1. Read text;
2. Skip the exercises unless checked (3) below:
[ ] Exercise A
[ ] Exercise B
3. Take quiz and score it;
4. Read relevant sections of text
again, to see why any questions were missed;
5. Discuss material, if you wish,
with supervisory staff;
6. Read Form B-101 (Employee Statement),
and sign the statement, and turn it in to your supervisor;
7. Keep this learning module
for future reference.
Materials in this learning
Text with references (pp. 2-9);
Exercises (p. 10);
Quiz (pp. 11-12);
Answers to exercises and quiz (p.13); and
Form SOC 341 and Form B-101 (pp.
1. ability to identify the major types of abuse sometimes perpetrated on adults;
2. ability to define dependent adult, elder, and care custodian within the context of abuse reporting;
3. ability to name at least three types of physical abuse (besides sexual abuse), and at least three types of sexual abuse;
4. knowledge of the conditions under which abuse (or suspected abuse) of elders and dependent adults "must be" or "may be" reported to outside agencies under California law;
5. knowledge of reporting requirements
in terms of to whom reports are submitted,
how, and how quickly.
* This module deals only
with "reporting the abuse of adults to outside agencies."
You may have other reporting responsibilities for (a) specials
incidents, (b) unusual occurrences, and (c) other events, under
law, regulation, and your Agency policy.
Under California law, Community
Care Facility (CCF) employees MUST report known (or suspected)
incidents of physical (including sexual) abuse of dependent adults,
when (a) the abuse incident is observed by the person reporting;
(b) the nature of the injury clearly indicates abuse; or (c) the
alleged victim reports an experience that constitutes abuse. Other
kinds of abuse (e.g., neglect, deprivation, abandonment) MAY be
reported. Required reports are to be made by telephone immediately
(or as soon as possible), and in writing (Form S0C 341) within
36 hours. If an incident occurs within a community care
or similar facility, the report goes to the local long-term care
ombudsman coordinator or a local law enforcement agency (LEA),
such as police or sheriff. If the incident occurs somewhere else,
the report is made to the county adult protective services agency
or LEA. Sanctions exist for failure to make required reports,
for false reports, for abuse itself, and for breaches of confidentiality.
The abuse of fellow human beings--physically,
psychologically, or financially--is abhorrent to civilized men
and women, and can never be tolerated. We share with our fellow
Californians a special concern for the abuse of children, dependent
adults, and the elderly. Being more vulnerable than others, such
individuals face greater risk of abuse.
Care custodians and
health practitioners (e.g., nurses) have a responsibility
under California law to report to outside law enforcement and
protective service agencies certain kinds of abuse of elders and
dependent adults. Employees of these latter agencies have comparable
A care custodian is an administrator
or employee of certain public or private facilities, including
but not restricted to (a) community care facilities, (b) 24-hour
health facilities, (c) respite care facilities, (d) foster homes,
(e) schools, (f) sheltered workshops, (g) regional centers for
persons with developmental disabilities, and (h) offices or clinics
of one kind or another.*
An elder is anyone residing
in California, who is 65 years of age or older, whether or not
impaired mentally or physically.
A dependent adult is any
California resident 18 to 64 years of age, who has physical or
mental limitations which restrict his or her ability to carry
out normal activities or to protect his or her rights, including,
but not limited to, persons who have physical or developmental
disabilities or whose physical or mental abilities have diminished
because of age. Included is any person 18-64 years of age, regardless
of physical or mental condition, who is admitted as an in-patient
to a 24-hour health facility.
II. WHAT IS ABUSE
OF ELDERS OR DEPENDENT ADULTS?
Abuse, in the reporting law, is
defined as physical abuse, neglect, intimidation, cruel punishment,
fiduciary abuse, abandonment, or other treatment with resulting
physical harm or pain or mental suffering, or the deprivation
by a care custodian of goods and services which are necessary
to avoid physical harm or mental suffering.
The reporting of some kinds of abuse
to outside agencies is MANDATORY. The reporting of other
kinds is VOLUNTARY.
III. WHAT KIND OF ABUSE MUST
Physical abuse must be reported
to outside agencies, by those required to report, if in the person's
professional capacity and within the scope of his or her employment:
(a) the incident reasonably appears
to be physical abuse and is observed by the person reporting;
(b) if physical injury is observed
and the nature of the injury, its location on the body, or the
repetition of the injury clearly indicates that physical abuse
has occurred; or
(c) if an elder or dependent adult
tells the reporter that he or she has experienced behavior constituting
Other forms of abuse, such as neglect,
deprivation, or abandonment, may be reported to
outside agencies under California law.
includes assault, battery, assault with a deadly weapon, prolonged
or continued deprivation of food and water, sexual assault, or
unreasonable physical restraint.
is the unlawful attempt, coupled with a present ability, to commit
a violent injury on the person of another.
Assault with a deadly weapon
is use of a deadly weapon
or force in an attempt to produce great bodily harm.
a willful and unlawful use of force or violence upon the person
Sexual assault means
any of the following: (a) sexual battery; (b) rape; (c) incest;
(d) sodomy; (e) oral copulation; or (f) penetration by foreign
Sexual battery is
touching an intimate part of a person who is institutionalized
or unlawfully restrained, against that person's will, for purposes
of sexual arousal, gratification, or abuse.
IV. WHAT KIND OF ABUSE MAY
The reporting to outside agencies
of abuse, other than physical (and sexual) abuse, is VOLUNTARY.
Included is neglect, deprivation, and abandonment.
negligent failure of a person having care and custody to exercise
that degree of care which a reasonable person in a like position
would exercise, including failure to (a) assist in personal hygiene,
or in provision of food, clothing, or shelter; (b) provide medical
for physical and health needs; (c) prevent malnutrition; or (d)
protect from health and safety hazards.
Mental suffering means deliberately
subjecting a person to fear, agitation, confusion, severe depression,
or other forms of serious emotional distress through threats,
harassment, or other forms of intimidating behavior.
Fiduciary abuse is
a situation in which anyone who has care or custody or
in a position of trust with the suspected victim takes, secretes,
or appropriates money or property to any use or purpose not in
the due and lawful execution of his or her trust.
means desertion or willful forsaking of an elder or dependent
adult by anyone having care or custody of that person under circumstances
in which a reasonable person would continue to provide
care and custody.
V. SELF ABUSE VS. ABUSE PERPETRATED
The form used to report the abuse
of elders and dependent adults (SOC 341) indicates that self-inflicted,
physical abuse is to be reported. Clearly, if a dependent adult
were to commit suicide, such an incident is to be reported, not
just as required by abuse reporting law, but by several other
laws, regulations, and organizational policies.
What about more typical forms of
self-injury, actual or attempted? Consider, for example, a person
in a community care facility who has a history of "picking
at his skin" or "biting her hand." Do care custodians
have a responsibility to report each such incident to outside
If one re-reads the definitions
of assault and battery on page 3, above, the terms "attempt
to commit a violent injury" and "unlawful use of force"
are used. Further, the definitions deal with aggressive actions
It seems clear that any self-abuse
physically that goes significantly beyond what is known
to be the person's established pattern of self-injury, or which
requires medical attention out of the ordinary, should be reported,
because it may raise new questions as to the person's program
of treatment and need for protective services--in this case, protection
from the person's own violent or forceful, self-injurious impulses.
Each employee is free to discuss
incidents with supervisory staff (e.g., the Administrator or a
house manager). However, such individuals may not, under any circumstances,
inhibit abuse reporting.
It is the responsibility of each
of us to do what we are required to do under the elder and dependent
adult abuse reporting law. Until "gray areas" are clarified,
it is up to each of us to arrive at a determination as to when
we must report abuse. In any event, we may report
any abuse we wish. No one should feel constrained in reporting,
so long as the incident is not false and known to be false by
the person reporting.
VI. WHERE, WHEN, AND HOW ARE
Physical abuse is reported to different
agencies, depending on where the alleged incident occurred. If
the incident occurred in a long-term care facility (e.g., ICF/DD-H,
adult residential facility), the report must go either to (a)
the long-term care ombudsman coordinator or (b) the local law
enforcement agency (e.g., police, sheriff, or probation).
If the incident occurred somewhere
else (e.g., on a bus; visit to someone's home), the report must
go either to (a) the County Adult Protective Services agency or
(b) the local law enforcement agency.
If a report is MANDATORY
(i.e., physical abuse), the report must be made immediately (or
as soon as possible) by telephone, with a follow-up, written report
within 2 working days. If the alleged (or suspected) abuse occurred
within the facility (group home), call the long-term care ombudsman
coordinator or the Police Department, as follows:
If the alleged (or suspected) abuse
occurred outside the facility (group home), call Adult
Protective Services or the appropriate, local law enforcement
agency, as follows:
When two or more persons, who are
required to report, are present and jointly have knowledge of
a known or suspected instance of elder abuse or abuse of a dependent
adult, and when there is agreement among them, the telephone report
may be made by a member of the team selected by mutual agreement,
and a single report may be made. Any member who has knowledge
that the member designated to report has failed to do so, shall
thereafter make the report.
The follow-up, written report should
be submitted on Form SOC 341 (4/87). A copy of this form is attached.
Additional copies are kept on file at the program, or may be obtained
from the local regional center.
If the alleged incident occurred
in a long-term care facility , the written report goes to the
ombudsman coordinator's office. If the incident occurred elsewhere,
SOC 341 is to be submitted within 2 working days to the county
adult protective services agency.
When making a report by telephone,
the ombudsman coordinator (or other agency representative) will
ask for the following information, which will be repeated on SOC
a. name of person making the report;
b. name of elder or dependent adult, along with the victim's age and location;
c. information about the incident:
nature, type of abuse, date and time; and,
d. names and addresses of family
members or any other person responsible for the victim's care.
In addition, the agency representative
to whom the telephone report is given may ask for additional information
as to (l) the physical, mental health, and competency of the alleged
victim; (2) whether the situation is an emergency; (3) family
or other social support systems; (4) whether other agencies are
involved; (5) degree of dependence on others; and (6) whether
there is a conservatorship or representative payee.*
VII. RESPONSIBILITIES OF THE
LOCAL OMBUDSMAN COORDINATOR
The local ombudsman coordinator
is responsible for investigating all allegations of abuse of elders
and dependent adults, when the alleged abuse occurs within
a long-term care facility. Such facilities include community care
facilities , intermediate care facilities of one kind or another,
and several other kinds of facilities.
To proceed with an investigation,
the ombudsman coordinator may need the consent of the alleged
victim. The ombudsman coordinator may report the alleged abuse
to the County Adult Protective Services Agency or to the local
law enforcement agency, and ask for assistance in the investigation
of the abuse. The police or sheriff's office typically does not
need consent of the victim for its investigation.
According to law, the ombudsman
coordinator is to notify as soon as possible, by telephone, the
appropriate licensing agency (e.g., Community Care Licensing;
Health Services Licensing) of alleged or suspected abuse.
VIII. CONFIDENTIALITY AND OTHER
In some instances, the local ombudsman
coordinator may need the consent of the alleged victim to disclose
his or her identity, and other confidential information, to others.
Since some victims may not be in a position to give consent or
to deny consent for an investigation or protective services, a
petition for temporary conservatorship of the victim may be initiated
through the courts.
Persons reporting alleged or suspected
abuse is also protected. The law provides, for example, that care
custodians, health practitioners, and others shall not
incur either civil or criminal liability for any report they are
required or permitted to make under California law.*
Further, such reports and the identity of the reporter are confidential
and may be disclosed only to specified agencies or under certain
Violation of confidentiality provisions
is a misdemeanor, punishable by not more than six months in the
county jail, by a fine or not more than five hundred dollars ($500)
or by both fine and imprisonment.
To encourage care custodians and
others to take seriously their reporting responsibilities, the
law also provides that failure to report physical abuse of
an elder or dependent adult is a misdemeanor, punishable by not
more than six months in the county jail or by a fine of not more
than one thousand dollars ($1,000), or by both fine and imprisonment.
1. California Department of Developmental
Services, RCO 87-28, Subject: "Reporting Requirements:
Elder and Dependent Adult Abuse," from Paul D. Carleton,
Deputy Director (May 4, 1987).
2. California Department of Developmental
Services, Regional Center Operations Manual
(March 1987). Contains a complete copy of the Welfare and Institutions
(W&I) Code, Section 15600, et seq., which covers
3. California Attorney General,
Penal Code of California, Peace Officer's
Abridged Edition with Index, 9th edition (1986).
Mike is severely developmentally
disabled, 29 years of age, and lives in a group home. He has a
history of tantrums, during which he often bangs the right side
of his head with his fist. The frequency of this behavior is recorded
daily; is targeted for change in Mike's Individual Program Plan;
and the behavior has been declining in frequency but not severity.
A new staff member sees bruises on Mike's head, asks Mike about
it, but Mike is unable to tell the staff member anything about
1. Is Mike a dependent adult? Why
or why not?
2. Is the suspected abuse physical
or something else? Explain:
3. May the staff member report the
abuse to the ombudsman coordinator? Explain:
Mary, age 37, is a sexually-active,
non-conserved adult with mild mental retardation. Mary spent Thanksgiving
with her parents. Returning to the group home, Mary tells staff
that she had sexual intercourse with a next-door neighbor. In
reply to questions, Mary says (a) that the neighbor is "about
her age"; (b) that he had asked her to go to bed with him
and she agreed to do so; and (c) that the experience was a good
one. Mary's mother found out about the incident, and threatened
the neighbor with a statutory rape complaint, because Mary's "mental
age" is about ten.
1. Has Mary experienced "sexual
abuse"? Why or why not?
2. Believing that the neighbor "took
unfair advantage" of Mary, if the staff member were to report
that Mary said that she was forced to have sex with the
neighbor, could the staff member be held liable for unlawful behavior?
Why or why not?
3. If the staff member were to report
the incident as a case of "suspected abuse," should
the report go to the ombudsman coordinator? Why or why not?
Please check the answer which best
describes the requirements of the elder and dependent adult abuse
reporting law in California:
1. Which of the following persons
working for a community care facility i5 least likely to be considered
a care custodian?
c. Direct-care aide
2. Which individual is not
included within the meaning of dependent adult for purposes
of abuse reporting?
a. 47-year old, living in an intermediate care facility
b. 76-year old, living in a nursing home
c. 20-year old, wheelchair bound, living with parents
d. 62-year old, with a pre-Alzheimer's
condition (e.g., significant memory loss), living with her husband
3. Which of the following lists includes
most (if not all) of the kinds of abuse that either must be or
may be reported?
a. self-inflicted fiduciary abuse, and physical abuse perpetrated by others
b. physical and sexual abuse, neglect, fiduciary abuse, abandonment, and infliction of pain or mental suffering
c. assault, battery, sexual battery, rape, incest, sodomy, oral copulation, and penetration by foreign object
d. failure to assist in personal
hygiene; failure to provide food, clothing, and shelter; failure
to provide medical care; and failure to prevent malnutrition or
to protect from health and safety hazards
4. In which case is Mary, a care
custodian in a group home for dependent adults, required to report
a. Mary sees Alice, a co-worker, encourage a resident with cerebral palsy to run on a track, and the resident falls down and skins his knee
b. Mary is told by a resident that his sister took $50 from his wallet when he went to his parents' home to visit
c. Julie, a resident, is in a rampage and threatening to destroy the office; Mary subdues Julie, but in the process one of Julie's fingers is broken
d. Mary sees Alice, a co-worker,
get upset at a resident's refusal to take a shower and slaps the
resident across the face
5. Which one of the following conditions
best describes the reporting timelines for required abuse reporting?
a. telephone immediately; send report within 48 hours
b. telephone within 8 hours; send report within 24 hours
c. telephone immediately; send report within 36 hours
d. telephone as soon as possible;
send report within 48 hours
True or False. --Please
circle T or F to indicate whether each statement
is true or false.
T F 6. A VOLUNTARY abuse report must
be made within 36 hours.
T F 7. Before submitting an abuse
report, the care custodian must obtain the informed consent of
the alleged victim.
T F 8. All types of abuse must be
reported to outside agencies.
T F 9. Under some circumstances,
neglect includes failure to assist in personal hygiene.
T F 10. All self-injurious behavior
observed in a group home may be reported to the local ombudsman
11. What agency(s) would you call
to report physical abuse that you believe occurred to a dependent
adult outside the facility (group home)?
12. What FORM would you use to send
in a subsequent written abuse report?
13. Name at least two places where
such a blank form may be obtained:
14. If you cannot find the proper
form, may you write a report on a piece of paper? Please explain:
1. Yes. Mike is between 18 and 64
years of age and has functional limitations associated with his
2. Physical (self-injury). Neglect
might also be involved, if a reasonable person in a like position
to the care custodian would (a) provide medical care or (b) protect
the resident from self-injury in some way.
3. Yes. All types of known or suspected
abuse may be reported. Only physical (including sexual) abuse
must be reported.
1. Probably not. Given her age and
experience, if her self-report is accurate, no sexual battery
occurred. Rape implies force (lack of consent), being under the
age of consent, or being known to be unable to give consent. The
presumption these days is that an adult who is developmentally
disabled is competent until a court order says that he or she
2. Yes. A mandated reporter is given
immunity unless he or she gives a false report and knows it is
false. In this case, there is also malicious intent.
3. No. Since the incident occurred
outside the group home, any report would go to the Adult
Protective Services agency.
1. D 6. F
2. B 7. F
3. B 8. F
4. D 9. T
5. C 10.T
11. Adult Protective Services; a
local law enforcement agency (e.g. Police or Sheriff)
12. SOC 341 (called: "Report
of Suspected Dependent Adult/Elder Abuse")
13. (Any two.) This learning module;
your agency; office of the local long-term care ombudsman coordinator;
local regional center.
14. Yes. The "fact" of
reporting in a timely fashion is infinitely more important than
the paper on which the report is written.