Department of Family and Protective Services
Increasing Efficiency
in
Adult Protective Services
Kez Wold and Karl Urban
May 7, 2012
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PRESENTATION OBJECTIVE
The Texas Adult Protective Services (APS)
program is having to do more with less.
Increasing intakes combined with decreasing
staff necessitates taking a hard look at who we
serve and how we serve them.
•This presentation will describe some of the
changes being contemplated by APS.
•To have a dialogue with the Aging Network
about these changes.
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OVERVIEW OF PRESENTATION
•Brief
overview of APS
•Current trends in APS
•Upcoming potential changes in APS
•Changes to definitions of who we
serve
•Changes to how we conduct
casework
•Questions and Answers
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MISSION
The mission of Adult Protective
Services (APS) is to protect the older
adults and people with disabilities
from abuse, neglect, and
exploitation.
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APS PROGRAMS
APS Program has two primary components:
•In-Home
Delivery
•Facility
Investigations and Service
Investigations
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STATUTORY AUTHORITY
Chapter 48 of the Texas Human Resources Code
authorizes APS to investigate reports of abuse, neglect, and
exploitation of:
•elderly
persons (age 65 and older);
•adults with disabilities; and
•persons receiving mental health and/or mental
retardation services in a state school, state hospital,
community center, state center, licensed intermediate
care facility for the mentally retarded (ICF/MR), or via
Home and Community-based Services (HCS) and Texas
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Home Living Medicaid
waiver programs.
IN-HOME INVESTIGATIONS
AND SERVICES
•In-Home
investigations are conducted in private residences, room
and board homes not subject to licensure, and/or adult foster care
homes with three or fewer residents.
•APS
may arrange for or provide the following services:
•emergency financial assistance for rent and utility restoration
•social services
•emergency shelter
•health services
•referral to or collaborate with other community services,
including guardianship
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CURRENT APS IN-HOME TRENDS
•The
client base and intakes are rapidly rising
•The 82nd Texas Legislature reduced the number of
caseworkers
•APS has implemented casework practice changes that
have improved efficiency and reduced caseloads
•Mobile caseworkers
•“As You Go” documentation using tablet-PCs
•Caseloads are projected to significantly increase over
the coming years
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KEY CHALLENGES
•
•Increasing intakes, decreasing staff
•Defensive
casework practice – “fear of the one bad
case”
•A changing, increasingly mobile workforce
•Casework practice that is uniform for all types of
allegations
•Limited ability to address needs of some clients
(especially mentally ill, chronically poor) leading to less
than optimal outcomes and frustrated (at best) or burnedout staff
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BACKGROUND ON CHANGING WHO
WE SERVE
(82nd R) granted HHSC the authority to
define In-Home ANE in APS investigations by
rule in the Texas Administrative Code.
•SB221
•Changes
to definitions will allow APS to:
•Focus
on providing the most effective protection
possible
•Make distinctions in the definitions between paid
and unpaid caretakers
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RULE PROMULGATION TIMELINE
14, 2012 – Internal agency deadline for rule
packet preparation
•February
•April
20, 2012 – Presentation to DFPS Council
•May
18 to June 18, 2012 - Public comment period
20, 2012 – DFPS Council meeting for adoption if
significant comments
•July
•September
1, 2012 – Effective date
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POTENTIAL TYPES OF
CHANGE
•Eliminate
cases when the APS investigation will
not alleviate the root cause
•Eliminate duplication of cases in which other
entities have clearer responsibility and resources
•Streamline cases in which an expedited
investigation would be more efficient
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IMPLEMENTATION OF CHANGE
•Rule
•Two
types of changes definitions of target
populations and definitions of ANE
•For APS to investigate, must be in target
population and then must meet definition of
ANE
•Program
policy
•Statewide Intake Guidelines
•Staff training and culture change
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SUICIDAL THREAT
•TAC
says APS conducts investigations of “[A]n
elderly person or an adult with a disability … at
risk of self neglect or suicidal threat.” [40 TAC
705.001(7) and (17)]
•Remove this as an APS responsibility in
cases with no other ANE because APS is not
a first responder
•Statewide Intake will continue to refer to law
enforcement or MH&ID crisis teams
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DEFINITION OF PERSON WITH
A DISABILITY
•A
person with a mental, physical, or developmental
disability that substantially impairs the person’s ability to
provide adequately for the person’s care or protection.”
•Proposed change is to define “substantial impairment” in
rule:
•“grossly
and chronically diminishes an adult’s physical or mental
ability to live independently or provide self-care”
•Current
APS policy defines "substantially impairs" as
"requires assistance" with one or more ADL or qualifies for
SSDI/SSI – Put in place a better way of determining
disability.
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PAID CARETAKER CHANGES
•Currently,
APS rules make no
distinctions between paid and nonpaid caregivers. Paid caretakers have
a different responsibility and
relationship in the following areas:
•Exploitation
•Neglect
•Emotional and Verbal Abuse
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New Definition of Caretaker
Unpaid
•A guardian, representative
payee, or other person who by
act, words, or course of
conduct has acted so as to
cause a reasonable person to
conclude that he has accepted
the responsibility for
protection, food, shelter, or
care for an alleged victim. This
excludes paid caretakers as
defined by this chapter.
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Paid
•An employee of a home and
community support services
agency licensed under
Chapter 142, Health and
Safety Code,
•An individual privately-hired
and receiving monetary
compensation to provide
personal care services…
FOCUS ON PHYSICAL INJURY
AND EMOTIONAL HARM IN
ANE
•Physical
Injury: Physical pain, harm,
illness, or any impairment of physical
condition.
•Emotional harm: Observable signs of
distress, such as anguish, grief, fright,
humiliation, or fury.
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Definition of Abuse
Current
Proposed
•The
negligent or willful
•Any knowing, reckless,
infliction of
or intentional act or
failure to act, including
•Injury,
•unreasonable
•unreasonable
confinement,
confinement,
•corporal punishment,
•intimidation, or
•inappropriate or
•cruel punishment
excessive force, or
•intimidation,
•with resulting physical or
•which caused [or may
emotional harm or pain.
have caused*] physical
injury, death, or
emotional harm.
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* included for paid caretakers
Definition of Neglect
Current
•The failure to provide
for one’s self the goods
or services, including
medical services, that
are necessary to avoid
physical or emotional
harm or pain or the
failure of a caretaker to
provide such goods or
services.
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Proposed
•Both: the failure to
provide the protection,
food, shelter, or care
necessary to avoid
emotional harm or
physical injury
•Plus, for Paid: a
negligent act or omission
that caused or may have
caused emotional harm,
physical injury, or death
NEGLECT AND EMOTIONAL
AND VERBAL ABUSE
•Current
definitions do not recognize that
paid employees have a higher standard of
care
•APS wants to make the definitions more
precise to the nature of the caretaker role
•For example, yelling and vilifying
among family is different than by a paid
caregiver
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Definition of Emotional or
Verbal Abuse
Current
•Any use of verbal
communication or
other behavior to
humiliate,
intimidate, vilify,
degrade, or
threaten with
harm.
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Proposed
•Paid
•act
or communication that is
(1) used to curse, vilify,
humiliate, degrade, or threaten
and that results in physical
injury or emotional harm; or
(2) of such a serious nature
that a reasonable person
would consider it emotionally
harmful
•Unpaid
•any
act or use of verbal or other
communication to threaten
violence
•causes person to fear imminent
physical injury
DEFINITION OF EXPLOITATION
•“The
illegal or improper act or process of a caretaker, family member, or other
individual who has an ongoing relationship with an elderly or disabled person
that involves using, or attempting to use, the resources of the elderly or
disabled person, including the person's social security number or other
identifying information, for monetary or personal benefit, profit, or gain without
the informed consent of the elderly or disabled person.” [HRC 48.002(a)(3); 40
TAC 705.1001(21)]
•APS
is no longer investigating theft except for paid caregivers
•If
client appears to have capacity and indicates they don't want to
address the issue, then:
•Have a process to assess if the client is in need of assistance from
APS or wants to make changes
•Where no ongoing protection is needed, streamline the investigation
to limit the amount of documentation and time spent on investigation
•Continue
to make appropriate referrals
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New “Financial” Exploitation
Definitions
Unpaid
Paid
•the
illegal or improper act or process of an
alleged perpetrator using, or attempting to
use, the resources of the person, including
the person’s social security number or
other identifying information, for monetary
or personal benefit, profit, or gain…
•without the informed consent of the
alleged victim.
•Financial exploitation excludes theft of
property.
•There is no informed consent when it is:
(1) not voluntary; (2) induced by deception
or coercion; or (3) given by an alleged
victim who the actor knows or should have
known to be unable to make informed and
rational decisions because of diminished
capacity or mental disease or defect.
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•the
illegal or improper act or process
of an alleged perpetrator using, or
attempting to use, the resources of the
person, including the person's Social
Security number or other identifying
information, for monetary or personal
benefit, profit or gain.
•This includes, but is not limited to,
offenses against property found in
Texas Penal Code Chapters 31 and 32.
Definition of Sexual Abuse
•Current
Practice
•Consensual sexual
relationship is not
abuse
•Non-consensual
sexual conduct is
abuse as defined by
penal code
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•Proposed
Changes
•Nonconsensual
relationships and those
in which an individual
does not have capacity
to enter into the
relationship.
Definitions of Sexual Abuse
Current
•involuntary
or
nonconsensual sexual
conduct with a person
age 65 or older or
person with a disability
that constitutes an
offense under Section
21.08,involuntary or
nonconsensual sexual
conduct with a person
age 65 or older or
person with a disability
that constitutes an
offense under Section
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21.08, Penal Code
Proposed
•nonconsensual
sexual
activity, which may
include, but is not limited
to, any activity that would
be a sexually-oriented
offense per Texas Penal
Code, Chapters 21, 22, or
43.
PROPOSED DEFINITION SEXUAL
ABUSE, CON’T.
•b)
There is no consent when:
(1) alleged victim is incapable of consenting because of
impairment in judgment due to mental or emotional disease or
defect;
(2) consent is induced by force or threat against any person;
(3) the alleged victim is unconscious or physically unable to
resist;
(4) the alleged perpetrator has intentionally impaired the
alleged victim by administering any substance without the
person’s knowledge; or
(5) consent is coerced due to fear of retribution or hardship, or
by exploiting the emotional dependency of alleged victim on
the alleged perpetrator.
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CHANGING CASEWORK
PRACTICE
•APS
treats all cases the same regardless of the
allegation type or the potential “risk” to the client
•Moving forward, APS is considering:
•Does
there need to be “differential response”
between self neglect and perpetrator-driven cases
•Are there tools to help determine risk, which would
indicate a different type of response
•If
the answer is yes, how do we make the changes
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NEXT STEPS
•APS
is preparing a procurement to
determine what types of risk assessment
tools are available and what it would take
to adapt APS policy and information
systems to use them
•Targeted implementation is FY 2014.
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QUESTIONS AND ANSWERS
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