PROFESSIONAL BOUNDARIES

PCA Boundaries - If you are a PCA, boundaries are important. These guidelines are for your safety as well as the safety of the person.

You may not:

·        Accept gifts or money from the person receiving services or from family members.

·        Borrow money, cars, equipment or anything else from the person receiving services or from family members.

·        Buy any possessions from the person receiving services or from their family members.

·        Have a romantic or sexual relationship with the person receiving services or with immediate family members.

·        Loan money to the person receiving services or their family members.

·        Sell items of any kind to the person receiving services or to family members.

·        Sexually harass the person receiving services or family members.

·        Verbally, physically, financially or sexually abuse the person receiving services or their family members.

Signs of boundary issues in the working relationship include:

·        Offers of gifts.

·        Person receiving services makes unreasonable requests.

·        Speaking negatively about other workers.

If you feel there are boundary issues with the person, talk to your Qualified Professional (QP). Addressing these issues early can help stop boundary violations.

Boundaries for Family Members and Friends - If you are a PCA, you must be careful to guard the person's privacy. You must have a professional manner while carrying out PCA services. If you are a family member or friend and the PCA, this could be more difficult and challenging.

For example, parents often tell stories about their children. "When Johnny was two, he would not go to bed without his stuffed blue dog."

This story may or may not cause Johnny (who is now 30) a bit of embarrassment, but his parents love to tell it. If you were a PCA to Johnny when he was two, you would not be able to share that tale if putting him to bed was a task you performed. Telling the story would be a violation of Johnny's privacy.

The tasks you do for a person as a PCA must remain between you, your agency and the person. You must also be cautious when talking about anyone else who provides PCA services.

As a family member or friend and PCA, it may be easy to talk about how the other PCAs are performing. Avoid this situation as much as possible. The qualified Professional (QP) or agency should be made aware if there are problems with another PCA.

Friends and family often do many small tasks for each other daily. As a PCA, you may count time only for activities that are in the care plan during scheduled PCA time.

For example, you are a friend of Johnny's and providing PCA services. Your task is to help Johnny bathe and dress. You notice that Johnny needs to have his laundry done. During your PCA scheduled time, you may NOT throw in a load of laundry. After you complete your PCA duties and time is noted, you may offer to begin the laundry for Johnny.

MALTREATMENT

As a PCA, you are a mandated reporter of any maltreatment of a vulnerable adult. Adults who receive PCA services are considered vulnerable adults. A mandated reporter is a person who MUST make a report if there is caused to believe that maltreatment of a vulnerable adult has occurred. The reporting rules vary some for vulnerable adults.

This section of the module covers very basic details on maltreatment and making a report. Your agency is required to provide you with detailed training.

The Department of Human Services Child Protection and Adult Protection units each have in-depth courses on the web. Maltreatment is the neglect or abuse of a vulnerable adult. Neglect is the failure to provide food, clothing, shelter, medical care and/or supervision. For children, abuse is defined in terms of physical or sexual.

For adults, abuse can be physical, emotional, sexual or financial. Financial exploitation includes:

·        Misuse of the person's funds, assets or property.

·        Failure to use the person's funds and resources to care for the person which may result in harm to the person.

MISSISSIPPI PROTECTIVE SERVICES OF VULNERABLE PERSONS

Training Goal: The overall goal for this training is to provide an overview of Mississippi Protective Services of vulnerable persons and increase awareness of the mandatory reporting requirements

Who Is A Vulnerable Adult?

Vulnerable Adult means a person age 18 or older whose ability to perform the normal activities of daily living, and/or to provide for his or her own care or protection, is impaired due to a mental, emotional, sensory, long-term physical, or developmental disability or dysfunction, or brain damage, or due to the infirmities of aging.

What is a Caregiver?

“Caregiver” means a person who has been entrusted with or has assumed the responsibility for frequent and regular care of or services to a vulnerable adult on a temporary or permanent basis and who has a commitment, agreement, or understanding with that person or that person’s guardian that a caregiver role exists.

Overview of Abuse, Neglect and Exploitation

Abuse, neglect and exploitation are complex and often hidden problems. The Mississippi Attorney General is responsible for the regulation and oversight of the Vulnerable Adults Unit. Adult Protective Services investigates and corrects abuse, neglect and exploitation through the reports taken by the Mississippi Abuse Hotline (1-844-437-6282). Everyone has a responsibility to make a report when abuse, neglect or exploitation is suspected.

What is Abuse?

“Abuse” means any willful act or threatened act by a relative, caregiver or household member which causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse includes acts and omissions.

What Is Neglect?

Neglect means the failure or omission on the part of the caregiver or vulnerable adult to provide the care, supervision, and services necessary to maintain the physical and mental health of a vulnerable adult. Neglect also means the failure of a caregiver or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect or exploitation by others. Neglect is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury, or a substantial risk of death.

What Is Exploitation?

Exploitation means knowingly, by deception or intimidation, obtaining or using, or attempting to obtain or use the adult’s funds, assets, or property with the intent to temporarily or permanently deprive the adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.

A Person Who Exploits is...

A person who stands in a position of trust and confidence with a vulnerable adult. A person who knows or who should know that the vulnerable adult lacks the capacity to consent. Not always known by the victim

What Does Abuse, Neglect and Exploitation Look Like, what are the Indicators, and Who are the Abusers?

·        Abusers are often a family members, trusted friends, and caregivers!

·        Likely to have a history of mental or behavioral disorders

·        May be using/abusing alcohol or other substances

·        May have a poor financial situation or financial dependency

·        Often are critical of others and lack understanding about the needs of those for whom they care

Indicators of Abuse, Neglect, and Exploitation

Physical Indicators:

·        Unexplained Fractures, Unexplained Burns, Unexplained Lacerations, Sexual Abuse,

·        Other such as emaciated, unusual lumps, protrusions, bald spots, scars, lack of clothing or same clothing, fleas or lice, unkempt or dirty.

Environmental Indicators:

·        Home; with garbage thrown about inside and outside, hazardous living conditions due to lack of repairs, human or animal excrement, fire hazards, large number of animals lacking care. Food and Clothing; little to no food, food spoiled or lying around, insufficient clothing for the weather.

·        Social Deprivations: no evidence of social visits, television, radio, physically isolated from community, lack of friends, attempt by caregiver to isolate the individual from others.

·        Financial: little or no money, activity in account not usual or age appropriate, POA given when the individual is clearly incapable of making this decision, recent will changed, lack of amenities.

·        Behavioral Indicators of Victim: Destructive Behavior of Victim; assault others, destroy belongings, threatens harm or suicide, inappropriately displays rage in public, afraid of being alone, recent and sudden changes in behavior or attitude, suspicion of other people, shows symptoms of withdrawal, severe hopelessness, constantly moves from place to place, frightened of caregiver, overly quiet, passive, timid, denial of problems.

·        Behaviors of Family or Caregivers: family discord, striking, shoving, beating, name-calling, scapegoating, hostile, secretive, frustrated, shows little concern, poor self-control, blames adult, impatient, irresponsible, denial of problem, recent crisis, inability to handle stress, recent loss of spouse, withholds food or medication, isolates individual from others in the household, lack of physical, facial, eye contact with individual, changes doctors frequently, past history of similar incidents, unrealistic expectations of individual.

How Does Abuse Happen?

Family dynamics contribute to abuse:

·        Marital conflict, family discord or isolation from others

·        Caregivers who feel forced to provide care, resentment, or jealousy

·        Too many people in a crowded home

·        Financial problems or lack of financial expertise

·        Medical issues, physical or cognitive limitations

·        Adverse life events such as death of a spouse/partner or close friends, financial setbacks, or change in health status

·        Inability to speak English, isolation or dependence

·        Loneliness, fatigue, fear or trauma

·        There is a family history of abuse.

The Protective Investigation

·        Commence investigation within 24 hours of receiving report

·        Determine any indicators of abuse, neglect or exploitation

·        Assess safety and risk of further harm

·        Determine need for services

·        Complete investigation within 60 days Investigative

Reporting Abuse, Neglect, and Exploitation Mandatory Reporting

·        Required by law: Any person who has reasonable cause to believe that a vulnerable adult is being abused, neglected or exploited; A person who knowingly and willfully fails to report a case of known or suspected abuse, neglect, or exploitation of a vulnerable adult, or who knowingly and willfully prevents another person from doing so, commits a misdemeanor of the second degree, punishable by law. 

·        Mississippi Hotline is (1-844-437-6282)

·        24-hour, toll-free statewide hotline

·        On-line reporting at https://reportabuse.dcf.state.ms.us/

Mandatory Reporters

Any person, including, but not limited to, any:

1.      Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of vulnerable adults;

2.      Health professional or mental health professional other than one listed in subparagraph 1.;

3.      Practitioner who relies solely on spiritual means for healing;

4.      Nursing home staff; assisted living facility staff; adult day care center staff; adult family-care home staff; social worker; or other professional adult care, residential, or institutional staff;

5.      State, county, or municipal criminal justice employee or law enforcement officer;

6.      Employee of the Department of Business and Professional Regulation conducting inspections of public lodging establishments Mississippi advocacy council or Disability Rights Mississippi member or a representative of the State Long-Term Care Program; or

7.      Bank, savings and loan, or credit union officer, trustee, or employee, shall immediately report such knowledge or suspicion to the central abuse hotline.

What to Report

1.      Name, age, race, sex, physical, mental or behavioral description or infirmity, and location of each victim alleged to have been abused, neglected, or exploited.

2.      Names, addresses, and telephone numbers of the victim’s family members.

3.      Name, address, and telephone number of each alleged perpetrator and the relationship.

4.      Name, address, and telephone number of the caregiver of the victim, if different from the alleged perpetrator.

5.      Name, address, and telephone number of the person reporting the alleged abuse, neglect, or exploitation.

6.      Description of the physical or psychological injuries sustained. A description of the abuse, neglect or exploitation, including any signs of harm or injuries.

7.      Actions taken by the reporter, if any, such as notification of the criminal justice agency.

8.      Any other information available to the reporting person which may establish the cause of abuse, neglect, or exploitation that occurred or is occurring.

Reporting & Barriers to reporting

·        Victims often find it difficult to file a report for themselves due to guilt, pride, shame, fear.

·        Recognizing the signs and symptoms of abuse, neglect and exploitation is sometimes not easy.

·        Lack of knowledge of mandatory reporting requirements inhibits reporting.

How Can You Help?

Learn effective interviewing techniques.

·        If the victim is in danger of immediate harm, call 911 or local law enforcement.

·        Learn about local support groups, counseling or other available services in your area to which the victim can be referred.

·        When in doubt about a situation, make the call and let the Hotline experts decide if investigation is needed.

Assisting Adult Protective Investigations: How can you help?

·        Provide specific information

·        It is essential to provide accurate demographics and the locations of the subjects of a report.

·        Provide collateral sources and contact information

·        Who can support or provide essential information regarding the allegations? How can the investigator contact them?

Assisting Adult Protective Investigations (continued)

·        Provide accurate contact information

·        It is essential that the adult protective investigator contact you to ensure accuracy of the report as well as any additional details.

·        Provide as much details as possible

·        Think the 5 “W”s: Who? What? Where? When? Why?

·        If you disagree with the counselor’s decision not to accept a report, ask to speak to a supervisor or manager.

Where To Report To report suspected abuse, neglect, self neglect or exploitation of a vulnerable adult:

·        Telephone reporting: (1-844-437-6282)

·        Always phone in information concerning emergency or critical situations.

·        On-line reporting: https://reportabuse.dcf.state.ms.us/

Reporting Maltreatment of a Vulnerable Adult - The Common Entry Point (CEP) is the local agency that takes call of suspected neglect or abuse of vulnerable adults. The CEP is available 24 hours a day, every day of the year. Call 911 if the vulnerable adult is in immediate danger.

A report starts with a telephone call to the CEP. Call the CEP if you believe that a vulnerable adult is being or has been neglected or abused. If a vulnerable adult has a physical injury and no sound reason for the injury, call the CEP. You should call the CEP as soon as possible and within 24 hours.

Information that will be helpful to have on hand when making a report includes:

·        Name, age and address of the vulnerable adult.

·        Your name and contact information (are you calling on behalf of a facility or personally making a complaint).

·        Brief description of the situation and the vulnerable adult.

·        Location of the incident and any other information that you believe might be helpful in investigating the suspected maltreatment.

·        Current injuries, medical problems or behavior problems.

·        Names of relatives or concerned parties in or outside the home.

·        Name and address of alleged perpetrator.

·        How you know about the situation, your relationship to the vulnerable adult.

As a mandated reporter for vulnerable adults:

·        You are safe from civil or criminal liability if the report is made in good faith.

·        Your identity is confidential and may not be shared with anyone other than the lead agency investigators and law enforcement.

·        You may be liable for damages caused by not reporting suspected neglect or abuse.

·        You may be prevented from providing direct contact services for failing to make a required report.

File a report with the proper agency or CEP anytime you think there may be neglect or abuse. Remember, it is not your job to decide if neglect or abuse is occurring. That decision is the job of the investigator. Your job is to report any situation or occurrence that is suspicious. The children and vulnerable adults in Mississippi are counting on you to help keep them safe.