Follow-up review. Adult Protective Service

FOLLOW-UP REVIEW

Adult Protective Services December 2002

Russell W. Hinton, State Auditor Performance Audit Operations Division 254 Washington St. S.W.

Department of Audits and Accounts

Atlanta, GA 30334-8400

This is a Follow-up Review of the Program Evaluation of Adult Protective Services, conducted by the Performance Audit Operations Division in December 2000. The original report was prepared for the Budgetary Responsibility Oversight Committee under its calendar year 2000 theme "Public Well-Being Through Human Services."

Background
Adult Protective Services (APS) are mandated under the Georgia Disabled Adult and Elder Person Protection Act to protect disabled (mentally or physically) adults (18 years of age and older) and elder persons (65 years of age and older) who are not residents of long-term care facilities from situations of domestic abuse, neglect, and exploitation (A/N/E). The Department of Human Resources' APS Program is responsible for receiving and investigating reports of A/N/E, deterring the ongoing maltreatment of disabled adults and elder persons, and preventing its recurrence. The APS policy manual defines A/N/E as:

ABUSE
Willful infliction of physical pain, physical injury, mental anguish, unreasonable confinement, or the willful deprivation of essential services. (Includes physical, sexual, and psychological abuse.)

NEGLECT
The absence or omission of essential services to the degree that it harms or threatens with harm the physical or emotional health of a disabled adult or elder person. (Includes both selfneglect and caregiver neglect.)

EXPLOITATION
The illegal or improper use of a disabled adult or elder person or that adult's resources for another's profit or advantage.

APS services may include, but are not limited to, providing or arranging for: respite care; homemaker, home health, personal care, and transportation services; and, mental health counseling.

Synopsis of the Program Evaluation
The evaluation focused on the following three questions, which were raised by the Budget Responsibility Oversight Committee:

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Does the Program promptly and effectively respond to allegations of abuse, neglect, or exploitation?
Is the Program staffed, organized, and managed to provide for an effective and efficient system throughout the state?
Does the Program coordinate its activities with the other programs responsible for abuse cases in long-term care facilities?
The evaluation found that APS staff were responding to allegations of A/N/E within 10 days for more than 90% of the cases evaluated and that overall, the Program coordinated well with programs responsible for investigating A/N/E in long-term care facilities. However, the evaluation also identified areas where action was needed to improve on the effectiveness and efficiency of Adult Protective Services. These areas are discussed below.

Evaluation Issues and Findings
Finding (as reported in 2000): The Program does not maintain the data necessary to determine if adult protective services are being effectively delivered. However, as discussed in subsequent findings the evaluation team did make observations indicating effectiveness problems. Current Status: The Program has recently instituted automatic review of all elderly and disabled cases that end in death or serious injury. The Program has also established Adult Protective Service Teams to foster cooperation and information sharing among different APS staff. Some of these staff have discussed implementing peer review of cases; however the Program has no immediate plans to require peer reviews. A new Social Services database system, the State Automated Child Welfare Information System (SACWIS), is also being created to replace the current Internal Data System (IDS). SACWIS is still in the development stages and is not scheduled for implementation for several years. Plans for APS inclusion in the system have not been approved, so the advantages of SACWIS over IDS cannot be identified at this time. In the meantime, APS staff indicated that they intend to begin development on improvements to IDS in 2003.
Finding (as reported in 2000): The Program does not have adequate information to determine if APS staff levels in counties are appropriate. An analysis of available information by the evaluation team indicated that some counties appeared to have extremely high caseloads while other counties had low caseloads indicating that they may not be appropriately staffed. Current Status: The Program agreed that a workload study was needed, and originally scheduled one for fiscal year 2003. Due to the economic downturn and budget cuts, the study has been delayed and will be included in a future budget proposal.
Finding (as reported in 2000): The lack of APS specialized case managers and inadequate training of APS staff contributes to varying levels of service delivery throughout the state. Current Status: The Program has expanded their specialized APS training for new workers

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from two days to seven days with three additional weeks of supervised on-the-job training. DHR records indicate that 64 workers have received the new training since June 2001. While online training modules may be developed in the future for APS-specific issues, training for veteran workers is still only provided on an as-needed basis at the local level. Program staff indicated that they hope to have formalized APS specific advanced training in two to three years.
The need for specialized APS case managers has not been addressed. Program personnel indicated that county DFCS directors continue to have the ability and discretion to assign staff to programs where the need is considered greater, and that child welfare is always given greater priority than APS. As noted in the Evaluation, caseworkers not specializing in adult welfare may not have knowledge or expertise to properly investigate APS cases, and may not know how to provide services to the broad array of APS clients. Also, clients with complex legal issues such as guardian of person, make it difficult for non-specialized case managers to manage these APS clients adequately.
Finding (as reported in 2000): Case managers at the county level who do not work fulltime on APS and a lack of APS management at the state level contribute to varying levels of service delivery throughout the state. Current Status: The Program has begun to increase APS management personnel at the state level. One additional consultant has been hired, bringing the total number of state-level staff to two. Program personnel indicated that they intended to request funds for a manager, support staff, and an additional consultant in the APS area in future budget proposals.
The Program has not addressed the need for fulltime APS caseworkers. As noted in the Evaluation and in the previous finding, case managers with high caseloads consisting of both APS cases and other social service cases (primarily child welfare) tend to rate APS as a lower priority. Part-time caseworkers may lack the expertise to effectively and consistently deliver APS services.
Finding (as reported in 2000): The Program needs to identify and evaluate all open cases in long-term care facilities that do not involve guardianship or representative payeeship to determine if these cases should remain open. Current Status: Program policy regarding case closure is now discussed more thoroughly in new worker training, and the policy has been discussed with some county personnel. However, there is no formalized effort to ensure that veteran case managers and supervisors are following case closure policies.
Program personnel stated that they believe that problems with open cases for clients in long-term care facilities are rare and that a full review off all cases would require too many resources. As noted in the Evaluation, the Program does not have any data on how many APS clients reside in long-term care facilities or how long they have been there. The Program also indicated that it supported removing the current requirement that county DFCS Directors act as the "Guardian of Person" of adults deemed incompetent when no one else is available or willing to fulfill this role. However, the Program noted that a change in the law would be required to create an Office of Guardianship and they had not taken any action to change the law.

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For additional information or to request a copy of the original report, please contact Paul E. Bernard, Director at 404-651-8855.
Or see our website: www2.state.ga.us/Departments/AUDIT/pao/pao_main.htm

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