Chapter 16. Adult Protective Services
Regulation .01 Purpose.LinkCopy Citation
Adult Protective Services is a social services program to assist vulnerable adults who are unable to provide for their basic living needs or access necessary professional services, or protect their own interests and are subject to abuse, neglect, exploitation, or self-neglect. Service provision is normally limited to 6 months in which time risk is reduced. Adult Protective Services makes every effort to stabilize the vulnerable adult in the adult's own home within the community through community support services that reduce risk factors.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Abuse” means the sustaining of any physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by a person.
(2)
“Adult” means a person 18 years old or older.
(3)
“Assisted living manager” means an individual who is designated by the licensee to oversee the day-to-day operation of the assisted living program.
(4)
Assisted Living Program.
(a)
“Assisted living program” means a residential or facility-based program that provides assistance in performing the activities of daily living or instrumental activities of daily living, in a way that promotes optimum dignity and independence of the individuals, such as providing:
(i)
Housing and supportive services;
(ii)
Supervision;
(iii)
Personalized assistance;
(iv)
Health-related services; or
(v)
A combination of these services.
(b)
“Assisted living program” does not include:
(i)
A nursing home, as defined under Health-General Article, §19-301, Annotated Code of Maryland;
(ii)
A State facility, as defined under Health-General Article, §10-101, Annotated Code of Maryland;
(iii)
A program licensed or approved by the Maryland Department of Health under Health-General Article, Title 7 or Title 10, Annotated Code of Maryland; or
(iv)
A hospice care program licensed by the Maryland Department of Health under Health-General Article, Title 19, Annotated Code of Maryland.
(5)
“Director” means the director of the local department of social services.
(6)
“Disabled person” means an adult who has been judged by a court for purposes of adult public guardianship of the person to be unable to provide for his daily needs sufficiently to protect his health or safety due to:
(a)
A mental disability;
(b)
Disease;
(c)
Habitual drunkenness; or
(d)
Addiction to drugs.
(7)
“Emergency” means that an adult is living in conditions which present a substantial risk of death or immediate and serious physical harm to himself or others.
(8)
“Exploitation” means any action which involves the misuse of a vulnerable adult's funds, property, or person.
(9)
“Guardian of the person” means an individual, agency, or corporation appointed by a court to undertake certain actions in the interest of a disabled person. The guardian is authorized by the court to make responsible decisions for the disabled person about the disabled person's health care, shelter, or daily needs for food or clothing and to receive and spend money from the disabled person's assets to meet those needs.
(10)
“Guardian of the property” means a person or agency appointed by the court to manage the property of a disabled person or a minor.
(11)
“Law enforcement agency” means a State, county, or municipal police department, bureau, or agency.
(12)
“Licensee” means the person, association, partnership, or corporation to whom the license is issued.
(13)
“Local department” means the department of social services or the Montgomery County Department of Health and Human Services, in the jurisdiction where the:
(a)
Vulnerable adult lives; or
(b)
Abuse, neglect, or exploitation is alleged to have taken place.
(14)
“Local State's Attorney” means the State's Attorney for the jurisdiction where the:
(a)
Vulnerable adult lives; or
(b)
Abuse, neglect, or exploitation is alleged to have taken place.
(15)
Neglect.
(a)
“Neglect” means the willful deprivation of a vulnerable adult of adequate food, clothing, essential medical treatment or habilitative therapy, shelter, or supervision.
(b)
“Neglect” does not include the providing of nonmedical remedial care and treatment for the healing of injury or disease if the nonmedical care and treatment is recognized by State law and is done with the informed consent of the vulnerable adult.
(16)
“Office of Health Care Quality” means the State office authorized to license and regulate quality of care in hospitals and health-related facilities in Maryland, as provided under COMAR 10.07.14.
(17)
“Police officer” means a State or local officer who is authorized to make arrests as part of the officer's official duty.
(18)
“Resident” means an individual 18 years old or older who requires assisted living services.
(19)
“Review board” means the Adult Public Guardianship Review Board.
(20)
“Self-neglect” means the inability of a vulnerable adult to perform activities of daily living or to provide the vulnerable adult with the services:
(a)
That are necessary for the vulnerable adult's physical and mental health; and
(b)
The absence of which impairs or threatens the vulnerable adult's well-being.
(21)
“Vulnerable adult” means an adult who lacks the physical or mental capacity to provide for the adult's daily needs.
Regulation .03 Eligibility Requirements.LinkCopy Citation
A.
A vulnerable adult is eligible for an investigation of reports by himself or others when abuse, neglect, self-neglect, or exploitation is occurring, except in instances of abuse of a patient occurring in a:
(1)
Mental health facility under Health-General Article, Title 10, Annotated Code of Maryland;
(2)
Facility for mentally retarded individuals under Health-General Article, Title 7, Annotated Code of Maryland; or
(3)
A nursing home or hospital under Health-General Article, Title 19, Annotated Code of Maryland.
B.
A vulnerable adult determined to be in need of and accepting services or who is under court order to receive service is eligible.
C.
There is no fee for Adult Protective Services, however, eligibility fees for ancillary services offered are governed by the regulations for that specific program.
Regulation .04 Report of Vulnerable Adults.LinkCopy Citation
A.
A health practitioner, police officer, or human service worker who contacts, examines, attends or treats an alleged vulnerable adult and who has reason to believe that the adult has been subject to abuse, neglect, self-neglect, or exploitation shall notify the local department of social services.
B.
An individual who has reason to believe that an alleged vulnerable adult has been subjected to abuse, neglect, self-neglect, or exploitation may file a report with the local department of social services.
C.
The local department shall request that the report contain as much of the following information as is known to the person making the report:
(1)
The name, age, and home address of the alleged vulnerable adult;
(2)
The name and home address of the individual responsible for the care of the alleged vulnerable adult;
(3)
The whereabouts of the alleged vulnerable adult;
(4)
The nature of the alleged vulnerable adult's incapacity;
(5)
The nature and extent of the abuse, neglect, self-neglect, or exploitation of the alleged vulnerable adult, including evidence or information available to the reporter concerning previous injury possibly resulting from abuse, neglect, self-neglect, or exploitation; and
(6)
Any other information that would help to determine the:
(a)
Cause of the suspected abuse, neglect, self-neglect, or exploitation, and
(b)
Identity of any individual responsible for the abuse, neglect, self-neglect, or exploitation.
D.
The local department shall notify the individual making the report that the investigation has begun as a result of the report. Confidentiality regulations shall determine the amount and kind of information disclosed.
Regulation .05 Response to Report of a Vulnerable Adult.LinkCopy Citation
A.
To protect the welfare of the alleged vulnerable adult the local department shall begin a thorough investigation:
(1)
Within 5 working days after the receipt of the report of suspected abuse, neglect, self-neglect, or exploitation; or
(2)
Within 24 hours after the receipt of the report of suspected abuse, neglect, self-neglect, or exploitation if the report indicates that an emergency exists.
B.
To protect the welfare of the alleged vulnerable adult the local department shall complete an investigation:
(1)
Within 30 days of the receipt of the report; and
(2)
Within 10 days of the receipt of the report, if the report indicates that an emergency exists as described in §A(2) of this regulation.
C.
A vulnerable adult is eligible for investigation of a report of suspected self-neglect, neglect, or exploitation when the vulnerable adult is a patient or resident in a facility identified in Regulation .03 of this chapter. The local department, when appropriate, may forward to the State Office of Aging or Office of Heath Care Quality a referral to investigate allegations received of suspected self-neglect, neglect, and exploitation within facilities identified in Regulation .03 of this chapter regarding a vulnerable adult's living environment and suspected maltreatment by facility staff.
D.
Report of a Resident in an Assisted Living Program.
(1)
If emergency flex funds or local department staff are available, the local department may assist the resident with relocation to another assisted living program, upon notification by the Office of Health Care Quality, or the assisted living manager or alternative manager of the emergency removal of a resident or the emergency suspension or revocation of a facility's license.
(2)
Upon completion of an investigation, the local department may send a report of the outcome of a completed investigation to the Office of Health Care Quality, the local law enforcement agency, and the State's Attorney's Office, if appropriate, or if there appears to be evidence of criminal intent to harm or exploit a vulnerable adult.
Regulation .06 Protective Service Investigation.LinkCopy Citation
A.
The investigation shall include:
(1)
A face-to-face interview with the vulnerable adult; and
(2)
Information gathered from the adult and collateral contacts.
B.
The investigation shall be directed to:
(1)
A determination of whether the individual is a vulnerable adult; and
(2)
Whether there has been abuse, neglect, self-neglect, or exploitation.
C.
If there is a finding of abuse, neglect, or exploitation of a vulnerable adult, the investigation shall include information regarding:
(1)
The nature, cause, and extent of the abuse, neglect, and exploitation; and
(2)
The identity of the individual or individuals responsible for the abuse, neglect, and exploitation.
D.
The information collected shall include:
(1)
Facts about whether the adult is unable to provide for his daily needs sufficiently to protect his health, welfare, or safety;
(2)
Psycho-social factors affecting functioning of the adult;
(3)
Medical factors affecting functioning of the adult; and
(4)
Environmental factors affecting the adult, including housing, availability of transportation, and income.
E.
The local department shall secure the cooperation of the vulnerable adult to the extent possible.
F.
The local department shall inform the referring party when the investigation begins and the name of the assigned caseworker. Except in accordance with a court order, local departments may not share information on a case unless it furthers the investigation or service provision or is required in reports to law enforcement officials.
Regulation .07 Coordination with Law Enforcement Officials.LinkCopy Citation
A.
The local department shall:
(1)
Report to the appropriate local law enforcement agency any incident of abuse, neglect, or exploitation of an alleged vulnerable adult when the possibility of a crime being committed against the alleged vulnerable adult is indicated by information provided in the initial report to the local department or by information obtained in the course of investigation; and
(2)
Send to the local State's Attorney and the appropriate law enforcement agency any incident of abuse, neglect, or exploitation of an alleged vulnerable adult which was or should have been reported to the appropriate law enforcement agency as described in §A(1) of this regulation.
B.
Each local department shall meet with the appropriate law enforcement agencies and State's Attorney's office to develop written agreements on procedures for joint investigation responsibilities and information sharing.
C.
A representative of the local department may contact the appropriate law enforcement agency if in the course of investigation the representative believes that an emergency exists. The representative may ask the police officer to accompany the representative and if the police officer agrees that an emergency exists, ensure that the individual is transported to an appropriate health care facility.
Regulation .08 Coordination With Other Agencies.LinkCopy Citation
As appropriate, a local or State Office on Aging or local geriatric evaluation service may assist in the investigation.
Regulation .09 Service Plan.LinkCopy Citation
A.
The local department shall develop, record, and initiate an appropriate plan for service for each client.
B.
The service plan shall include the following:
(1)
An assessment of the situation which describes the:
(a)
Client's level of risk which means the nature and imminence of risk to the client without intervention;
(b)
Client's ability to act on his own behalf which means a statement of the client's strengths and weaknesses in planning and effecting strategies to ameliorate risk;
(c)
Current strengths and supports to the client; and
(d)
Person or persons contributing to the client's risk by action or inaction;
(2)
A plan for intervention which directly addresses the strategies to reduce identified risk;
(3)
Specific measurable objectives with an estimated time for achievement, keeping the timelines consistent with the 6-month timeframe.
Regulation .10 Provision of Services.LinkCopy Citation
A.
Services provided by the local department include:
(1)
Counseling;
(2)
Coordinating and facilitating the client's use of community resources including health services.
B.
The following services are available through the local department of social services directly or by purchase and may be provided when they are a part of the service plan:
(1)
Home care and chore services as provided for in the In-Home Aide Services regulations under COMAR 07.06.12;
(2)
Adult day care provided by contractual arrangement with the Maryland Department of Health and subject to that Department's regulations, limitations, and eligibility schedules;
(3)
Transportation provided through the In-Home Aide Services program, or any transportation available from community resources or governmental agencies in the local subdivision;
(4)
Emergency arrangement of food or shelter as available from resources such as:
(a)
Federal, State, or local programs, or
(b)
Private providers;
(5)
Provision of any recommendation, reports, or petitions concerning the adult in need of protective services to the court;
(6)
Legal assistance including assistance to arrange for purchase of counsel with the vulnerable adult's own resources when the adult is not eligible for legal services from any other source.
C.
If, after the investigation under this chapter, the director determines that the adult requires protective services, with the adult's consent the director shall provide the services.
D.
If the Department believes that the client is disabled and the client is unable or unwilling to accept services necessary for the client's health, safety, or well-being and there is not a less restrictive form of intervention available, the director shall petition the court for:
(1)
An emergency order for protective services under the Estates and Trusts Article, Title 13, Subtitle 7, Annotated Code of Maryland, and Regulation .12 of this chapter;
(2)
The appointment of a guardian of the person under the Estates and Trusts Article, Title 13, Subtitle 7, Annotated Code of Maryland, and Regulation .11 of this chapter; or
(3)
The appointment of a guardian of the property under the Estates and Trusts Article, Title 13, Subtitle 2, Annotated Code of Maryland.
Regulation .11 Guardianship Procedures.LinkCopy Citation
A.
The local department shall file a petition for guardianship in the appropriate court when:
(1)
A vulnerable adult who is a client of the Adult Protective Services program is in need of services but lacks sufficient understanding to make and communicate responsible decisions about his person because of mental disability, disease, habitual drunkenness, or addiction to drugs. The petition requires two statements from either two licensed physicians or one licensed physician and one licensed psychologist or licensed certified social worker-clinical, attesting to the nature, severity, and probable duration of any disability or condition.
(2)
A less restrictive form of intervention is not available which is consistent with the vulnerable adult's welfare, safety, or condition.
(3)
There is no known individual or agency already empowered to act as surrogate decision maker.
(4)
There is no interested individual or agency who can or will serve as guardian. The local department shall make a thorough effort to locate such an individual or agency.
B.
The director shall submit with any petition filed under this regulation the findings of the investigation including:
(1)
An evaluation of the medical, psychiatric, and social factors that affect the individual's condition; and
(2)
A description of recommended services.
C.
The director shall request specific powers limited to those necessary to provide for the care and safety of the adult.
D.
The local department shall make a thorough effort to locate an individual or agency who can or will serve as guardian.
E.
For adults younger than 65 years old, the director of the local department of social services, upon appointment as the court-appointed guardian of the person, may delegate responsibilities of guardianship to the director's designee, staff person or persons whose names and positions have been registered with the court prior to the guardianship proceedings.
F.
The local department may not request appointment of the director as guardian of property.
G.
The local department shall ensure that an attorney is appointed by the court to represent the alleged disabled adult if the adult is not otherwise represented.
H.
Office on Aging.
(1)
When the local department of social services determines that an adult 65 years old or older is the subject of a proposed petition for guardianship, the local department shall notify the Secretary of the Department of Aging or the Secretary's designee and arrange a conference between the staff of the two agencies to give notice of the need to file for guardianship, the authority to be requested for the guardianship, a basic plan for services, and who shall file the guardianship petition.
(2)
If the two agencies cannot agree, the director of the local department of social services shall:
(a)
Consult with the Executive Director of the Social Services Administration or the Executive Director's designee;
(b)
Initiate any action they agree is necessary to protect the interests of the adult; and
(c)
Provide notice of the Executive Director's action to the State Program Manager for Adult Public Guardianship of the Department of Aging (including a copy of any petition and notice of any hearing dates).
Regulation .12 Emergency Procedures.LinkCopy Citation
A.
Petition.
(1)
When a local department of social services determines that the conditions set forth in Regulation .11A exist except for statements by two authorized licensed health professionals and, in addition, determines that an emergency exists, the local department shall file a petition for services to address the emergency.
(2)
Whenever a local department is informed that a law enforcement officer has transported an adult to a health care facility because, from personal observation, the officer believes it is possible that the adult will suffer immediate and serious physical injury or death, the director shall within 24 hours of notification file a petition.
(3)
The petition shall include a statement of the facts demonstrating that an emergency exists and that the local department has attempted without success to obtain the person's consent to services.
B.
A court order authorizing emergency services is in effect for a maximum of 144 hours. However, in accord with Estates and Trusts Article, §13-709(c)(5), Annotated Code of Maryland, the court may extend the terms of the emergency order until appointment of a guardian of the individual pursuant to Estates and Trusts Article, §13-705, Annotated Code of Maryland.
C.
When protective services are given on the basis of an emergency order, the temporary guardian shall file a report with the court of the services given.
D.
The local department of social services shall in each case of emergency services determine whether a continuing guardianship is required.
E.
When an emergency petition is filed on a person 65 years old or older, the local department shall advise the Secretary of Aging or the Secretary's designee or the director of the local office on aging or the director's designee of the filing so that the Secretary or the director or their assigned designees have an opportunity to attend the hearing on the petition and to develop a service plan. This notice may be given by telephone.
Regulation .13 Redetermination and Termination.LinkCopy Citation
A.
The local department of social services shall:
(1)
Review the service plan and the effectiveness of the service given;
(2)
Decide whether to continue the service at least every 6 months; and
(3)
Decide whether to extend voluntary service beyond the initial 6 months. Extension of service is permissible with supervisory approval and specific documentation of the need to extend the service and if the criteria for termination are not met, as listed in §B of this regulation.
B.
The local department of social services shall terminate services for any recipient of Adult Protective Services when:
(1)
The goals and objectives outlined in the service plan have been attained and the adult is not at risk;
(2)
The adult's service needs are not protective in nature and can be met by another local department program or a community service;
(3)
The adult decides to terminate and the local department determines that there is neither sufficient risk nor evidence of incapacity to warrant court action;
(4)
The adult refuses voluntary services and the court dismisses a petition to provide services or to appoint a guardian of the person;
(5)
The court revokes a guardianship and the adult refuses voluntary services; or
(6)
The court appoints as guardian another agency or individual and that guardian does not wish the local department to continue services.
C.
Services provided without a court order may be terminated if a recipient has moved from the local department of social services jurisdiction or is placed in a Maryland Department of Health facility for a period exceeding 30 days.
D.
Local Department.
(1)
The local department may request termination of its status as guardian when the circumstances or capacity of the adult changes so that the local department determines that guardianship is no longer necessary.
(2)
The local department may not justify termination of guardianship solely because a disabled adult has been placed in a licensed and regulated facility which assures the adult's needs are met (including a nursing home or State mental hospital) until the placement has continued for at least 6 months.
E.
Written Notice.
(1)
The local department of social services shall send a written notice of its intent to deny, reduce, suspend, or terminate services at least 10 working days before the action is taken.
(2)
The notice shall include:
(a)
The action to be taken;
(b)
The reason for the action;
(c)
The specific regulation supporting this action; and
(d)
The right to and method for an appeal for a fair hearing.
Regulation .14 Appeal from Local Department Decision.LinkCopy Citation
A.
Appeals for a fair hearing and the conduct of the hearing are according to the fair hearing regulations in COMAR 07.01.04.
B.
The local department shall give written and oral notification of the right to and methods of requesting and obtaining a fair hearing to each applicant for, and to each recipient of, adult protective services at application and whenever the local department notifies the applicant or recipient of any pending action that may deny, suspend, reduce, or terminate this service.
Regulation .15 Adult Public Guardianship Review Board.LinkCopy Citation
A.
There are one or more boards serving each subdivision for the purpose of reviewing at least semi-annually the guardianship cases which are held by any public agency. The boards are advisory to the court and make recommendations to the court to continue, modify, or terminate a guardianship. The local department shall cooperate with the Adult Public Guardianship Review Board in the review of guardianships and provide administrative support staff, office space and any reports required by the Board.
B.
Within 6 months following receipt of guardianship, the local department shall make a report to the Board, and shall make reports at 6-month intervals as long as the local department retains guardianship. The reports shall be made in a timely fashion to meet scheduled reviews of the Board.
C.
Reports to Adult Public Guardianship Review Boards shall include the:
(1)
Present place of residence and health status of the ward;
(2)
Guardian's plan for preserving and maintaining the future well-being of the ward;
(3)
Need for continuation or cessation of the guardianship or for any plans in altering the powers of the guardian; and
(4)
Most recent dates of contact with the ward by the director or the director's designee.
Regulation .16 Discrimination.LinkCopy Citation
A.
An individual in the United States may not be excluded from participating in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance on the grounds of race, color, sex, national origin, or religious and political beliefs.
B.
An individual acting on behalf of a vulnerable adult, who believes the vulnerable adult has been discriminated against may file a written complaint that sets forth the events and circumstances of the alleged discrimination.
C.
Complaints may be filed with:
(1)
The Secretary of Human Services;
(2)
The Office of Employment and Program Equity; or
(3)
The Office of Civil Rights, Department of Health and Human Services, Region III, Philadelphia, Pennsylvania.
D.
The Department shall investigate promptly and notify the complainant of its findings within 60 days.
Regulation .17 Fraud.LinkCopy Citation
Suspected fraud is to be referred by the local department to the State's Attorney for a decision with regard to any necessary legal action, if the facts indicate that an individual has knowingly obtained, attempted to obtain, or aided in the obtainment of, services to which he is not entitled or which are greater than those to which he is justly entitled, by means of a willfully false statement or misrepresentation, by the willful failure to disclose to the local department a change in household or financial condition, or by impersonation or other fraudulent device.
Chapter annotations
Authority: Family Law Article, §§14-101—14-404, Annotated Code of Maryland
History: Effective date: August 8, 1980 (7:16 Md. R. 1593)
History: Regulations .10E and .11 amended effective October 6, 1986 (13:20 Md. R. 2209)
History: Chapter revised effective October 31, 1988 (15:22 Md. R. 2555)
History: Regulation .10B amended effective August 19, 1991 (18:16 Md. R. 1811)
History: Regulation .15A amended effective February 18, 1991 (18:3 Md. R. 302)
History: Recodified from COMAR 07.02.16 to 07.06.14, December, 1992
History: Regulation .11 amended as an emergency provision effective October 1, 1997 (24:19 Md. R. 1334); amended permanently effective December 1, 1997 (24:24 Md. R. 1669)
History: Regulation .12B amended effective January 17, 1994 (21:1 Md. R. 29)
History: Chapter revised effective December 10, 2001 (28:24 Md. R. 2127)
History: Regulation .01 amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .02B amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .05 amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .07A amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .09B amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .11 amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .12A, E amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .13D, E amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .15A amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Regulation .16B amended effective July 28, 2008 (35:15 Md. R. 1347)
History: Chapter recodified from COMAR 07.06.14 to COMAR 07.02.16, effective June, 2009