North Dakota Vulnerable Adult Protective Services Report (Mandatory Reporter)

NORTH DAKOTA VULNERABLE ADULT PROTECTIVE SERVICES REPORT

TABLE OF CONTENTS

1. Reporter Identification and Mandatory-Reporter Status
2. Vulnerable Adult Identification
3. Nature of the Concern — Abuse, Neglect, or Exploitation
4. Description of Incident or Conditions
5. Alleged Perpetrator(s)
6. Imminent Risk Assessment
7. Witnesses, Collateral Contacts, and Evidence
8. Prior Reports and Existing Protective Orders
9. Action Requested
10. Submission and Routing
11. Confidentiality, Immunity, and Retaliation Protections
12. Reporter Signature and Date
13. North Dakota Practice Notes
14. Sources and References

1. REPORTER IDENTIFICATION AND MANDATORY-REPORTER STATUS

Reporter status (check all that apply — mandatory under N.D.C.C. § 50-25.2-03):

• ☐ Physician, physician assistant, or other licensed health-care provider
• ☐ Registered nurse, LPN, CNA, or home-health aide
• ☐ Mental-health professional (psychologist, LCSW, LPCC, addiction counselor)
• ☐ Dentist, dental hygienist
• ☐ Pharmacist
• ☐ Chiropractor, optometrist, podiatrist
• ☐ EMT / paramedic / first responder
• ☐ Coroner / medical examiner
• ☐ Hospital, nursing facility, basic-care facility, assisted-living, or swing-bed staff
• ☐ Adult-day-services or HCBS-waiver provider
• ☐ Long-Term Care Ombudsman
• ☐ Law-enforcement officer
• ☐ Educator / school staff
• ☐ Clergy member (privilege limitations may apply — see Section 11)
• ☐ Financial institution employee (for suspected exploitation)
• ☐ Attorney (privilege limitations may apply — see Section 11)
• ☐ Concerned citizen / family member / friend (permissive reporter)
• ☐ Other [________________________________]

Reporter requests confidentiality of identity under DHHS VAPS policy: ☐ Yes ☐ No

2. VULNERABLE ADULT IDENTIFICATION

Basis for "vulnerable adult" status under N.D.C.C. § 50-25.2-01 (substantial mental or functional impairment, or unable to protect self from abuse, neglect, or exploitation):

[________________________________]
[________________________________]

3. NATURE OF THE CONCERN — ABUSE, NEGLECT, OR EXPLOITATION

Check all that apply. Definitions tracked from N.D.C.C. § 50-25.2-01.

A. Physical abuse:

• ☐ Hitting, slapping, pushing, or other infliction of pain or injury
• ☐ Inappropriate physical or chemical restraint
• ☐ Sexual abuse or sexual contact without consent
• ☐ Confinement against will

B. Emotional / psychological abuse:

• ☐ Verbal threats, intimidation, humiliation
• ☐ Isolation from family, friends, or services
• ☐ Coercion or harassment

C. Neglect (caregiver) or self-neglect:

• ☐ Failure to provide food, water, hygiene, clothing, shelter
• ☐ Failure to provide or follow through with medical care, medications
• ☐ Unsafe living conditions (hoarding, no heat, infestation, electricity off)
• ☐ Pressure injuries, malnutrition, dehydration, untreated wounds
• ☐ Inadequate supervision creating risk
• ☐ Self-neglect — adult unable or unwilling to perform essential self-care

D. Financial exploitation:

• ☐ Misuse of POA, joint account, or fiduciary authority
• ☐ Forged checks, unauthorized withdrawals, ATM/online theft
• ☐ Unauthorized changes to deed, beneficiary designation, or will
• ☐ Coerced loans, gifts, or transfers
• ☐ Identity theft, scam (romance, lottery, IRS, tech support, grandparent)
• ☐ Unpaid bills despite available funds
• ☐ Caregiver / family member receiving unexplained benefits

E. Abandonment:

• ☐ Caregiver desertion at hospital, facility, or in the home

F. Misappropriation of property (in facility setting): ☐ Yes ☐ No

4. DESCRIPTION OF INCIDENT OR CONDITIONS

Provide a chronological narrative. Use objective, observable facts; quote statements when possible; identify sources of information. Attach photographs, financial records, medical records as exhibits where available and authorized.

Date(s) of incident or onset of conditions: [__/__/____] to [__/__/____]

Location: [________________________________]

Narrative:

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Observable signs (check all observed):

• ☐ Bruises, abrasions, lacerations, fractures
• ☐ Pressure injuries (stages I–IV)
• ☐ Weight loss, dehydration, malnutrition
• ☐ Poor hygiene, soiled clothing, untreated medical conditions
• ☐ Withdrawal, fearfulness, agitation in presence of caregiver
• ☐ Unexplained financial transactions / missing funds
• ☐ Recent change in legal documents (will, POA, deed, account)
• ☐ Caregiver controls communication / blocks visitors
• ☐ Other [________________________________]

5. ALLEGED PERPETRATOR(S)

For each alleged perpetrator (use additional sheets if needed):

6. IMMINENT RISK ASSESSMENT

Is the vulnerable adult in imminent danger of death or serious bodily harm? ☐ Yes — CALL 911 IMMEDIATELY ☐ No ☐ Uncertain

Is the alleged perpetrator currently with or has access to the vulnerable adult? ☐ Yes ☐ No

Does the vulnerable adult have access to food, water, medication, heat? ☐ Yes ☐ No ☐ Unknown

Is there risk of imminent financial loss (e.g., pending wire, scheduled real-estate closing, bank withdrawal in progress)? ☐ Yes — describe and request emergency intervention ☐ No

Recommended urgency: ☐ Emergency (within hours) ☐ Urgent (within 24 hours) ☐ Routine

7. WITNESSES, COLLATERAL CONTACTS, AND EVIDENCE

Documentary evidence attached (do not include originals — provide copies):

• ☐ Photographs (with date stamps)
• ☐ Medical records / chart notes
• ☐ Bank statements, transaction histories
• ☐ Recorded telephone messages or voicemails (with consent / lawful basis)
• ☐ Text messages, emails, social-media screenshots
• ☐ Powers of attorney, deeds, beneficiary designations
• ☐ Police-incident numbers (if any)
• ☐ Other [________________________________]

8. PRIOR REPORTS AND EXISTING PROTECTIVE ORDERS

• Prior VAPS reports filed (dates, intake numbers): [________________________________]
• Prior law-enforcement reports: [________________________________]
• Existing protection orders / no-contact orders: ☐ Yes — case # [____] ☐ No
• Existing guardianship or conservatorship: ☐ Yes — case # [____] ☐ No

9. ACTION REQUESTED

The reporter requests that the Department:

• ☐ Conduct an immediate evaluation under N.D.C.C. § 50-25.2-05
• ☐ Coordinate with law enforcement (in-person welfare check)
• ☐ Coordinate with the Long-Term Care Ombudsman (facility cases) per N.D.C.C. § 50-25.2-04
• ☐ Refer to State's Attorney for criminal investigation (N.D.C.C. § 12.1-31-07 exploitation; § 12.1-16-07.1 endangerment)
• ☐ File for emergency guardianship / conservatorship under N.D.C.C. ch. 30.1-29 / 30.1-31
• ☐ Notify financial institution to freeze suspected account / hold suspicious transaction
• ☐ Provide protective services per N.D.C.C. § 50-25.2-06
• ☐ Other [________________________________]

10. SUBMISSION AND ROUTING

Primary submission — North Dakota Vulnerable Adult Protective Services Central Intake:

• Phone (toll-free, 24/7 voicemail after hours): 1-855-462-5465, Option 2
• Email (encrypted): [email protected] (CONFIRM at filing)
• Mail: ND DHHS Aging Services Division — VAPS, 1237 W. Divide Avenue, Suite 6, Bismarck, ND 58501-1208 (CONFIRM)

Secondary / parallel routing as appropriate:

• ☐ Local law enforcement: [Agency] [Phone]
• ☐ State Long-Term Care Ombudsman (facility complaints): 1-855-462-5465, Option 3
• ☐ DHHS Health Facilities Section (licensed facility): 1-800-755-8408 (CONFIRM)
• ☐ Local Human Service Zone APS worker: [Phone]
• ☐ State's Attorney — [County]
• ☐ Tribal social services (if tribal member on or near reservation)
• ☐ 911 (if imminent danger)

11. CONFIDENTIALITY, IMMUNITY, AND RETALIATION PROTECTIONS

A. Confidentiality. The identity of a reporter is confidential under DHHS VAPS policy and is not disclosed to the alleged perpetrator absent court order or written consent. Reports and investigation files are not subject to general public-records release.

B. Immunity (N.D.C.C. § 50-25.2-09). Any person, other than an alleged perpetrator, who in good faith makes a report, cooperates in an investigation, or testifies in a related proceeding is immune from civil or criminal liability arising from the report or participation.

C. Penalty for failure to report (N.D.C.C. § 50-25.2-10). A mandatory reporter who willfully fails to report may be subject to civil and/or criminal penalties as set forth in the statute. Professional licensing consequences may also apply.

D. Retaliation prohibited (N.D.C.C. § 50-25.2-11). No employer may discharge, demote, transfer, or otherwise retaliate against an employee who in good faith reports under this chapter or participates in an investigation. The aggrieved employee has a civil cause of action for damages, reinstatement, and attorney's fees.

E. Privilege. The reporting duty does not abrogate attorney-client privilege or the clergy-penitent privilege except as expressly provided by statute. Where privilege applies, consult counsel before disclosure.

12. REPORTER SIGNATURE AND DATE

I declare under penalty of perjury under the laws of the State of North Dakota that the foregoing report is, to the best of my knowledge, true and made in good faith for the purpose of protecting a vulnerable adult.

13. NORTH DAKOTA PRACTICE NOTES

1. Single point of intake. ND consolidates VAPS reporting through Aging & Disability Resource-LINK at 1-855-462-5465. Calling this line and selecting Option 2 reaches central intake; the call is then triaged to the regional VAPS social worker.
2. Imminent danger. If the vulnerable adult is in immediate danger, call 911 first; then file the VAPS report. Law enforcement and VAPS coordinate under N.D.C.C. § 50-25.2-05.
3. Facility cases are reported under § 50-25.2-04 to the Long-Term Care Ombudsman and DHHS Health Facilities Section. Many practitioners file in parallel to VAPS to ensure no gap.
4. Financial exploitation. Banks and credit unions may file Suspicious Activity Reports (SARs) and may invoke transaction-hold safe harbors. Encourage parallel reporting to the institution's BSA officer.
5. Self-neglect. Self-neglect is reportable. Adults with capacity may refuse services per § 50-25.2-07; intervention may still be needed where capacity is compromised.
6. Capacity vs. autonomy. Capable adults have the right to make unwise decisions. The report is appropriate when (a) impairment exists, (b) abuse/neglect/exploitation is suspected, and (c) the adult cannot protect themselves.
7. Time-stamp the report. Note exact time of call and any case-intake number; some licensing boards require proof of timely reporting.
8. Document the duty. Mandatory reporters should document in their own records the date, time, recipient, and substance of the report — without storing confidential VAPS communications in shared files.
9. Coordinate with guardianship counsel. Where exploitation is by a fiduciary (POA, trustee, guardian), expedited petitions for accounting, removal, or emergency guardianship under N.D.C.C. ch. 30.1-29 may be necessary alongside the VAPS report.
10. Tribal jurisdiction. Where the vulnerable adult resides on a reservation, federal and tribal jurisdiction may control. Coordinate with the appropriate tribal social services and, where applicable, the BIA.

14. SOURCES AND REFERENCES

• ND HHS — Reporting Abuse and Neglect of a Vulnerable Adult: https://www.hhs.nd.gov/adults-and-aging/reporting
• ND HHS — Vulnerable Adult Protective Services Program (fact sheet): https://www.hhs.nd.gov/sites/www/files/documents/DHS%20Legacy/fact-sheet-vulnerable-adults-protective-services.pdf
• ND HHS — Adult and Aging Services: https://www.hhs.nd.gov/adults-and-aging
• N.D.C.C. ch. 50-25.2 (Vulnerable Adult Protection Services) — full text PDF: https://ndlegis.gov/cencode/t50c25-2.pdf
• N.D.C.C. ch. 50-25.2 — Justia annotations: https://law.justia.com/codes/north-dakota/title-50/chapter-50-25-2/
• DHHS Vulnerable Adult Protective Services Policy Manual (Division 690-01): https://www.nd.gov/dhs/policymanuals/69001/Content/Printed%20Docuementation/4-1-13.pdf
• ND Aging & Disability Resource-LINK (Carechoice): https://carechoice.nd.assistguide.net/
• National Adult Protective Services Association — Help in Your Area: https://www.napsa-now.org/help-in-your-area/
• N.D.C.C. § 12.1-31-07 (Exploitation of an eligible adult): https://ndlegis.gov/cencode/t12-1c31.pdf
• N.D.C.C. § 12.1-16-07.1 (Endangering an eligible adult): https://ndlegis.gov/cencode/t12-1c16.pdf