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3500 Service Delivery in Complex Cases

APS IH June 2012

Some APS investigations require complex service delivery to remedy abuse or neglect. The APS specialist must be aware of the client’s needs and carefully address them. Support for service delivery in complex cases is available to the APS specialist and supervisor as follows:

Case Management Quality Assurance Team (CMQAT): This team is convened by the region to staff complex cases that may not be appropriate for referral to either a Special Task Unit or Community Resources Coordination Group for Adults. The district director determines the criteria for selecting which group addresses the special needs of a particular client. The CMQAT includes but is not limited to the:

  •   subject matter experts;

  •   APS program administrators; and

  •   APS district director or their designee.

Special Task Units: The Human Resources Code §48.1521 requires each county with a population of 250,000 or more to convene a unit available to monitor that county’s complex cases. The APS specialist and the APS supervisor are involved. Standing members include but are not limited to:

  •   providers of aging or mental health services

  •   law enforcement, and

  •   legal experts.

The APS specialist follows regional procedures related to Special Task Units.

See:

2621 Procedure for Special Task Units

3430 Community Resources Coordination Groups for Adults

3510 Providing Services to APS Clients Who Are Victims of Family Violence

APS IH June 2009

Prompt intervention in family violence cases is extremely important because the violence often increases in frequency and severity and may be lethal.

In accordance with 40 TAC §705.3101, when the APS specialist validates that an adult who has a disability or who is age 65 or older is a victim of family violence as specified in the Texas Family Code §71.004 (1) and (3), then the specialist:

  •   documents the findings; and

  •   provides the victim with written information in English or Spanish, as appropriate, concerning community services that are available.

Types of Services

The APS specialist informs the client of appropriate services available through the local family violence center. Services offered by family violence centers, nonresidential centers (NRC) or a nonresidential special project (SNRP) may include, but are not limited to:

  •   24-hour shelters;

  •   24-hour crisis call hotlines;

  •   emergency medical care;

  •   intervention services;

  •   emergency transportation;

  •   legal representation in the civil and criminal justice systems;

  •   information about education arrangements for children;

  •   information about training for and obtaining employment;

  •   referral systems to existing community services; and

  •   protective orders.

Clients at risk of ongoing abuse may need to request a protective order. The staff of the local family violence center has the expertise to assist the APS specialist and the client with this process. If there is no local family violence center to assist the client, the APS specialist and client consult with the county or district attorney regarding alternatives.

See:

§705.3101 Validation of Family Violence Allegations

Title 1, Code of Criminal Procedure, Chapter 7A

4900 Family Violence Protective Orders Against a Perpetrator

3511 Procedure for Providing Family Violence Literature to APS Clients

APS IH January 2010

The APS specialist is sensitive to the potential danger that providing written information may pose. The specialist consults with the client as to whether the client may be at further risk of harm if the alleged perpetrator or other household members discover information about family violence services.

If the client feels it is safe to leave written materials, the APS specialist provides the client with:

  •   the Notice to Victims of Family Violence form (located in DFPS Forms) in English or in Spanish, as appropriate; or

  •   literature obtained from the local family violence center.

Clients who have limited English proficiency (LEP) are provided with literature in their preferred language. If this is unavailable, the APS specialist may request the services of an interpreter to translate the materials provided to the client.

Providing Family Violence Materials to Non-APS Clients

If, during the course of an investigation, the APS specialist becomes aware of a member of the family or household who is not an APS or a CPS client, but who is a victim of family violence, the specialist offers the person information about family violence. The specialist takes this step because the client could be at risk of family violence either directly or indirectly as a result of violence between other household members.

See:

2630 Investigations Involving Family Violence Reports

3510 Providing Services to APS Clients Who Are Victims of Family Violence

3512 Procedure for Developing a Family Violence Safety Plan

APS IH September 2014

The APS specialist and the client develop a family violence safety plan. A family violence safety plan is a verbal or written plan that identifies ways to promote the safety of the client and includes:

  •   preparation necessary to separate from the batterer;

  •   identification of community resources; and

  •   recommendations to plan for future safety.

The APS specialist contacts the APS regional liaison who is a resource for addressing family violence and obtains assistance in developing the family violence safety plan. The APS specialist may also:

  •   request assistance from the staff of a family violence center to assist in developing the family violence safety plan; or

  •   use literature from a local family violence center to assist the client to develop the plan.

If a pre-printed family violence safety plan is not available from the center, the APS specialist and the client discuss important documents that should be kept in a safe place that is easily accessible in case the client needs to leave the residence immediately. If the client feels that it is not safe to store the following items in the home, the client may choose to ask a trusted friend or relative to store the items.

Documents and items may include, but are not limited to:

  •   a driver’s license;

  •   birth certificates for the client, his or her children, and dependent persons who are age 65 or older or are adults with a disability;

  •   Social Security cards for the client and family members (as described above);

  •   Lone Star/TANF cards and other certifications;

  •   medical insurance, Medicaid, and Medicare cards;

  •   legal documents (such as a protective order, passport, custody order, or divorce decree);

  •   financial documents and information (such as bank account numbers, credit cards, ATM cards, or a checkbook);

  •   medical information (such as the family physician’s name and phone number, immunization records, or medical histories);

  •   medical necessities, including:

  •   prescription medications,

  •   a list of all medications with dosages, prescription numbers, and pharmacy contact information, and

  •   medical supplies (such as an inhaler, a glucometer, diabetic test strips, or syringes);

  •   miscellaneous items, such as:

  •   the phone numbers of people who can assist in an emergency (including trusted friends or relatives),

  •   a cell phone (if available),

  •   the phone number of the local family violence center,

  •   a bus pass or car keys,

  •   a bag with a change of clothes and personal items for adults and children, as applicable, and

  •   personal items (such as eyeglasses, contacts, or dentures).

3513 Documenting the Family Violence Safety Plan

APS IH September 2014

The APS specialist documents development of the family violence safety plan in contact narrative in IMPACT.

If the APS specialist uses a pre-printed form obtained from the local family violence provider, the APS specialist places a copy of the completed form in the paper case file and notes the existence of the family violence safety plan in the External Documentation page in IMPACT.

Documentation that family violence materials were provided to non-APS clients is not required.

See:

2630 Investigations Involving Family Violence Reports

3511 Procedure for Providing Family Violence Literature to APS Clients

3520 Service Delivery to Noncitizens

APS April 2019

Law requires APS to provide short-term services that are necessary to alleviate or resolve the immediate effects of abuse, neglect, or financial exploitation without discrimination to all clients. This applies regardless of the following:

  •   The client’s citizenship or immigration status.

  •   The client’s income.

Texas Human Resources Code §48.002

Long-Term Care Services

For some clients, APS may determine that the client’s age or disability makes abuse, neglect, or financial exploitation likely to continue or to happen again, unless the client receives long-term care services.

A client who needs long-term care services is required to pay for them with the client’s own money.

If the client does not have the money to pay for long-term care, federal benefits may be available. However, a person’s immigration status affects whether the person is eligible for federal benefits, so APS needs to determine the client’s citizenship or immigration status.

Guardianship programs use the client’s own money to pay for care and do not accept a person without funds. Therefore, APS does not refer a client to the Health and Human Services Commission (HHSC) Office of Guardianship Services (OGS) or other guardianship programs unless at least one of the following applies:

  •   The client is eligible for federal benefits.

  •   The client can afford to pay the cost of the client’s care and medical needs without relying on federal benefits, for as long as the guardianship lasts.

See:

3523 Noncitizen Without Appropriate Immigration Documents

Appendix XI: Procedures for Accessing Long-Term Care Benefits and Resources Based on Citizenship Status

3521 Noncitizens and Use of PCS Funds

APS April 2019

APS provides purchased client services (PCS) to noncitizens based on the same criteria as for other APS clients. See 3600 Purchased Client Services and its subitems for procedures for using PCS.

Law prohibits APS from using PCS to provide long-term care services for clients, except when both of the following apply:

  •   The PCS funds are used on a short-term emergency basis.

  •   There is a reasonable belief that the client is eligible for other long-term care funding or will become eligible.

Texas Human Resources Code §48.002

3522 Noncitizen with a Permanent Resident Card or Other Appropriate Immigration Documents

APS April 2019

A client is likely to be eligible for some federal services if the client has a lawful permanent resident card (green card) that was issued more than five years ago. However, some other services may require the client to become a US citizen in order to be eligible for all benefits. In most cases, a person is required to be a permanent resident for five years before the person may apply for citizenship.

The client and the APS specialist may consider repatriation (moving back) to the client’s country of origin when there are no resources available in the US. However, moving back to the country of origin may affect the client’s ability to seek US citizenship in the future. The APS specialist advises the client to obtain immigration counseling before the APS specialist helps the client return to the country of origin.

Permanent Resident Card Is Five Years Old or More

The APS specialist refers the client to a private organization that helps people obtain citizenship, if both of the following apply:

  •   At least five years have passed since the client was issued a permanent resident card.

  •   The client is not eligible for the services that he or she needs because he or she is not a citizen.

Permanent Resident Card Is Less Than Five Years Old

A client whose permanent resident card was issued less than five years ago is not eligible for most federal benefits and may have difficulty accessing state and local services. 

Permanent Resident Card Is Expired

A client who has an expired permanent resident card may be required to pay a fee to renew the card before the client can become eligible for federal benefits.

Renewal of a permanent resident card is a procedural matter. A person with an expired permanent resident card still has the immigration status of a permanent US resident.

Client Has Other Immigration Documents

A client who has current immigration documents other than a permanent resident card may be eligible for federal benefits under some circumstances.

3523 Noncitizen Without Appropriate Immigration Documents

APS April 2019

A client might have a situation such as one of the following:

  •   The client has no immigration documents.

  •   The client had a temporary visa but stayed in the US after it expired.

APS refers to these clients as undocumented persons.

Undocumented persons are not eligible for most Medicaid benefits, including long-term care benefits.

Most undocumented persons are unlikely to be able to change their immigration status. Even if this change is possible, it is a long process. The APS specialist may refer the undocumented person to a nonprofit organization that handles immigration matters. This type of organization can assess whether or how the client’s immigration status can change.

If a client who is an undocumented person needs services, the APS specialist tries to help the client obtain services through the following:

  •   Having family or friends pay for the services.

  •   Getting assistance from local government agencies or private organizations.

The APS specialist consults with the supervisor, for approval, before giving permission for services for a client who is an undocumented person.

The APS specialist may help the client with the process of moving back to the client’s country of origin.

See:

3524 Change of Immigration Status

Appendix XI: Procedures for Accessing Long-Term Care Benefits and Resources Based on Citizenship Status

3524 Change of Immigration Status

APS April 2019

Federal laws and regulations about eligibility for Medicaid and Social Security benefits are restrictive. Legal immigration into the US is a complicated process. For most undocumented persons, it is not possible to change immigration status to obtain benefits. The few undocumented persons whose immigration status can be changed usually need help from an attorney or an accredited advocate.

The APS specialist completes Form 2203 Noncitizen Worksheet when both of the following apply:

  •   The client and his or her family do not have the money to pay for long-term care.

  •   The client cannot receive federal benefits because of the client’s citizenship or immigration status.

This form helps the APS specialist do the following:

  •   Determine the client’s immigration status.

  •   Explore whether the client has an opportunity to obtain an immigration status that would make the client eligible for federal benefits (for example, permanent resident status or political asylum status).

The APS specialist sends Form 2203 Noncitizen Worksheet to the APS mailbox. Staff members at state office (in APS and in the DFPS Legal Division) review the submitted form. The Legal Division may advise the regional staff to try to obtain help from a private entity.

Help from Private Entities

APS may refer the client to private entities that help with immigration matters, if the client consents. These entities may be able to help determine how likely it is that the client’s immigration status can be changed.

See Appendix XI: Procedures for Accessing Long-Term Care Benefits and Resources Based on Citizenship Status.

3525 The Mexican Consulate and El Desarrollo Integral de la Familia (DIF)

APS April 2019

Mexican Consulate

The APS specialist contacts the Mexican consulate for help if the client was born in Mexico. See the Texas Secretary of State’s website for contact information for Mexico’s consulate offices in Texas.

The consulate may be willing to help by doing one or more of the following:

  •   Obtaining birth certificates and other documents.

  •   Contacting the client’s family, or arranging for contact with them.

  •   Referring APS to another resource to contact in Mexico.

  •   Referring the client to local services that may be available if the client moves back to Mexico.

El Desarrollo Integral de la Familia (DIF)

The Mexican counterpart to DFPS is Sistema Nacional para el Desarrollo Integral de la Familia (DIF). Each Mexican state has a director of that state’s DIF offices.

The APS specialist contacts the nearest consulate office to find out which DIF office to work with, unless the regional APS office already has a relationship with the appropriate DIF office.

3526 Consulates of Countries Other Than Mexico

APS April 2019

The APS specialist contacts the nearest consulate of the client’s home country when trying to help a client who is a citizen of another country. See the Texas Secretary of State’s website for contact information for consulate offices in Texas. See the US Department of State – Bureau of Consular Affairs website if the client’s home country does not have a consulate in Texas.

Each country’s consulate has different policies and practices about what type of help it provides. In general, consulates may be willing to help with one or more of the following:

  •   Obtaining birth certificates and other documents.

  •   Contacting the client’s family.

  •   Explaining local services that may be available if the client moves back to the client’s home country.

The APS specialist may verbally share information from the APS case as necessary to help the client obtain services. The APS specialist discusses with the regional attorney any questions about what case information APS may share with a consulate.

3527 Transporting Clients Who Do Not Have Valid Immigration Documents

APS IH December 2008

If possible, an APS specialist always arranges paid transportation for a client who needs to be moved from one place to another. The APS specialist avoids transporting the client personally.

It is a federal crime to knowingly transport an undocumented person to assist the person to remain in the U.S. There is no exemption for APS specialists, so under no circumstance should an APS specialist transport an undocumented person in the specialist’s own vehicle.

3528 Crossing an International Border

APS IH December 2008

An APS specialist does not cross an international border as a part of work duties unless the program administrator (PA) gives prior approval.

If PA approval is given for a specific purpose, the APS specialist is responsible for determining what personal identification is required by the Department of Homeland Security to leave the U.S. and return to the U.S. In addition, the APS specialist must carry a DFPS badge.

In no circumstances does an APS specialist cross the international border in order to interview or locate a client or collateral in an APS case. Requests for assistance to locate or interview a client or collateral believed to be in Mexico must be made formally through the Mexican Consulate. The Mexican Consulate determines whether a Mexican agency can assist APS to obtain the desired information.

In no circumstances does the APS specialist escort a person across the international border.

The APS specialist always cooperates with a Border Patrol agent in the same manner that the APS specialist cooperates with any other law enforcement agency.

3530 Service Delivery From Other State Agencies to APS Clients With Intellectual Disabilities or Mental Health Diagnoses

APS IH November 2011

The Health and Human Services Commission (HHSC) and Department of State Health Services (DSHS) provide case management services to persons in the community who need services. The local area authorities for intellectual disabilities and mental health services are the appropriate sources for information on eligibility or receipt of services.

3531 Roles and Responsibilities of APS

APS IH September 2014

Chapter 48 of the Human Resources Code (HRC) requires APS to investigate abuse, neglect, and financial exploitation of persons age 65 or older and adults with disabilities, including those served by HHSC or DSHS.

Intakes Involving HHSC or DSHS Case Management Clients

When APS receives an intake involving HHSC or DSHS case management clients, the APS specialist:

  •   accepts the intake if there are allegations of abuse, neglect, or financial exploitation;

  •   initiates an investigation of the allegations, including a discussion with the HHSC or DSHS case manager in regard to the allegations;

  •   assesses the client;

  •   determines the validity of allegations; and

  •   identifies needs in conjunction with the HHSC or DSHS case manager, if possible.

Procedures for Valid Cases

The APS specialist:

  •   staffs the case with the HHSC or DSHS case manager to obtain information regarding their treatment plan for the client;

  •   assesses the roles and responsibilities of APS and HHSC or DSHS in regard to meeting the client’s needs; and

  •   documents in the APS Service Plan in IMPACT the actions to be completed by the case manager and the actions to be completed by APS.

Avoiding Duplication of Services

Although DFPS staff provide services to remedy abuse, neglect, or financial exploitation, staff also avoid duplication of services between agencies. This prevents two agencies from using federal funds for the same purpose.

See also:

1540 Allegations Involving HHSC Long-Term Care Regulatory Services

1560 Allegations Involving the Texas Department of State Health Services (DSHS)

3540 Financial Exploitation and Medicaid Eligibility

APS April 2019

Financial exploitation may affect whether a client is eligible for Medicaid. The APS specialist needs to be aware of this.

APS investigates allegations of financial exploitation, no matter when the alleged act occurred, if it currently affects a client’s ability to qualify for Medicaid funding to live in a nursing home.

See 1341 Procedure for Assessing Allegations.

3541 Financial Exploitation of Income and Medicaid Eligibility

APS April 2019

Payments that government programs issue for a client count as income when determining whether the client is eligible for Medicaid for long-term care and home and community-based waiver services. This applies whether or not the client actually received the money and had an opportunity to use it.

Other sources of income may or may not count as available income for Medicaid purposes. This depends on the authority and circumstances under which a perpetrator collects the income on the client’s behalf. These other sources of income include, for example, the following:

  •   Rent for property that the client owns.

  •   Royalties from the client’s property, such as mineral rights and intellectual property.

  •   Payments from promissory notes (when someone owes money to the client).

The designated perpetrator or the APS specialist gives the Medicaid eligibility specialist a written statement that explains the following:

  •   What authority the designated perpetrator had, in order to collect the income on the client’s behalf.

  •   That the income is not and will not be available to the client, and why.

The Medicaid eligibility specialist determines whether the income described in the statement counts as income for Medicaid purposes.

See 1341 Procedure for Assessing Allegations.

3542 Financial Exploitation of Resources and Medicaid Eligibility

APS April 2019

Resources That Are in the Client’s Name

Resources that are in a client’s name count for the purpose of determining whether the client is eligible for Medicaid. This applies even if the designated perpetrator states that the resources are not available to the client.

Resources That Have Been Transferred out of the Client’s Name

The client usually becomes ineligible for Medicaid vendor payments and home and community-based waiver services when resources are transferred out of the client’s name without payment to the client. The client remains ineligible for a certain period of time (penalty period), depending on the value of the resources transferred.

This penalty period does not apply if either of the following applies:

  •   The resources were transferred without the client’s knowledge, without the client’s consent, or without the client’s participation. According to Medicaid policy, a transfer of resources occurs with the client’s knowledge and consent if either of the following occurs:

  •   When the resources are transferred, the client knows and does not object.

  •   The client later learns of the transfer and does not object.

  •   The client has no place to go in the community to receive care that meets the client’s needs, and one of the following situations exists:

  •   None of the people involved (including the client, family, and others) know where the person who received the resources is.

  •   Physical harm may result from APS trying to get the resources returned.

  •   The person who received the resources is not willing to cooperate, resulting in the client’s needs not being met.

See 1341 Procedure for Assessing Allegations.

3550 Facilitating Hospital and Nursing Home Admissions

APS IH October 2013

The APS specialist may facilitate a client’s voluntary hospital or nursing home admission by helping the client to provide to facility staff the documentation of his or her:

  •   medical coverage, including Medicaid and Medicare identification numbers; and

  •   ability to pay deductibles.

3551 APS Role in Completing Hospital and Nursing Home Admission Forms

APS April 2019

The APS specialist may write the client’s name beside the APS specialist’s name and DFPS title, as a representative of DFPS, if all of the following apply:

  •   The client is being admitted to a hospital or nursing home.

  •   The client is not able to sign the admission forms, such as the Preadmission Screening and Resident Review (PASRR).

  •   The facility refuses to admit the client without a signature.

The APS specialist indicates on these forms that neither the specialist nor DFPS is responsible for the cost of the care. For example, the specialist could write the following:

Neither I, (APS specialist’s name and title), nor the Texas Department of Family and Protective Services, assumes responsibility for payment.

3552 Involuntary Hospital and Nursing Home Admissions

APS IH October 2013

The APS specialist may petition the court to order involuntary hospitalization, medical treatment, or nursing home placement if:

  •   the client suffers from abuse or neglect that presents a threat to life;

  •   the client lacks capacity to consent; and

  •   no consent can be obtained.

See 4510 Procedures for Requesting an Emergency Order for Protective Services.

In such situations, the APS specialist gives a copy of the court order to hospital or nursing home staff.

The APS specialist may authorize hospitalization, medical treatment, or nursing home placement without a court order if the court is closed and all the conditions are met that are listed in 4520 Authorization for Emergency Protective Services Before a Court Order Can Be Obtained.

See also 4150 Completion of Legal Forms by the APS Specialist.

3560 Managing the Affairs and Assets of Clients

APS IH April 2015

Situations may occur in which the APS specialist temporarily manages the personal assets of clients who experience medical emergencies. This temporary management period may range from just a few hours to days or weeks. APS management of the affairs and assets of a client occurs only when every other option has been eliminated.

Clients in this situation are often ill, frightened, and very vulnerable. Their overriding concerns are the protection of their homes, their belongings, and, if applicable, their pets. It is important that the APS specialist attempt to maintain the client’s situation until:

  •  a designee can be located;

  •  the client is able to manage his or her own affairs; or

  •  the client is referred for guardianship.

See also 3695 Care of an APS Client’s Pet.

3561 Procedures for Managing the Affairs and Assets of Clients

APS IH April 2015

The APS specialist obtains supervisory approval before managing a client’s affairs, unless the situation is an emergency. In such a case, the specialist notifies the supervisor as soon as possible. The supervisor and the district director or designee jointly determine the extent of the personal affairs management that APS will offer to the client.

Procedures for APS Specialists

When temporarily managing a client’s assets, the APS specialist:

  •  has a witness (a co-worker, supervisor, law enforcement, or regional attorney) present when acting on the client’s behalf regarding finances or property;

  •  ensures all financial transactions are well-documented, including copies of all money orders, receipts, deposit slips, and so on, placed in the paper case (external documentation) folder;

  •  provides the client with the originals of all the papers mentioned above;

  •  obtains witnessed receipts for any cash that is received from or given to the client, regardless of the amount;

  •  advises the supervisor of all matters, including actions requested by the client that could be perceived as inappropriate, and

  •  advises the supervisor of any accusations by the client or others of actual or perceived wrongdoing by the APS specialist.

When temporarily managing a client’s affairs, the APS specialist never:

  •  is named or becomes the client’s attorney of fact as under a power of attorney;

  •  is named as the representative payee for the client;

  •  moves the client’s money into the APS specialist’s bank account; or

  •  stores the client’s personal items on or in the APS specialist’s property.

Procedures for Supervisors

The APS supervisor:

  •  advises the district director or designee if an APS specialist is handling the financial or personal assets of a client who is not a ward;

  •  accompanies the APS specialist as often as possible to serve as the witness;

  •  staffs the case with the APS specialist on a regular basis to determine the level of APS involvement; and

  •  considers whether an evaluation for guardianship is needed.

3570 Client Dies During Service Delivery

APS IH October 2018

When a client dies during the Maintenance stage or Intensive Case Services stage, the APS specialist consults with the supervisor and, when appropriate, the subject matter expert to determine whether the client’s death was due to:

  •   self-neglect, accident, or natural causes; or

  •   abuse or neglect by an alleged perpetrator that was:

  •   not previously investigated,

  •   alleged but not validated during the Investigation stage, or

  •   validated during the Investigation stage.

If the specialist suspects that abuse or neglect by an alleged perpetrator contributed to the alleged victim’s death, the specialist:

  •   immediately reports the situation to law enforcement; and

  •   follows 2134.1 Procedure for High Profile Cases within 24 hours of being notified of the alleged victim’s death.

When evidence indicates both self-neglect and abuse or neglect by a perpetrator may be present, the APS specialist analyzes the available evidence, including information provided by medical professionals, to determine whether an alleged perpetrator contributed to the client’s death.

In some instances, a new intake report is required following a client’s death. SWI only creates a new intake after a client dies, as outlined in policy, and when APS staff reports the death to SWI.

If the case involved misconduct or violation of law or DFPS policies by a DFPS employee, follow policy 2641 Notifying Office of Inspector General When an Alleged Victim Dies.

See:

2640 Alleged Victim Dies During the Investigation

3572 Procedure When a Death Is Related to Natural Causes, an Accident, or Self-Neglect During Service Delivery

3573 Client’s Death May Involve Allegations Validated in the Investigation Stage

3574 Procedure When Client’s Death May Involve New Incidents of Allegations Investigated or Validated During the Investigation Stage

3575 Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator

3571 Procedure When a New Intake Is Received Before Client’s Death During Service Delivery

APS IH October 2018

The APS specialist consults with the supervisor about a client’s death when:

  •   a new intake report is received before the client’s death;

  •   the client dies while the new case is in the Investigation stage; and

  •   the original case is in Maintenance stage or Intensive Case Services stage.

If the APS specialist or supervisor does not suspect an alleged perpetrator contributed to the client’s death, the APS specialist:

  •   documents the Maintenance or Intensive Case Services case as outlined in:

  •   3572.2 Documentation When a Client Dies From Self-Neglect, or

  •   3572.1 Documentation When a Client’s Death Results From Natural Causes or an Accident;

  •   closes the Maintenance or Intensive Case Services case using the closure reason code Client Died; and

  •   refers to 2640 Alleged Victim Dies During the Investigation and its sub-items for guidance on completing the investigation or on rapidly closing the case that is open in the Investigation stage.

If the APS specialist or supervisor suspects that an alleged perpetrator could have contributed to the client’s death, the APS specialist:

  •   documents the Maintenance or Intensive Case Services case, as outlined in 3575.1 Documentation When Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator;

  •   closes the case in Maintenance or Intensive Case Services by selecting the closure reason Client Died on the Stage Closure page; and

  •   completes the investigation of the death in the case open in the Investigation stage.

3572 Procedure When a Death Is Related to Natural Causes, an Accident, or Self-Neglect During Service Delivery

APS IH October 2018

If a client dies during the Maintenance stage or Intensive Case Services stage and the death is related to natural causes, an accident, or self-neglect, the APS specialist:

  •   consults with the supervisor; and

  •   documents the client’s death in IMPACT, as outlined below, before submitting the case for closure.

See Appendix XV: Client Death Decision-Making Trees.

3572.1 Documentation When a Client’s Death Results From Natural Causes or an Accident

APS IH October 2018

If a client dies as a result of an accident or natural causes, the APS specialist does as follows in IMPACT:

  •   Documents all of the contacts made during the Maintenance stage or Intensive Case Services stage of the case, as outlined in 3215 Documentation of Contacts During Service Delivery.

  •   Enters any external documentation, including photographs, on the External Documentation page.

  •   Records the date of death on the Person Detail page.

  •   Selects Not Related to A/N in the Reason for Death dropdown box.

  •   Selects Client Died as the closure reason on the Stage Closure page.

The APS specialist is not required to complete the Strengths and Needs Assessment.

3572.2 Documentation When a Client Dies From Self-Neglect

APS IH October 2018

If a client dies as a result of self-neglect, the APS specialist does as follows in IMPACT:

  •   Documents all of the contacts made during the Maintenance stage or Intensive Case Services stage, as outlined in 3215 Documentation of Contacts During Service Delivery.

  •   Enters any external documentation, including photographs, on the External Documentation page.

  •   Records the date of death on the Person Detail page.

  •   Selects UTD/INC (Unable to Determine/Inconclusive) in the Reason for Death dropdown box.

  •   Selects Client Died as the closure reason on the Stage Closure page.

The APS specialist is not required to complete the Strengths and Needs Assessment.

3573 Client’s Death May Involve Allegations Validated in the Investigation Stage

APS IH October 2018

If a client dies during the Maintenance stage or Intensive Case Services stage of a case and the original allegation of ongoing neglect by the caretaker or a specific incident of abuse by a perpetrator was found to be valid during the Investigation stage of the current case, the APS specialist:

  •   consults the supervisor;

  •   makes any additional contacts necessary to establish the reason for death; and

  •   documents the case as outlined in policy.

If the APS specialist determines that the validated allegation contributed to the client’s death, the APS specialist:

  •   follows 2134.1 Procedure for High Profile Cases; and

  •   follows 3573.2 Corrections to the Allegation Detail When Investigated Allegations Contribute to a Client’s Death During Service Delivery before closing the case.

Regardless of the finding or the reason for death, the supervisor adds either the program administrator or subject matter expert as the secondary approver in IMPACT for closing the Investigation stage.

Examples of When a Death May Involve a Validated Allegation

The following are examples of allegations validated in the Investigation stage which may have contributed to a client’s death during the Maintenance stage or Intensive Case Services stage.

  •   Physical neglect due to the perpetrator not feeding a client who is non-ambulatory and this has been ongoing.

  •   Physical abuse when the perpetrator kicked and choked the client and there have been no subsequent incidences of abuse.

3573.1 Documentation When a Client’s Death May Involve Allegations Validated During the Investigation Stage

APS IH October 2018

If a client dies during the Maintenance stage or Intensive Case Services stage and the original allegations were found to be valid for neglect or for a specific incident of abuse by a perpetrator during the Investigation stage, the APS specialist takes the following steps in the IMPACT system:

  •   Documents all contacts made while investigating the reason for the client’s death, including narrative information, as outlined in 3215 Documentation of Contacts During Service Delivery.

  •   Enters any external documentation, including photographs, on the External Documentation page.

  •   Records the date of death in the Person Detail page.

  •   Records the appropriate reason for death in the Reason for Death dropdown box by selecting one of the following:

  •   Related to A/N (AP or self) Related to abuse or neglect by a perpetrator.

  •   Not related to A/N Not related to abuse or neglect (used when an alleged perpetrator did not contribute to the client’s death).

  •   UTD or INC  Undetermined or inconclusive (used when the client dies of natural causes, an accident, or the actions of the client in valid self-neglect cases, or when the available evidence does not indicate whether or not the death was related to abuse or neglect).

  •   Selects Client Died as the closure reason on the Stage Closure page.

The APS specialist is not required to complete the Strengths and Needs Assessment.

3573.2 Corrections to the Allegation Detail When Investigated Allegations Contribute to a Client’s Death During Service Delivery

APS IH October 2018

The APS specialist submits a ticket for an IMPACT Database Correction to the Application Development and Maintenance (AD&M) division of Information Technology (IT) when either of the following ultimately contributed to the client’s death:

  •   Neglect or abuse by a perpetrator that is validated during the Investigation stage.

  •   A new incident of an allegation involving a perpetrator that was investigated, but not validated during the Investigation stage.

If abuse or neglect by a perpetrator that was validated in the Investigation stage contributed to the client’s death, the APS specialist submits a data correction form to request that AD&M mark the appropriate box on the Allegation Detail page indicating that the allegation contributed to the client’s death.

If a new incident of an allegation involving a perpetrator that was investigated but not validated during the Investigation stage contributed to the client’s death during the Maintenance stage or Intensive Case Services stage, the data correction requests that AD&M:

  •   validate the appropriate allegation; and

  •   mark the appropriate box on the Allegation Detail page indicating that the allegation contributed to the client’s death.

Since the Investigation stage is closed once the APS specialist progresses the case to Maintenance or Intensive Case Services, the APS specialist asks AD&M to mark the appropriate allegation as contributing to the client’s death in the investigation stage to accurately reflect that the neglect or abuse contributed to the death.

See:

2646.1 Documentation When the Alleged Perpetrator’s Actions May Have Contributed to the Alleged Victim’s Death

3570 Client Dies During Service Delivery

3573.1 Documentation When Client’s Death May Involve Allegations Validated in the Investigation Stage

3574.1 Documentation When Client’s Death May Involve New Incidents of Allegations Investigated or Validated During the Investigation Stage

3574 Procedure When a Client’s Death May Involve New Incidents of Allegations Investigated or Validated During the Investigation Stage

APS IH October 2018

The APS specialist follows the steps outlined below when a client dies during the Maintenance stage or Intensive Case Services stage, allegedly as the result of:

  •   new incidents of allegations against an alleged perpetrator that were validated during the Investigation stage of the current case; or

  •   allegations that were investigated but not validated during the Investigation stage of the current case.

In either of these situations, the APS specialist:

  •   follows 2134.1 Procedure for High Profile Cases;

  •   consults with the supervisor;

  •   investigates the new incident as a new investigation;

  •   follows 2646 Procedure When Alleged Perpetrator’s Actions May Have Contributed to the Alleged Victim’s Death for the procedures on notifying and consulting with law enforcement; and

  •   documents the new investigation in the Maintenance stage or Intensive Case Services stage of IMPACT, as outlined in 3575.1 Documentation When Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator.

If the finding is changed to Valid as a result of the new investigation, the APS specialist also ensures that the perpetrator is given the opportunity to request a desk review or due process hearing.

See:

2134.1 Procedure for High Profile Cases

5300 Desk Review for Designated Perpetrators

5400 Due Process

If the new incident may have contributed to the client’s death, then before closing the case the APS specialist refers to 3573.2 Corrections to Allegation Detail When Investigated Allegations Contribute to Client’s Death During Service Delivery.

Regardless of the finding or reason for the death, the supervisor adds the program administrator or subject matter expert as a secondary approver in IMPACT for closing the Maintenance stage or Intensive Case Services stage.

Examples of When a Death May Involve New Incidents of Investigated or Validated Allegations

The following are examples of a new incident of an allegation investigated or validated in the Investigation stage which may have contributed to a client’s death during the Maintenance stage or Intensive Case Services stage.

  •   Physical abuse was validated in the Investigation stage when the perpetrator broke the client’s arm, but then the perpetrator hit the client with a cane. This would be the same allegation, but a new incident.

  •   Financial exploitation and physical abuse were both investigated in the Investigation stage, but only financial exploitation was validated. During the Maintenance stage or Intensive Case Services stage, the client dies allegedly as the result of physical abuse.

3574.1 Documentation When a Client’s Death May Involve New Incidents of Allegations Investigated or Validated During the Investigation Stage

APS IH October 2018

The APS specialist follows the steps outlined below when a client dies during the Maintenance stage or Intensive Case Services stage of a case, allegedly as the result of:

  •   new incidents of allegations against an alleged perpetrator that were validated during the Investigation stage of the current case; or

  •   allegations that were investigated, but not validated during the Investigation stage of the current case.

In either of these situations, the APS specialist does as follows in IMPACT:

  •   Documents all contacts made investigating the reason for the client’s death, including narrative information, as outlined in 3215 Documentation of Contacts During Service Delivery.

  •   Enters any external documentation, including photographs, on the External Documentation page.

  •   Records the date of death on the Person Detail page.

  •   Selects the appropriate reason for death in the Reason for Death dropdown box on the Person Detail page:

  •   Related to A/N (AP or self) — Related to abuse or neglect by a perpetrator;

  •   Not related to A/N — Not related to abuse or neglect (used when an alleged perpetrator did not contribute to the client’s death); or

  •   UTD or INC — Undetermined or inconclusive (used either when the client dies from natural causes, an accident, or the actions of the client (in the case of valid self-neglect), or when the available evidence does not indicate whether the death was related to abuse or neglect).

  •   Selects Client Died as the closure reason on the Stage Closure page.

If it is determined that abuse or neglect by a perpetrator contributed to the client’s death during the Maintenance stage or Intensive Case Services stage, the APS specialist refers to 3573.2 Corrections to the Allegation Detail When Investigated Allegations Contribute to a Client’s Death During Service Delivery before closing the case.

The APS specialist is not required to complete the Strengths and Needs Assessment.

3575 Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator

APS IH October 2018

The APS specialist follows these procedures when:

  •   a client dies during the Maintenance stage or Intensive Case Services stage; and

  •   the client’s death may be the result of new allegations of physical or sexual abuse or physical or medical neglect by an alleged perpetrator that was not alleged or investigated in the Investigation stage of the current case.

If the criteria above are met, the APS specialist:

  •   follows 2134.1 Procedure for High Profile Cases;

  •   consults with the supervisor;

  •   contacts SWI to create a new intake report for the new allegations;

  •   documents the Maintenance or Intensive Case Services case, as outlined in 3575.1 Documentation When Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator;

  •   notes the new intake in the documentation for the Maintenance case or Intensive Case Services case;

  •   closes the Maintenance case or Intensive Case Services case in IMPACT using the closure reason Client Died; and

  •   completes the new investigation by following the procedures in 2640 Alleged Victim Dies During the Investigation.

Example

The APS specialist investigated the allegation of self-neglect during the Investigation stage. During the Maintenance stage or Intensive Case Services stage, the client dies allegedly as a result of physical abuse that was not alleged during the Investigation stage.

3575.1 Documentation When a Client’s Death Involves New Allegations of Abuse or Neglect by an Alleged Perpetrator

APS IH October 2018

The APS specialist follows the steps outlined below when:

  •   a client dies during the Maintenance stage or Intensive Case Services stage; and

  •   the client’s death may be the result of new allegations of physical or sexual abuse or physical or medical neglect by an alleged perpetrator that were not alleged or investigated during the investigation stage of the current case.

The APS specialist does as follows in IMPACT:

  •   Documents the IMPACT case ID number for the new intake report in a contact narrative.

  •   Records the date of death on the Person Detail page.

  •   Selects APS Death in SVC/New INT in the Reason for Death dropdown box on the Person Detail page.

  •   Documents all Maintenance or Intensive Case Services contacts, as outlined in 3215 Documentation of Contacts During Service Delivery.

  •   Selects Client Died as the closure reason on the Stage Closure page.

The APS specialist is not required to complete the Strengths and Needs Assessment.

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