Protective Services for Adults: Elder Abuse

Sections 660.250 – 660.295, RSMo
State legislation mandates protection for vulnerable adults in Missouri. Eligible adults include persons over the age of 60 who are unable to protect their own interests or adequately perform or obtain services necessary to meet essential human needs, or adults with disabilities between the ages of 18 and 59 who are unable to protect their own interests or adequately perform or obtain services necessary to meet essential human needs. Adult Protective Service laws are intended to provide a mechanism for state intervention and protection to eligible adults when it has been reported that there is a likelihood of serious physical injury or harm. Any person who has reason to suspect an eligible adult may be facing situations that present a likelihood of serious harm shall report such information to the Department of Health and Senior Services.

The department maintains a toll free telephone number (1-800-392-0210) for the receipt of these reports. Reports of abuse, neglect, misappropriation, or falsification of in-home clients by in-home employees are investigated by department staff. All reports and investigative findings are confidential.

If, during the initial contact, another person prevents department staff from gaining access to the alleged victim, the court may issue a warrant for entry. Eligible adults may refuse intervention or protective services; however, in determining whether or not to proceed, the department staff shall attempt to determine the decisional capacity of the reported adult. Adults with questionable capacity to consent may warrant legal intervention and the department can involve mental health professionals, physicians, law enforcement or other professionals to assist with intervention and protection.

Definitions
“Abuse,” the infliction of physical, sexual, or emotional injury or harm including financial exploitation by any person, firm or corporation.

“Neglect,” the failure to provide services to an eligible adult by any person, firm or corporation with a legal or contractual duty to do so, when such failure presents either an imminent danger to the health, safety, or welfare of the client or a substantial probability that death or serious physical harm would result.

“Likelihood of serious physical harm” is defined as one or more the following: A substantial risk that physical harm will:

• Occur because of the failure or inability of the person to provide for essential human needs. This is evidenced by acts or behaviors that have caused such harm, or which give another person probable cause to believe that such harm will be sustained.
• Be inflicted by the adult upon himself, as evidenced by recent credible threats, acts, or behaviors which have caused such harm, or which place another person in reasonable fear that the adult will sustain such harm.
• Be inflicted by another person upon the adult as evidenced by recent acts or behaviors which have caused such harm, or which give another person probable cause to believe the adult will sustain such harm.
• Occur to the adult who has suffered physical injury, neglect, sexual or emotional abuse, or other maltreatment, or use of financial resources by another person.

Who Must Report
State law requires that any person having reasonable cause to believe that there is a likelihood that, without protection, serious physical harm may occur to an eligible adult shall report information to the department.

Where statute mandates certain professionals (see below) to report, failure to report known information or filing a false report can be prosecuted as a misdemeanor offense. Likewise, a reporter (who has not participated in or benefited from mistreatment) has immunity from civil and criminal prosecution for filing a report or participating in an investigation in good faith. Anyone who makes a report pursuant to any of these laws, or who testifies in any administrative or judicial proceeding arising from the report, is immune from any civil or criminal liability, unless the person acted negligently, recklessly, in bad faith or with malicious purpose, or committed perjury.

How to Report
Report should be made to the department orally (1-800-392-0210), or in writing and include the following:

• Name, age and address of the adult;
• Name and address of any person responsible for the adult’s care;
• Nature and extent of the adult’s condition;
• Information regarding the nature of the abuse or neglect; and
• Other relevant information.

Sections 565.180-565.190, RSMo
Primarily for use by prosecutors, the “Crime of Elder Abuse,” establishes three degrees of criminal abuse, including respective criminal penalties.

Mandated Reporters
The following persons are mandated under state law to report Elder Abuse if he/she has reasonable cause to suspect, or has observed a senior being subjected to abuse or neglect:

Adult Day Care Worker
Chiropractor
Christian Science Practitioner
Coroner
Dentist
Embalmer
Employee of the Department of Social Services
Employee of the Department of Mental Health
Employee of the Department of Health and Senior Services
Employee of a local Area Agency on Aging or an organized Area Agency on Aging Program
Funeral Director
Home Health Agency or Home Health Agency Employee
Hospital and Clinic Personnel engaged in examination, care, or treatment of persons
In-Home Services Owner, Provider, Operator, or Employee
Law Enforcement Officer
Long-Term Care Facility Administrator or Employee
Medical Examiner
Medical Resident or Intern
Mental Health Professional
Minister
Nurse
Nurse Practitioner
Optometrist
Other Health Practitioner
Peace Officer
Pharmacist
Physical Therapist
Physician
Physician’s Assistant
Podiatrist
Probation or Parole Officer
Psychologist
Social Worker

Section 660.300, RSMo
Recipients of in-home services have added statutory protection from mistreatment by agencies authorized to provide services to them in their home. Any in-home services employee or home health employee who knowingly abuses or neglects an in-home services client shall be guilty of the crime of Elder Abuse and be subject to criminal prosecution under 565.180, 565.182, or 565.184, RSMo. Penalties of incarceration range from 15 days to life imprisonment and fines may range from $300 to $20,000.

Definitions
“In-home services client,” an eligible adult who is receiving services in his/her private residence through any in-home services provider agency.

“In-home services employee,” a person employed by an in-home services provider agency.

“In-home services provider agency,” a business entity under contract with the department, or with a Medicaid participation agreement which employs persons to deliver any kind of services provided for eligible adults in their private homes.

“Home health agency,” the same meaning as such term is defined in section 197.400, RSMo. (In 197.400, RSMo, home health agency is defined as “a public agency or private organization or a subdivision or subunit of an agency or organization that provides two or more home health services at the residence of a patient according to a physician’s written and signed plan of treatment.”)

“Home health agency employee,” a person employed by a home health agency.

“Home health patient,” an eligible adult who is receiving services through any home health agency.

Mandated Reporters
The following professionals are mandated under state law to report if he/she has reasonable cause to believe that an in-home services client is being abused or neglected as a result of the services being provided to him/her at home:

Adult Day Care Worker
Chiropractor
Christian Science Practitioner
Coroner
Dentist
Embalmer
Employee of the Department of Social Services
Employee of the Department of Mental Health
Employee of the Department of Health and Senior Services
Employee of a local Area Agency on Aging or an organized Area Agency on Aging Program
Funeral Director
Home Health Agency or Home Health Agency Employee
Hospital and Clinic Personnel engaged in examination, care, or treatment of persons
In-Home Services Owner, Provider, Operator, or Employee
Law Enforcement Officer
Long-Term Care Facility Administrator or Employee
Medical Examiner
Medical Resident or Intern
Mental Health Professional
Minister
Nurse
Nurse Practitioner
Optometrist
Other Health Practitioner
Peace Officer
Pharmacist
Physical Therapist
Physician
Physician’s Assistant
Podiatrist
Probation or Parole Officer
Psychologist
Social Worker

Anyone who makes a report pursuant to any of these laws or who testifies in any administrative or judicial proceeding arising from the report is immune from any civil or criminal liability unless the person acted negligently, recklessly, in bad faith or with malicious purpose, committed perjury, or perpetrated the abuse or neglect.

Required Information
In addition to information required for all reports, in-home services reports include:

• Name and addresses of the in-home services provider/home health agency;
• Name of the in-home services/home health employee;
• Name of the complainant;
• Names of any witnesses; and
• Other helpful information.

Section 660.305, RSMo
Any in-home services provider agency or in-home services employee who puts to his/her own use or the use of the agency, or otherwise diverts from the client’s use any personal property or funds of the client, or falsifies any documents for service delivery, shall be guilty of a Class A misdemeanor.

Who Must Report
Any person having reasonable cause to believe that property or funds of an in-home services client has been misappropriated, or has knowledge that documentation that verifies service delivery has been falsified, may report such information to the department.

Anyone who makes a report pursuant to any of these laws, or who testifies in any administrative or judicial proceeding arising from the report, is immune from any civil or criminal liability unless the person acted negligently, recklessly, in bad faith or with malicious purpose, committed perjury, or participated in or benefited from the misappropriation of funds/property.

Section 660.315, RSMo
Employees who are finally found to have abused, neglected, misappropriated funds or property, or falsified time sheets which verify service delivery for recipients of in-home services are placed on a list that prohibits employment in specific agencies within the health care industry for a period of time that is determined by the director of the Department of Health and Senior Services, or the director’s designee and will be based on several factors, such as whether the person acted recklessly or knowingly, the severity of the incident, and/or whether the person has previously been listed on the employee disqualification list. The department maintains “The Employee Disqualification List” (EDL), which contains the names of persons who have been finally determined by the department to have recklessly, knowingly, or purposely abused or neglected an in-home services client, home health patient, or facility resident, misappropriated any property or funds of an in-home client or facility resident, or falsified any documents for service delivery of an in-home services client.

This EDL is provided to other state departments upon request and to any person, corporation, or association that is licensed in Missouri as a hospital, ambulatory surgical center, home health agency, skilled nursing facility, residential care facility, intermediate care facility, or adult boarding facility, provides in-home services under contract with the department, employs nurses and nursing assistants for temporary or intermittent placement in health care facilities, or is approved by the department to issue certificates for nursing assistants’ training. No person, corporation, or association who receives the EDL shall knowingly employ any person who is on the list.

Section 198.070, RSMo
Similar statues exist to protect residents of residential care facilities, intermediate care facilities, or other nursing facilities. Reports are also registered by the department and investigations initiated within twenty-four hours. As soon as possible during the course of the investigation, department staff notify the resident’s next of kin or responsible party of the report and the investigation, and upon conclusion of the investigation, notify them whether the report is substantiated or unsubstantiated. These reports are confidential.

Any person who knowingly abuses or neglects a resident of a facility shall be guilty of a Class D felony.

Mandated Reporters
The following professionals are mandated under state law to report if he/she has reasonable cause to believe that a resident of a facility has been abused or neglected:

Adult Day Care Worker
Chiropractor
Christian Science Practitioner
Coroner
Dentist
Embalmer
Employee of the Department of Social Services
Employee of the Department of Mental Health
Employee of the Department of Health and Senior Services
Employee of a local Area Agency on Aging or an organized Area Agency on Aging Program
Funeral Director
Home Health Agency or Home Health Agency Employee
Hospital and Clinic Personnel engaged in examination, care, or treatment of persons
In-Home Services Owner, Provider, Operator, or Employee
Law Enforcement Officer
Long-Term Care Facility Administrator or Employee
Medical Examiner
Medical Resident or Intern
Mental Health Professional
Minister
Nurse
Nurse Practitioner
Optometrist
Other Health Practitioner
Peace Officer
Pharmacist
Physical Therapist
Physician
Physician’s Assistant
Podiatrist
Probation or Parole Officer
Psychologist
Social Worker

Anyone who makes a report pursuant to any of these laws, or who testifies in any administrative or judicial proceeding arising from the report, is immune from any civil or criminal liability unless the person acted negligently, recklessly, in bad faith or with malicious purpose, or committed perjury.

What to Include in a Report

Reports will contain the following:

• Name and address of the facility;
• Name of the resident;
• Information regarding the nature of the abuse or neglect;
• Name of the complainant; and
• Other helpful information.

Return to Table of Contents