Code of Colorado Regulations
2500 - Department of Human Services
2518 - Adult Protective Services
12 CCR 2518-1 - ADULT PROTECTIVE SERVICES
Section 12 CCR 2518-1-30.100 - DEFINITIONS
Current through Register Vol. 47, No. 5, March 10, 2024
The following definitions shall apply to these rules.
"Abuse", pursuant to Section 26-3.1-101(1), C.R.S., means any of the following acts or omissions committed against an at-risk adult:
A. The non-accidental infliction of physical pain or injury, as demonstrated by, but not limited to, substantial or multiple skin bruising, bleeding, malnutrition, dehydration, burns, bone fractures, poisoning, subdural hematoma, soft tissue swelling, or suffocation;
B. Confinement or restraint that is unreasonable under generally accepted caretaking standards; or,
C. Unlawful sexual behavior as defined in Section 16-22-102(9), C.R.S.
"Adult Protective Services (APS) Program" means the State Department supervised, county department administered program that has the authority to investigate and/or assess allegations of mistreatment and self-neglect of at-risk adults. The APS Program offers protective services to prevent, reduce, or eliminate the current or potential risk of mistreatment or self-neglect to the at-risk adult using community based services and resources, health care services, family and friends when appropriate, and other support systems. The APS Program focuses on the at-risk adult and those services that may prevent, reduce, or eliminate further mistreatment or self-neglect. The APS Program refers possible criminal activities to law enforcement and/or the district attorney for criminal investigation and possible prosecution.
"Allegation" means a statement asserting an act or suspicion of mistreatment or self-neglect involving an at-risk adult.
"Alternative Response" means the pilot program authorized by 26-3.1-103.3, C.R.S., allowing pilot-participant county departments to engage in a dual-track response model for response to allegations of mistreatment and self-neglect against at-risk adults beginning January 4, 2023. The two response options are the traditional response track and the alternative response track.
"Alternative response track" means the response track established as an option for allegations of mistreatment or self-neglect determined by a pilot-participant county department to be low risk. No finding shall be made in the alternative response track.
"Assessment" means the process of evaluating a client's functional abilities to determine the client's level of risk and, in cooperation with the client whenever possible, to identify service needs for the case plan.
"Assumed responsibility", as used in the definition of caretaker, means a person who is providing or has provided recurring or temporary assistance to help meet the basic needs of an at-risk adult. The assumption of responsibility can attach by entering into a formal or informal agreement, whether paid or unpaid; by identifying oneself as a caretaker to others; or based on the nature of the situation or relationship between the caretaker and the at-risk adult.
"At-risk adult", pursuant to Section 26-3.1-101 (1.5), C.R.S., means an individual eighteen (18) years of age or older who is susceptible to mistreatment or self-neglect because the individual is unable to perform or obtain services necessary for his or her health, safety, or welfare, or lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his or her person or affairs.
"Authorized requestor" as used in section 30.960, means an employer, a person or entity conducting the employee CAPS check on behalf of the employer, or the court that are required to request CAPS checks.
"CAPS" means the Colorado Adult Protective Services data system that includes records of reports of mistreatment of at-risk adults.
"CAPS check" means a check of the Colorado Adult Protective Services data system pursuant to Section 26-3.1-111, C.R.S.
"Caretaker", pursuant to Section 26-3.1-101(2), C.R.S., means a person who:
A. Is responsible for the care of an at-risk adult as a result of a legal relationship; or
B. Has assumed responsibility for the care of an at-risk adult; or,
C. Is paid to provide care, services, or oversight of services to an at-risk adult.
"Caretaker neglect", pursuant to Section 26-3.1-101 (2.3), C.R.S., means neglect that occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, habilitation, supervision, or other treatment necessary for the health, safety, or welfare of the at-risk adult is not secured for an at-risk adult or is not provided by a caretaker in a timely manner and with the degree of care that a reasonable person in the same situation would exercise, or when a caretaker knowingly uses harassment, undue influence, or intimidation to create a hostile or fearful environment for an at-risk adult. However, the withholding, withdrawing, or refusing of any medication, any medical procedure or device, or any treatment, including but not limited to resuscitation, cardiac pacing, mechanical ventilation, dialysis, artificial nutrition and hydration, any medication or medical procedure or device, in accordance with any valid medical directive or order, or as described in a palliative plan of care, is not deemed caretaker neglect. In addition to those exceptions identified above, pursuant to 25-48-1-16(2), C.R.S., access to medical aid-in-dying medication in good faith shall not be considered caretaker neglect.
"Case" means the process by which a county department provides services to an at-risk adult. A case begins when a report identifies an at-risk adult and allegations that qualify as a mistreatment or self-neglect, and the report is screened in for investigation and assessment. The county department may continue to provide services under a case after the investigation has concluded.
"Caseload average" means the fiscal year monthly average of new cases and the sum of cases carried over from the prior fiscal year, per caseworker. The fiscal year caseload average is calculated as: [(new cases/12) + cases carried over from prior FY] / FTE on June 30 = caseload average]. Caseload average will fluctuate on a monthly basis that may be influenced by a number of factors; therefore, the caseload average is based on the fiscal year average.
"Case planning" means using the information obtained from the investigation and/or assessment to identify, arrange, and coordinate protective services in order to reduce the client's level of risk for mistreatment and self-neglect and improve safety.
"Certification due date" means the date by which new APS staff must complete certification training. The certification due date for supervisors, lead caseworkers, and caseworkers is six months from the date the supervisor, lead caseworker, or caseworker was hired or transferred to the APS program. The certification due date for case aides and screeners is one month from the date the case aide or screener was hired or transferred to the APS program.
"Clergy member", pursuant to Section 26-3.1-101 (2.5), C.R.S., means a priest; rabbi; duly ordained, commissioned, or licensed minister of a church; member of a religious order; or recognized leader of any religious body.
"Client" means an actual or possible at-risk adult for whom a report has been received and the county department has made a response.
"Collateral contact" means a person who has relevant knowledge about the client's situation that supports, refutes, or corroborates information provided by a client, reporting party, or other person involved in the case. Examples of contacts include, but are not limited to, family members, law enforcement, health care professionals, service providers, facility staff, neighbors, the reporting party, friends, and any person who provides/provided ongoing care or support to the client.
"Conclusion", as used in alternative response track investigations, means a determination of whether mistreatment or self-neglect occurred as alleged.
"County Department" means a county department of human/social services.
"Court", as used in Section 30.960, means the Denver probate court or a state district court that hears petitions for and appoints guardians and/or conservators for at-risk adults.
"Date of notice" means the date that the notice of a substantiated finding against a perpetrator(s) is mailed to the last known mailing address(es) of the perpetrator(s).
"Direct care", pursuant to Section 26-3.1-101 (3.5), C.R.S., means services and supports, including case management services, protective services, physical care, mental health services, or any other service necessary for the at-risk adult's health, safety, or welfare.
"DORA" as used in Section 30.520, means the Department of Regulatory Agencies, Division of Professions and Occupations that oversees the licensure of healthcare professionals.
"Employee", pursuant to Section 26-3.1-111(2)(a), C.R.S., means a person, other than a volunteer, who is employed by or contracted with an employer and includes a prospective employee.
"Employer", pursuant to Section 26-3.1-111(2)(b), C.R.S., means a person, facility, entity, or agency described in Section 26-3.1-111(7), C.R.S., and includes a prospective employer. "Employer" also includes a person hiring someone to provide Consumer-Directed Attendant Support Services pursuant to C.R.S. Article 10 of Title 25.5, if the person requests a CAPS check.
"Enhanced supervision" means CAPS security access that prevents a caseworker from finalizing an investigation, assessment, case plan, or case closure without supervisory approval.
"Exploitation", pursuant to Section 26-3.1-101(4), C.R.S., means an act or omission that:
A. Uses deception, harassment, intimidation, or undue influence to permanently or temporarily deprive an at-risk adult of the use, benefit, or possession of anything of value; or,
B. Employs the services of a third party for the profit or advantage of the person or another person to the detriment of the at-risk adult; or,
C. Forces, compels, coerces, or entices an at-risk adult to perform services for the profit or advantage of the person or another person against the will of the at-risk adult; or,
D. Misuses the property of an at-risk adult in a manner that adversely affects the at-risk adult's ability to receive health care or health care benefits or to pay bills for basic needs or obligations.
"Facility" means a medical or long-term care facility that provides 24 hour care and oversight for residents, and includes a group home, alternative care facility, state regional center, or state mental health facility.
"Financial institution", pursuant to Section 26-3.1-101(5), C.R.S., means a state or federal bank, savings bank, savings and loan association or company, building and loan association, trust company, or credit union.
"Fiscal Year" means the State Department fiscal year, which begins July 1 and ends June 30.
"Flagged check", as used in Section 30.960, means any substantiated finding of mistreatment made after the initial CAPS check that is provided to the authorized requestor, employer, or to the employee/employer's parent company and/or oversight agency(ies).
"FTE" means Full Time Equivalent. The actual percentage of time a person works on the APS program shall be considered that person's FTE.
"Good cause", except as applied by a court, means emergency conditions or other circumstances which would prevent a reasonable person from meeting a deadline or complying with APS rule or practice. Examples include, but are not limited to, law enforcement request to delay the APS investigation; inability to locate the client or collaterals despite reasonable, documented attempts; additional time required to obtain documents which were timely requested but not delivered; lack of proper notice to the substantiated perpetrator of the availability of an appeal; etc.
"Harmful act", pursuant to Section 26-3.1-101 (5.5), C.R.S., means an act committed against an at-risk adult by a person with a relationship to the at-risk adult when such act is not defined as abuse, caretaker neglect, or exploitation but causes harm to the health, safety, or welfare of an at-risk adult.
"Health Insurance Portability and Accountability Act of 1996 (HIPAA)" means the healthcare privacy law and its accompanying regulations found at p.l. 104-191, 110 stat. 1936 (Aug. 21, 1996), 45 C.F.R. parts 160, 162, 164 (2021), which are herein incorporated by reference. No later additions or amendments are incorporated. The public law is available at https://www.govinfo.gov. The regulations are available at https://www.ecfr.gov. Both the public law and the regulations are also available for public inspection and copying at the Colorado Department of Human Services, Office of Adult, Aging and Disability Services, 1575 Sherman St., Denver, CO 80203, during regular business hours.
"Inconclusive finding", as used in traditional response track investigations, means that indicators of mistreatment or self-neglect may be present but the investigation could not confirm the evidence to a level necessary to substantiate the allegation.
"Investigation" means the process of determining whether mistreatment or self-neglect occurred pursuant to Section 26-3.1-101, C.R.S.. In traditional response track investigations, this includes reaching a finding as determined by a preponderance of the evidence. In alternative response track investigations, a conclusion will be determined.
"Least restrictive intervention" means acquiring or providing services, including protective services, for the shortest duration and to the minimum extent necessary to remedy or prevent mistreatment or self-neglect.
"Licensed healthcare professional" as used in Section 30.520, means a person who is licensed through the Department of Regulatory Agencies, Division of Professions and Occupations (DORA) for a healthcare profession or healthcare occupation, as defined in DORA's healthcare professions and occupations scope statute, Section 12-30-101, C.R.S.
"Medical Directive or Order", pursuant to Section 26-3.1-101 (2.3)(c), C.R.S., includes a medical durable power of attorney, a declaration as to medical treatment executed pursuant to Section 15-18-104, C.R.S., a medical order for scope of treatment form executed pursuant to Article 18.7 of Title 15, C.R.S., and a cardiopulmonary resuscitation (CPR) directive executed pursuant to Article 18.6 of Title 15, C.R.S.
"Minor impact" means the client may experience some difficulty with the assessment risk indicator, but there is very little impact on the client's overall health, safety, and/or welfare and no intervention is necessary to improve overall safety.
"Mistreatment", pursuant to Section 26-3.1-101(7), C.R.S., means:
A. Abuse;
B. Caretaker neglect;
C. Exploitation; or,
D. A harmful act.
"Mistreatment occurred - not culpable finding", as used in traditional response track investigations, means the investigation established by a preponderance of the evidence that mistreatment occurred but the individual who caused the mistreatment is not culpable. Documentation must clearly support that the individual who caused the mistreatment is an at-risk adult or a minor child with cognitive functioning that prevents the at-risk adult or child from having awareness of the consequences of their actions, as demonstrated by county department observations of cognition or behaviors, and/or interviews with expert collaterals, and/or medical or neuro-psych records, and/or behavioral plans developed by the adult's or child's service agency. A "mistreatment occurred - not culpable finding" must be used if the individual who caused the mistreatment is a child under the age of ten (10) years old.
"Person with a relationship", as applied to the definition of harmful act, means a person who can be identified as having a relationship or attempting to develop a relationship with an at-risk adult. The relationship may include but is not limited to a familial, legal, caretaking, pastoral, friendship, or other relationship and excludes strangers.
"Potential appointee", as used in Section 30.960, means a person nominated in a petition filed with the court who may be appointed by the court as a guardian or conservator of an at-risk adult.
"Preponderance of the evidence" means credible evidence that a claim is more likely true than not.
"Protective Services" means services by the state or political subdivisions or agencies thereof in order to prevent the mistreatment or self-neglect of an at-risk adult. Such services include, but are not limited to:
A. Providing casework services;
B. Arranging for, coordinating, delivering where appropriate, and monitoring services, including medical care for physical or mental health needs;
C. Protection from mistreatment and self-neglect;
D. Assistance with applications for public benefits;
E. Referral to community service providers; and,
F. Initiation of probate proceedings.
"Reassessment" means the process of updating the assessment status areas and the case plan, including the status of any services implemented and any new services and/or goals identified since the last assessment.
"RED Team" is an acronym that stands for Review, Evaluate, and Direct. The RED Team is a decision making process that utilizes a structured framework to determine the county department's response to reports.
"Report" means an oral, electronic, or written report of suspected mistreatment or self-neglect of a suspected at-risk adult, received by the county department.
"Risk" means conditions and/or behaviors that create increased difficulty or impairment to the client's ability to ensure health, safety, and welfare.
"Safety" means the extent to which a client is free from harm or danger, or to which harm or danger is lessened.
"Self-Determination" means the right to decide for one's self; the ability or right to make one's own decisions without interference from others.
"Self-neglect", pursuant to Section 26-3.1-101(10), C.R.S., means an act or failure to act whereby an at-risk adult substantially endangers his or her health, safety, welfare, or life by not seeking or obtaining services necessary to meet the adult's essential human needs. Choice of lifestyle or living arrangements shall not, by itself, be evidence of self-neglect. Refusal of medical treatment, medications, devices, or procedures by an adult or on behalf of an adult by a duly authorized surrogate medical decision maker or in accordance with a valid medical directive or order, or as described in a palliative plan of care, shall not be deemed self-neglect. Refusal of food and water in the context of a life-limiting illness shall not, by itself, be evidence of self-neglect. "medical directive or order" includes, but is not limited to, a Medical Durable Power of Attorney, a Declaration as to Medical Treatment executed pursuant to Section 15-18-104, C.R.S., a Medical Orders for Scope of Treatment Form executed pursuant to Article 18.7 of Title 15, C.R.S., and a CPR Directive executed pursuant to Article 18.6 of Title 15, C.R.S. In addition to those exceptions identified above, access to Medical Aid in Dying, pursuant to Title 25, Article 48, C.R.S., shall not be considered self-neglect.
"Severity Level" means the extent of the impact caused to the client as a result of mistreatment.
A. Minor - Mistreatment occurred that resulted in little to no harm or change to the client's health, safety, welfare, or finances.
B. Moderate - Mistreatment occurred that resulted in harm or change to the client's health, safety, welfare, or finances.
C. Severe - Mistreatment occurred that resulted in substantial harm or change to the client's health, safety, welfare, or finances.
"Significant impact" means that the client's impairment diminishes the client's health, safety, and/or welfare and intervention is necessary to improve overall safety.
"Staffing a case" means the review of an APS case between the supervisor and caseworker to ensure the appropriateness of the investigation findings, client assessment, case plan, service provision, need for ongoing services, plans to terminate services, documentation, and overall intervention as it relates to APS rules and best practices. Staffing a case may include the county department APS unit, the State Department APS unit, and/or the APS Team in addition to the supervisor and caseworker.
"Staffing agency", as used in these rules, means an individual or organization, including any partnership, limited liability partnership, limited liability company, limited liability limited partnership, association, trust, joint stock company, insurance company, or corporation, whether domestic or foreign, engaged in the business of providing and assigning workers to placements with employers described in Section 30.960.A and pursuant to Section 26-3.1-111(7). C.R.S.. "Staffing agency" includes, but is not limited to, supplemental health-care staffing agencies defined in Section 8-4-125 (1)(e), C.R.S.
"State Department" means the Colorado Department of Human Services.
"Substantiated finding", as used in traditional response track investigations, means that the investigation established by a preponderance of the evidence that mistreatment or self-neglect has occurred.
"Support network" means persons who provide consistent, recurrent, or ongoing care or support to the client, such as family members, doctors, care providers, or guardians.
"Traditional response track" means the response track established for allegations of mistreatment or self-neglect that includes completion of a traditional response track investigation as outlined in Section 30.520. The traditional response track shall be assigned to all allegations that are not determined to be low risk by county departments participating in the Alternative Response pilot program described in 26-3.1-103.3, C.R.S.
"Unable to investigate/not required" means an investigation was not possible because the county department was unable to gather any investigative evidence and exhausted all options and leads by which to conduct an investigation; or the report was screened in and later determined it did not meet APS criteria for investigation, as outlined in Section 30.510.B.
"Undue Influence" means the use of influence to take advantage of an at-risk adult's vulnerable state of mind, neediness, pain, or emotional distress.
"Unsubstantiated finding", as used in traditional response track investigations, means the investigation did not establish any evidence that mistreatment or self-neglect has occurred.
