Parking Lot Recommendations The TG strongly agrees that a mandatory report alone is not sufficient to protect the vulnerable adults in Colorado. While SB15-109 asked the TG to make recommendations related to expansion of mandatory reporting to adults with IDD, including the costs for the investigation, provision of services, and training costs for those professionals who are mandated to respond to reports and the mandatory reporters, the TG believes there are other critical needs that must be addressed in future legislation to develop a more comprehensive system of reporting and services that will lead to improved outcomes for vulnerable adults experiencing mistreatment. Vulnerable adult mistreatment – including all vulnerable populations in mandatory reporting The TG recommends statutory changes to implement a complete system of mandatory reporting for all of Colorado’s vulnerable adults experiencing mistreatment. With this expansion of mandatory reporting for adults with IDD, Colorado has created a patchwork of protections for some vulnerable populations, while leaving others without this added layer of protection. Additionally, the category of “at-risk elder” is in conflict with the target population for APS or “at-risk” (or vulnerable) adults. APS does not provide services simply based on age or disability, instead focusing resources on those who’s needs are so great that they are unable to secure necessary services to meet their basic health, safety, and welfare needs or those who are unable to understand or make responsible decisions. The TG recommends that the mandatory reporting statute be modify in the next legislative session to define a new term of “vulnerable” adult, which is defined in the same way as “at-risk adult” is currently defined int he APS statute. Changing the term from “at-risk” to “vulnerable” ensures that district attorneys can continue to recommend enhanced sentencing when crimes are committed at-against persons that meet criteria of the more broadly defined “at-risk adult” in the criminal code. Mandatory reporting should extend to this complete “vulnerable” population to ensure that Colorado has a complete system of mandatory reporting. Approximately 55% of APS reports involve a person who is 70 or older and 8% involve an adult with IDD, the two populations that will be covered under mandatory reporting. That means that approximately 37% of Colorado’s vulnerable adults served by APS are not protected by the mandatory reporting law. These adults have early onset dementia, traumatic brain injuries, are medically fragile, have advanced neurological disease, such as ALS, MS, or Parkinson’s, have a complex physical disabilities or a condition that requires total physical care, or have a major and persistent mental illness that impairs their capacity. Colorado remains as an outlier across the nation by not having a complete system of mandatory reporting.

Office of Public Guardianship The TG supports efforts that may lead to a comprehensive public guardianship and conservatorship program, which would eventually take over the county role of petitioning and acting as guardians and conservators. The TG recommends implementing the recommendations made by the Office of Public Guardianship Task Force in its 2014 report to the Legislature. The State of Colorado does not have a public guardianship program for persons in need of guardianship and who do not have appropriate family or friends available to act as the guardian. Additionally, the state does not have the resources available to provide a professional guardian to these individuals. Currently, the State relies on a patchwork system of private and volunteer guardians and Adult Protective Services staff to provide guardianship services for adults with no other appropriate guardian available. For example, APS routinely gets calls from health care providers and long-term care facilities requesting that APS take guardianship in order to make health care and end of life decisions for patients or residents with no advanced directive and with no one available to assist with these decisions. Not only is APS prohibited from petitioning for guardianship to make health care decisions, these highly personal and sensitive decisions are outside the statutory authority and ethical scope of the APS program. Guardianships and conservatorships are the most restrictive interventions used in APS. For APS clients with adequate resources, a private guardian or conservator can be appointed as there are assets available to pay the guardian’s and conservator’s fees. But, for many APS clients there are not adequate resources to cover the costs of a private guardian or conservator. Some counties do have a public administrator available to take on the role of conservator. In these situations, APS will generally file the petition for conservatorship with a recommendation to appoint the public administrator. However, the state of Colorado does not have a public guardianship program that can assume this role for clients in need of a guardian. The Denver metro area and the Colorado Springs metro area do have a volunteer guardianship organization that may be utilized for some clients, but this type of organization is not available in other areas of the state. Additionally, volunteer guardianship programs have limitations, particularly in the type of client they can serve and the overall number of clients they can serve. Volunteer organizations generally do not provide services to manage difficult individuals. County APS units are the guardian and conservator of last resort and the county departments look to others to step in as a client’s guardian whenever possible. Family members, clergy, neighbors, and so on are identified and reviewed to determine if they would be appropriate to serve as the client’s guardian. But, in many situations, APS is the only appropriate guardian available. In FY 2012, counties held a total of 325 guardianships and 15 conservatorships. APS may petition for guardianship and/or conservatorship on behalf of another party or the public administrator. Data on the number of these petitions is not available. The costs associated with guardianship and conservatorship cases are many, and vary from case to case. A guardianship and conservatorship can consume the majority of a worker’s time on

one case. County attorneys, supervisors, Adult Protection Team members, and directors often contribute time to guardianships. Workers are required to have monthly contacts with wards and clients, coordinate and monitor ongoing services, make medical and placement decisions, communicate with family and interested parties, manage financial assets, and provide court reports, in addition to meeting typical APS requirements and documentation. Expansion of Necessary Services The TG recommends increased funding for some existing services and the development of new services necessary to meet the protective services needs of all vulnerable adults in Colorado. The Task Force has identified numerous deficiencies in Colorado’s ability to adequately respond to mistreatment of at-risk elders, adults with IDD, and other vulnerable populations served by APS, each of which must be addressed by the Legislature. Failure to address deficiencies in the service system means poorer outcomes for vulnerable adults, even with mandatory reporting and law enforcement and APS intervention. These deficiencies include but are not limited to: (NOTE: These will need to be further expanded for the final report.) 

General safety net services, such as food, shelter, transportation, and/or medical care;



Respite care for caregivers;



Mental health services;



Services for persons with a developmental disability;



Safety planning;



Placements for clients with difficult and/or violent behaviors and/or criminal histories.

Expansion of the Single Entry Point (SEP) System In addition to these services, the Task Force recommends expansion of the Single Entry Point (SEP) case management system. Currently, program rules require SEP case managers to conduct a face-to-face home visit with clients just one time per year. Adults who qualify for HCBS services and SEP case management must have needs great enough to meet nursing home level of care standards. These are vulnerable adults who are susceptible to abuse, neglect, and exploitation by the care givers who come into their homes to provide services. SEP case managers should have eyes on these clients quarterly, at a minimum. However, in order to meet this standard, additional FTE would need to be funded for the system.

Authority for APS and Law Enforcement to Access Records and Victims The TG recommends providing statutory authority to APS for access to the victim and any pertinent documentation, such as medical records, care plans, daily chart notes, and bank records. The TG further recommends modification of reporting requirements in statute to compel reporters to provide more detailed information and records necessary for law enforcement and APS to conduct a thorough investigation. Often, APS receives a report of mistreatment of an at-risk adult and while trying to conduct an investigation is blocked from receiving evidence needed to determine whether an allegation is substantiated or not. Other times, APS is prevented from seeing a client by the alleged perpetrator or facility staff. In the Federal Draft Guidelines for State APS Systems released in July 2015, the Administration for Community Living (ACL) recommends that states provide the APS program with statutory authority that clearly:  Delineates the APS program’s authority to access alleged victims of mistreatment and to prevent another person’s interference in an APS case. This access should include the authority to conduct a private interview with the alleged victim.  Delineates the APS program’s authority to access documents from individuals and institutions for the purpose of investigating alleged maltreatment. The access should include the power of APS to subpoena records. Delays in getting access to a client or to pertinent records could lead to further mistreatment and poorer outcomes for that client. Currently, if law enforcement is not involved in a case, APS has no authority to compel access or documents. Approximately 45% of all types of alleged mistreatment for APS is self-neglect. Law enforcement is not involved with cases alleging selfneglect, unless there are allegations of abuse, neglect, or exploitation in addition to the selfneglect. In many other cases, law enforcement does not investigate the possible criminal activity. The TG believes that it is critical to provide APS this statutory authority to ensure that full access to evidence and victims is available when law enforcement is not involved. *Note: this paragraph needs further development, but this begins to lay out the recommendation explanation related to LE: Law enforcement finds similar problems in that some mandatory reporters will call to make the required report but refuse to provide critical evidence and information for law enforcement to begin an investigation because the statute does not provide enough authority to compel the sharing of critical information. The TG recommends statutory updates to further delineate the information to be provided by the reporter.

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