South Dakota Adult Protective Services Report — Abuse, Neglect, or Exploitation of an Elder or Adult with a Disability

SOUTH DAKOTA ADULT PROTECTIVE SERVICES REPORT

Abuse, Neglect, or Exploitation of an Elder or Adult with a Disability — SDCL Ch. 22-46

URGENT — READ FIRST

If the elder or disabled adult is in immediate danger, call 911 first.

South Dakota APS / Dakota at Home intake line: 1-833-663-9673
Email: [email protected]
Online: https://dakotaathome.sd.gov/

Mandatory reporters must report within 24 hours under SDCL § 22-46-9. This written form is a follow-up record; make the oral/electronic report first.

TABLE OF CONTENTS

1. Reporter Information
2. Mandatory Reporter Status
3. Subject of Report — Elder or Adult with a Disability
4. Alleged Perpetrator / Caretaker
5. Type of Abuse, Neglect, or Exploitation
6. Narrative — What Was Observed
7. Evidence and Witnesses
8. Imminent Risk Assessment
9. Recipient Agency and Reporting Channel
10. Reporter Certification, Immunity, and Confidentiality
11. Sources and References

1. REPORTER INFORMATION

2. MANDATORY REPORTER STATUS

Under SDCL § 22-46-9, the reporter is a mandatory reporter as: (check all that apply)

• ☐ Physician, dentist, osteopath, chiropractor, optometrist, podiatrist, or religious healing practitioner
• ☐ Hospital intern or resident
• ☐ Registered nurse, licensed practical nurse, or other licensed nursing personnel
• ☐ Paramedic or emergency medical technician
• ☐ Social worker
• ☐ Other health-care professional (specify: [____________])
• ☐ Psychologist, licensed mental-health professional, or licensed counselor
• ☐ State, county, or municipal criminal-justice employee
• ☐ Law-enforcement officer
• ☐ Voluntary reporter under SDCL § 22-46-11 (not a mandatory reporter, but reporting in good faith)

Time of formation of reasonable cause to suspect: [__/__/____] at [____]:[____] ☐ AM ☐ PM

Twenty-four-hour reporting window expires: [__/__/____] at [____]:[____] ☐ AM ☐ PM

3. SUBJECT OF REPORT — ELDER OR ADULT WITH A DISABILITY

Legal representatives (if known):

4. ALLEGED PERPETRATOR / CARETAKER

5. TYPE OF ABUSE, NEGLECT, OR EXPLOITATION

Check all that apply. Definitions are summarized from SDCL § 22-46-1; refer to the statute for full text.

Physical abuse — physical harm, bodily injury, attempt to cause harm, or fear of imminent harm:

• ☐ Hitting / slapping / striking
• ☐ Pushing / shoving / restraining
• ☐ Misuse of restraints (chemical or physical)
• ☐ Burns, bruises, lacerations, fractures inconsistent with explanation
• ☐ Sexual abuse / unwanted contact
• ☐ Threat of imminent harm

Emotional or psychological abuse:

• ☐ Verbal harassment, threats, intimidation
• ☐ Ridiculing or demeaning conduct
• ☐ Isolation from family, friends, or services
• ☐ Humiliation, derogatory remarks
• ☐ Coercion or manipulation

Neglect (SDCL § 22-46-1; exclusions per § 22-46-1.1):

• ☐ Failure to provide adequate food, water, or nutrition
• ☐ Failure to provide adequate clothing, shelter, or hygiene
• ☐ Failure to provide medical care, medications, or supervision
• ☐ Unsafe living conditions (sanitation, heat, fall hazards)
• ☐ Self-neglect (subject lives alone and is unable to provide for self)
• ☐ Failure to assist with activities of daily living
• ☐ Untreated pressure injuries / wounds / infections

Exploitation — wrongful taking or exercise of control over property with intent to defraud:

• ☐ Theft of cash, checks, or property
• ☐ Forged signatures on checks, deeds, contracts, or POA
• ☐ Unauthorized ATM / debit-card withdrawals
• ☐ Misuse of power of attorney, joint account, or fiduciary position
• ☐ Coerced gifts, transfers, or estate-plan changes
• ☐ Predatory lending, scam, or undue influence
• ☐ Failure to use subject's funds for subject's care
• ☐ Suspected violation of SDCL § 22-46-3 (theft by exploitation)

Abandonment:

• ☐ Caretaker has deserted the subject without arranging adequate care

6. NARRATIVE — WHAT WAS OBSERVED

Provide a chronological, factual account. Use direct observation; identify hearsay and its source. Avoid conclusions; report what you saw, heard, smelled, and learned.

Date(s), time(s), and location(s) of observation:

[____________________________________________________________]

Description of physical, behavioral, financial, or environmental indicators observed:

[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]
[____________________________________________________________]

Statements made by the subject (verbatim where possible):

[____________________________________________________________]
[____________________________________________________________]

Statements made by the alleged perpetrator (verbatim where possible):

[____________________________________________________________]
[____________________________________________________________]

Statements by other witnesses or staff:

[____________________________________________________________]
[____________________________________________________________]

History of prior reports, incidents, or concerns (if known):

[____________________________________________________________]

7. EVIDENCE AND WITNESSES

Witnesses:

8. IMMINENT RISK ASSESSMENT

If any answer above is "Yes": call 911 and APS immediately. Document the call.

9. RECIPIENT AGENCY AND REPORTING CHANNEL

Under SDCL § 22-46-9 and § 22-46-10, mandatory reporters may report to any one of the following. Best practice: report to APS for protective services AND law enforcement / state's attorney for criminal investigation.

☐ South Dakota DSS / DHS-LTSS Adult Protective Services (Dakota at Home)

• Phone: 1-833-663-9673
• Email: [email protected]
• Online: https://dakotaathome.sd.gov/
• Mail: Division of Long-Term Services and Supports, Hillsview Plaza, c/o 500 E. Capitol Avenue, Pierre, SD 57501

☐ State's Attorney for [____________] County

• Address: [________________________________]
• Phone: [____________]

☐ Law-Enforcement Agency

• Agency: [________________________________]
• Officer: [________________________________]
• Phone: [____________]
• Case / report number: [________________________________]

☐ Long-Term Care Ombudsman (if subject is in a nursing or assisted-living facility) — 1-833-663-9673 (also Dakota at Home).

☐ Federal / additional referrals (as appropriate):

• ☐ FBI Internet Crime Complaint Center (IC3) — https://www.ic3.gov/
• ☐ U.S. Postal Inspection Service (mail fraud)
• ☐ Social Security Administration OIG (SSA fraud)
• ☐ South Dakota Attorney General — Consumer Protection Division (605-773-4400; 1-800-300-1986)

10. REPORTER CERTIFICATION, IMMUNITY, AND CONFIDENTIALITY

Statutory immunity (SDCL § 22-46-8): Any person who, in good faith, makes a report of abuse, neglect, or exploitation of an elder or disabled adult is immune from civil and criminal liability that might otherwise be incurred or imposed, and has the same immunity for participation in any judicial proceeding resulting from the report. Immunity extends to public officials and persons or institutions who in good faith cooperate with an investigation. Immunity does not extend to any person alleged to have committed the act or to any person who aided and abetted such an act.

Confidentiality (SDCL § 22-46-13): Reports and the identity of the reporter are confidential, with disclosure permitted to the investigating agency, prosecuting authority, court, and others as authorized by law.

Penalty for failure to report (SDCL § 22-46-9): Class 1 misdemeanor.

Reporter's certification:

I declare under penalty of perjury under the laws of the State of South Dakota that the information contained in this report is true and correct to the best of my knowledge and belief, and that I make this report in good faith pursuant to SDCL § 22-46-9 and/or § 22-46-11.

Signature: [________________________________]

Printed name: [________________________________]

Title / license number (if applicable): [________________________________]

Date: [__/__/____] Time: [____]:[____] ☐ AM ☐ PM

11. SOURCES AND REFERENCES

South Dakota statutes:

• SDCL Chapter 22-46 (Abuse, Neglect, or Exploitation of Elders or Adults with Disabilities) — https://sdlegislature.gov/Statutes/22-46
• SDCL § 22-46-1 (Definitions) — https://sdlegislature.gov/Statutes/22-46-1
• SDCL § 22-46-2 (Caretaker abuse — felony) — https://sdlegislature.gov/Statutes/22-46-2
• SDCL § 22-46-3 (Theft by exploitation) — https://sdlegislature.gov/Statutes/22-46-3
• SDCL § 22-46-8 (Immunity) — https://sdlegislature.gov/Statutes/22-46-8
• SDCL § 22-46-9 (Mandatory reporting; misdemeanor) — https://sdlegislature.gov/Statutes/22-46-9
• SDCL § 22-46-10 (Reporting recipients) — https://sdlegislature.gov/Statutes/22-46-10
• SDCL § 22-46-11 (Voluntary reporting) — https://sdlegislature.gov/Statutes/22-46-11
• SDCL § 22-46-12 (Information in report) — https://sdlegislature.gov/Statutes/22-46-12
• SDCL § 22-46-13 (Confidentiality) — https://sdlegislature.gov/Statutes/22-46-13

State agencies:

• DHS Adult Protective Services — https://dhs.sd.gov/ltss/adultprotective.aspx
• Dakota at Home (APS / LTC intake) — 1-833-663-9673 — https://dakotaathome.sd.gov/
• DSS Protective Services — https://dss.sd.gov/childprotection/protective.aspx
• South Dakota Attorney General — Senior Fraud — https://atg.sd.gov/Victim/Seniors/abuse.aspx
• Consumer Protection Division — 1-800-300-1986

Federal authority:

• Older Americans Act, 42 U.S.C. § 3058i — https://www.acl.gov/about-acl/elder-justice
• Elder Justice Act, 42 U.S.C. § 1397j et seq. — https://www.justice.gov/elderjustice
• DOJ Elder Justice Initiative — https://www.justice.gov/elderjustice

Reference / training materials:

• South Dakota Adult Protective Services site — https://www.southdakotaaps.com/
• DOJ Responding to Elder Abuse in South Dakota — https://www.justice.gov/elderjustice/file/1194011/dl

This template is provided for informational purposes only and does not constitute legal advice. Mandatory reporters must report orally or in writing within 24 hours under SDCL § 22-46-9. Use this form as a documentation aid; make the oral/electronic report first. Confirm the current APS hotline before relying on a number listed here.