Webinar Transcript:

Bob Brocker:

Good morning, everyone. My name is Bob Brocker and our esteemed executive director is on. Barbara Boyer is on here as well. And we are going to be talking today about elder abuse and how to prevent elder abuse and how to deal with it when it does happen. We have three great panelists, and I’m going to introduce them in just a moment. But first, I’m going to show you just a little bit about what we’re doing here at AgeWise Colorado, and then we’ll get right into it.

This is our 43rd webinar since we launched AgeWise Colorado two and a half years ago, and today we’re talking about preventing elder abuse. This is part one. We’re more focused on physical and mental abuse. And then in a couple of weeks, we’re going to have another session focused more on financial, which is scams, fraud, and so on.

Our panelists today. Our first panelist is Jane Walsh, who is the Chief Deputy District Attorney at the Denver District Attorney’s office. I know Jane focuses a lot on elder abuse and prevention. Kathleen Calderon is our Adult Protective Services Policy Unit Supervisor within the Department of Human Services and is a former county level APS manager. And Leah McMahon is our State Long-Term Care Ombudsman. They’ll all be explaining what all that actually means.

A little bit about us at AgeWise Colorado. Our mission, as it shows here, is to connect people at no cost, all older Coloradans and their families to reliable, helpful services and products, information assistance, and education to help the over 3 million people over age 40 in Colorado on their aging journey. As you can see from the illustration, we’re that connecting bridge between those 3 million and, we estimate, roughly 3,000 service providers in the state who have something to help you with aging.

This is a screenshot. This is our homepage. So I would encourage folks, if you haven’t been on our website yet, please take a look. Our educational webinars. Obviously we’re here today on February 7th, I mentioned the next one coming up. And then in March, we’re going to be focusing on the housing. First, on decluttering and relocation. And then the next one more on affordable housing.

A few testimonials that we’ve received from people who have actually used our site and a longer bio of each of our panelists. So this will be included in the recording. I’m not going to read all these right now, but suffice it to say all three panelists are very distinguished in their fields.

Then I’m going to stop that and turn this over now to Jane, and she’s going to tell us more about what she does in the Denver VA’s office.

Jane Walsh:

Thanks, Bob. Good morning, everyone. Thank you for logging on. It’s great to have this chance to talk to everyone and I want to really start by thanking AgeWise Colorado for the good work that is out there that they are doing to connect people and provide information for them to be a hub for information. We at the Denver District Attorney’s office, we’re happy to be here and happy to get this chance to work with the other panelists also with AgeWise Colorado.

So who are we and what do we do? Well, you obviously are going to be aware of the district attorney’s offices, which are around the state of Colorado. We work out of the 2nd Judicial District, District Attorney’s Office at the city and county of Denver, but we work with our colleagues on a daily and weekly basis who are operating in other jurisdictions, so we’re connected to the larger group of district attorneys across the state. And as you know, the district attorneys, we are responsible for prosecuting crimes, crimes that are state related crimes in Colorado. Basically, right now, we have a unit in our office that’s responsible for prosecuting crimes against older adults and crimes against people with disabilities.

And you might wonder, well why does the district attorney’s office need to have a unit to do that? The reason for that is that there are barriers to justice for certain populations and we want to make sure that the justice system is fair and treats everyone similarly and ensures that whether you are five or whether you are 95, that if you are a victim of a crime, that crime gets prosecuted and the offender is held accountable.

So in my unit we have myself, I’m the chief deputy. I have an associate deputy working with me, Robert Brasher, and we have a dedicated victim advocate, Betsy [inaudible 00:05:39], and a dedicated investigator, Danielle Madril. So we have a team of four, but obviously we can call on other resources, and we do in relation to some of the larger cases that we deal with.

Now, you might be surprised and it might not be good news to tell you that right now we have over 100 current felony cases involving older adults and people with disabilities that are ongoing. So we have a pretty busy brief here at the district attorney’s office, and I want to tell you what resources we can offer to you and what you can do if you have a concern about maybe a family member or you have a concern about a friend or in fact you have a concern about your own situation.

We do deal with all types of crime, and as Bob has said, today the focus is on mental and physical abuse, which makes up a significant number of our cases, but we also deal with cases of financial exploitation and theft and fraud and forgery. We deal with sex crimes. We deal with crimes of neglect. In fact, our last trial involved a case of criminal negligence, severe neglect of a disabled person. We’re dealing with a wide range of cases. The first thing I think that you should know is obviously if a situation is urgent and requires immediate police involvement, you should not ever hesitate to call 911. I say that because I recognize that in my own life I’ve had to call 911 a couple of times and I would say it’s kind of a difficult decision to make sometimes. Obviously sometimes it’s going to be crystal clear but never hesitate to call the police. In our area, that’s going to be Denver Police Department. Never hesitate to call and to make that call if you need some kind of urgent or immediate response.

There is also a non-emergency line that you can call when you want to report something to the police. So in Denver that number is 720-913-2000. And I’m going to suggest to you that maybe you would like to take a look at our district attorney website. So our district, you can Google Denver District Attorney. Our website is actually denverda.org, and if you go to that website, there is a page which has information on how to report a crime and crime tips. That’s going to give you the non-emergency line for the police. So if you want to speak to the police, you want to make a report, but it’s not a case where you’re dialing 911, that’s the number that you’re going to call, which is 720-913-2000. And that is going to kick off a law enforcement record of your complaint and you’re going to get advice on what you need to do following up from that.

I’m sure that Kathleen is going to talk to you about the process for making a report to Adult Protective Services, but there is an adult abuse or neglect hotline for the city and county of Denver, and that number is also on our website because we work with Adult Protective Services regularly. Day by day, we are working on cases together. And that number is 720-944-2994. So if you had concerns about an older adult, but perhaps you don’t feel like it rises to the level where police involvement is needed, but you would like to involve Adult Protective Services, then follow Kathleen’s information and instruction on how to do that.

So various ways of reporting things into the system. I think what you might want to know if you are thinking about having to make a report is that if the report goes to law enforcement, then there is no confidentiality around your name and information and I’m sure that’s something that Kathleen will touch on, the different requirements for Adult Protective Services.

In our office, and I just want to mention this, this is really kind of more on the financial side, but we do have a consumer fraud hotline. Again, that number is on the same page on our website. It is 720-913-9179. So if you’re not sure whether a situation is a situation where law enforcement would become involved, then that’s the number you can call. We have two intake specialists. They’re very experienced and well-trained, and they kind of act as our triage for folks. If it’s not a situation where you’re calling police to make a police report but you’re not sure if that’s something criminal and you want to check that out in a little more detail, particularly if it is a financial crime, they can help you with this, like contractor fraud, identity theft, general consumer issues, but they also deal with elder financial exploitation, door to door solicitation. So they really deal with a very wide range of situations and they’ll be able to help you.

In terms of what we do, as I’ve told you, in this office, we prosecute a pretty significant number of felony cases. One of the things that we do every morning is we receive reports which have been made on older adults in the city and county of Denver over the past 24 hours by mandatory reporters. On Monday, Robert and I can be reviewing sometimes up to 20 reports of what has happened over the weekend. Usually during the week, that number is less day by day.

But if you make a report to the police, that’s one thing that you can have confidence, that you can have confidence that the district attorney’s office is going to be looking at those reports within 24 or 48 hours. By making a report, you’re getting it to the professionals who are working in the field very quickly. It doesn’t only go to the police. The police are going to send those reports every day to both Adult Protective Services and to us. So that kind of ensures that multiple different agencies are looking at these cases, but in the first instance it’s going to be the police who investigate any complaint that’s passed to them.

Now, unfortunately, a lot of times the economy has made it that there are multi-generational families living together within the jurisdiction. I’m talking about maybe sons or daughters, maybe grandsons, granddaughters living with an older family member, maybe living in a large house that the older family member is still living in, has space for them to live there. Sometimes that’s a fantastic thing. For instance, this morning I’ve spoken to a daughter who’s really caring for her mom, who’s in her nineties. She’s helping her mom. A third party, a carer actually was involved in some criminal activity there. But that can be a great thing for the senior, but sometimes not so much and sometimes that can create tension, and tension can escalate into the types of things that we’re here to talk about today. So mental persecution, mental victimization, psychological bullying, and unfortunately, sometimes that will escalate into physical violence.

What we want to say to people who maybe have some personal knowledge of this or have a concern about someone they know is that first we understand that it’s difficult for people to come forward. It’s difficult for them to come forward themselves and say, “Hey, my loved one is the person who’s making my life hell.” But we want people to know that we have a specialist team involved here who are not in the business of any judgment and neither are the police. The police are trained detectives who are going to be assigned these cases. So Denver Police Department has a Special Victims Unit and that is staffed with four specialist detectives who have investigated this type of crime for years. They understand the dynamics that are involved, they want to ensure that a situation is made safe, and then they want to look at the situation and they will often talk to us or file a report with us if they feel that the dynamic has got to a place where a criminal offense has occurred.

Every day, those detectives are out investigating cases, and then they submit those cases to my unit and myself and Robert look at those cases and decide what should happen. We don’t just make our determination separately. We will call the detective. We’ll have a consultation on the case, and then we’ll decide whether this is a case that does need to go ahead for charging. If the case goes ahead for charging, then another member of our team is involved, Betsy, who is our elder victim advocate. She’s responsible for keeping in touch with the person who’s the victim and really supporting them throughout the process.

What we’re all about here is being accessible, being transparent, being responsive in these cases, and also helping other members of the public. So obviously we can’t talk to third parties about a criminal case when it’s ongoing, but if people have a concern, if they have a question, we’re always happy to direct people in the correct way as to how… For instance, if someone calls us and says, “I have information on a case,” we’ll connect them with the detective who’s carrying out the investigation and let the information flow into the case that way.

We anticipate that only a tiny proportion of our cases will get this far. Hopefully a lot of them may even be diverted from the system before criminal proceedings are initiated or at the point of filing. We have restorative justice programs through our office through Restorative Denver so that if there is an isolated incident and if there’s a situation where it’s appropriate, then that case may go through the restorative justice process with community members involved in helping the perpetrator make right the harm that they’ve caused.

We also have diversion programs. Our aim is not simply to prosecute people to the fullest extent of the law. There might be cases where that’s called for, but there are other cases where those alternative systems of resolving situations is more appropriate. So those are the cases we’re going to refer there.

As I say, we try to be open, we try to be approachable. We understand that a district attorney’s office can be an authoritarian kind of intimidating office for people to contact. It’s a very big office. This office has hundreds of people working in it or working for the residents of the city and county of Denver. If you have a concern in your outside city and county of Denver, you can contact your local district attorney’s office. You can contact us if you have difficulty making those connections. We do get a number of referrals. For instance, a month or so ago I had one from an elder abuse prosecutor in Washington State who was speaking to someone who had a situation in, it was actually Douglas County. So people are linked up all over the country to make sure that if there is an older adult who’s being abused, who’s being neglected, who’s being exploited, that we are available to make sure that we can answer people’s questions and help them get them connected in the right direction.

So finally, I’m just going to wrap up by saying that one thing you might not know is that Colorado courts are now live streaming their trials. So if you Google Colorado courts live stream, then that will take you to a site which now gives you links to courts right across the state and you can actually click on those links. You won’t be going into court unmuted, but you will be able to watch the live stream of the proceedings that are taking place. As members of the community, it’s important that you have access to these systems so that you can see what’s actually going on day to day. If you have an interest in seeing proceedings in court, then you’re able to just click the link and log on and watch trials happening in real time in Colorado courts. That’s something that the legislature has encouraged and the courts have taken that up and started that website with live streaming of court proceedings. If you’re interested in courts generally, then that can be an educational thing to do.

I hope that some of that information is useful to you. Again, thank you, Bob, for inviting me to be here this morning and to chat with you. I’m very happy to answer any questions that anyone has. And if anyone has a question which is to do with a specific situation, then they can contact us offline also.

first order: Bob Brocker:

Thanks so much, Jane. Does anybody have a question for Jane? Because she does have to go pretty soon.

Karen Summers:

I do. This is Karen Summers. I’m a placement agent with Aging At 5280. I have a lovely gentleman who is a church elder who has been concerned about this couple for, gosh, probably about a year now. Adult Protective Services is involved, but I don’t know what to do. I mean, she has dementia so bad and we’re questioning him having dementia and he has got a bit of paranoia also. He won’t even let us come in to even have a chat, not going to the doctor, not eating properly. She had the police called on her because he asked her to follow in a second vehicle from a dealership and she ended up in Deer Creek Canyon and was stuck. So lots of bad decisions, neglect, and we just feel at a loss. What do we do? APS is involved. There’s a son that is very loosely involved out of state, but they’re keeping him at bay. I don’t even know what to do in this situation. If nothing is done, there will be a crisis in the home. We know that.

Jane Walsh:

Yeah, that sounds like a complicated situation, and I’m really happy to hear that Adult Protective Services is involved. Also, if I’m understanding it correctly, it sounds like that couple, you mentioned that the gentleman was concerned who was the church elder, but it sounds like maybe the couple also have links to a faith community and those links can be extremely important really in getting people to buy into sitting down and kind of talking about the situation.

I would also suggest that Kathleen may have some better advice for you than I do, but I just feel the experts are already involved in that situation. Hopefully it does not sound like… It sounds like there is an intervention that may be proceeding in a positive direction. I know people are concerned. If the level of concern rises to a police report, then I guess that’s something that would have to be that discussed and have to be considered. But that is a complicated situation. I don’t think I have a packaged answer for that. We find these cases complex. We’ll staff them. We might talk about a case for half an hour, so I think it’s probably more than we can do justice to. But I’ll pass to Kathleen perhaps to add her comments. If I’m missing something, I’m sure she’ll do that.

Kathleen Calderon:

Yeah, thank you. And I will put our email address and even my email address in the chat a little bit later on as well. If APS is involved, we have certain confines which we have to work within, but if there is concerns for capacity, that does give APS a little bit more leeway to potentially explore some more involuntary options as far as services go. But I would be more than happy to talk with you offline about what APS may or may not be able to do as well.

Karen Summers:

No, I would love that. Yeah, I am just at a loss. They’re very vulnerable to all kinds of exploitation. And honestly, I’m a little bit leery about the son that’s out of state too because they certainly were coming in blazing about wanting to know about the finances and getting power of attorney. So I have concerns on multiple levels. Yeah, I would love to have an opportunity to talk offline with you.

Kathleen Calderon:

Absolutely. Yes.

first order: Bob Brocker:

Jane, thanks again so much for joining us this morning and for providing all this great information, who to contact, and how to contact. It’s all good. It’ll all be in the recording as well. So next guest here is Kathleen. She’s on the screen now and she’s going to talk more about what APS is, does, and how to use APS. So go ahead, Kathleen.

Kathleen Calderon:

Thanks, and thank you everyone for joining us today. Thank you guys for having me. I thoroughly enjoy getting to talk to members of the community about our program since sometimes it can either be misunderstood or just not known about in general. So thank you.

Like Bob said, my name is Kathleen, and I work at the state level in Adult Protective Services or APS. So the way Colorado is set up is it is a county administered program with state oversight. The team that I work on and the team that I supervise, we provide the training to county programs, we develop policy procedures, we provide case consult support, all of that good stuff. We are essentially responsible for the oversight of the county programs. The county programs are the ones that house the caseworkers that go out and actually do the investigations and do the casework and work with clients directly in the community. I do have experience doing that as well. Prior to moving up to the state, I was a caseworker in a metro county for a couple of years as well, so I’ve got experience on both sides of the coin.

But overall, what Adult Protective Services or APS does is we are responsible for investigating allegations of mistreatment or self-neglected at-risk adults. So we are more of what we would call a reactive program versus a proactive program. We can only become involved when there is an allegation of something happening. It doesn’t obviously need to have proof that it’s happening at intake, but at least an allegation of either a mistreatment or a self-neglect occurring to an at-risk adult. What I mean by at-risk adult is folks who either can’t perform services necessary for their health safety and welfare, so they can’t do things to meet their basic needs, eat, drink, bathe, do those kinds of things independently or they can’t obtain services, so they can’t do them or reach out. They have either a physical or cognitive deficit that prevents them from being able to arrange for services for themselves or they lack the understanding or capacity to make responsible decisions for their health, safety, or welfare.

We don’t define an at-risk adult by any sort of specific diagnoses, any sort of specific age limit. In Colorado, that is our definition for APS. Someone just has to be 18 or over to be an adult, but it’s really based on an individual’s level of functioning, what they’re able to do for themselves, what they require assistance with and so on. So really, it’s just if somebody has physical or cognitive disabilities or deficits that prevent them from being able to meet their own needs independently, they would likely meet our definition of an at-risk adult.

When I say mistreatment, the term mistreatment really we use as an umbrella term. So mistreatment is defined as any abuse, neglect, or exploitation or harmful acts of an at-risk adult. I know we are focusing here on physical and mental abuse, so those are the ones that I will focus on for APS in this presentation.

When we refer to physical abuse in Adult Protective Services, it means any non-accidental infliction of pain or injury upon someone, so the things you would typically think of as being physical abuse, any hitting, kicking, punching, biting, burning, those types of things. Any sort of non-accidental means to hurt somebody or to cause an injury. For Adult Protective Services, it’s not required to leave a mark, so there doesn’t have to be a bruise or a cut or laceration, things like that in order for something to be considered physical abuse for Adult Protective Services because we do have that infliction of pain. So if you think of things like somebody getting slapped across the face, reasonably that would hurt. It may not leave a bruise or a mark. It might have a red mark that kind of fades in a few minutes, but if that inflicted pain upon that person, that would also still meet our definition of physical abuse in APS.

There’s also a second type of physical abuse that we have in our definition or a second way to meet our definition of physical abuse, and that is the unreasonable confinement or restraint of somebody that is outside of what we call generally accepted care taking standards. This isn’t something that necessarily needs to cause pain or injury, but it is simply that confinement or that restraint of an individual that prevents them from free movement or meeting their own needs. This would include things like tying somebody to a bed or a chair to prevent them from pulling out an oxygen tube or prevent them from getting into something. It could be somebody who is in a motorized wheelchair.

If somebody turned that wheelchair off and that person doesn’t have the ability to independently turn it back on for themselves, they would be confined to that wheelchair and that would be unreasonable as well. It can be locking somebody in a room. Even if it’s their bedroom and they have a TV and a bathroom and stuff like that, if you’re being locked in a room. We’ve seen cases where a family member will lock their parent in a bedroom for the day while they go to work because they want to prevent that individual, maybe they have dementia or lack of safety awareness, but they want to prevent them from wandering or doing anything to harm themselves. That would be unreasonable confinement.

So anything outside of what is prescribed in a care plan or if there’s an emergency safety need. So if a person has soft restraints that are part of a care plan because at night maybe they are at risk of scratching themselves, things like that, if a doctor is ordering that and those are used appropriately, that wouldn’t be considered unreasonable and that wouldn’t be considered physical abuse. Or folks that use a seatbelt on a wheelchair because they have limited trunk control or they’re a fall risk, that kind of stuff, those wouldn’t be unreasonable restraints. Those would be reasonable and follow a caretaking standard. So what we’re talking about is anything outside of that. Those would be things that we would consider physical abuse in APS, and those would be things that we would then look into investigating if the victim of that alleged abuse does meet our criteria for an at-risk adult or our definition of an at-risk adult.

When I listed out the types of mistreatment for APS, you might’ve noticed that I didn’t actually specify any sort of mental or emotional type of abuse or psychological abuse, any of the myriad terms for it. And that’s because in Colorado, APS doesn’t have a specific mistreatment type of mental abuse, so we don’t have a definition for it. It’s not something that is included in our mistreatment categories in what we investigate per statute. But there are some things in our definitions of our existing mistreatment types that are very close to it or can kind of get you there depending on the situation.

I do want to assure you all that that does not mean that we in APS think that mental abuse isn’t real or that we don’t think it’s harmful. We 100% believe that yes, that is a thing, and yes, that is harmful to an individual. It’s just that the way that our mistreatments are defined, we don’t have a specific mistreatment type of just mental abuse or psychological abuse or emotional abuse in our state.

The closest that we do have within our existing definitions, the first part is there’s a portion of our caretaker neglect definition that is somewhat similar to what I would consider a mental abuse. That is defined as when a caretaker is knowingly using harassment, intimidation, undue influence, threats, things like that to create a hostile or fearful environment for somebody. We think of things like threatening an older adult with moving them to a nursing home if they are incontinent one more time or if they forget something one more time, “Then I’m going to send you to a nursing home where you’re not going to get cared for,” that kind of thing. That would then create a fearful environment for that person. So if the individual doing that to somebody is a caretaker in Colorado, that type of situation would fit our caretaker neglect definition. So that creation of that hostile or fearful environment.

When I say caretaker, that is not limited to just professional caretakers. That is not just paid care providers, things like that. We do have a definition in APS for a caretaker, and that is anyone essentially who has assumed responsibility, whether paid or unpaid, for care of somebody else. Or it could be somebody who has either a legal or professional obligation to care for somebody. So it does include professional caregivers, paid caregivers. It also includes folks like legal guardians, conservators, things like that. They would be considered caretakers, but it could also just be a family member who says, “I will do X, Y and Z for you.” So they’re assuming that responsibility for that care and they would then become a caretaker, even if it’s short-term, even if it’s sort of episodic, they are considered a caretaker. So if this is happening within that relationship, that would be considered caretaker neglect and that would be something we would investigate.

Another mistreatment type that can sort of encompass that mental abuse piece is what we define as a harmful act. A harmful act is defined as any act against an at-risk adult that essentially causes harm and isn’t defined as any of the other mistreatment types. So we wouldn’t double dip, I guess for lack of a better term. If it’s physical abuse, we call it physical abuse. If it’s not neatly fitting in one of our existing definitions but it is causing harm to the at-risk adult, that is what we would classify as a harmful act, and those are committed by folks with a relationship to the client or to the adult. So it’s not going to then include those sort of scammers, things like that. That falls under our exploitation definition.

But a harmful act if it’s causing harm, that can be more of those things of… It may not be a caretaker, but they are creating a hostile or fearful environment. That would be a harmful act. So any of those sort of situations that don’t really fit neatly into these other mistreatment types, but something is causing harm or somebody is doing something to an adult that is harmful, that is something we could potentially investigate as well, so long as that adult is also an at-risk adult per our definition. Those are the two that we can really tackle that mental abuse piece.

Physical abuse is a little bit a more well-defined. A harmful act is a pretty sort of vague and nebulous definition, but it is done intentionally to catch those things. It would be really hard to define all of the what-ifs in the world if we were to try to pick out more specific things. That is what we would look at that’s relevant to this presentation here. We do have, of course, other mistreatment types as well, but I want to talk a little bit about how to report to APS, how to get us involved, that kind of thing.

You by no means need to be an expert on our definitions or whether or not somebody is an at-risk adult or whether or not something is meeting our definitions of mistreatment or self-neglect. If you are concerned about an adult, we encourage you very strongly to just call and make the report. In order to make a report to APS, you would call the county department in the county where the adult lives to make that report. And I’ll drop a link in the chat of a list of the numbers for all the counties in Colorado so that you have access to those phone numbers to make a report. That information is also found on our website as well, which I will put in the chat here in a moment, too. But yeah, if you are concerned, we just really strongly encourage you to call. And also if then you’re a mandatory reporter as well and that person is over the age of 70 or an adult with an intellectual or developmental disability, please also call law enforcement. But please do give us a call.

And when you call a county, you’ll probably feel they’re asking you a lot of questions and it’s because they are, but there is good reason for asking a lot of those questions. The most information you can provide in an intake, that’s the best. So any information you can provide, please do. There is no detail that is too small. They will ask you questions about, “Does this adult have any sort of conditions?” And that’s kind of trying to get to that determination of, is this person an at-risk adult per our statutory definition, per our program? And then they’ll ask you questions about any sort of the concerns that you have going on. They’ll probably ask you some more specific questions as they get more into the report. For example, if you’re reporting physical abuse, they’ll ask you, “Were there any cuts, bruises, marks, things like that? Did it cause pain?” Those kinds of things.

Answer to the best of your ability. If you truly don’t know something, that is totally okay, just let the person taking the call know that. But really, the purpose is just to try to get the most robust information they can because after a report is made, then that team on that county or the supervisor in the county will make a determination whether or not what’s being reported meets our criteria for involvement. Like I mentioned before, we are more of what I would call a reactive program just by statute. We have to have an allegation and there has to be information to support that that person meets our definition of an at-risk adult for us to become involved.

Once the report is made, the counties will review those reports and make a determination on whether or not we can screen that in or investigate those allegations. If that happens, a caseworker gets assigned to a case, they will then go out, conduct interviews of the client, the reporting party most of the time, and any sort of collaterals and supports to try to get as much information as they can. An alleged perpetrator will also be interviewed if they’re involved in the case, and they will make a determination about did a mistreatment occur here, did a physical abuse? Did the caretaker neglect, whatever, did that occur? But then also what APS is doing is assessing the client more globally or as a whole. A caseworker will also conduct a thorough assessment of that client’s needs and strengths. That way we can determine are there services available in the community that would help assist this person? Are there things that we can set up to kind of make life a little bit easier or reduce the risk of further mistreatment? Should that be an issue? So that is sort of the main purpose.

APS, we’re a civil entity. We aren’t law enforcement. We aren’t cops. We don’t press charges. We don’t do any of that. We do work alongside law enforcement very frequently or often in investigations, but we are sort of separate arms of the process. Law enforcement looks at, is there a criminal act happening? Is there a criminal charge? What we’re looking at is trying to determine, did the thing happen or not? And also, does this person have needs either related to that allegation or just in general that we could then offer to implement services for to increase safety and reduce risk? Our overall goal is just that. It’s to improve safety of individuals living in the community, of older adults living in the community. So long as they want to live independently and they can do so safely, that is what we want to help facilitate. At the end of the day, our goal is that service provision and that safety and prevention of further mistreatment.

Jane had also mentioned some pieces about confidentiality of information, so I did just want to make sure to touch on that really quickly as well. That is to say that all APS information is strictly confidential by state law. There are limited exceptions in which we can release information without a court order, and those exceptions are found in state law as well as our program rules as well. We are very limited in what we can share, but I do want you to know that when you are making a report, we are required by law to share those reports with law enforcement. Just as Jane was referring to sharing reports with our program, counties are required to share any reports of mistreatment with law enforcement within 24 hours of receiving that report. So that information does go to law enforcement, and as she mentioned, they don’t have the same confidentiality requirements that we do.

APS cannot disclose who a reporting party is. We cannot disclose contact information, anything like that to those involved in the case or to anyone else. So if a client is asking us or an adult is asking us, “Well, who called in and reported this?” Or, “Who called in and reported me for this?” We have to respond that, “We actually can’t share that information. Sorry.” But law enforcement, of course, doesn’t have those same restrictions. So we do try to work very closely with them. When we are working side-by-side with them on an investigation, we do tend to explain, “We do want to keep this private,” or, “Could you please not share who a reporting party is?” And they can then make a determination whether or not they should do that or shouldn’t based on their protocols. So there is some variance in that information’s availability to folks involved in the case. But from the APS side of things, that is not something that we would disclose or it’s not something we can disclose.

You can report anonymously to APS as well, so if you don’t want to leave your contact information or your name, that’s okay. Tell the person taking the report you do want to make this report anonymously, but I will say it is very helpful for us to have your contact information. A lot of times when a caseworker is assigned a case and they’re beginning that investigation or that assessment, there might be some pieces of information that you as the reporting party would know or have easy access to. So reporting parties are someone that we do identify as important to contact during an investigation for an interview. So there might be additional questions that a caseworker has, so that information is really helpful for a caseworker to have. But if you want to remain anonymous, you are welcome to. That is certainly up to you and your discretion when you are making those reports.

But other than that, our work is completely confidential. We only share, like I said, in limited circumstances. So trying to set up services, we’ll share what’s needed. If we’re doing a joint investigation, we can share information that’s needed to accomplish that. But other than that, we can’t provide general status updates. If somebody is calling and saying, “Hey, do you have a case with this person?” We can’t really just provide an update on that kind of stuff. So our information is strictly confidential. So that’s my whole spiel.

first order: Bob Brocker:

Thank you so much, Kathleen. I know we probably have a few questions for Kathleen, but I’m going to ask you to hold those for a few minutes so that I can introduce Leah. And then we’ll have more time for more questions after that. Thanks so much, Kathleen.

Kathleen Calderon:

Thank you.

first order: Bob Brocker:

These are always great learning experiences for all of us, including me. Leah, please.

Leah McMahon:

Thank you, Bob, and thank you, AgeWise Colorado, for the work you do and hosting the webinar today. I’m learning something as well. Jane and Kathleen, thank you so much for your presentations.

Today, I thought I would talk a little bit about the Ombudsman Program, give an overview, talk about the work that we do, and a little bit about the structure here in Colorado and how you can access an ombudsman and then talk about the strengths of the Long-Term Care Ombudsman program. I have been an ombudsman for about 14 years now, and I’ve worked every aspect of the program. I started off as a local Ombudsman supervisor and I’ve been a part of the state office of the Long-Term Care Ombudsman program now for about seven years, and I’ve been in this role for a little over four years. The origins of the Ombudsman Program comes from a directive from former President, Richard Nixon, in response to abuses that were occurring in nursing homes and failed oversight by regulators. Established in 1972 under the Older Americans Act, every state is required to have an ombudsman program that addresses complaints and advocates for improvements of people in the long-term care system, which has also expanded to assisted living homes.

Ombudsman is a Swedish word. I know it’s a big word, it’s a mouthful, but it is a Swedish word for carrier of the message. So that’s a big part of our job. That’s what we do. We speak on behalf of residents every day and address their concerns. In Colorado, we now are administered directly through the Department of Human Services. Prior to that, for over 30 years, the State Office of the Long-Term Care Ombudsman Program was hosted by Disability Law Colorado. In June 2023, we moved over to the Department of Human Services and I have my own website where you can access all of our information, and it’s on the last slide, so we’ll make sure that Bob shows that last slide at the end.

The local ombudsmen are placed within 16 regions around our state, and each region is primarily inside the area Agency on Aging where you can access an array of services for the community as well as the Long-Term Care Ombudsman program. And within the program, I have a leadership team that is the ombudsman supervisor for each region, and they help make sure that the ombudsmen are acting within their role. They help protect the overall integrity of the program. Our mission is to advocate and protect and promote the health, safety, welfare, and rights of people living in long-term care, and that includes the right to live free from abuse and neglect.

Our jurisdiction here in Colorado includes serving people who are in licensed assisted living homes and nursing homes, and we serve anyone in those settings. We do not have any age restrictions. So anybody living in an assisted living home or nursing home can access an ombudsman and receive our advocacy services. Our primary duty is to identify, investigate, and resolve complaints made on behalf of residents. We are at residents’ bedside every day, all day, listening to concerns and making every attempt to resolve them to the satisfaction of the resident. We also-

first order: Bob Brocker:

Leah?

Leah McMahon:

Yep.

first order: Bob Brocker:

Let me ask you a quick question.

Leah McMahon:

Sure.

first order: Bob Brocker:

How many nursing homes and assisted living places are you visiting in total around the state?

Leah McMahon:

Yeah, that’s a great question, Bob. There’s about 50,000 licensed beds throughout Colorado between the assisted living homes and the nursing homes. Nursing homes, we have approximately 223 in our state, and assisted living homes, we have approximately 691. So we need to be in every corner of the state.

first order: Bob Brocker:

And these all vary in size quite a lot, don’t they?

Leah McMahon:

Yes, yes. We have large continuums that… Continuum of care where the nursing home may have independent living, assisted living, and nursing home, all on one location, on one piece of property, and some of those nursing homes are rather large and can have 200 to 300 people living in the apartments inside the nursing home. Then our assisted living homes span from smaller homes in the community. There could be some of them located right next door to you where there’s maybe eight residents living there or five residents all the way up to having 100 apartments in one building as well for assisted living.

first order: Bob Brocker:

Okay.

Leah McMahon:

Our main goal is to educate and inform so that we can empower residents and their family members as well as staff. That is always our goal in the forefront of our minds is to offer that education and information and the Long-Term Care Ombudsman Program services, as well as educating on the rights that people have and the additional rights that they have while living in an assisted living home or nursing home.

We also ensure that residents have timely access to the Ombudsman Program and that we also have timely access to them, and this has to be unimpeded and without the fear of retaliation. So there is no person or entity that can interfere with our ability to access the residents with ease and for them to access us. As far as our visibility goes, we are by federal law a distinct entity that is separate and identifiable. That’s one of the reasons why we have our own website. You can see my logo here on the slide so that you can see the Ombudsman Program and you have that visual to access us. If you were just relying on the agency that we’re in, it might be a little harder to find our services in the Department of Human Services because there are so many other programs that are within them, and so we want that visibility to be front and center always.

I think that a lot of people have not heard of the Long-Term Care Ombudsman Program, even though we have a presence across the nation, including Guam, D.C., and Puerto Rico, and that’s why we spend so much time really talking about what it is that we do and take the opportunity, like today from the invitation from Bob, and being able to present.

My role really is to direct and manage the statewide program and make sure that all of my ombudsman representatives have the support that they need to advocate for the rights of residents and protect confidential records. I know that Kathleen talked about her confidentiality laws. We have some of the most strict confidentiality laws that are governed by federal and state regulations, and so a big part of my job is to make sure that I’m protecting those Ombudsman records. I also certify new Long-Term Care Ombudsman through our training process. I manage fiscal responsibilities and protect the independent voice of the Long-Term Care Ombudsman to speak on behalf of residents.

I do have some additional support within the Office of the State Long-Term Care Ombudsman. I have a deputy who is my right-hand person that assists me with internal operations, policies and procedures, and ensuring that they’re being followed. I also have a quality assurance program manager that helps manage the data and helps us analyze the information based off of the types of complaints and things that we receive every day from the community and put that together in an annual federal report. Then I make a public version of that for the community so that you can see what the residents are saying and what their concerns are while living in an assisted living home or nursing home.

One of the things that the Ombudsman Program was able to do in 2016 was expand our advocacy services to people who live in their own home. So anyone who is enrolled in the program of all-inclusive care for the elderly can also access an ombudsman now. And that program, gosh, has been around since 2017, and I was the first state PACE ombudsman to help build that program and get one local program established in Denver. And then we have the state PACE ombudsman who will advocate for everybody else across the state who is enrolled in the program of all-inclusive care for the elderly.

Another aspect of my job where I take the lead is I comment on current and proposed laws, regulations, and policies. I work with governmental agencies that oversee licensing and enforcement. I work with lawmakers to promote quality of life and care for people living in assisted living homes and nursing homes. Then I analyze and look at our complaint trends in our data.

Let’s talk a little bit about a day in the life of the ombudsman and the statewide team, what they do. They’re the folks that are inside the assisted living homes and nursing homes every day, and they are working on resolving concerns of people who live in assisted living homes and nursing homes every day. Also, educating and informing people in different forums within the assisted living home and nursing home. They have what they call Resident Council, and so that’s where residents get to convene inside their home, the assisted living home or nursing home, and voice their concerns about life inside the nursing home or assisted living home, but also talk about what’s going on in the community. What are some of the good things that are happening? They can give input on the types of food they would like to have for dinner or breakfast. They can give input on different processes around communication that they would like to see improve or change or be different.

One of the things about our complaint investigation, you heard Jane talk a little bit about their process and you heard Kathleen talk about hers, anybody at any time can call the Ombudsman Program. We hear from family members, we hear from residents themselves, we hear from the greater community, and we hear from staff who work inside the assisted living homes and nursing homes. So people can either report that anonymously or they can provide us with their contact information. We take action from getting permission from the resident.

Even if we get a call from a family member or somebody else from the community, we always meet with the resident first or talk to the resident first to see if they have that same concern that we received to see if it is a concern of theirs. Then we educate and inform and we ask them maybe what parts of the concern would they like resolved? What parts would you like us to help with? Or if they want us to resolve all of it, we then do that with their permission, their consent, and at their direction. They tell us the way that they want us to resolve it.

We do respond to all complaints within 24 hours. Please note we are not an emergency service. We are low level problem solvers really trying to work at the lowest level within the assisted living home or nursing home to resolve the concern to the satisfaction of the resident and what their expressed interest is. I would like to add a note, too, that on my website there’s a training series about abuse prevention. Jane Walsh was actually interviewed and is in that training series, so you can access that through the resource tab on my website. And I’ll open it up for questions.

first order: Bob Brocker:

I’ll leave that up there for a minute and make sure people see your contact info. Do we have any questions for Leah?

I have a question. So I know a lot of your ombudsman are volunteers, so how many total people are in the Ombudsman Program in the state, the Long-Term Care?

Leah McMahon:

Yeah, thank you, Bob. We have 70 ombudsman that are long-term care certified ombudsman, and we have approximately 16 volunteers, and that’s actually growing a little bit across the state. During the pandemic, we did lose some of our volunteers. The mean age nationally is about 72 to 75. So those folks left the program for their own concern and perhaps their own health reasons and to take care of their loved ones. So we’re in the process of looking to build that back up. The program was originally built off the backbone of volunteers. They go through the same certification process, do the exact same work that the paid staff do, and there is no difference between the work that the volunteers do and the paid staff.

first order: Bob Brocker:

And we have a question from Maggie Miller. Maggie?

Leah McMahon:

Hi, Maggie.

Maggie Miller:

Hey there. Actually, this is a question for Kathleen. I don’t think we had a chance to ask her questions. Would that be all right?

first order: Bob Brocker:

Sure. Go ahead.

Maggie Miller:

Okay, terrific. And maybe I can follow up with you because I have a question similar to a question that was asked earlier. I work with people. I’m an executive coach, and I coach adult children of older parents, and I get all kinds of super complex situations. So there’s often an older adult who is very fiercely independent, lives independently, refuses help, very private and even secretive about their health and their finances and that sort of thing, and doesn’t appear to have dementia and they are not taking care of themselves.

Often, the people who see me have complex relationships with their parents. The parents are possibly verbally abusive to the children or are manipulative of them. So there’s just so many dimensions for thinking about what the child’s responsibility is. And also, usually in these cases, there is no way that the elder wants to move or change anything about their lives. They could run themselves into the ground and be perfectly happy doing that.

So that’s a complex situation. I’m just curious about your initial thoughts, and then I’d love to follow up with you to really kind of delve into all the variables.

Kathleen Calderon:

Yeah, absolutely. So just sort of quickly right off the bat in hearing that, it does get a little tricky in working with adults, as I’m sure you know, because adults do have the right to self-determination. So for someone to be an at-risk adult, they don’t have to have dementia, it could very well be that they aren’t taking care of themselves because they’re suffering other sort of deficits or disabilities that impact their ability to do so. That is something we could look into as self-neglect if they do meet criteria as an at-risk adult. It gets to a point where even APS isn’t necessarily able to do much if an adult is refusing services. I mean, we could offer all the help in the world if that adult maintains the right to make the choices and maintains that ability to make choices for themselves, no matter how bad those choices are, we would have to walk away if they don’t want to accept services from us.

Something in our casework and stuff that we often see caseworkers having to do is talk to family members about those tough decisions and saying, “You can offer them all the things. We’ve offered them all the things. It is up to them because they have the ability to make decisions.” If they want to make poor choices, they can do that. People can get in bad relationships. People can choose to not take care of themselves. Even if they know that they’re being scammed, they can choose to continue to give money to those individuals that are taking advantage of them. It is great that adults have choice, but it can make our jobs very, very difficult when we know that they do need help with things that are going on.

So it’s certainly something that we encourage our caseworkers to build that rapport and to try and at least offer something that they will accept. If someone will accept even the smallest service to try to improve safety, then we want our caseworkers to go for that and to push for that. Sometimes that can kind of open the door and build trust to allow APS to offer more services, but it can also just be a very difficult situation where even we’re sort of against the wall in what we can do.

Maggie Miller:

That’s super helpful. Thank you so much. And if you don’t mind, I will contact you and set up a time to talk.

Kathleen Calderon:

Yes, absolutely. I would love that.

Maggie Miller:

Thanks.

Kathleen Calderon:

Yeah. Of course.

first order: Bob Brocker:

Well, thank you Kathleen and Leah for participating today. This is great information and once we get the recording edited just a little bit, we’ll be posting it on our website. I would encourage all of you who are on here still to share that with people that you know, because people need to know this information that has been shared with all of us today and you never know when you might need it.

So with that, I’ll say goodbye to everybody and thanks again for joining us and have a great rest of your day. Take care.

Kathleen Calderon:

Thank you.

first order: Bob Brocker:

Thank you. Bye-bye.

Maggie Miller:

Thank you, Bob. Thank you, speakers. Thanks, everyone.

Kathleen Calderon:

Thank you.

Nan Smith:

Thank you.