Delaware Adult Protective Services Report of Harm

DELAWARE ADULT PROTECTIVE SERVICES — REPORT OF HARM

TABLE OF CONTENTS

1. Reporter Information
2. Vulnerable Adult Information
3. Alleged Perpetrator Information
4. Type of Harm Alleged
5. Detailed Narrative of Concerns
6. Indicators of Impairment or Incapacity
7. Immediate Risk Assessment
8. Witnesses and Collateral Sources
9. Documentary Evidence
10. Prior Reports / Open Cases
11. Mandatory Reporter Status and Statutory Basis
12. Transmittal Cover Letter to DSAAPD
13. Reporter's Verification
14. Delaware Practice Notes
15. Sources and References

1. REPORTER INFORMATION

2. VULNERABLE ADULT INFORMATION

3. ALLEGED PERPETRATOR INFORMATION

4. TYPE OF HARM ALLEGED

Mark all that apply. Definitions are drawn from 31 Del. C. § 3902 and 11 Del. C. § 1105.

• ☐ Physical abuse — non-accidental infliction of physical injury, pain, or impairment (bruises, fractures, burns, restraint marks)
• ☐ Sexual abuse — non-consensual sexual contact, assault, or exploitation
• ☐ Emotional / psychological abuse — verbal threats, intimidation, isolation, humiliation, harassment
• ☐ Neglect by caregiver — failure of a caregiver to provide goods or services necessary to avoid physical harm, mental anguish, or mental illness
• ☐ Self-neglect — adult is unable to manage essential needs (food, shelter, hygiene, medication, safety) without assistance and has no person willing and able to assist
• ☐ Financial exploitation — illegal or improper use of funds, property, or assets, including theft, forgery, undue influence, misuse of POA, predatory lending, or coerced transfers
• ☐ Abandonment — desertion of a vulnerable adult by a person who has assumed responsibility for that person's care or custody
• ☐ Medication misuse — withholding, diverting, or over-administering medication
• ☐ Unlawful restraint / confinement
• ☐ Other (describe): [________________________________]

5. DETAILED NARRATIVE OF CONCERNS

Provide a detailed factual narrative. State only facts personally observed or directly reported, identify sources for hearsay, and avoid legal conclusions.

[________________________________________________________________]

[________________________________________________________________]

[________________________________________________________________]

[________________________________________________________________]

[________________________________________________________________]

[________________________________________________________________]

[________________________________________________________________]

Date(s) of incident(s): [__/__/____] through [__/__/____]

Location(s) of incident(s): [________________________________]

How did reporter learn of the harm? [________________________________]

6. INDICATORS OF IMPAIRMENT OR INCAPACITY

Mark observed indicators that the adult is impaired or incapacitated as defined by 31 Del. C. § 3902.

• ☐ Diagnosed dementia, Alzheimer's, or other neurocognitive disorder
• ☐ Diagnosed intellectual or developmental disability
• ☐ Diagnosed serious mental illness
• ☐ Significant physical disability impairing self-protection or self-care
• ☐ Unable to manage finances or property
• ☐ Unable to perform activities of daily living without assistance
• ☐ Confusion, disorientation, impaired judgment
• ☐ No available person willing and able to provide care
• ☐ Other (describe): [________________________________]

7. IMMEDIATE RISK ASSESSMENT

If "Yes" to question 1, a 31 Del. C. § 3907 probable-cause notification and § 3908 emergency petition for protective services should be considered.

8. WITNESSES AND COLLATERAL SOURCES

9. DOCUMENTARY EVIDENCE

The following items support the report and are available on request to APS investigators:

• ☐ Photographs of injuries, environment, or property
• ☐ Medical records / hospital admission summaries
• ☐ Bank statements, canceled checks, account activity
• ☐ Power of attorney / guardianship documents
• ☐ Will, trust, or beneficiary designations recently changed
• ☐ Text messages, emails, voicemails
• ☐ Surveillance / doorbell camera footage
• ☐ Police reports / incident numbers
• ☐ Facility incident reports
• ☐ Pharmacy records / medication administration records
• ☐ Other: [________________________________]

10. PRIOR REPORTS / OPEN CASES

11. MANDATORY REPORTER STATUS AND STATUTORY BASIS

Universal duty to report. Under 31 Del. C. § 3910, "any person" with reasonable cause to believe that an adult who is impaired or incapacitated is in need of protective services has a duty to report that information to the Department of Health and Social Services. Professional privilege (other than attorney-client) does not exempt a person from reporting.

Heightened duties. Specific affirmative duties also apply to:

• Medical practitioners with direct contact with a vulnerable adult (must report past, current, or attempted abuse, neglect, or exploitation)
• Financial institutions with direct contact with a vulnerable adult (must report financial exploitation; transaction holds are authorized with immunity)
• Long-term care facility staff (additional reporting to the Division of Health Care Quality and CMS under 16 Del. C. § 1136 and federal 42 C.F.R. § 483.12)

Time frame. Reports should be made within 24 hours of forming reasonable cause. Delays may aggravate the harm and may themselves constitute neglect.

Immunity. Under 31 Del. C. § 3910, any person participating in good faith in making a report or in any judicial proceeding resulting from a report is immune from civil and criminal liability that might otherwise exist.

Confidentiality. Reporter identity and report contents are confidential under 31 Del. C. § 3912. Unauthorized disclosure is an unclassified misdemeanor.

Penalties for failure to report. Knowing failure of a mandatory reporter to report may give rise to civil liability and, in long-term care settings, regulatory sanctions under 16 Del. C. Chapter 11 and 16 Del. Admin. C. § 3201.

This report is made pursuant to:

• ☐ 31 Del. C. § 3910 (general APS duty)
• ☐ 16 Del. C. § 1136 (long-term care facility reporting)
• ☐ 24 Del. C. § 1731(b) (medical practitioner duty)
• ☐ Voluntary report (no statutory mandate; immunity still applies)

12. TRANSMITTAL COVER LETTER TO DSAAPD

[DATE]

Delaware Adult Protective Services
Division of Services for Aging and Adults with Physical Disabilities (DSAAPD)
1901 N. DuPont Highway
New Castle, DE 19720

Phone: 1-800-223-9074 (DSAAPD) / 1-888-APS-4302 (APS line)

Re: Report of Harm Concerning [VULNERABLE ADULT NAME]

Dear Adult Protective Services Investigator:

Pursuant to 31 Del. C. § 3910, I am submitting the attached Report of Harm regarding [VULNERABLE ADULT NAME], an impaired or incapacitated adult residing at [ADDRESS] in [COUNTY] County, Delaware. I have reasonable cause to believe that this adult is in need of protective services as a result of [abuse / neglect / exploitation / abandonment / self-neglect] as further described in the attached report.

I respectfully request that DSAAPD:

1. Initiate an investigation within the statutory time frame;
2. Conduct a wellness check at the adult's current location;
3. Coordinate with [ ☐ local police ☐ Delaware State Police ☐ DHCQ ☐ MFCU ☐ Long-Term Care Ombudsman ] as appropriate; and
4. Consider an emergency petition under 31 Del. C. § 3908 if probable cause of imminent harm exists.

I have provided my contact information for follow-up. I assert my immunity under 31 Del. C. § 3910 and the confidentiality protections of 31 Del. C. § 3912.

Respectfully submitted,

[________________________________]

[REPORTER NAME / TITLE]

[ADDRESS / PHONE / EMAIL]

13. REPORTER'S VERIFICATION

I, [REPORTER NAME], declare under penalty of perjury under the laws of the State of Delaware that the foregoing Report of Harm is based on my personal knowledge or on information I have received and believe to be true, that I am making this report in good faith pursuant to 31 Del. C. § 3910, and that I am not aware of any retaliatory or improper purpose for this report.

Date: [__/__/____]

Signature: [________________________________]

Print name: [________________________________]

14. DELAWARE PRACTICE NOTES

• Two phone numbers, one program. DSAAPD operates a general 24-hour line (1-800-223-9074) for aging and disability inquiries and a dedicated APS line (1-888-APS-4302 / 1-888-277-4302) launched for direct reporting of abuse, neglect, and exploitation. Either reaches a Delaware APS intake worker.
• Online reporting. DSAAPD provides an APS Online Submission Form at https://dhss.delaware.gov/dsaapd/aps/. Online submission is recommended for non-urgent reports because it produces a date-stamped record.
• Long-term care facilities. When the vulnerable adult resides in a long-term care facility, the reporter must ALSO notify the Division of Health Care Quality (DHCQ) at 1-877-453-0012 and the Long-Term Care Ombudsman at 1-855-773-1002. Federal facility reporting requirements under 42 C.F.R. § 483.12 may also apply (CMS within 24 hours; reasonable suspicion of crime within 2 hours where serious bodily injury).
• Financial exploitation. Delaware law authorizes financial institutions to place a "transaction hold" on suspicious transactions involving a vulnerable adult and grants immunity for good-faith holds (5 Del. C. § 902, in addition to 31 Del. C. § 3910).
• No attorney-client carve-out from reporting. While other professional privileges are abrogated by § 3910, the attorney-client privilege under D.R.E. 502 generally is not — but Rule 1.14 of the Delaware Lawyers' Rules of Professional Conduct permits a lawyer to take protective action for a client with diminished capacity, including consulting with appropriate persons or agencies.
• Emergency court intervention. If APS finds probable cause of immediate and irreparable physical injury or death, DSAAPD may petition the Court of Chancery under 31 Del. C. § 3908 for emergency protective services, which may include emergency relocation, medical care, or appointment of a temporary guardian.
• Crimes against vulnerable adults. Delaware criminal law (11 Del. C. § 1105 et seq.) parallels APS jurisdiction. Where criminal conduct is suspected, APS coordinates with the Attorney General's Medicaid Fraud Control Unit (MFCU) for facility-based exploitation, or with state/local police for community cases.
• Records retention. The reporter should retain a dated copy of the completed report, along with any underlying notes and evidence, for at least seven years or until any related civil/criminal matter is resolved.

15. SOURCES AND REFERENCES

• 31 Del. C. Chapter 39 (Adult Protective Services) — https://delcode.delaware.gov/title31/c039/index.html
• 31 Del. C. § 3902 (Definitions) — https://delcode.delaware.gov/title31/c039/index.html
• 31 Del. C. § 3910 (Duty to report; immunity)
• 16 Del. C. Chapter 11 (Long-Term Care Facilities) — https://delcode.delaware.gov/title16/c011/index.html
• 11 Del. C. § 1105 (Crime against a vulnerable adult)
• DSAAPD Adult Protective Services — https://dhss.delaware.gov/dsaapd/aps/
• DSAAPD APS Reporting FAQ — https://dhss.delaware.gov/dsaapd/faq_reportabuse/
• Delaware Long-Term Care Ombudsman — https://dhss.delaware.gov/ltcop/
• Division of Health Care Quality (DHCQ) — https://dhss.delaware.gov/dhcq/
• 42 C.F.R. § 483.12 (federal nursing facility reporting requirements)

Disclaimer: This template is provided for informational and documentary purposes only and is not legal advice. The duty to report under 31 Del. C. § 3910 is independent of and is not satisfied by the use of this template — a verbal or online report to APS must be made within the statutory time frame. A Delaware-licensed attorney should review the contents before any disclosure beyond statutorily authorized recipients.