12 CCR 2509-2
DEPARTMENT OF HUMAN SERVICES Social Services Rules RULE MANUAL VOLUME 7 PROGRAM FOR THE PROTECTION OF AT-RICK ADULTS UNABLE TO PROTECT THEIR OWN INTERESTS (PROGRAM AREA 2)
12 CR 2509-2 [Editor’s Notes follow the text of the rules at the end of this CCR Document.]
7.100 PROGRAM AREA 2: PROTECTION OF AT-RISK ADULTS UNABLE TO PROTECT THEIR
OWN INTERESTS
7.101 Program Definition
This program is designed to intervene with, or on the behalf of, at-risk adults to correct or alleviate situations in which actual or imminent danger of abuse, neglect, exploitation (herein known as mistreatment), or self-neglect exists and to utilize support systems to provide continuing safety from the incident(s) of mistreatment or self-neglect.
7.102 Definitions
The definitions set forth in Section 26-3.1-101, C.R.S., shall apply to these rules.
7.103 Target Population
A. Protective services to at-risk adults are provided without regard to income or resources.
B. At-risk adults 18 years of age and older who are unable to protect their own interests, and who are:
1. In need of assessment for protection; and/or, 2. In need of short term services due to a report of actual or potential mistreatment or self- neglect; and/or, 3. In need of ongoing protection as the result of documented evidence of mistreatment or self- neglect.
C. At-risk adults for whom the county department has been appointed guardian and/or conservator.
D. At-risk adults for whom the county department is designated as representative payee.
E. At-risk adults who are residents of long term care facilities, such as nursing homes, assisted living residences, adult foster care, and personal care boarding homes, who must relocate due to the closure of the facility and:
1. For whom the county department has been appointed guardian and/or conservator; or 2. Who are in need of protective services due to a lack of case management and/or assistance from any other reliable source.
7.104 Interagency Coordination
A. The county department, in conjunction with local law enforcement agencies and the Office of the District Attorney, shall develop a cooperative agreement regarding the investigative duties of each agency. The focus of such agreements shall be the coordination of investigations and protective services that promotes the protection of at-risk adults. The agreement shall, at a minimum, include:
1. A process outlining the role of law enforcement receiving, assessing, referring, and responding to reports received during the county department's non-business hours, if applicable;
2. A procedure regarding the county department's submission of written and/or verbal reports of mistreatment and self-neglect to local law enforcement agencies and to the Office of the District Attorney;
3. Procedures for the provision of assistance from one agency upon the request of the other agency; and, 4. Procedures to coordinate investigative duties.
B. The county department shall collaborate with other government and community agencies to coordinate services that promote the protection of at-risk adults.
7.105 Intake
A. The county department shall receive oral or written reports of at-risk adult mistreatment and/or self- neglect, pursuant to Section 26-3.1-101, C.R.S., et seq.
B. The county department shall have an established process during business and non-business hours for receiving such reports.
C. The county department staff shall secure intake information to, at a minimum, include:
1. The adult’s information, such as name, gender, date of birth or approximate age, address, current location if different from permanent address, and phone number;
2. The reporter’s information, unless the reporter requests anonymity, such as name, phone number, address, relationship to client and, if applicable, the reporter’s agency or place of business;
3. Allegations of mistreatment or self-neglect;
4. Safety concerns for the adult;
5. Safety concerns for the caseworker; and, 6. The alleged perpetrator’s information, such as name, gender, address, phone number, and relationship to the client.
D. The county department shall screen the report to determine whether:
1. The adult meets the definition of an at-risk adult as defined in Section 26-3.1-101, C.R.S.; and, 2. The allegations involve mistreatment and/or self-neglect as defined in Section 26-3.1-101, C.R.S.
E. For reports not meeting the guidelines set forth in Section 7.105, D, and therefore not requiring an investigation, the county department may provide appropriate information and referral(s) to the reporting party. Either casework or supervisory staff may inform the reporting party of the decision not to investigate.
F. The county department shall document intake information within two working days of the receipt of the report.
7.106 Assessment and Response
A. For reports meeting the guidelines set forth in Section 7.105, D, the county department shall immediately assess the allegation(s) in order to determine the level of risk to the client.
B. Upon completion of the initial assessment, the county department shall:
1. Determine a timeframe for investigation based upon the following definitions of risk:
2. Determine whether an investigation should be made in conjunction with law enforcement and/or personnel from other agencies.
3. Document all actions related to client contact, including barriers to completing the contact, if applicable.
C. When the report indicates that there is clear and imminent danger to the client, the county department shall make a face-to-face contact with the client immediately, and further clarify and investigate the level of risk of mistreatment and/or self-neglect to the client.
D. When the report indicates urgent risk to the client, the county department shall make a face-to-face contact with the client within 24 hours and further clarify and investigate the level of risk of mistreatment and/or self-neglect to the client.
E. When the report indicates moderate risk to the client, the county department shall make a face-to-face contact with the client no later than three working days after the county department’s receipt of the report, and further clarify and investigate the level of risk of mistreatment and/or self-neglect to the client.
F. When the report originally appears to indicate a need for a face-to-face investigation but further assessment determines that a face-to-face contact is not required to resolve potential risk, the county department may provide telephone assistance, such as:
1. A referral to community service providers; and/or, 2. Information to the client and/or reporter enabling him/her to secure services or legal authority to address the client’s needs; and/or, 3. Communication with service providers and coordination of existing services.
7.107 Investigation
A. If a face-to-face visit occurs, the county department shall open the case for further investigation and provision of protective services. The investigation shall include, at a minimum, evaluation of the following:
1. Indicators of mistreatment or self-neglect.
2. Level of risk to the client.
3. Details of the allegations, including the person(s) or situation(s) causing the risk to the client.
4. The reason(s), if any, the client is unable to act on the client’s own behalf, including:
B. Additionally, the investigation shall include evaluation and written documentation of the following, as applicable:
1. Physical status, including the client’s ability to perform various activities of daily living and any indicators of physical (including sexual) trauma to or neglect of the client.
2. Environmental status, including the conditions within the client’s residence, and the functionality of heating, plumbing, and electrical systems.
3. Financial status, including the client’s income, sources of income, status of bank accounts, monthly bills, assets, and the existence of others assuming authority over the client’s finances.
4. Medical status, including the client’s current and previous medical conditions, hospitalizations, and prescribed medications.
5. Mental status, including the client’s capacity to make decisions; ability to receive or communicate information; behaviors that threaten the safety of the client or others; a history of mental health conditions, hospitalizations, and medications; and, the existence of others with legal authority for decision-making for the client.
6. Support system status, including family members, friends, caregivers, involvement with organizations, health providers, and legal representation.
C. When it is determined through an investigation that risk of mistreatment and/or self-neglect to the client exists, a plan shall be developed for the provision of ongoing protective services.
7.108 Case Plan and Provision of Services
A. The client’s written consent is required for the provision of ongoing protective services. If written consent cannot be obtained, verbal consent shall be obtained. The receipt of verbal consent and the reason written consent could not be obtained shall be documented in the case record.
B. If a client is at risk for harm, refuses to consent to services, and is suspected to lack capacity to make decisions, the county department is urged to pursue court intervention as outlined in Section 7.114.
C. If a client is suspected to lack capacity and court intervention has been initiated, the county department may continue to assess the client’s situation and offer services.
D. The case plan shall, at a minimum, include the following:
1. The client’s service needs to reduce risk;
2. Goals for implementing services, including the proposed activities of the caseworker, client, community agencies, and informal support systems; and, 3. The date the client consented to the protective services and the service goals outlined in the case plan.
E. The county department shall maintain ongoing client contact.
1. In situations in which there are continuing factors of client risk and vulnerability, a face-to-face client contact shall be made by the county department at least every thirty calendar days.
2. In situations in which the client resides in a supervised in-home or facility setting that reduces the possibility of further mistreatment or self-neglect, a face-to-face contact with the client shall be made by the county department at least every sixty calendar days. A face-to- face or telephone contact shall be made with the caretaker or responsible collateral at least once during the sixty day period.
7.109 Reassessment
A written reassessment shall be completed at least once every six months and at the time of case closure. The reassessment shall include all of the following:
A. A reassessment of the client’s status as outlined in Section 7.107.
B. A reassessment of the client’s case plan as outlined in Section 7.108, A – C.
C. Documentation of services provided or arranged, including the date of implementation.
D. Case plan goals that have not been achieved and the reasons for not achieving the goals.
E. Documentation of new client needs and goals for meeting the needs.
F. The ongoing service plan and time frame for achieving remaining and/or new goals.
7.110 Case Closure
A. Cases not requiring additional protective assessment or ongoing intervention shall be closed within sixty calendar days of the last phone, mail, or face-to-face contact with the client.
B. Cases in which the client is relocated to a nursing home may remain open for evaluation of the continuing need for this level of care for no longer than six months, unless the county department has a court appointed guardianship or conservatorship, in which situation the case shall remain open for the duration of the court order.
C. Case closure may occur for any or all of the following reasons:
1. The client does not meet the definition of an at-risk adult.
2. The allegations are determined to be unfounded.
3. The assessment uncovers situations of actual or potential mistreatment or self-neglect and the client is competent to make decisions and refuses services. Whenever possible, a signed statement shall be obtained from the client affirming that the client is aware of the situation which places the client at risk, the possible consequences if the situation continues, and the client’s refusal of services.
4. If, after repeated and documented efforts, the whereabouts of the client cannot be established.
5. The client no longer needs protective services.
6. Service goals are completed.
7. Repeated efforts at service delivery have proven to be ineffective and no additional alternatives exist.
8. The client died. The case may remain open for as long as activities related to the settlement of the client’s estate continue.
D. At the time of case closure, a final summary shall be written which shall include:
1. An assessment of the client’s status as outlined in Section 7.107;
2. An evaluation of the client’s risk factors and associated risk level;
3. A summary of the client’s service plan, including goals achieved and goals not achieved; and, 4. The reason(s) for case closure.
7.111 Multi-Disciplinary Teams
A. The director of each county department is encouraged to convene and coordinate a community at-risk adult protection team.
B. The purpose of such teams shall be to:
1. Facilitate interagency cooperation regarding services to at-risk adults;
2. Review the procedures developed for the investigation of reports of mistreatment or self- neglect of at-risk adults;
3. Review the provision of protective services to at-risk adults; and, 4. Provide community education on the mistreatment and self-neglect of at risk adults.
C. The director of the county department or the director's designee shall identify and recruit team members consistent with professional groups as specified in Section 26-3.1-102(1)(b), C.R.S., and other relevant community agencies or individuals.
D. An established team shall develop and adopt written by-laws that define the team's:
1. Purpose;
2. Structure;
3. Rules for membership;
4. Members’ duties;
5. Terms of office;
6. Process for resignation and termination from the team; and, 7. Process for handling potential conflict of interest.
E. Each team member shall be advised of the confidential nature of his/her responsibilities in accordance with Section 26-3.1-102(7), C.R.S., and shall be required to sign a confidentiality agreement.
7.112 Intercounty Case Transfers
A. When a client relocates to a new county, the case shall be transferred to the receiving county, except in situations as outlined in Section 7.112, B.
1. Within three (3) working days after the county department’s decision to transfer a case, the county department of former residence shall notify the receiving county department of the client’s relocation.
2. In situations where a case has been transferred, case record information shall be supplied to the receiving county department within fifteen (15) working days from the day that the former county notified the receiving county of the transfer.
3. The receiving county will consider the transfer as a new report and will establish a timeframe for investigation as specified in Section 7.106, B.
4. If, after repeated and documented efforts, the receiving county department is unable to locate the client, the receiving county department shall notify the former county department and the case may be closed.
B. When a client relocates to a new county, the case may remain with the former county department if:
1. Transfer would adversely affect the client’s health, safety, or welfare; and/or, 2. The case is within three months of resolution and the former county department chooses to retain the case; and/or, 3. The former county department holds representative payeeship and chooses to retain the case; and/or, 4. The former county department holds guardianship or conservatorship.
7.113 Least Restrictive Intervention
A. Unless the client has been adjudicated incapacitated by the court, the final decision as to acceptance of protective services and services provided by collaborating agencies shall rest with the client.
B. Protective services provided to and other services arranged for the client shall be those services provided for the shortest duration and to the minimum extent necessary to meet the needs of the client.
7.114 Court Intervention
A. When it appears that the client is at risk for mistreatment and/or self-neglect and to lack sufficient capacity to consent to services, the county department is urged to petition the court for an order authorizing the provision of specific protective services and for the appointment of a guardian and/or conservator.
B. Prior to reaching a decision to petition the court, the following factors shall be investigated and documented:
1. No other method of intervention will meet the client's needs.
2. The degree of incapacity, as supported by medical or psychiatric evidence, and the degree of risk as supported by investigative evidence warrants this action.
3. The suspected incapacity of the client and the degree of risk, as supported by the investigative evidence, warrants this action and medical or psychiatric evidence of incapacity cannot be obtained without court intervention.
4. The type of court intervention sought shall be the least restrictive intervention required to meet the needs of the client.
C. In the absence of other responsible parties, such as family or friends, county departments are urged to accept guardianship and/or conservatorship for at-risk adults who lack sufficient capacity to make decisions.
1. The county department shall consult with an attorney prior to filing a petition.
2. The county department shall provide all information deemed necessary by legal counsel.
3. A representative of the county department shall be prepared to testify in support of the petition.
4. When a county department is appointed by the court to act as guardian or conservator, certified copies of the letter of appointment shall be maintained in the client record.
5. The county department shall petition the court to vacate the appointment at such time as court ordered intervention is no longer necessary or the county department is no longer able to fulfill the obligations of the role assigned by the court. Editor’s Notes History