim:

  A. Has a mental or physical dysfunction;

  B. Is unable to manage his/her own resources, carry out the activity of daily living or protect himself from neglect, exploitation, or a hazardous or abusive situation without assistance from others; and

  C. Needs protective services;

2. The alleged victim is under the age of eighteen (18) and not married to the alleged perpetrator at the time of the alleged abusive incident;

3. There is insufficient information to identify or locate the adult, or explore leads to identify or locate the adult;

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

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

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

7. The reporting source reports inadequate hygiene conditions that, although not optimal, do not adversely affect the well-being of the adult;

8. The reporting source reports of threats to commit suicide;

9. The adult’s right to self-determination and lifestyle issues are compromised with no allegation of abuse, neglect or exploitation; or

10. The report concerns a situation or specific incident investigated in the past thirty (30) days and no new or additional information or change in the adult's circumstances is communicated by the reporting source.

11. When a report does not meet the criteria for investigation, the SSW:

  A. Provides information pertaining to acceptance criteria to the individual making the report, if requested;

  B. Review reports not requiring investigation to determine if they can be referred; and

  C. Enters the report as a resource linkage and documents the reason for not accepting the report.

 

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