Minnesota Adult Protective Services Report — Vulnerable Adult Maltreatment (MAARC)

MINNESOTA VULNERABLE ADULT MALTREATMENT REPORT — MAARC SUBMISSION

TABLE OF CONTENTS

1. Reporter Information
2. Mandated Reporter Status
3. Vulnerable Adult Identification
4. Alleged Perpetrator(s) / Caregiver(s)
5. Nature of Maltreatment
6. Detailed Narrative
7. Immediate Risk Assessment
8. Evidence and Witnesses
9. Prior Reports and Pattern Evidence
10. Requested Protective Action
11. Parallel Notifications
12. Reporter Certification and Immunity Invocation
13. Receipt and Tracking
14. Minnesota Practice Notes
15. Sources and References

1. REPORTER INFORMATION

2. MANDATED REPORTER STATUS

Per Minn. Stat. § 626.5572, subd. 16, reporter is a mandated reporter because reporter is (check all that apply):

☐ A professional or professional's delegate engaged in care of vulnerable adults
☐ Employee of a facility licensed under Minn. Stat. ch. 144, 144A, 144G, or 245A
☐ Health-care professional (physician, nurse, PA, dentist, pharmacist, EMT, etc.)
☐ Mental-health professional or psychologist
☐ Social worker / case manager
☐ Law-enforcement officer
☐ Educator or school employee
☐ Clergy (subject to penitential-communication exception)
☐ Financial institution employee (financial exploitation only)
☐ Coroner / medical examiner
☐ Voluntary (non-mandated) reporter

If reporter is not mandated, reporter is making this report voluntarily. Reporter requests confidentiality of identity to the maximum extent permitted by Minn. Stat. § 626.557, subd. 12b.

3. VULNERABLE ADULT IDENTIFICATION

3.1 Statutory Basis for "Vulnerable Adult" Status — Minn. Stat. § 626.5572, subd. 21

Subject qualifies as a vulnerable adult because (check all that apply):

☐ Resident or inpatient of a facility (nursing home, hospital, boarding-care home, ICF/DD, etc.)
☐ Receives services from a home-care provider licensed under Minn. Stat. ch. 144A
☐ Receives services from a provider licensed under Minn. Stat. ch. 245A (DD, MH, chemical dependency, child care)
☐ Receives PCA services under § 256B.0625, subd. 19a
☐ Possesses a physical or mental infirmity or other physical, mental, or emotional dysfunction that impairs ability to provide adequately for self-care AND impairs ability to protect from maltreatment

Specific facts establishing dysfunction / impairment: [________________________________]

4. ALLEGED PERPETRATOR(S) / CAREGIVER(S)

5. NATURE OF MALTREATMENT

Pursuant to Minn. Stat. § 626.5572, subd. 15, "maltreatment" means abuse (subd. 2), neglect (subd. 17), or financial exploitation (subd. 9). Reporter alleges the following (check all that apply):

5.1 Abuse — Subd. 2

☐ Physical abuse — hitting, slapping, kicking, pushing, restraint, rough handling
☐ Sexual abuse / criminal sexual conduct
☐ Use of aversive or deprivation procedures
☐ Mental / emotional abuse — demeaning, threatening, intimidating language
☐ Drug-facilitated crime
☐ Solicitation of prostitution

5.2 Neglect — Subd. 17

☐ Caregiver failure to provide food, clothing, shelter, or hygiene
☐ Caregiver failure to provide necessary health care or medication
☐ Caregiver failure to provide adequate supervision
☐ Inadequate staffing or supervision in facility
☐ Pressure injuries / bedsores
☐ Falls due to inadequate supervision
☐ Self-neglect by vulnerable adult unable to provide for own basic needs

5.3 Financial Exploitation — Subd. 9

☐ Unauthorized expenditure of vulnerable adult's funds
☐ Failure to use vulnerable adult's resources for necessary care
☐ Theft, forgery, or unauthorized credit-card / bank transactions
☐ Unlawful control of property through undue influence, deception, or coercion
☐ Improper use of POA, guardianship, conservatorship, or representative-payee authority
☐ Predatory marriage, deed transfer, or beneficiary change
☐ Scam / fraud (telemarketing, sweepstakes, romance, IRS impersonation, etc.)

6. DETAILED NARRATIVE

Date and time of alleged incident(s): [__/__/____] [____:____]

Location of alleged incident(s): [________________________________]

Detailed description of what reporter observed, was told, or has reason to believe occurred. Use specific, factual language; quote statements verbatim where possible; include source of each fact (personal observation, statement by vulnerable adult, statement by witness, document review):

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

Observed injuries / physical findings (location, size, color, age of bruise/wound, with photos if permitted):

[____________________________________________________________]

Statements by the vulnerable adult (verbatim where possible):

"[____________________________________________________________]"

Statements by alleged perpetrator (verbatim where possible):

"[____________________________________________________________]"

7. IMMEDIATE RISK ASSESSMENT

☐ Vulnerable adult is in IMMEDIATE danger of death or serious bodily harm — 911 contacted at [____:____] on [__/__/____].
☐ Vulnerable adult requires emergency medical attention — currently being treated at [________________________________].
☐ Alleged perpetrator has continued unsupervised access to vulnerable adult.
☐ Vulnerable adult lacks decision-making capacity and has no responsible representative.
☐ Risk of further financial loss is ongoing — assets are actively being depleted.
☐ Victim is socially isolated; alleged perpetrator controls communication or transportation.
☐ Risk level (reporter's good-faith assessment): ☐ Imminent ☐ High ☐ Moderate ☐ Low.

8. EVIDENCE AND WITNESSES

8.1 Documents and Physical Evidence

8.2 Witnesses

9. PRIOR REPORTS AND PATTERN EVIDENCE

☐ Prior MAARC reports filed: [__/__/____], [__/__/____].
☐ Prior OHFC complaints filed: [__/__/____].
☐ Active law-enforcement investigation — agency [____________], case # [____________].
☐ Pending or recent guardianship / conservatorship petitions — case # [____________].
☐ Prior facility licensing actions: [________________________________].

Pattern of conduct (frequency, escalation, history): [________________________________]

10. REQUESTED PROTECTIVE ACTION

Reporter respectfully requests that the lead investigative agency:

☐ Conduct an immediate (within 24 hours) face-to-face safety check
☐ Coordinate with law enforcement for criminal investigation
☐ Coordinate with OHFC for facility-licensing investigation
☐ Issue an emergency hold on financial accounts in coordination with the financial institution under Minn. Stat. § 626.557, subd. 4(a)
☐ Refer to the county attorney for emergency protective services / petition for guardianship under Minn. Stat. ch. 524 Art. 5
☐ Coordinate with Adult Protective Services for in-home safety planning
☐ Notify the Long-Term Care Ombudsman (1-800-657-3591) for facility-resident advocacy
☐ Notify the Minnesota Attorney General's Office (financial exploitation / consumer fraud)

11. PARALLEL NOTIFICATIONS

This report has been or will be filed simultaneously with:

12. REPORTER CERTIFICATION AND IMMUNITY INVOCATION

I certify under penalty of perjury under the laws of the State of Minnesota that the foregoing is true and accurate to the best of my knowledge and that this report is made in good faith based on the facts and observations described above.

Reporter expressly invokes the immunity from civil and criminal liability provided by Minn. Stat. § 626.557, subd. 5, which shields any person making a good-faith report or participating in any related investigation from civil or criminal liability arising from the report or related conduct, including any failure to fully comply with subdivision 3.

Reporter further invokes the anti-retaliation protections of Minn. Stat. § 626.557, subd. 17, and (where applicable to nursing-home residents and employees) Minn. Stat. § 144.6512.

[________________________________] Date: [__/__/____]
Signature of reporter

[________________________________]
Printed name

13. RECEIPT AND TRACKING

(For reporter's records — completed after submission.)

14. MINNESOTA PRACTICE NOTES

1. Time limits. Mandated reporters must report "immediately" — no later than 24 hours after first becoming aware of the suspected maltreatment. Minn. Stat. § 626.557, subd. 3. Failure to report is a misdemeanor (subd. 7) and may trigger licensing-board discipline. Use the MAARC hotline first; this written supplement does NOT satisfy the immediate-reporting requirement on its own.

2. Common Entry Point. MAARC is the statewide common entry point under § 626.557, subd. 9. MAARC routes the report to the appropriate lead investigative agency: MDH-OHFC (licensed health-care facilities), DHS Licensing (licensed providers under chapter 245A), or county Adult Protection (community / unlicensed settings).

3. Investigation timeline. Lead agency must issue final disposition within 60 calendar days. § 626.557, subd. 9c. If extended, written notice must be given.

4. Reporter identity. A reporter's identity is confidential and may be released only on a court order finding the report was false and made in bad faith. § 626.557, subd. 5; subd. 12b. Mandated reporters must still provide name and contact information.

5. Penitential exception. Clergy are not required to report communications protected by the priest-penitent privilege under Minn. Stat. § 595.02, subd. 1(c); other observations remain reportable.

6. Financial-institution reports. Banks, credit unions, and broker-dealers are mandated reporters of suspected financial exploitation and may delay or refuse transactions under Minn. Stat. § 45A.01–.05 (Safeguarding the Funds of Vulnerable Adults Act).

7. Civil claims. Substantiated maltreatment may support civil claims for damages under Minn. Stat. §§ 626.557 (private right where authorized), 144.651 (nursing-home bill of rights), and common-law negligence. Coordinate with civil counsel.

8. Guardianship / conservatorship. Where a vulnerable adult lacks capacity, consider an emergency petition under Minn. Stat. § 524.5-311 (emergency guardian) or § 524.5-412 (emergency conservator).

9. Update on appeal. A finding of substantiated maltreatment against a named alleged perpetrator may be appealed under Minn. Stat. § 256.045. Coordinate response with counsel.

15. SOURCES AND REFERENCES

• Minn. Stat. § 626.557 — https://www.revisor.mn.gov/statutes/cite/626.557
• Minn. Stat. § 626.5572 (definitions) — https://www.revisor.mn.gov/statutes/cite/626.5572
• Minn. Stat. § 144.6512 (nursing-home retaliation) — https://www.revisor.mn.gov/statutes/cite/144.6512
• DHS Adult Protection / MAARC — https://mn.gov/dhs/people-we-serve/adults/services/adult-protection/
• MAARC online reporting — https://tnt09.agileapps.dhs.mn.gov/networking/sites/880862836/MAARC
• MAARC hotline: 1-844-880-1574 (24/7 toll-free)
• Office of Health Facility Complaints (MDH-OHFC) — https://www.health.state.mn.us/facilities/regulation/ohfc/index.html
• OHFC complaint line: 1-800-369-7994
• Office of Ombudsman for Long-Term Care — https://mn.gov/ooltc/
• OOLTC: 1-800-657-3591
• Minnesota House Research, "The Minnesota Vulnerable Adults Act" — https://www.house.mn.gov/hrd/pubs/vuladult.pdf
• Minnesota Attorney General — Senior Fraud: 651-296-3353 / 1-800-657-3787