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6000 In-Home Adult Protective Services (APS)

SWI Policy and Procedures May 2017

APS investigates abuse, neglect, or financial exploitation and provides protective services to persons age 65 or older and adults with disabilities.

HRC §48.001

SWI receives information alleging abuse, neglect, or financial exploitation, and assesses this information to determine if APS guidelines for investigation have been met. If the information meets guidelines, SWI generates an intake and sends it to the appropriate APS office for investigation.

6100 APS In-Home Eligibility Criteria

SWI Policy and Procedures May 2017

APS In-Home investigates allegations of abuse, neglect, and financial exploitation and provides protective services, regardless of race, creed, color, or national origin to people who are:

  •   age 65 or older;

  •   age 18-64 with a mental, physical, or developmental disability that substantially impairs the ability to live independently or provide for their own self-care or protection; or

  •   emancipated minors with a mental, physical, or developmental disability that substantially impairs the ability to live independently or provide for their own self-care or protection.

The alleged victim is often referred to as the client (CL) in IMPACT documentation.

6110 Definitions

SWI Policy and Procedures May 2017

Adult: A person aged 18 or older, or an emancipated minor.

Alleged victim: An adult aged 65 or older or with a disability, or an emancipated minor with a disability, who has been reported to APS to be in a state of or at risk of harm due to abuse, neglect, or financial exploitation.

Emancipated minor: A person under 18 years of age who has the power and capacity of an adult. This includes a minor who has had the disabilities of minority removed by a court of law or a minor who, with or without parental consent, has been married. Marriage includes common-law marriage.

Person with a disability: An adult with a physical, mental, or developmental disability that substantially impairs the adult's ability to adequately provide for his or her own care or protection.

DFPS Rules, 40 TAC §705.1001

In the APS In-Home Handbook, see 1300 Scope and Eligibility.

6120 Determination of Eligibility

SWI Policy and Procedures May 2017

Adults age 65 or older automatically meet APS In-Home eligibility criteria based on their age. There is no need to determine disability in order to qualify someone for APS services for persons age 65 or older.

An emancipated minor or an adult age 18-64 must be substantially impaired to be eligible for APS services.

Some persons will automatically be determined to be substantially impaired. See 6122 Individuals who Automatically Qualify as Substantially Impaired.

For others, SWI will have to make a determination as to substantial impairment.

For reports regarding persons who do not meet the criteria specified above, the intake specialist attempts to gather sufficient information to establish the alleged victim's level of disability and determine if the alleged victim has a substantial impairment. If it appears that he or she meets the definition of a person with a disability, and there are allegations of abuse, neglect, or financial exploitation, the intake specialist completes an intake for investigation.

Reports regarding persons who do not meet APS In-Home eligibility criteria are completed as I&Rs, and the reporters may be referred to local community resources.

In the APS In-Home Handbook, see 1310 APS Eligibility Criteria.

6121 Substantial Impairment

SWI Policy and Procedures May 2017

Adults age 65 or older are automatically eligible for APS In-Home services based on their age. An adult age 18 to 64 old must be substantially impaired to be eligible for APS services.

A person is considered to be substantially impaired when a mental, physical, or developmental disability chronically diminishes the person's ability to provide adequately for the person's care, protection, or ability to live independently, as determined through observation, diagnosis, evaluation, or assessment.

DFPS Rules, 40 TAC §705.1001(27)

As part of the substantial impairment determination, an emancipated minor or an adult age 18 to 64 must have a mental, physical, or developmental disability as indicated by one of the following:

  •   A medical condition

  •   Professional diagnosis

  •   Reported or observed behavior that is consistent with such a diagnosis. The disability must cause a long lasting and considerable inability to live independently or provide self-care.

To determine an individual's ability to live independently or provide self-care, limitations in the following activities are considered:

  •   using a phone;

  •   shopping;

  •   cooking or preparing food;

  •   housekeeping;

  •   self-administration of medications;

  •   dressing in clothing appropriate for the weather;

  •   obtaining needed medical services, support services, or transportation;

  •   making sound decisions; or

  •   preventing harm to self or others.

If an emancipated minor or an adult age 18 to 64 is unable or unwilling to perform one or more of these activities, then the person may be unable to live independently or provide self-care.

In cases in which it is difficult to determine whether the individual is able to live independently or provide self-care, the individual's degree of vulnerability, such as the ability to protect himself or herself, is considered. If the degree of vulnerability is significant, then the individual is assessed to be substantially impaired.

A reporter may not be able to provide sufficient information to clearly establish that the impairment is substantial, but if the reporter states that the alleged victim has a disability, the intake specialist accepts this statement and generates an intake.

Adults who need assistance but do not meet the protective services eligibility criteria may be referred to local community resources. The intake specialist then completes the report as an I&R.

In the APS In-Home Handbook, see:

1311 Substantial Impairment

1311.3 Examples: of What Is and Is Not Considered Substantial Impairment

6122 Individuals who Automatically Qualify as Substantially Impaired

SWI Policy and Procedures May 2017

An individual is automatically considered substantially impaired when he or she:

  •   has a legal guardian of the person or estate; or

  •   has been determined to qualify for one or more of the following Medicaid waiver programs:

  •   State of Texas Access Reform + PLUS (STAR+PLUS)

  •   Medically Dependent Children's Program (MDCP)

  •   Deaf/Blind with Multiple Disabilities (DBMD)

  •   Community Living Assistance and Support Services (CLASS)

  •   Home and Community-based Services (HCS)

  •   Texas Home Living (TxHmL)

  •   Youth Empowerment Services (YES)

Medicaid waiver services have a higher threshold to meet in order to qualify for their services than what is required to qualify for other available provider services. Community Attendant Services, Family Care, Primary Home Care, and other sources of provider services (such as home health services through a physician's order), are not Medicaid waiver programs and, therefore, are not automatic qualifiers for APS eligibility.

Allegations involving individuals receiving Medicaid Home and Community Based Services (HCBS), or using the Consumer Directed Services (CDS) option normally fall within the jurisdiction of the APS Provider Investigations program.

If SWI is unable to determine from what type of provider program the alleged victim receives services, and there are allegations of abuse, neglect, or financial exploitation, the intake specialist completes an intake for investigation. APS In-Home field staff will make the final determination of eligibility.

6123 Disability Payments

SWI Policy and Procedures May 2017

Adults who receive Supplemental Security Income (SSI), Social Security Disability (SSD), or other types of disability payments (such as veterans' benefits or workers' compensation) do not automatically meet APS In-Home eligibility criteria.

The person's level of disability must be assessed by the intake specialist based on the interview or submitted written report, to determine whether he or she is substantially impaired.

6124 Chronic Substance Abuse and APS In-Home Eligibility

SWI Policy and Procedures May 2017

APS In-Home does not investigate issues of chronic substance abuse, such as excessive use of alcohol, prescription medications, or illicit drugs, unless the situation involves abuse, neglect, or financial exploitation.

The intake specialist generates an intake involving an adult with chronic substance abuse when:

  •   the substance abuse has progressed to a permanent condition that causes substantial impairment, such as organic brain syndrome, or kidney failure, and

  •   there are other factors that meet the definition of an allegation of abuse, neglect, or financial exploitation.

If the adult is not substantially impaired and there are no allegations other than the adult's chronic substance abuse, the intake specialist provides the reporter with community resources, and generates an I&R.

6200 APS In-Home Perpetrators

SWI Policy and Procedures May 2017

Alleged Perpetrator: a person who is reported to be responsible for the abuse, neglect, or financial exploitation of a person age 65 or older, or an emancipated minor or adult with a disability.

Alleged Victim/Perpetrator: a person age 65 or older, an emancipated minor, or an adult with a disability who is reported to be in a state of, or at risk of, self-neglect. A person who has been declared incompetent, and who has a legal guardian, cannot be an alleged victim/perpetrator, as he or she is not considered capable of self-care.

Caretaker: 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 or she has accepted the responsibility for protection, food, shelter, or care for an alleged victim. This excludes paid caretakers as defined by this chapter.

DFPS Rules, 40 TAC §705.1001(8)

Paid Caretaker:

  •   An employee of a home and community support services agency (HCSSA) providing non-Medicaid services to an alleged victim; or

  •   An individual or family member privately hired and receiving monetary compensation to provide personal care services, as defined in §142.001(22-a) of the Health and Safety Code, to an alleged victim.

DFPS Rules, 40 TAC §705.1001(18)

      For more information on personal care services, also see 2672 Investigations in Boarding Home Facilities in the APS In-Home Handbook.

Ongoing Relationship: A personal relationship that includes:

  •   frequent and regular interaction;

  •   a reasonable assumption that the interaction will continue; and

  •   an establishment of trust beyond a commercial or contractual agreement.

6210 Determining In-Home or Provider Jurisdiction Based on Payment Source

SWI Policy and Procedures May 2017

The APS In-Home program investigates allegations of abuse, neglect, and financial exploitation of adults age 65 or older and adults with disabilities when the alleged perpetrators are caretakers, family members, or individuals who have ongoing relationships with the persons served. The alleged perpetrator can not be a provider under the jurisdiction APS Provider Investigations, as defined in Human Resources Code §48.251(a)(9).

The APS Provider Investigations (PI) program investigates allegations of abuse, neglect, and exploitation of adults and children who receive services from certain providers as defined in Human Resources Code §48.251(a)(9).

In order to determine whether APS In-Home or APS Provider has jurisdiction to investigate abuse, neglect, or exploitation by an alleged perpetrator, the intake specialist determines if the alleged victim receives Medicaid. If so the intake specialist determines if the alleged perpetrator is paid with Medicaid. In some instances, the reporter may not know this information.

  •   If it is known that the alleged perpetrator is paid with Medicaid, then the intake specialist assesses for APS Provider. The intake specialist asks the reporter for the client's Medicaid number and the name of the agency for which the alleged perpetrator works. If any of this information is known, the intake specialist documents it in the narrative.

  •   If it is known that the alleged perpetrator is not paid, paid with private insurance, out-of-pocket, or with Medicare, then the intake specialist assesses for APS In-Home.

  •   If it is unknown if the alleged perpetrator is paid, and there is no indication the alleged perpetrator is paid, then the intake specialist assesses for APS In-Home.

  •   The intake specialist assumes the alleged perpetrator is paid with Medicaid and APS Provider has jurisdiction when:

  •   It is unknown how the alleged perpetrator is paid; or

  •   The client receives both Medicaid and Medicare, and it is unknown with which the alleged perpetrator is paid.

Intakes for both APS Provider and APS In-Home may be necessary in situations where:

  •   There is both abuse, neglect, or exploitation by a Medicaid-paid alleged perpetrator and self-neglect by the client unrelated to the paid alleged perpetrator's actions.

  •   The client is in a state of self-neglect as a result of abuse, neglect, or exploitation by a Medicaid-paid alleged perpetrator.

  •   There is both abuse, neglect, or exploitation by a Medicaid-paid alleged perpetrator and abuse, neglect, or exploitation by an alleged perpetrator with an ongoing relationship to the client.

6220 DADS Guardianship Employee is the Alleged Perpetrator

SWI Policy and Procedures May 2017

APS In-Home investigates when a DADS Guardianship employee or DADS guardian specialist who is working as an agent of the guardian is the alleged perpetrator of abuse, neglect, or financial exploitation of a DADS client or guardianship ward.

The intake specialist completes an intake and designates the case as sensitive.

See 2500 Sensitive Reports.

6230 Children as Perpetrators in an APS In-Home Intake

SWI Policy and Procedures May 2017

Occasionally, children are alleged to be perpetrators of abuse, neglect, or financial exploitation against adults age 65 or older or emancipated minors or adults with disabilities. Children are determined to be perpetrators based on the child's age and the allegation.

A child under 10 years of age is never considered a perpetrator. Any child age 10 or older, including those in DFPS conservatorship or those who reside in or attend a CCL-licensed facility, may be designated as an alleged perpetrator in an APS In-Home intake. In order to be an alleged perpetrator of neglect, a child 10 or older must be in the role of a caretaker for the alleged victim.

In the APS In-Home Handbook see 1333 Children as Perpetrators.

6240 Alleged Perpetrator Access to Client

SWI Policy and Procedures October 2017

If the information reported indicates that the alleged perpetrator no longer has access to the client or no longer has the opportunity to harm the client, the intake specialist still generates an intake. APS In-Home will investigate to determine if the information reported is accurate and if the client is in a state of abuse, neglect, or exploitation.

6300 Allegations That APS In-Home Investigates

SWI Policy and Procedures October 2017

An allegation is an assertion that an alleged victim is in a state of or at risk of harm due to abuse, neglect, or financial exploitation.

DFPS Rules, 40 TAC §705.1001(2)

APS In-Home investigates only the allegations that meet the definitions of abuse, neglect, or financial exploitation in Title 40, Part 19 of the Texas Administrative Code Chapter 705;

APS In-Home does not investigate allegations of suicide threat. These allegations are referred to the appropriate first responders.

In the APS In-Home Handbook see 1340 Allegations That APS Investigates.

In the SWI Handbook see:

6310 Physical Abuse (PHAB)

6320 Neglect (PHNG, MDNG, MHNG)

6330 Sexual Abuse (SXAB)

6340 Emotional Abuse (EMAB)

6350 Financial Exploitation (EXPL)

6310 Physical Abuse (PHAB)

SWI Policy and Procedures May 2017

Physical abuse (PHAB) includes slapping, shoving, pinching, hair pulling, hitting, kicking, intimidation, and the use of improper restraints or unreasonable confinement.

Abuse does not include the actions a person may reasonably believe to be immediately necessary to avoid imminent harm to self or others, provided the actions are limited only to those actions reasonably believed to be necessary under the existing circumstances.

6311 Determining Physical Abuse in APS In-Home Reports

SWI Policy and Procedures May 2017

Alleged Perpetrator Is Not a Paid Caretaker

When an alleged perpetrator is an unpaid caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, physical abuse is defined as any knowing, reckless, or intentional act or failure to act, including unreasonable confinement, corporal punishment, inappropriate or excessive force, or intimidation, which caused physical injury, death, or emotional harm.

DFPS Rules, 40 TAC §705.1003

Alleged Perpetrator Is a Paid Caretaker

When an alleged perpetrator is a paid caretaker, physical abuse is defined as any knowing, reckless, or intentional act or failure to act, including unreasonable confinement, corporal punishment, inappropriate or excessive force, or intimidation, which caused or may have caused physical injury, death, or emotional harm.

DFPS Rules, 40 TAC §705.1003

Key Terms in the Definition of Physical Abuse

Unreasonable Confinement: An act that results in a forced isolation from the people one would normally associate with, including friends, family, neighbors, and professionals; an inappropriate restriction of movement; or the use of any inappropriate restraint.

Physical Injury: Physical pain, harm, illness, or any impairment of physical condition.

Emotional Harm: A highly unpleasant mental reaction with observable signs of distress, such as anguish, grief, fright, humiliation, or fury.

Intimidation: Behavior by actions or words creating fear of physical injury, death, or abandonment.

DFPS Rules, 40 TAC §§705.1001(17); 705.1003

In the APS In-Home Handbook, see:

1344 Physical Abuse (PHAB) Allegations

1344.1 Procedure for Assessing Physical Abuse (PHAB) Allegations (this item contains examples of physical abuse)

6320 Neglect (PHNG, MDNG, MHNG)

SWI Policy and Procedures May 2017

Self-Neglect

When the alleged perpetrator is an alleged victim/perpetrator, neglect is defined as the failure of one's self to provide the protection, food, shelter, or care (to include medical or mental health) necessary to avoid emotional harm or physical injury.

Neglect by an Alleged Perpetrator (Caretaker or Paid Caretaker)

When an alleged perpetrator is a caretaker or paid caretaker, neglect is defined as:

  •   the failure to provide the protection, food, shelter, or care (including medical or mental health) necessary to avoid emotional harm or physical injury; or

  •   a negligent act or omission that caused or may have caused emotional harm, physical injury, or death.

DFPS Rules, 40 TAC §705.1009

Key Terms in the Definition of Neglect

Negligence: The failure to exercise the care that a reasonably prudent person would exercise in like circumstances.

Emotional Harm: A highly unpleasant mental reaction with observable signs of distress, such as anguish, grief, fright, humiliation, or fury.

DFPS Rules, 40 TAC §705.1001(15)

Physical Injury: Physical pain, harm, illness, or any impairment of physical condition.

DFPS Rules, 40 TAC §705.1001(20)

6321 Types of Neglect

SWI Policy and Procedures May 2017

Physical Neglect (PHNG): The failure to adequately provide goods and services to avoid emotional harm or physical injury.

      In the APS In-Home Handbook, see 1342.1 Procedure for Assessing Physical Neglect (PHNG) Allegations.

Medical Neglect (MDNG): The failure to adequately provide for or obtain the medical treatment necessary to avoid emotional harm or physical injury. MDNG includes lack of medications, inappropriate dispensing of medications, or failure to seek necessary medical care.

      In the APS In-Home Handbook, see 1342.3 Procedure for Assessing Medical Neglect (MDNG) Allegations.

Mental Health Neglect (MHNG): The failure to provide the mental health treatment necessary to avoid emotional harm or physical injury. However, failure to participate in mental health treatment does not constitute mental health neglect of self.

      Mental health neglect is never assigned as a sole allegation. It is listed as a secondary allegation only when it has resulted in another allegation such as abuse, neglect, or financial exploitation. If no other allegations of abuse, neglect, or financial exploitation are appropriate after assessing all information provided by reporter, the intake specialists completes an I&R. The reporter may be provided information regarding community resources.

APS does not investigate allegations of suicide threat. These allegations are referred to the appropriate first responders.

6330 Sexual Abuse (SXAB)

SWI Policy and Procedures May 2017

Nonconsensual sexual activity, which may include, but is not limited to, any activity that would be a sexually-oriented offense per Texas Penal Code, Chapter 21 (indecent exposure), Chapter 22 (sexual assault), or Chapter 43 (public indecency).

6331 Determining Sexual Abuse in APS In-Home Reports

SWI Policy and Procedures May 2017

When an alleged perpetrator is a caretaker or paid caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, sexual abuse is defined as involuntary or nonconsensual sexual activity.

There is no consent when:

  •   the alleged perpetrator knows or should know that the alleged victim is incapable of consenting because of impairment in judgment due to mental or emotional disease or defect;

  •   consent is induced by force or threat against any person;

  •   the alleged victim is unconscious or physically unable to resist;

  •   the alleged perpetrator has intentionally impaired the alleged victim by administering any substance without the person's knowledge; or

  •   consent is coerced due to fear of retribution or hardship, or by exploiting the emotional dependency of the alleged victim on the alleged perpetrator.

In the APS In-Home Handbook, see 1345 Sexual Abuse (SXAB) Allegations.

DFPS Rules, 40 TAC §705.1005

6340 Emotional Abuse (EMAB)

SWI Policy and Procedures May 2017

The criteria for what constitutes emotional abuse is stricter for a paid caretaker than an unpaid caretaker.

6341 Determining Emotional or Verbal Abuse in APS In-Home Reports

SWI Policy and Procedures May 2017

Key Terms in the Definition of Emotional Abuse

Imminent: Being menacingly close at hand; impending or threatening.

Reasonable person: A hypothetical person in society who exercises average care, skill, and judgment in conduct.

Alleged Perpetrator Is Not a Paid Caretaker

When an alleged perpetrator is a caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, emotional or verbal abuse is defined as any act or use of verbal or other communication to threaten violence that makes a reasonable person fearful of imminent physical injury.

Alleged Perpetrator Is a Paid Caretaker

When an alleged perpetrator is a paid caretaker, emotional or verbal abuse is defined as any act or communication that is:

  •   used to curse, vilify, humiliate, degrade, or threaten and that results in emotional harm; or

  •   of such a serious nature that a reasonable person would consider it emotionally harmful.

DFPS Rules, 40 TAC §705.1007

In the APS In-Home Handbook, see:

1343 Emotional or Verbal Abuse (EMAB) Allegations.

1344 Physical Abuse (PHAB) Allegations (for the definitions of emotional harm and physical injury)

6350 Financial Exploitation (EXPL)

SWI Policy and Procedures May 2017

Financial exploitation (EXPL) is illegal or improper acts or processes perpetrated without the informed consent of the victim, which use, or attempt to use, the resources of the alleged victim, including the alleged victim's Social Security number or other identifying information, for:

  •   monetary or personal benefit,

  •   profit, or

  •   gain.

Informed consent does not occur when:

  •   the alleged perpetrator knows or should know that the alleged victim is incapable of consenting because of impairment in judgment due to mental or emotional disease or defect;

  •   consent is induced by force or threat against any person;

  •   the alleged victim is unconscious or physically unable to resist;

  •   the alleged perpetrator has intentionally impaired the alleged victim by administering any substance without the person's knowledge; or

  •   consent is coerced due to fear of retribution or hardship, or by exploiting the emotional dependency of alleged victim on the alleged perpetrator.

6351 Determining Financial Exploitation in APS In-Home Reports

SWI Policy and Procedures May 2017

Financial exploitation (EXPL) includes taking money, property, identifying information, or other assets.

Resources include, but are not limited to:

  •   cash;

  •   money from checking or savings accounts;

  •   certificates of deposit or other interest-earning or investment accounts;

  •   credit, debit, or other electronic benefits such as a food stamp card; and

  •   Social Security number and other identifying information.

Property may also be considered a resource if it has monetary value from which the alleged perpetrator derives personal benefit, profit, or gain.

Perpetrators of Financial Exploitation

Alleged Perpetrator Is a Paid Caretaker or Is Not a Paid Caretaker

When an alleged perpetrator is a paid or unpaid caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, financial exploitation is defined as the illegal or improper act or process of an alleged perpetrator using, or attempting to use, the resources of the alleged victim, including the alleged victim's Social Security number or other identifying information:

  •   for monetary or personal benefit, profit, or gain; and

  •   without the informed consent of the alleged victim.

In the APS In-Home Handbook, see 1346 Financial Exploitation (EXPL) Allegations.

Alleged Perpetrator Is Not a Paid Caretaker

When the alleged perpetrator is a caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, financial exploitation does not include theft in Texas Penal Code, Chapter 31 (theft offenses).

Alleged Perpetrator Is a Paid Caretaker

When the alleged perpetrator is a paid caretaker, financial exploitation includes, but is not limited to, theft in Texas Penal Code, Chapter 31 (theft offenses).

DFPS Rules, 40 TAC §705.1011

In the APS In-Home Handbook, see 2673.1 Procedure for Investigations Involving Allegations of Financial Exploitation Against a Resident of a Nursing Home.

See also 6670 Reports From the Elder Fraud Abuse Units of Financial Institutions.

6360 Death Caused by Abuse or Neglect

SWI Policy and Procedures May 2017

APS In-Home (IH) does not investigate the death of persons age 65 or older; or of adults or emancipated minors with disabilities, unless APS already has an open case on the alleged victim and it is suspected that an alleged perpetrator (AP) contributed to the alleged victim's death.

If a client dies during APS IH service delivery, and APS IH staff suspect that an alleged perpetrator may have contributed to the alleged victim's death, APS IH contacts SWI and provides the detailed information to be entered into IMPACT.

The intake specialist creates a new intake only if all of the following conditions are met:

  •   the reporter is an APS IH staff member;

  •   there is a current open case involving the alleged victim; and

  •   there are new allegations of physical or sexual abuse, or physical or medical neglect by an alleged perpetrator that were not alleged or investigated in the investigation stage of the current case.

If a reporter who is not an APS IH staff person reports an alleged victim's death and there is an open case in any stage, the intake specialist sends an I&R to the open case.

If there is not an open case and SWI receives a report about the death of a person age 65 or older or an adult or emancipated minor with a disability that may be the result of abuse or neglect, the intake specialist:

  •   enters an I&R; and

  •   refers the matter to the appropriate law enforcement agency, and to the agency responsible, such as to DADS if it involved a nursing home resident, assisted living resident; or a client receives services from a home health agency and the client's provider is paid with Medicare or is privately paid.

If other persons age 65 or older or adults or emancipated minor with disabilities reside in the same location as the deceased and are alleged to be in danger, the intake specialist completes intake reports on those individuals.

In the APS In-Home Handbook, see 3570 Client Dies During Service Delivery.

6400 APS In-Home Priorities

SWI Policy and Procedures May 2017

Intake specialists assess APS In-Home intakes with the following priorities:

Priority I — Reports that allege the victim is in a state of serious harm or is in danger of death from abuse or neglect.

Priority II — Reports that allege the victim is abused, neglected, or exploited and, as a result, is at risk of serious harm.

Priority III — All other reports that allege the victim is in a state of abuse or neglect.

Priority IV — Reports that allege financial exploitation when there is no danger of imminent impoverishment or deprivation of basic needs.

DFPS Rules, 40 TAC §705.2101

6500 Victims Located in Facilities Licensed or Regulated by Other DFPS Programs or Other State Agencies

6510 Facility Licensed by Residential Child Care Licensing (RCCL)

SWI Policy and Procedures May 2017

APS In-Home investigates allegations of abuse, neglect, or financial exploitation of adults with disabilities who reside in facilities licensed by RCCL.

In the APS In-Home Handbook, see 1420 Assessing Residential Child-Care Facility Allegations.

6520 Hospitals, Assisted Living Facilities, Nursing Homes, and Hospice Facilities

SWI Policy and Procedures August 2017

When information is received that is under the jurisdiction of DADS or DSHS, the intake specialist assesses an I&R Referred to DADS or DSHS. If SWI receives a report that includes allegations under the jurisdiction of both APS In-Home and under the jurisdiction of DADS or DSHS, then the intake specialist assesses an APS In-Home intake and an I&R Referred to DADS or DSHS.

In the APS In-Home Handbook, see 1500 Allegations in Facilities Investigated by Texas State Agencies Other Than DFPS.

See also:

2700 Reports for Other State or Community Agencies

2712 Department of Aging and Disability Services (DADS)

2713 Texas Department of State Health Services (DSHS)

6521 Discharge Issues

SWI Policy and Procedures August 2017

In order to determine if a discharge situation requires an APS In-Home intake, the intake specialist determines if the client will be entering or returning to a situation involving abuse, neglect, or financial exploitation upon discharge.

Returning to an Unsafe Environment

An established discharge plan or date for a client may not be in place at the time of a report. However, if the client was abused or neglected prior to hospital or nursing home admission and there is a reasonable likelihood that they will be returning home, an APS In-Home intake is completed.

If the client is likely to need intervention even after a discharge plan is completed, an APS In-Home intake is completed. If the discharge plan or date is unknown, the intake specialist documents what information is available in the narrative and completes the intake. The intake specialist does not decline to take an intake solely because the discharge date or plan is unknown.

Need for Alternative Placement

Hospitals, Nursing Homes, and Hospice Facilities

APS In-Home does not investigate neglect allegations from hospitals, nursing homes, and hospice facilities when the only need is placement in another long-term care facility. If the client is in a safe environment and has a discharge plan that includes transfer to another safe environment then the client is not considered to be in a state of abuse or neglect.

Assisted Living Facilities

Assisted living facilities are not required to develop a post-discharge plan of care or ensure a safe discharge. Locating alternate placement is not the legal responsibility of the assisted living facilities. When a client needs a new place to live upon discharge from an assisted living facility and lacks the means to obtain or pay for a new living arrangement, an APS In-Home intake is assessed.

6522 Self-Neglect

SWI Policy and Procedures August 2017

Clients who have been appointed a guardian have been determined by the court to lack the ability to provide for their own care. A client who has a guardian cannot be a victim/perpetrator; the guardian must be the AP if self-neglect is alleged.

Refusal or Lack of Services

Assisted Living Facilities

Assisted living facilities offer many services to clients (e.g. reminding the client to take medications, providing meals), but the client can refuse these services. In other instances, the client is unable to provide a needed service to him or herself and it is not the assisted living facility's responsibility to provide the service (e.g. purchasing durable medical equipment or other necessities).

APS In-Home investigates allegations of self-neglect (physical, medical, or mental health) in an assisted living facility when the client is unable or unwilling to provide for his or her own protection, food, shelter, or care necessary to avoid emotional harm or physical injury.

Hospitals, Nursing Homes, and Hospice Facilities

APS In-Home does not investigate self-neglect in hospitals, nursing homes, or hospice facilities in this situation.

In the APS In-Home Handbook, see 1543 Allegations in Assisted Living Facilities.

Eviction from Nursing Home, Assisted Living Facility, or Hospice Facilities

If a client is or will be evicted, the facility is not required to create a discharge plan. An APS In-Home intake for physical and/or medical neglect-of-self is assessed in this situation.

Leaving Against Medical Advice

If a client chooses to leave a facility against medical advice and the client will be without necessary medical treatment or shelter, an APS In-Home intake is assessed for physical and/or medical neglect-of-self. If a client is taken from a facility by another person against medical advice, the intake specialist considers designating that person as an alleged perpetrator.

6523 Abuse, Neglect, or Exploitation by an Employee

SWI Policy and Procedures August 2017

The agency that licenses or regulates the facility investigates the abuse, neglect, or exploitation of a client by an employee of the facility, even if the incident happened off the grounds of the facility.

2712 Department of Aging and Disability Services (DADS)

2713 Texas Department of State Health Services (DSHS)

6524 Abuse, Neglect, or Exploitation by Someone Other than an Employee

SWI Policy and Procedures August 2017

Allegation is Physical, Emotional, or Sexual Abuse

If an APS In-Home eligible alleged perpetrator who does not work at the facility abused a client and:

  •   the client was not on facility premises when the act occurred; and

  •   the client was not under the supervision or service delivery of the facility when the act occurred,

then the intake specialist assesses an intake for APS In-Home.

Allegation is Financial Exploitation

If the allegation is financial exploitation, and the alleged perpetrator meets the APS In-Home definition, the intake specialist assesses an intake for APS In-Home.

Allegation is Physical, Medical, or Mental Health Neglect

If the actions of a person who meets the definition of an APS In-Home alleged perpetrator are causing the client to go without necessary treatment or services, then the intake specialist assesses an APS In-Home intake.

6600 APS In-Home Involvement in Other Situations

6610 Request for APS In-Home to Provide Consent for Medical Treatment

SWI Policy and Procedures May 2017

APS In-Home has the authority to give legal consent to medical treatment only when APS In-Home invoked an Emergency Order for Protective Services to hospitalize the individual and the order is still in effect.

In the APS In-Home Handbook, see 1380 Need for Consent to Medical Treatment Allegations.

6620 Do Not Resuscitate (DNR) or Removal of Life Support

SWI Policy and Procedures May 2017

APS In-Home has no legal authority to consent to a DNR order or removal of life support.

If a caller is requesting that an APS In-Home intake be taken because an individual cannot give consent for a DNR, the intake specialist refers the caller to the Health and Safety Code §166.088(f) and §166.039 which allow two physicians to issue DNR and life support orders.

In the APS In-Home Handbook, see 1370 Do Not Resuscitate (DNR) and Removal of Life Support Allegations.

6630 Guardianship

SWI Policy and Procedures May 2017

Guardianship is the legal process created in which a court gives a competent adult (guardian) specified duties and rights to act on behalf of a minor child or incapacitated adult (ward) in making decisions affecting the ward's life.

If the only concern reported to SWI is the need for a guardian, but there is no allegation of abuse, neglect or financial exploitation, APS In-Home does not investigate.

The intake specialist:

  •   completes an I&R Clearly Not Reportable;

  •   tells the reporter that an intake will not be completed; and

  •   refers the reporter to the guardianship court (county court) for information and assistance with guardianship issues.

Note: DADS does not accept referrals for guardianship from the public. For information about DADS guardianship, the intake specialist directs the caller to the Long Term Care Provider Search on the DADS website.

SWI does not fax I&Rs about guardianship issues to DADS.

A person who has a guardian is automatically considered substantially impaired for eligibility purposes. In most circumstances, APS In-Home investigates allegations of abuse, neglect, or financial exploitation involving wards following normal intake procedures. The intake specialist assesses whether the allegation requires an intake for APS In-Home. Once this determination is made, the intake specialist completes the intake for routing to the appropriate program.

6640 Unlicensed Facilities

SWI Policy and Procedures May 2017

APS In-Home investigates abuse, neglect, and financial exploitation of a person age 65 or older, or an emancipated minor or adult with a disability that live in the following facilities:

  •   boarding facilities or halfway houses that do not provide personal care (the alleged perpetrator of neglect would always be the client);

  •   personal care homes; and

  •   adult foster homes.

6650 Private and Public Schools

SWI Policy and Procedures May 2017

APS In-Home investigates allegations of abuse, neglect, and financial exploitation involving a school when:

  •   the alleged victim is an emancipated minor or adult with disabilities;

  •   school employees, contractors, or volunteers are alleged to be responsible for the maltreatment; and

  •   the alleged acts occurred when the school was responsible for care and control of the alleged victim.

6660 Indian Reservations and Military Bases

SWI Policy and Procedures May 2017

When there are allegations of abuse, neglect, or financial exploitation alleged of a person who is age 65 or older or adults with disabilities or emancipated minors with disabilities; and who lives on an Indian reservation or a military base, the intake specialist generates an APS In-Home intake and marks the intake for Special Handling.

See 2311 Special Handling Intakes.

6670 Reports from the Elder Fraud Abuse Units of Financial Institutions

SWI Policy and Procedures May 2017

On occasion, SWI receives reports from financial institutions such as banks alleging financial exploitation (EXPL) of an elderly client. These reports may be faxed to SWI from the bank's Elder Fraud Unit. Within these reports, an Agent ID reference number is documented in either the body of the information or in the comments on the fax cover sheet. To protect confidentiality, the bank's Elder Fraud Unit staff will only communicate details of the client's financial affairs to the APS In-Home investigator if the investigator can provide this reference number.

When SWI processes one of these reports, the intake specialist documents the Agent ID reference number at the top of the intake Narrative, underneath the source of the report, when applicable.

Once documented in IMPACT the report is assessed according to standard policy and procedures.

See 3324.4 Narrative Documentation Specific to Correspondence.

6700 Allegations Made by an APS In-Home Client That Are Frivolous or Patently Without a Factual Basis (Chronic Callers)

SWI Policy and Procedures May 2017

The APS In-Home program allows regional staff to establish particular procedures for certain clients who make allegations that are frivolous or patently false. Regional staff for APS In-Home makes such determinations when clients establish a pattern of repeatedly making the same allegation or similar allegations, as reported in an open investigation.

When APS In-Home determines that a client has established a pattern of making frivolous or false allegations, regional APS staff ask SWI staff to place the client on the Chronic Caller List. The list is published in SWIndex (an internal resource), under the "Intake Specialists" heading.

Anytime an intake specialist receives a report, the intake specialist completes a history search in IMPACT. If the search results indicate an extensive history of APS involvement with a client, it might be indicative of the client being a chronic caller. To determine whether the client is on the Chronic Caller List, the intake specialist checks the Chronic Caller List in SWIndex. If the client is on the Chronic Caller List, the intake specialist follows the specific directions provided by APS In-Home investigative staff, as documented on the list. In most instances, the intake specialist:

  •   completes an I&R Chronic Caller;

  •   chooses the county for the I&R; and

  •   assigns the I&R.

With supervisory approval, regional APS staff may contact SWI to request that the I&R be entered as an intake. In that case, SWI completes the intake as requested.

See:

2323 Information & Referrals.

2161 Chronic Callers

In the APS In-Home Handbook, see 1390 Allegations Involving Chronic Callers

6800 Case-Related Special Requests (CRSR)

SWI Policy and Procedures May 2017

Case-Related Special Requests are used for situations where there is no alleged abuse, neglect, or financial exploitation, but APS assistance is still needed. The drop-down list for the Special Rqst Program Type contains various CRSR types; however, only three types of CRSRs are used by APS In-Home. They are only used under very limited circumstances. The specific types entered by SWI are described below.

See 2322 Case-Related Special Requests.

6810 Types of CRSR Reports for APS In-Home Cases

SWI Policy and Procedures May 2017

CRSR – Out-of-State (shows in IMPACT as C-OS)

The intake specialist completes a CRSR – Out-of-State if:

  •   a probate court or an Adult Protective Services (APS) agency/program in another state requests assistance from APS In-Home to provide services to an individual 65 years of age or older, or an emancipated minor or adult with disabilities; and

  •   the situation does not involve allegations of abuse, neglect, or financial exploitation.

For example, an intake specialist would complete a CRSR – Out-of-State if a probate court in New Mexico requests that APS In-Home make a home visit to check on a ward of the court who is residing in Texas.

CRSR – APS Court (shows in IMPACT as C-REG)

The intake specialist processes a CRSR – APS Court when:

  •   directed by APS state office staff because a court or legislator requests assistance from APS on a high-profile situation that involves a person age 65 years of age or older, or an emancipated minor or adult with disabilities; and

  •   the situation does not involve allegations of abuse, neglect, or financial exploitation.

CRSR – Law Enforcement (shows in IMPACT as C-REG)

The intake specialist processes a CRSR – Law Enforcement when:

  •   requested by APS state office staff; or 

  •   law enforcement requests assistance from APS In-Home on a high-profile situation that involves a person who is age 65 years of age or older, or an emancipated minor or adult with disabilities; and

  •   the situation does not involve allegations of abuse, neglect, or financial exploitation.

6900 Documentation and Processing of APS In-Home CRSRs

SWI Policy and Procedures May 2017

The intake specialist enters the client (CL) as a principal (PRN) with a role of CL, and with a relationship of self (SL) on all CRSRs. All other people are listed on the Person List as collateral contacts (COLs).

The intake specialist routesthe CRSR as follows:

  •   CRSR – Law Enforcement – as directed by APS state office staff or to the county where the CL is currently located if reported by law enforcement.

  •   CRSR – APS Court – to the county where the CL is currently located; or

  •   CRSR – Out-of-State – to the county where the CL is currently located.

IMPACT automatically assigns the CRSR to the county listed as the primary address of the client. A change of county may be needed if the client is not currently in the same county as his or her county of residence.

See:

6914 APS In-Home Change of County for Case Assignment

3910 Change of County for Case Assignment

6910 IMPACT Procedures Specific to APS In-Home

SWI Policy and Procedures May 2017

This section contains only documentation details that are unique to APS. For a more complete reference, see 3000 Processing Reports.

If a report is received alleging abuse, neglect, or financial exploitation of more than one victim, the intake specialist:

  •   assesses each victim's eligibility for APS In-Home intervention; and

  •   completes separate intakes for each qualified victim.

6911 APS In-Home Case Name

SWI Policy and Procedures May 2017

The case name is the alleged victim's name.

6912 APS In-Home Report Person Detail

SWI Policy and Procedures May 2017

When completing the Report Person Detail page in IMPACT, the intake specialist obtains and documents the alleged victim's:

  •   date of birth;

  •   Social Security number; and

  •   current, valid locating information, including complete address and phone, directions to the home, the name of the apartment complex or mobile home park, or the name of the subdivision.

The intake specialist also obtains and documents the names and contact information for relevant collateral contacts.

6913 APS In-Home Person List

SWI Policy and Procedures May 2017

For an APS In-Home intake:

  •   Only the alleged victim and alleged perpetrator are listed as principals.

  •   The "Unknown" role is not used.

  •   Children are not listed on the Person List unless they are 10 years of age and older and are an alleged perpetrator (AP); or they have relevant collateral information, such as a teen grandchild (GC) who may help provide care for the alleged victim (CL).

  •   If there are younger children in the home the intake specialist may document them in the Narrative (for example, "The CL takes care of 12 young great-grandchildren.").

6914 APS In-Home Change of County for Case Assignment

SWI Policy and Procedures May 2017

APS In-Home intakes are assigned to the county where the alleged victim is staying at the time the intake is taken; regardless of the:

  •   reason the client is not in their county of residence;

  •   length of time the client will be away from his or her county of residence;

  •   client's current placement (such as a hospital, jail, and so on); or

  •   case priority.

IMPACT automatically assigns the intake to the county listed as the primary address of the client. A change of county may be needed if the client is not currently in the same county as his or her county of residence.

See 3910 Change of County for Case Assignment.

6920 APS In-Home Call Out and Assignment

SWI Policy and Procedures May 2017

Intake specialists assign all APS In-Home intakes following established procedures.

See the Manual Assignment Chart.

 

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