Tracking# 2013-01314 
FA/P 2/7/14, eff. 4/1/14 

I:/13071601.rtf 
(I:/13071601.doc) 

(12 CCR 2518-1) 

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Revisions to Sections 30.100, 13.210, 30.330, 30.410, 30.520, 30.610, 30.620, and 30.830 were final adoption following publication at the 2/7/2014 State Board rule-making session, with an effective date of 4/1/2014 (Rule-making# 13-7-16-1). Statement of Basis and Purpose and specific statutory authority for these revisions were incorporated by reference into the rule. These materials are available for review by the public during normal working hours at the Colorado Department of Human Services, Office of Enterprise Partnerships, Division of Boards and Commissions, State Board Administration. 

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30.100  DEFINITIONS [Rev. eff. 4/1/14]
The following definitions shall apply to these rules.
“Abuse”, pursuant to Section 26-3.1-101(7)(a)(I)-(III), C.R.S., means mistreatment that occurs where there is infliction of physical pain or injury, as demonstrated by, but not limited to, substantial or multiple skin bruising, bleeding, malnutrition, dehydration, burns, bone fractures, poisoning, subdural hematoma, soft tissue swelling, or suffocation; or, where unreasonable confinement or restraint is imposed; or where there is subjection to nonconsensual sexual conduct or contact classified as a crime under the “Colorado Criminal Code”, Title 18, C.R.S. 
“Adult Protective Services (APS) Program”  means the State Department supervised, county department administered program that has the authority to investigate and/or assess allegations of mistreatment and self-neglect of at-risk adults. The APS Program offers protective services to prevent, reduce, or eliminate the current or potential risk of mistreatment or self-neglect to the at-risk adult using community based services and resources, health care services, family and friends when appropriate, and other support systems. The APS Program focuses on the at-risk adult and those services that may prevent, reduce, or eliminate further mistreatment or self-neglect. The APS Program refers possible criminal activities to law enforcement and/or the district attorney for criminal investigation and possible prosecution.
“Allegation” means a statement asserting an act or suspicion of mistreatment or self-neglect involving an at-risk adult.
“Assessment” means the process of evaluating a client’s functional abilities to determine the client’s level of risk, the appropriate mistreatment category(ies), and, in cooperation with the client whenever possible, to identify service needs for the case plan.
"Assumed responsibility", as used in the definition of caretaker, means a person who is providing or has provided recurring assistance to help meet the basic needs of an at-risk adult. The assumption of responsibility can attach by entering into a formal or informal agreement, whether paid or unpaid; by identifying oneself as a caretaker to others; or based on the nature of the situation or relationship between the caretaker and the at-risk adult.
"At-risk adult" means an individual eighteen years of age or older:
A.  Who is susceptible to mistreatment because he/she is unable to perform or obtain services necessary for his/her health, safety, or welfare; or,
B.  Who lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his/her person or affairs.
C.  Persons are not considered “at-risk”  solely because of age and/or disability.
"Caretaker", pursuant to Section 26-3.1-101(2), C.R.S., means a person who is responsible for the care of an at-risk adult as a result of a family or legal relationship or a person who has assumed responsibility for the care of an at-risk adult or is paid to provide care or services to an at-risk adult. 
"Caretaker neglect", pursuant to Section 26-3.1-101(2.3), C.R.S., means neglect that occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, or supervision is not secured for an at-risk adult or is not provided by a caretaker in a timely manner and with the degree of care that a reasonable person in the same situation would exercise; except that the withholding, withdrawing, or refusing of any treatment, including but not limited to resuscitation, cardiac pacing, mechanical ventilation, dialysis, artificial nutrition and hydration, any medication or medical procedure or device, in accordance with any valid medical directive or order, or as described in a palliative plan of care, shall not be deemed caretaker neglect. As used in this subsection (2.3), "medical directive or order" includes, but is not limited to, a medical durable Power of Attorney, a declaration as to medical treatment executed pursuant to Section 15-18-104, C.R.S., a Medical Order for Scope of Treatment form executed pursuant to Article 18.7 of Title 15, C.R.S., and a CPR Directive executed pursuant to Article 18.6 of Title 15, C.R.S. 
“Caseload average” means the fiscal year monthly average sum of new reports plus ongoing cases per caseworker. The fiscal year caseload average is calculated as: [(fiscal year total of new reports/12) + (beginning cases on July 1 + ongoing cases on June 30/2)]/FTE on June 30 = caseload average. 
"Case Planning" means using the information obtained from the investigation and/or assessment to identify, arrange, and coordinate protective services in order to reduce the client’s level of risk for mistreatment.
“Clergy member”, pursuant to Section 26-3.1-101(2.5), C.R.S., means a priest; rabbi; duly ordained, commissioned, or licensed minister of a church, member of a religious order, or recognized leader of any religious body. 
"Client" means an actual or possible at-risk adult for whom a referral has been received and the county department has made a response, via telephone resolution or open case.
"Collateral contact" means a person who has knowledge about the client’s situation that supports, refutes, or corroborates information provided by a client, reporter, or other person involved in the case. Examples of contacts include, but are not limited to, family members, law enforcement, health care professionals, service providers, neighbors, and friends.
"County Department" means a county department of human/social services.
"Data system" means the State Department prescribed data system that the county department shall use to document APS Program activities, including all reports and casework.
"Exploitation" means an act or omission committed by a person that:
A.  Uses deception, harassment, intimidation, or undue influence to permanently or temporarily deprive an at-risk adult of the use, benefit, or possession of his or her money, assets, or property;
B.  In the absence of legal authority:
1.  Employs the services of a third party for the profit or advantage of the person or another person to the detriment of the at-risk adult; or,
2.  Forces, compels, coerces, or entices an at-risk adult to perform services for the profit or advantage of the person or another person against the will of the at-risk adult; or,
C.  Misuses the property of an at-risk adult in a manner that adversely affects the at-risk adult's ability to receive health care or health care benefits or to pay bills for basic needs or obligations.
"Financial institution" means a state or federal bank, savings bank, savings and loan association or company, building and loan association, trust company, or credit union.
"Fiscal Year" means the State Department fiscal year, which begins July 1 and ends June 30. 
“FTE” means Full Time Equivalent. The actual percentage of time a person works on the APS program shall be considered that person’s FTE. 
"Inconclusive report" means that indicators of mistreatment or self-neglect may be present but the investigation and/or assessment could not confirm the evidence necessary to make a substantiated report.
"Information and Referral (I&R)" means providing information about services available from public and private organizations or individuals after conducting a brief assessment to determine that the request does not involve an at-risk adult who is vulnerable or subject to mistreatment or self-neglect. An I&R does not require further investigation or assessment.
"Investigation" means the process of determining if an allegation(s) of mistreatment involving an at-risk adult can be substantiated by a preponderance of evidence.
"Least Restrictive Intervention" means acquiring or providing services, including protective services, for the shortest duration and to the minimum extent necessary to remedy or prevent mistreatment.
"Mistreatment", pursuant to Section 26-3.1-101(7), C.R.S., means an act or omission that threatens the health, safety, or welfare of an at-risk adult or which exposes the at-risk adult to a situation or condition that poses a risk of death or physical injury or harm. Mistreatment includes, but is not limited to, abuse and caretaker neglect. 

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30.210  APS PROGRAM ADMINISTRATION [Rev. eff. 4/1/14]
A.  The Adult Protective Services (APS) Program (Program) is mandated by Title 26, Article 3.1, Parts 1 and 2 of the Colorado Revised Statutes. The county department shall administer the APS Program in accordance with the statutes and rules governing the APS Program and in general State Department fiscal and program regulations.
B.  The county department shall make reasonable efforts to utilize funding appropriated by the State Legislature to maintain a fiscal year caseload average of 25:1, as intended by S.B. 13-111. 
C. The county department shall report to the State Department the active caseworker, case aide, and supervisory staff, including FTE, and the county department’s fiscal year caseload average beginning June 30, 2015 and annually thereafter. 
D.  The county department shall make reasonable efforts to advise county residents of services available through the APS Program by such methods as Adult Protection Team mandated community education, as defined at Section 30.830, B, 4, press releases, presentations, pamphlets, and other mass media.
E.  The county department shall handle responses to requests for services from other agencies, including the State Department, other county departments, or another state’s APS Program, in the same manner and timeframes as requests received from within the county.
F.  The county department shall report to the State Department at such times and in such manner and form as the State Department requires, including through the data system, case file documentation, manually generated reports, quality improvement and assurance processes, and other forms of reporting. 

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30.330  TRAINING REQUIREMENTS [Rev. eff. 4/1/14]

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B.  The county department shall ensure that any APS staff member on the job longer than fifteen (15) months completes ongoing training relevant to the APS Program and client populations. Attendance at any specific training event is at the supervisor’s discretion.
1.  Caseworkers shall successfully complete at least thirty (30) hours of ongoing training per fiscal year related to the APS Program, target populations, and the provision of casework services, as follows:
a.  At least fifteen (15) hours shall be state department provided training specifically related to the APS Program, which may include:
1)  Statewide training;
2)  Regional training;
3)  Quarterly training meetings;
4)  County department onsite training; and/or,
5)  Live webinar or self-directed web-based training.
b.  Additional training options relevant to the APS Program, target populations, and/or the provision of casework services shall include, but are not limited to:
1)  National APS organizations’ webinar training;
2)  Colorado aging and disability conference;
3)  Child Welfare Training Academy coursework that has cross-over relevance and has been approved by the State Department APS unit;
4)  Other State Department APS conferences;
5)  Regional training conducted by agencies or professionals that work with older adults or people with disabilities including, but not limited to, a community centered board, Alzheimer’s association, Colorado legal assistance developer, Colorado Coalition for Elder Rights and Abuse Prevention (CCERAP), Colorado Long-Term Care Ombudsman, local law enforcement, AP team, APS supervisor or county department attorney; and/or,
6)  Reading reports or professional journals provided or approved by the State Department APS unit about current APS best practices, research, and interventions.
2.  Supervisors, managers, administrators, and/or county department directors with direct casework supervision duties shall successfully complete at least 20 hours of ongoing training per fiscal year related to the APS Program, target populations, the provision of casework services, or general supervision of employees, as follows:
a.  At least 10 hours shall be State Department provided training specifically related to the APS Program, as outlined for caseworkers.
b.  Additional training options include those outlined for caseworkers plus training options related to general employee supervision.
3.  Case aides shall successfully complete at least 15 hours of ongoing training per fiscal year, as outlined for caseworkers. At least seven (7) hours shall be State Department provided training.
4.  Required training hours as outlined in Section 30.330, B, 1-3, shall be prorated for part time APS staff.
a.  Persons working less than 25% in APS shall complete a minimum of:
1)  Six (6) hours for caseworkers;
2)  Four (4) hours for supervisors, managers, administrators, and/or county directors with direct casework supervision duties; and,
3)  Three (3) hours for case aides.
b.  Persons working 25-49% in APS shall complete a minimum of:
1)  Fifteen (15) hours for caseworkers;
2)  Eight (8) hours for supervisors, managers, administrators, and/or county directors with direct casework supervision duties; and,
3)  Eight (8) hours for case aides.
c.  Persons working 50-74% in APS shall complete a minimum of: 
1)  22 hours for caseworkers;
2)  15 hours for supervisors, managers, administrators, and/or county directors with direct casework supervision duties; and,
3)  Eleven (11) hours for case aides.
d.  Persons working 75-100% in APS shall complete the full training requirement outlined in 30.330, B, 1-3. 

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30.410  INTAKE [Rev. eff. 4/1/14]

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E.  The county department shall document the report disposition and close the report within twenty (20) working days of receipt of the report. 

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30.520  INVESTIGATION [Rev. eff. 4/1/14]

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B.  The county department shall:
1.  Complete the initial investigation within thirty (30) working days of the receipt of the referral. If the investigation cannot be completed within this time frame, the county department shall document the reason why in the data system.
2.  Document the investigation in the data system within five (5) working days of completion of the investigation, to minimally include window fields and narrative of the:
a.  Allegations;
b.  Mistreatment category(ies) identified by the reporter and any additional mistreatment or self-neglect identified during the investigation;
c.  Worker safety issues, if different from the information in the initial referral;
d.  Client interview information;
e.  Alleged perpetrator(s) information, if applicable;
f.  Collateral interview information;
g.  Evidence collected;
h.  A determination of whether the allegation(s) and additional mistreatment or self-neglect identified during the investigation is substantiated, unsubstantiated, or is inconclusive; and,
i.  The date referred to law enforcement or the District Attorney, and a description of law enforcement or District Attorney (DA) involvement, if any.

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30.610  CASE PLAN DEVELOPMENT [Rev. eff. 4/1/14]
A.  The county department shall develop a case plan for protective services based upon the findings of the investigation and assessment and in accordance with APS principles.
B.  A case plan shall not be developed when the allegations are unsubstantiated and there is no other identified need.
C.  The case plan shall include:
1.  Client strengths, including services in place, support systems, resources, and the client’s personal abilities;
2.  Client needs, including the nature of the protective issue and/or needs of the client and why the client is unable to meet his/her own needs without APS intervention;
3.  Service goals, including why the goal was identified, why it is the least restrictive intervention, how it will meet the client’s needs and reduce risk, the person responsible for implementing the goal, and the implementation date; and,
4.  Client’s and/or client’s fiduciary’s input into the development of the case plan, including the client’s and/or the fiduciary’s consent to the overall plan and the specific goals as outlined in Section 30.620.
D.  The county department shall: 
1.  Complete the initial case plan within thirty (30) working days of the receipt of the referral. If the case plan cannot be completed within this time frame, the county department shall document the reason why in the data system.
2.  Document the case plan, as developed in Section 30.610, C, in the data system within five (5) working days of completion of the case plan, to minimally include window fields and narrative.
E.  The county department shall implement services, upon consent of the client, that are available in the community and that the client is eligible to receive at no or reduced cost or is able to pay for privately.
1.  The county department shall not be required to provide and/or pay for services that are not available in the community or those that the client is not eligible to receive at no or reduced cost or is able to pay for privately; but,
2.  The county department is urged to explore all available options, including private companies, to secure needed services. 
F.  If services are unavailable through other government programs or local service providers and the APS client is unable to pay for the services, the county shall utilize APS county services funds, within available appropriations, to purchase services for the APS client. APS county services funds shall be utilized: 
1.  In emergency situations, to include, but not limited to, emergency shelter, food, or utilities; and/or, 
2.  For one-time, temporary, or short-term needs while the APS client is waiting for other service providers or funding sources to be approved and services begun; and/or, 
3.  To develop a county or regional contract with an agency or professional to provide a specific service for multiple APS clients throughout the contract duration, such as a specialist to conduct in-home capacity evaluations, a registered nurse to do in-home medical evaluations, or a long-term care facility to provide emergency shelter beds.
30.620  CONSENT TO THE PROVISION OF SERVICES [Rev.eff. 4/1/14]
A.  If the client appears to have capacity to make decisions, the client’s consent or refusal to the provision of protective services shall be obtained and documented on the State Department prescribed form.
1.  Written or verbal consent or refusal shall be obtained within 30 working days of receipt of the referral. If verbal consent or refusal is received, the caseworker shall document the verbal consent or refusal on the State Department prescribed form.
2.  If a client refuses protective services, but consents to additional visits from the caseworker, the caseworker shall document the consent to visits on the State Department prescribed form and continue to conduct home visits to assess the client’s need for protective services.
3.  Clients with capacity may refuse any or all services and may revoke consent at any time.
4.  Caseworkers shall provide clients who refuse services with the county department contact information for future reference.
B.  If a client is suspected to lack capacity to make decisions, is at risk for harm, and refuses to consent to services, the county department shall document the client’s inability to provide consent on the State Department prescribed form. The county department shall: 
1.  Make its best effort to obtain an evaluation of the client’s decision making capacity from a qualified professional; and,
2.  Intervene as necessary to provide for the immediate safety and health of the client.
C.  If a client lacks capacity and has a fiduciary to make decisions on behalf of the client, the county department shall consult with supervisors, the county director, the county attorney, law enforcement, and/or the district attorney to determine whether the county department should petition the court for a review of the fiduciary’s actions if:
1.  The fiduciary refuses to allow the provision of protective services, which places the client at-risk for continued mistreatment or self-neglect; or,
2.  There are allegations and evidence of mistreatment of the client by the client’s fiduciary.
D.  The county department shall petition the court under the appropriate statute:
1.  Uniform Power of Attorney Act, as outlined in Title 15, Article 14, Part 7, C.R.S.;
2.  Guardianship or conservatorship statutes as outlined in Title 15, Article 14, Parts 3 and 4, C.R.S.;
3.  Fiduciary oversight statute, as outlined in Title 15, Article 10, Part 5. C.R.S. 

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30.830  ADULT PROTECTION TEAMS [Rev. eff. 4/1/14]
A.  The director of each county department with ten (10) or more referrals of at-risk adult mistreatment and/or self-neglect in the prior state fiscal year is required to establish or coordinate an adult protection team.
1.  The county department may establish its own team or may coordinate with another contiguous county department(s) that is required to coordinate a team.
2.  The team shall meet quarterly, at a minimum.
3.  The county department shall determine the level of decision making authority for the team. The role of the team may be advisory only.
B.  The purpose of the team shall be to:
1.  Review the processes used to report and investigate mistreatment and self-neglect of at-risk adults;
2.  Staff particular cases or possible cases with team members, such as those that: 
a.  Have proven difficult to resolve and team members may be able to identify solutions; 
b.  Are situations where early intervention by other community systems may prevent mistreatment; and/or, 
c.  Are valuable for educating team members on APS program processes and requirements.
3.  Facilitate interagency cooperation regarding services to at-risk adults including the development of solutions and action steps necessary to reduce risk; and, 
4.  Provide community education on the mistreatment and self-neglect of at risk adults. The county department shall be the primary training agency, but may utilize training provided by team members or another designee. The county department shall: 
a.  Determine the topic to be presented, based upon county department or community need;
b.  Use materials developed by the county department, the State Department, national associations, or other professional adult protective services agencies;
c.  At a minimum, provide five (5) training activities per fiscal year, in any combination of the following:
1)  A live presentation to a community or professional group;
2)  Participation in a senior or community forum, such as:
a) Providing an article for a newsletter or local community newspaper; or,
b)  Providing brochures or other written materials at a county department or other community event.
3)  Sponsorship of a community Elder Abuse Awareness Day or similar event.
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.
D.  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 annually.
E.  The team shall develop and adopt written By-laws or a Memorandum of Understanding that minimally include the team's: 
1.  Purpose;
2.  Structure, including: 
a.  Meeting facilitation. Teams that conduct education to the community as part of the team meeting shall adjourn to executive session prior to staffing any case or discussing any APS client or community member;
b.  Frequency of meetings; and,
c.  Composition of the team.
3.  Rules for membership, including:
a.  Member duties;
b.  Process for resignation and causes for termination from the team.
4.  Process for handling potential conflicts of interest.
F.  The county department shall complete and submit to the State Department no later than August 31 an annual team report, which details team activity for the prior fiscal year, utilizing a State Department developed report form. 

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