The Virtual Hospital: The Iowa Child Abuse Resource: Conferences and Symposiums

A Social Overview
A dependent Adult Abuse typically involves allegations about adults who are incapable of adequate selfcare due to physical or mental conditions. Often dependent adults are either elderly or have diminished physical or mental capacities which prevent them from meeting their own needs adequately. Iowa has an increasing proportion of people who are aged 60 and over. The group that is 80 and over is increasing more rapidly than any age group. Iowa's proportion of older adults in the population exceeds that of the United States as a whole. Nationwide, lowa ranks:

1st - percentage of persons aged 85+ at 1.99%
2nd - percentage of persons aged 75 + at 7.17%
3rd - percentage of persons aged 65 + at 15.35%
4th - percentage of persons aged 60 + at 19.91%

In 1993 the Department of Elder Affairs, Iowa State University and area agencies on aging conducted a statewide needs assessment of non institutionalized Iowans aged 60 - 104. It would appear that in general, older people in Iowa are doing fairly well, but there are also large numbers who are vulnerable and at risk. They found that about half of those in the study lived alone. This trend is likely to continue into the next century. As a rule, the older person who lives alone is considered vulnerable and at risk in our society. They have lower incomes, they are women and they are older. The older a woman becomes in our society, the more likely she is to live alone. Health problems that occur when an elderly person lives alone are more likely to create problems for independent living. While many family and friends provide strong support systems for the elderly, many who live alone have no one to help them and must rely on the provision of services or on paid assistance. In fact, the information shows that a lot of the assistance the elderly are receiving is coming from professionals. The elderly who are living alone must have services available to them in order to maintain their independence.

Researchers estimate that only 1 in 14 incidents of elder abuse actually come to the attention of law enforcement or human service agencies. Elder abuse is one of the most underrecognized and underreported social problems in the United States. It is far less likely to be reported than child abuse because of the lack of public awareness. Nationally, it is estimated that over 55% of elder abuse is due to selfneglect. Such abuse can happen anywhere. . . in private homes, at health care facilities and in the community at large.

Dependent adults are not all elderly. A dependent adult is someone aged 18 or over. This includes those who have diminished physical or mental capacity. Such persons, who have a diminished ability to protect themselves and who are dependent on others for basic needs are particularly vulnerable to mistreatment, physical violence, threats of assault, verbal abuse, financial exploitation, physical or emotional neglect or sexual abuse. Iowa has a sizable population of adults who are dependent but are not elderly.

APPLICATION OF THE LAW

The Dependent Adult Abuse Law, lowa Code Section 235B, was initially enacted effective January 1, 1983 and has been amended yearly since then. This legislation authorized the Department of Human Services to accept reports of suspected dependent adult abuse, evaluate reports, complete an assessment of needed services, make appropriate referrals for services and maintain a central registry. Dependent Adult Abuse which occurs in the community is evaluated by the Department of Human Services. The Department of Human Services conducts approximately 1300 such evaluations annually.

Dependent Adult Abuse which occurs in a licensed health care facility is evaluated by the Department of Inspections and Appeals. The two departments may work together on an abuse evaluation. Additionally, Dependent Adult Abuse may be a crime. Often times the D.H.S. worker and Law Enforcement work together jointly. Criminal laws provide for the prosecution of alleged perpetrators in cases where a criminal act has been committed. Other laws provide other means of protection for Dependent Adults including guardianships and conservatorships, and, when necessary, for the involuntary commitment of adults for substance abuse or mental health reasons. Services can be provided for Dependent Adults, however all adults have a right to selfdetermination. This means that the Dependent Adult can refuse services unless the Court determines that the adult is not competent to make decisions or is threatening his or her own life or that of others.

PHYSICAL INDICATORS OF DEPENDENT ADULT ABUSE

Environment -

No food in the house or rotted, infested food,
Lack of proper food storage,
Special dietary foods not available,
Inadequate cooking facilities or equipment,
Clothes extremely dirty or uncared for,
Not dressed appropriately for the weather,
Inadequate or ill fitting clothing, not dressing,
Wearing all of one's clothing at once,
Dilapidated structure or structure in poor repair,
Fallen steps, high grass, rotted porch, leaking roof,
Utilities cut off - Lack of heat in winter,
Doors/windows made out of cardboard,
Unvented gas heaters, chimney in poor repair,
No fuel for heating or fuel is dangerously stored,
Lack of water or contaminated water,
Gross accumulation of garbage, papers and clutter,
Lack of access to essential rooms,
Lack of access to community resources,
Lives on the street,
Large number of pets with no apparent means of care,
No income, unpaid bills,
Out of money by second week of the month,
Signs checks over to others,
Sudden change in money management habits,
Sudden withdrawals or closing out of bank accounts,
Income does not meet monthly expenditures,
No TV, radio, telephone, newspapers, magazines,
No friends or family visits,
No means of transportation,
Not physically able to get out and shop, pay bills, etc.
Physical Condition -
1. Lack of medical care
2. Lack of personal cleanliness and grooming - body odors,
3. Swollen eyes or ankles, decayed teeth or no teeth,
4. Bites, fleas, sores, lesions, lacerations,
5. Multiple or repeated or untreated injuries Injuries incompatible with explanation
6. Bruises, broken bones or burns on the body
7. Untreated pressure sores
8. Signs of confinement (tied to furniture, locked in a room, etc.)
9. Tremors
10. Difficulty in communication
11. Broken glasses frames or lenses
12. Drunk, overly medicated Lying in urine, feces, old food
13. No use of limbs, lack of mobility
BEHAVIORAL INDICATORS
1. Intentional physical self-abuse - suicidal statements
2. Persistent liar,
3. Does not follow medication directions,
4. Refuses needed medical attention,
5. Refuses to accept services offered by others,
6. Threatens or attacks others physically or verbally,
7. Refusal to accept presence of visitor,
8. Refusal to open door,
9. In total darkness,
10. Denies obvious problems (medical conditions, etc.),
11. Increased depression, anxiety or hostility,
12. Withdrawn, reclusive, suspicious, timid, unresponsive,
13. Refusal to discuss the situation,
14. Lack of trust in family as well as in others,
15. Refusal to take medication,
16. Denial of any wrong-doing - medically or otherwise,
17. Unjustified pride in self-sufficiency,
18. Procrastination,
19. Turns off hearing aid,
20. Hallucinations, confusion or delusions,
21. Disonentation as to place and time,
22. Forgetfulness, losing things, not shutting stove off,
23. Loneliness, anger or fearfulness,
24. Diminished mental capacity,
25. Vague health complaints,
26. Longing for death.
BASIC INFORMATION AND DEFINITIONS
The Department of Human Services has legal authority to conduct evaluations and assessments of alleged dependent adult abuse when it is alleged that:
a. The victim meets the definition of being a dependent adult, and
b. is alleged to be the victim of one or more of the four categories of abuse or neglect c. as a result of the acts or omissions of a responsible caretaker or as the result of the acts or omissions of the dependent adult.

DEPENDENT ADULT is defined in the Code of Iowa 235B.2 as being:
"a person eighteen years of age or older who is unable to protect the person's own interests or unable to adequately perform or obtain services necessary to meet essential human needs, as a result of a physical or mental condition which requires assistance from another"

CARETAKER, defined in the Code of Iowa 235B.2, means a related or nonrelated person who has the responsibility for the protection, care, or custody of a dependent adult as a result of assuming the responsibility voluntarily, by contract, through employment, or by order of the court.

FOUR CATEGORIES OF DEPENDENT ADULT ABUSE
DEPENDENT ADULT ABUSE is defined in the Code of Iowa 235B.2 as being any of the following four categories of abuse as the result of the willful or negligent acts or omissions of a caretaker:
1. Physical Abuse (including unreasonable confinement or punishment and assault)
2. Sexual Abuse
3. Financial Exploitation
4. Denial of Critical Care (including Denial of Critical Care by the Dependent Adult.)

Physical Abuse:
Physical injury to, or injury which is at a variance with the history given of the injury, or unreasonable confinement, unreasonable punishment, or assault of a dependent adult, as a result of the willful or nealigent acts or omissions of a caretaker.

Sexual Abuse:
The commission of a sexual offense under chapter 709 or section 726.2 with or against a dependent adult as a result of the willful or negligent acts or omissions of a caretaker.

This includes the following 7 sub-catagories:
First Degree Sexual Abuse,
Second Degree Sexual Abuse,
Third Degree Sexual Abuse,
Detention in a Brothel,
Indecent Exposure,
Assault with Intent to Commit Sexual Abuse, and
Incest.

Financial Exploitation:
The act or process of taking unfair advantage of a dependent adult or the adult's physical or financial resources for one's own personal or pecuniary profit, including theft, by the use of undue influence, harassment, duress, deception, false representation, or false pretenses as a result of the willful or negligent acts or omissions of a caretaker.
Denial of Critical Care:
The deprivation of the minimum food, shelter, clothing, supervision, physical or mental health care, or other care necessary to maintain a dependent adult's life or health, as a result of the willful or negligent acts or omissions of a caretaker.

This includes the following sub-categories:
Denial of or Failure to Provide Adequate Food,
Denial of or Failure to Provide Adequate Shelter,
Denial of or Failure to Provide Adequate Clothing,
Denial of or Failure to Provide Adequate Medical Care,
Denial of or Failure to Provide Adequate Mental Health Care,
Denial of or Failure to Meet Emotional Needs Necessary for Normal Functioning,
Denial of or Failure to Provide Proper Supervision, and
Denial of or Failure to Provide Adequate Physical Care.

Note:
Denial of Critical Care may also be the deprivation of the minimum food, shelter, clothing, supervision, physical or mental health care, and other care necessary to maintain a dependent adult's life or health as a result of the acts or omissions of the dependent adult. (This includes the subcategories listed above.)

Dependent adult abuse does not include depriving a dependent adult of medical treatment if the dependent adult holds a belief or is an adherent of a religion whose tenets and practices call for reliance on spiritual means in place of reliance on medical treatment. However, this provision does not preclude a court from ordering that medical service be provided to the dependent adult if the dependent adult's health requires it.

Dependent adult abuse does not include the withholding or withdrawing of health care from a dependent adult who is terminally ill in the opinion of a licensed physician, when the withholding or withdrawing of health care is done at the request of the dependent adult or at the request of the dependent adult's next of kin, or guardian pursuant to the applicable procedures under chapter 125, 144A, 222, 229, or 633.

Dependent adult abuse does not include domestic abuse situations where the victim is not dependent.

Dependent adult abuse does not include those persons legally incarcerated in a penal setting, either in a local jail or confined to the custody of the director of the Department of Corrections.
THE EVALUATION/ASSESSMENT PROCESS
The process of evaluating reports of dependent adult abuse is as follows:
1. Intake
2. Appropriate evaluation or assessment
a. Contact with the dependent adult at their residence or at a program providing care or training.
b. Interview with the alleged perpetrator
c. Obtaining information from collateral sources (subjects of the report and other relevant parties)
3. Documentation of evaluative conclusions, recommendations for services, and for district court action,
4. Documentation of evaluation through completion of reports
5. Completion of required correspondence to subjects and mandatory reporters

REPORT CONCLUSIONS
The conclusion of the investigation is based on an evaluation of all of the information gathered during the investigation.

There are three possible outcomes in a Dependent Adult Evaluation/Assessment:

Founded:
It has been determined by a preponderance of evidence (51% or greater) that abuse has occurred
Undetermined:
It cannot be determined by a preponderance of evidence (51% or greater) that child abuse has or has not occurred. To found or unfound is equally compelling.
Unfounded:
It has been determined by a preponderance of evidence (51% or greater) that abuse has not occurred.
Upon completion of the report, all subjexts and mandatory reporters are notified in writing of the conclusions of the report.
MANDATORY REPORTERS OF
DEPENDENTADULT ABUSE
Code of lowa 235B.3(2)
1. All of the following persons shall report suspected Dependent Adult Abuse to the department:
2. A self-employed social worker.
3. A social worker or an income maintenance worker under the jurisdiction of the Department of Human Services.
4. A social worker employed by a public or private person including a public or private health care facility as defined in section 135.C.1.
5. A certified psychologist.
6. A person who, in the course of employment, examines, attends, counsels, or treats a dependent adult and reasonably believes the dependent adult has suffered abuse, including: member of the staff of a community mental health center, a member of the staff of a hospital, a member of the staff or employee of a public or private health care facility as defined in section 135C. 1
7. A peace officer,
8. An in-home homemaker-home health aide,
9. An individual employed as an outreach person,
10. A health practitioner, as defined in section 232.68,
11. A member of the staff or an employee of a community supervised apartment living arrangement, sheltered workshop, or work activity center.
12. A person who performs inspections of elder group homes for the department of elder affairs and a care review committee member assigned to an elder group home pursuant to chapter 231B
NOTE:
ANY OTHER PERSON WHO BELIEVES THAT A DEPENDENT ADULT HAS SUFFERED ABUSE MAY MAKE A REPORT OF THE SUSPECTED ABUSE TO THE DEPARTMENT OF HUMAN SERVICES. MANDATORY REPORTERS, OUTSIDE THE SCOPE OF THEIR PROFESSIONAL PRACTICE, MAY ALSO REPORT SUSPECTED ABUSE, BUT AS PERMISSIVE REPORTERS.

INFORMATION, EDUCATION AND TRAINING REQUIREMENTS
The Code of Iowa 235B.16 provides that:

1. The Department of Elder Affairs, in cooperation with the Department, shall conduct a public information and education program. The elements and goals of the program include but are not limited to:
a. Informing the public regarding the laws governing dependent adult abuse and the reporting requirements for dependent adult abuse.
b. Providing caretakers with information regarding services to alleviate the emotional, psychological, physical, or financial stress associated with the caretaker and dependent adult relationship.
c. Affecting public attitudes regarding the role of the dependent adult in society.
2. The Department, in cooperation with the Department of Elder Affairs and the Department of Inspections and Appeals, shall institute a program of education and training for persons, including members of provider groups and family members, who may come in contact with dependent adult abuse. The program shall include but is not limited to instruction regarding recognition of dependent adult abuse and the procedure for the reporting of suspected abuse.

3. The content of the continuing education required pursuant to chapter 272C for a licensed professional providing care or service to a dependent adult shall include, but is not limitedto, the responsibilities, obligations, powers, and duties of a person regarding the reporting of suspected dependent adult abuse, and training to aid the professional in identifying instances of dependent adult abuse.

4. The Department of Inspections and Appeals shall provide training to investigators regarding the collection and preservation of evidence in the case of suspected dependent adult abuse.

5. A person required to report cases of dependent adult abuse pursuant to section 235B.3, other than a physician whose professional practice does not regularly involve providing primary health care to adults, shall complete two hours of training relating to the identification and reporting of dependent adult abuse within six months of initial employment or self-employment which involves the examination, attending, counseling, or treatment of adults on a regular basis. Within one month of initial employment or self-employment, the person shall obtain a statement of the abuse reporting requirements from the person's employer or, if self employed, from the Department. The person shall complete at least two hours of additional dependent adult abuse identification and reporting training every five years.

If the person is an employee of a hospital or similar public or private facility, the employer shall be responsible for providing the training. To the extent that the employer provides approved training on the employer's premises, the hours of training completed by employees shall be included in the calculation of nursing or service hours required to be provided to a patient or resident per day. If the person is self-employed, the person shall be responsible for obtaining the training.

The person may complete the initial or additional training as a part of a continuing education program required under chapter 272C or may complete the training as a part of a training program offered by the Department of Human Services, the Department of Elder Affairs, the Department of Inspections and Appeals, the lowa Law Enforcement Academy, or a similar public agency.

A person required to complete both child abuse and dependent adult abuse mandatory reporter training may complete the training through a program which combines child abuse and dependent adult abuse curricula and thereby meet the training requirements of both this subsection and section 232.69 simultaneously. A person who is a mandatory reporter for both child abuse and dependent adult abuse may satisfy the combined training requirements of this subsection through completion of a twohour training program, if the training program curriculum and content are approved by the Department of Human Services.

6. The department shall require an educational program for employees of the registry on the proper use and control of dependent adult information.
REPORTING PROCEDURE -
Iowa Administrative Code 441-176
441-176.4 (235B) Reporters.
The central registry and local office shall accept reports from mandatory reporters or any other person who believes dependent adult abuse has occurred. Mandatory reporters shall make a written report within 48 hours after an oral report. The reporter may use the Department's Form 470-2441, Suspected Dependent Adult Abuse Reporting Form, or may use a form developed by the reporter which meets the requirements of Iowa Code section 232.70.

441-176.5 (235B) Reporting Requirements.
(1) Each report made by someone other than a mandatory reporter may be oral or written.

(2) The report shall be made by telephone or otherwise to the Department of Human Services. When the person making the report has reason to believe that immediate protection for the dependent adult is advisable, that person shall also make an oral report to an appropriate law enforcement agency.

(3) The Department of Human Services shall: a. Immediately, upon receipt of a report, make an oral report to the registry; b. Forward a copy of the report to the registry; and c. Promptly notify the appropriate county attorney of the receipt of any report.

(4) The report shall contain the following information, or as much thereof as the person making the report is able to furnish:
a. The names and home addresses of the dependent adult, appropriate relatives, caretakers, and other persons believed to be responsible for the care of the dependent adult.
b. The dependent adult's present whereabouts if not the same as the address given.
c. The reason the adult is believed to be dependent. Dependency is the first criterion to be considered before beginning an evaluation.
d. The dependent adult's age.
e. The nature and extent of the adult abuse, including evidence of previous adult abuse. The existence of alleged adult abuse is the second criterion to be considered before beginning an evaluation.
f. Information concerning the suspected adult abuse of other dependent adults in the same residence.
g. Other information which the person making the report believes might be helpful in establishing the cause of the abuse or the identity of the person or persons responsible for the abuse, or helpful in providing assistance to the dependent adult.
h. The name and the address of the person making the report.

(5) A report shall be accepted whether or not it contains all of the information requested in 176.5(4), and may be.made to the Department, county attorney, or law enforcement agency. When the report is made to any agency other than the Department of Human Services, that agency shall promptly refer the report to the Department.
CONFIDENTIALITY AND IMMUNITY FROM LIABILITY
Code of Iowa 235B.3
(7) The Department shall inform the appropriate county attorneys of any reports of dependent adult abuse. The Department may request information from any person believed to have knowledge of a case of dependent adult abuse. The person, including but not limited to a county attorney, a law enforcement agency, a multidisciplinary team, or a social services agency in the state shall cooperate and assist in the evaluation upon the request of the Department. County attorneys and appropriate law enforcement agencies shall also take any other lawful action necessary or advisable for the protection of the dependent adult.

(8) A person participating in good faith in reporting or cooperating with or assisting the Department in evaluating a case of dependent adult abuse has immunity from liability, civil or criminal, which might otherwise be incurred or imposed based upon the act of making the report or giving the assistance. The person has the same immunity with respect to participating in good faith in a judicial proceeding resulting from the report or cooperation or assistance or relating to the subject matter of the report, cooperation, or assistance.

(9) It shall be unlawful for any person or employer to discharge, suspend, or otherwise discipline a person required to report or voluntarily reporting an instance of suspected dependent adult abuse pursuant to subsection 2 or 4, or cooperating with, or assisting the Department of Human Services in evaluating a case of dependent adult abuse, or participating in judicial proceedings relating to the reporting or cooperation or assistance based solely upon the person's reporting or assistance relative to the instance of dependent adult abuse. A person or employer found in violation of this subsection is guilty of a simple misdemeanor.

SANCTIONS FOR FAILURE TO REPORT - Code of Iowa 235B.3

(10)A person required by this section to report a suspected case of dependent adult abuse who knowingly and willingly fails to do so is guilty of a simple misdemeanor. A person required by this section to report a suspected case of dependent adult abuse who knowingly fails to do so is civilly liable for the damages proximately caused by the failure.
DUTIES OFTHE DEPARTMENT UPON RECEIPT OF A REPORT
Iowa Administrative Code 441176.6 (235B)
(1) When a report is received, the department shall promptly commence an appropriate evaluation or assessment, except that the state Department of Inspections and Appeals is responsible for the evaluation and disposition of a case of adult abuse in a health care facility, including hospitals as defined in lowa Code section 1358.1, subsection 1, and facilities as defined in Iowa Code section 135C.1, subsection 5. The Department shall forward all reports and other information concerning adult abuse in a health care facility to the state Department of Inspections and Appeals on the first working day following the submitting of the report. The state Department of Inspections and Appeals shall inform the registry of all actions taken or contemplated concerning the evaluation or disposition of a case of adult abuse in a health care facility. The primary purpose of the evaluation or assessment by the Department shall be the protection of the dependent adult named in the report.

(2) The evaluation or assessment shall include all of the following:
a. Identification of the nature, extent, and cause of the adult abuse, if any, to the dependent adult named in the report.
b. The identification of the person or persons responsible for the adult abuse.
c. A determination of whether other dependent adults in the same residence have been subjected to adult abuse.
d. A critical examination of the residential environment of the dependent adult named in the report, and the dependent adult's relationship with caretakers and other adults in the same residence.
e. A critical explanation of all other pertinent matters.
(3) The evaluation or assessment, with the consent of the dependent adult or caretaker, when appropriate, may include a visit to the residence of the dependent adult named in the report and an examination of the dependent adult. If permission to enter the residence and to examine the dependent adult is refused, the district court, upon a showing of probable cause that the dependent adult has been abused, may authorize a person, authorized by the Department, to make an evaluation or assessment, to enter the residence of, and to examine the dependent adult. Upon a showing of probable cause that the dependent adult has been financially exploited, a court may authorize a person, also authorized by the department, to make an evaluation, and to gain access to the financial records of the dependent adult.

(4) County attorneys, law enforcement agencies, multidisciplinary teams as defined in section 235A.113, subsection 9, and social services agencies in the state shall cooperate and assist in the evaluation or assessment upon the request of the department. County attorneys and appropriate law enforcement agencies shall also take any other lawful action necessary or advisable for the protection of the dependent adult.

(5) The Department, upon completion of its evaluation, shall transmit a copy of its preliminary report, including actions taken or contemplated, to the registry within four regular working days after the Department receives the adult abuse report, unles.s the registry grants an extension of time for good cause shown. If the preliminary report is not a complete report, a complete report shall be filed within ten working days of the receipt of the abuse report, unless the registry grants an extension of time for good cause shown. The Department, upon completion of its assessment in reports when the abuse is the result of the acts or omissions of the dependent adult, shall place the report, including actions taken or contemplated, in the file of the dependent adult. The central registry shall be notified as to the disposition of the assessment.

(6) The Department shall also transmit a copy of the report of its evaluation or assessment to the appropriate county attorney. The county attorney shall notify the county office of the Department of any actions or contemplated actions with respect to a suspected case of adult abuse.

(7) Based on the evaluation, the Department shall complete an assessment of services needed by a dependent adult believed to be the victim of abuse, the dependent adult's family, or a caretaker. The Department shall explain that the Department does not have independent legal authority to compel the acceptance of protective services. Upon voluntary acceptance of the offer of services, the Department shall make referrals or may provide necessary protective services to eligible dependent adults, their family members, and caretakers. The Department may establish a sliding fee schedule for those persons able to pay a portion of the protective services provided. The following services may be offered and provided without regard to income: dependent adult protection, social casework, adult day care, adult support, transportation, and family planning.

(8) When, upon completion of the evaluation or assessment or upon referral from the state Department of Public Health, the Department determines that the best interests of the dependent adult require court action, the Department shall initiate action for the appointment of a guardian or conservator, or for the admission or commitment to an appropriate institution or facility, pursuant to the applicable procedures under lowa Code chapter 125, 222, 229, or 633. The appropriate county attorney shall assist the Department in the preparation of the necessary papers to initiate the action, and shall appear and represent the Department at all district court proceedings.

(9) The Department shall assist the district court during all stages of court proceedings involving a suspected case of adult abuse.

(10) In every case involving adult abuse which is substantiated by the Department and which results in a judicial proceeding on behalf of the dependent adult, legal counsel shall be appointed by the court, to represent the dependent adult in the proceedings. The court may also appoint a guardian ad Item to represent the dependent adult when necessary to protect the dependent adult's best interests. The same attorney may be appointed to serve both as legal counsel and as guardian ad litem. Before legal counsel or a guardian ad litem is appointed pursuant to 1983 lowa Acts, chapter 153, section 4, the court shall require the dependent adult to complete under oath a detailed financial statement. If, on the basis of that financial statement, the court deems that the dependent adult or the legally responsible person is able to bear all or a portion of the cost of the legal counsel or guardian ad litem, the court shall so order. In cases where the dependent adult or the legally responsible person is unable to bear the cost of the legal counsel or guardian ad litem, the expense shall be paid out of the court expense fund.
LEGAL REMEDIES
Adults have constitutional rights which guarantee certain freedoms. The Department of Human Services strives to balance a person's right to personal freedom with the need to protect dependent adults who are unable to protect themselves. In some dependent adult situations there are treatment services that are available and may be offered to assist the dependent adult. Adults have a right to self-determination and have the right to voluntarily accept such services or to decline or refuse them.

In some instances a dependent adult may be the victim of a criminal act by the caretaker. A caretaker of a dependent adult may be criminally charged for maltreatment of the dependent adult. Some examples are:

Neglect or abandonment of a dependent person - Iowa Code 726.3
Wanton neglect of a dependent adult - Iowa Code 726.8(1 )
Nonsupport of a dependent adult - Iowa Code 726.8(2)
Assault (various forms) - Iowa Code 708
Sexual abuse (various forms) - Iowa Code 709
Incest - Iowa Code 726.2

In some cases there is no way to adequately protect a dependent adult through such voluntary services and the district court must be petitioned to intervene on behalf of the dependent adult. There are four such interventions possible through the district court.

They are:

Substance abuse commitment - Iowa Code 125
Mental health commitment - Iowa Code229
Guardianship - Iowa Code 633.552 - 633.565
Conservatorship - Iowa Code 633.566 - 633.667

Substance abuse commitment

Proceedings for the involuntary commitment of a substance abuser to a facility may be commenced by the county attorney or an interested person. Proceedings are begun by filing a verified application with the clerk of the district court of the county where the respondent is presently located or which is the respondent's place of residence.

a. The applicant believes that the respondent is a chronic substance abuser
b. Other pertinent facts
c. One or more of the following
1. written statement of support by a physician
2. one or more supporting affidavits
3. other corroborative information

An attorney is appointed to represent the respondent.
A hearing is ordered by the court.
An examination is ordered by the court.
An order for immediate custody may be issued if the respondent is believed to be a danger to self or others.
A commitment hearing is held.
The respondent's welfare is paramount.

If the evidence is clear and convincing a complete evaluation is ordered.

A hearing is held to determine whether:
1. Respondent does not require further treatment
2. Respondent requires full-time (inpatient) treatment
3. Respondent requires out patient treatment
Further hearings can order continued treatment if warranted.

Mental health commitment

Proceedings for the involuntary hospitalization of a person may be commenced by any interested person. Proceedings are begun by filing a verified application with the clerk of the district court of the county where the respondent is presently located, or which is the respondent's place of residence.
a. The applicant believes that the respondent is seriously mentally impaired
b. Other pertinent facts
c. One or more of the following:
1. written statement of support by a physician
2. one or more supporting affidavits
3. other corroborative information

An attorney is appointed to represent the respondent.
A hearing is ordered by the court.
An examination is ordered by the court.
An order for immediate custody may be issued if the respondent is believed to be a danger to self or others.
A commitment hearing is held.
The respondent's welfare is paramount.

If the evidence is clear and convincing a complete evaluation is ordered.

Another hearing is held to determine whether:
1. Respondentdoesnotrequirefurthertreatment
2. Respondent requires fulltime (inpatient) treatment
3. Respondent requires out patient treatment
Further hearings can order continued treatment if warranted.

Conservatorship

A conservatorship is a Court authorized relationship whereby one person assumes the responsibility for the custody and control of the property of another. The person to whom custody of the property is awarded is called a conservator. The person over whose property custody is granted is called a ward. The appointment of a conservator means that the ward is either under legal age or by reason of mental, physical, or other incapacity is unable to make or carry out important decisions concerning the ward's financial affairs. It does not mean that the ward is of unsound mind.

A petition for the appointment of a conservator of the property of a dependent adult may be sought to protect the property of the dependent adult if the protective concern is based on an imminent danger to that person's property. In the absence of such action or other legal action, no person has the right to manage the property of an adult contrary to the adult's consent.

A conservator must do all of the following:
1. Take possession of the ward's property and protect and preserve it, invest it prudently and account for it. A complete list of all receipts and disbursements must be maintained by the conservator.

2. Within 60 days of appointment, file an Initial Report and Inventory of the property of the ward in the Conservator's possession or of which the Conservator has knowledge.

3. File the following reports with the Court containing full itemized accounting and a list of all assets (Failure in getting the required report filed is a breach of the Conservator's duty to the ward and to the Court.):
a. An Annual Report within 30 days of the anniversary date of the appointment.
b. A Final Report at the termination of the conservatorship.

4. If the ward's will comes into the Conservator's hands, it must be delivered to the Court for safekeeping.

A conservator has these general powers:
1. Collect, receive and receipt for any property or income of the ward, including Social Security or Veterans Benefits.

2. Sell or transfer perishable personal property or personal property having an established market value.

3. Receive additional property from any source.

4. Make payments to the ward or to others for the benefit of the ward.

5. After obtaining a court order the conservator may:
a. Invest and reinvest the funds of the ward
b. Sell, lease or mortgage real estate
c. Do any other thing the Court determines to be in the best interest of the ward.

Guardianship

When the concern is for the dependent adult's life, rather than the adult's property, a person may seek guardianship appointment to provide for the legal sanction of moving the adult or protecting the adult. In the absence of such legal action, no one has the right to physically relocate an adult against the adult's will. The appointment of a guardian shall not constitute an adjudication that the ward is of unsound mind.

The following conditions must be verified before filing a guardianship petition:
1. The dependent adult is incompetent to make decisions regarding the adult's person.

2. A qualified professional has written a document clearly stating that the dependent adult is incompetent to make decisions regarding the adult's person and the reasons for this.

3. That a qualified person has agreed to act as the guardian if appointed.

Responsibilities of a guardian:

1. A guardian may be granted the following powers and duties which may be exercised without prior court approval:
a. Providing for the care, comfort and maintenance of the ward, including the appropriate training and education to maximize the ward's potential.
b. Taking reasonable care of the ward's clothing, furniture, vehicle and other personal effects.
c. Assisting the ward in developing maximum self-reliance and independence.
d. Ensuring the ward receives necessary emergency medical services.
e. Ensuring the ward receives professional care, counseling, treatment or services as necessary.
f. Any other powers or duties the court may specify.

2. A guardian may be granted the following powers which may only be exercised upon court approval:
a. Changing, at the guardian's request the ward's permanent residence if the proposed new residence is more restrictive of the ward's liberties than the current residence.
b. Arranging the provisions of major elective surgery or any other nonemergency major medical procedure.
c. Consent to the withholding or withdrawal of life-sustaining procedures in accordance with chapter 144A.

3. The court may take into account all available information concerning the capabilities of the ward and any additional evaluation deemed necessary, and may direct that the guardian have only a specially limited responsibility for the ward. In that event, the court shall state those areas of responsibility which shall be supervised by the guardian and all others shall be retained by the ward.

4. From time to time, upon a proper showing, the court may alter the respective responsibilities of the guardian and the ward, after notice to the ward and an opportunity to be heard.

A guardian must file the following reports with the Court:
1. An initial report within 60 days of appointment;
2. An annual report within 30 days of the anniversary date of the appointment;
3. A final report within 30 days of the event causing termination.
CENTRAL ABUSE REGISTRY
Code of Iowa 235B.4
The general assembly finds and declares that a central registry is required to provide a single source for the statewide collection, maintenance, and dissemination of dependent adult abuse information. Such a registry is imperative for increased effectiveness in dealing with the problem of dependent adult abuse. The general assembly also finds that vigorous protection of rights of individual privacy is an indispensable element of a fair and effective system of collecting, maintaining, and disseminating dependent adult abuse information.

The purpose of this section and sections 235B.5 to 235B.13 are to facilitate the identification of victims or potential victims of dependent adult abuse by making available a single, statewide source of dependent adult data; to facilitate research on dependent adult abuse by making available a single, statewide source of dependent adult abuse data; and to provide maximum safeguards against the unwarranted invasions of privacy which such a registry might otherwise entail.

Code of Iowa 235B.5
1. There is created within the department a central registry for dependent adult abuse information. The department shall organize and staff the registry and adopt rules for its organization.

2. The registry shall collect, maintain, and disseminate dependent adult abuse information as provided in this chapter.

3. The department shall maintain a tollfree telephone line, which shall be available on a twenty-four-hour-a-day, seven-day-a-week basis and which the department and all other persons may use to report cases of suspected dependent adult abuse and that all persons authorized by this chapter may use for obtaining dependent adult abuse information.

4. An oral report of suspected dependent adult abuse initially made to the central registry shall be immediately transmitted by the department to the appropriate county department of human services or law enforcement agency, or both.

5. An oral report of suspected dependent adult abuse initially made to the central registry regarding a health care facility shall be transmitted by the department to the department of inspections and appeals on the first working day following the submitting of the report.

6. The registry, upon receipt of a report of suspected dependent adult abuse, shall search the records of the registry, and if the records of the registry reveal any previous report of dependent adult abuse involving the same adult or if the records reveal any other pertinent information with respect to the same adult, the appropriate office of the department of Human Services or the appropriate law enforcement agency shall be immediately notified of that fact.

7. The central registry shall include but not be limited to report data, investigative data, and disposition data.

Code of Iowa 235B.13
1. The registry may compile statistics, conduct research, and issue reports on dependent adult abuse, provided identifying details of the subjects of dependent adult abuse reports are deleted from any report issued.

2. The registry shall issue an annual report on its administrative operation, including information as to the number of requests for dependent adult abuse data, the proportion of requests attributable to each type of authorized access, the frequency and nature of irregularities, and other pertinent matters.
ACCESS TO DEPENDENT ADULT ABUSE INFORMATION
Iowa Code 235B(6) (paraphrased) provides that:

Confidentiality of dependent adult information shall be maintained, except as specifically authorized.

Note: The Department shall withhold the name of the person who made the report of suspected dependent adult abuse. Only the court or the central registry may allow the release of that person's name.

Access to dependent adult abuse information (founded, undetermined or unfounded) is authorized to Subjects of a Report (the adult victim, the guardian or legal custodian of the adult victim, alleged perpetrator) or to the attorney for any subject, as well as an employee or agent of the Department of Human Services responsible for investigating a child abuse report, D.H.S. registry and department personnel when necessary for the performance of their official duties and functions, and to the mandatory reporter who reported the abuse)

Access to dependent adult abuse information (other than unfounded) is also authorized to persons involved in an investigation of dependent care, including a health practitioner or mental health professional, a law enforcement officer, a multidisciplinary team.

Access to certain dependent adult abuse information (other than unfounded) is authorized to individuals, agencies, or facilities providing care to a dependent adult named in a report under some circumstances, including a facility licensing authority, a person or agency responsible for the care of a dependent adult victim or perpetrator, a D.H.S. registration or licensing employee, or an individual providing care to an adult and regulated by the department, or the legally authorized protection and advocacy agency recognized pursuant to section 135C.2.

Access to dependent adult abuse information (other than unfounded) is also authorized under some circumstances as it relates to judicial and administrative proceedings. (District Court, a court or administrative agency hearing an appeal for correction of dependent adult abuse information, an expert witness at any stage of an appeal hearing).

Access to certain dependent adult abuse information (other than unfounded) is also authorized to others under certain circumstances as follows: To a person conducting bona fide dependent adult abuse research, registry or Department personnel or a person or agency under contract with the Department to carry out the duties of the registry, the Department of Justice, a legally constituted adult protection agency from another state for investigative or treatment purposes, the attorney for D.H.S., or a health care facility administrator or designee.
EXAMINATION, REQUEST FOR CORRECTION OR EXPUNGEMENT OF DEPENDENT ADULT ABUSE INFORMATION
Code of Iowa 235B.10
1. Any person or that person's attorney shall have the right to examine dependent adult abuse information in the registry which refers to that person. The registry may prescribe reasonable hours and places of examination.

2. A person may file with the department within six months of the date of the notice of the results of an investigation, a written statement to the effect that the dependent adult abuse information referring to the person is in whole or in part erroneous, and may request a correction of that information or of the findings of the investigative report. The department shall provide the person with an opportunity for an evidentiary hearing pursuant to chapter 17A to correct the information or of the findings, unless the department corrects the information or findings as requested. The department shall delay the expungement of information which is not determined to be founded until the conclusion of a proceeding to correct the information or findings. The department may deter the hearing until the conclusion of a court case relating to the information or findings.

3. The decision resulting from the hearing may be appealed to the court of Polk county by the person requesting the correction or to the court of the district in which the person resides. Immediately upon appeal the court shall order the department to file with the court a certified copy of the dependent adult abuse information. Appeal shall be taken in accordance with chapter 17A.

4. Upon the request of the appellant, the record and evidence in such cases shall be closed to all but the court and its officers, and access to the record and evidence shall be prohibited unless otherwise ordered by the court. The clerk shall maintain a separate docket for such actions. A person other than the appellant shall not permit a copy of the testimony or pleadings or the substance of the testimony or pleadings to be made available to any person other than a party to the action or the party's attorney. Violation of the provisions of this subsection shall be a public offense punishable under section 235B.12

5. If the registry corrects or eliminates information as requested or as ordered by the coart, the registry shall advise all persons who have received the incorrect information of the fact. Upon application to the court and service of notice on the registry, an individual may request and obtain a list of all persons who have received dependent adult abuse information referring to that individual.

6. In the course of any proceeding provided for by this section, the identity of the person who reported the disputed information and the identity of any person who has been reported as having abused an adult may be withheld upon a determination by the registry that disclosure of the person's identity would be detrimental to the person's interest.

Procedure
A subject of a dependent adult abuse evaluation or assessment may request a copy of the report by completing form SS-1114-0, the Request for Dependent Adult Abuse Information, and forwarding it to the local Department of Human Services office or to the central registry. Upon receipt of a copy of the report, a subject of that report may, if they feel there is incorrect or erroneous information contained in the report, or if they disagree with the conclusions of the report, request correction of the report by writing within six months of the completion of the report to the:

Central Abuse Registry -5th Floor
Hoover State Office Building
Des Moines, Iowa 50319-0114.

Registry personnel will review the request for correction along with any additional information that the requester provides, and may uphold, modify or overturn the original finding. If the requester is not satisfied with the Registry decision they may file for an evidentiary hearing at which time the matter will be heard before an Administrative Law Judge. The Administrative Law Judge may also uphold, modify or overturn the finding. If the requester is not satisfied with the decision of the Administrative Law Judge, the matter may be appealed to the District Court.

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Last Modified: February 27, 1997