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1500 Allegations in Facilities Investigated by Texas State Agencies Other Than DFPS

APS IH / May 2007

APS refers reports relating to persons age 65 or older and adults with disabilities in facilities investigated by state agencies other than DFPS to the appropriate investigatory agency.

Allegations of Abuse, Neglect, and Financial Exploitation Involving Persons Age 65 or Older and Adults With Disabilities in Facilities Investigated by Texas State Agencies Other Than DFPS

APS investigates allegations of ...

only when ...

abuse and neglect ...

all of the following criteria are present:

  •   The alleged victim was not on the facility grounds when the alleged acts occured.

  •   The facility was not responsible for supervision or service delivery when the alleged acts occurred.

  •   The alleged perpetrators are not affiliated with facility.

financial exploitation ...

the perpetrator is:

  •   a family member, caretaker, or other person with whom the individual has an ongoing relationship; and

  •   not a staff member of the facility.

 

Temporary Safe Environment

If alleged victims are temporarily in facilities investigated by state agencies other than DFPS, such as a hospital or other temporary residence, but will return to a situation of abuse, neglect, or financial exploitation, an APS investigation is conducted.

1510 Procedure for Allegations in Facilities Investigated by Texas State Agencies Other Than DFPS

APS IH / May 2011

The APS specialist:

  •   investigates allegations of abuse, neglect, or financial exploitation of persons age 65 or older and adults with disabilities in facilities regulated by other state agencies in situations specified by policy; and

  •   refers allegations in facilities regulated by other state agencies that do not meet specific criteria for APS involvement to the appropriate investigatory authority.

See:

Appendix II: Facilities and Jurisdictions

1500 Allegations in Facilities Investigated by Texas State Agencies Other Than DFPS

1520 Examples of Allegations in Facilities Regulated by Other Texas State Agencies

APS IH / May 2011

Facility Resident Is Abused When at Home On a Visit

The alleged victim goes home on a weekend pass with her daughter. The daughter slaps the alleged victim because she refuses to eat dinner.

The alleged victim is not under the care or supervision of the facility when the incident occurs.

APS investigates the alleged act of abuse.

Facility Resident Is Abused at a Facility by a Family Member

The daughter strikes the alleged victim at the facility.

Although the alleged perpetrator is not a facility staff member, the alleged victim is on the premises of the facility and the facility is responsible for providing services to her at the time of the alleged incident.

APS does not investigate the alleged act of abuse.

As appropriate, APS refers the situation to:

  •   law enforcement; and

  •   the appropriate state agency for investigation of possible neglectful supervision.

Facility Resident Is Abused at a Facility by a Staff Person

A facility staff member slaps the alleged victim in the cafeteria or while on a field trip.

The alleged victim is under the care and control of the facility at the time of the alleged act, and the alleged perpetrator is a facility staff member.

APS does not investigate the alleged act of abuse.

APS refers the situation to the appropriate state agency for investigation of the alleged abuse.

1530 Procedure for Complaints That Do Not Allege Abuse, Neglect, or Financial Exploitation

APS IH / October 2013

If APS receives complaints regarding...

then APS refers the situations to...

investigations conducted by other state agencies

the state agency named in the complaint for review according to that agency’s internal procedures.

policies or practices conducted within a licensed facility

the licensing agency for those facilities (such as DADS and DSHS).

waste, abuse, or fraud within the Texas Health and Human Services system

the Office of the Inspector General for investigation.

conduct or practices of a licensed person that does not allege abuse, neglect, or financial exploitation

the appropriate licensing board after consulting with the regional attorney.

See:

5424.4 Release of APS Findings to Professional Licensing Boards, Commissions, and Other Agencies

Appendix ll: Facilities and Jurisdictions

1540 Allegations Involving Texas Department of Aging and Disability Services (DADS)

APS IH / April 2015

APS refers allegations of abuse, neglect, or financial exploitation of persons 65 or older or adults with disabilities that do not meet the criteria for APS involvement to DADS as appropriate.

The DADS Regulatory Services program provides:

  •  federal certification for health care facilities participating in the Medicaid and Medicare programs;

  •  state licensure for facilities providing licensed health care services; and

  •  licensure of Home and Community Support Services Agencies (HCSSAs) that provide home health, personal assistance, and hospice services.

For a list of provider facilities, see Appendix II: Facilities and Jurisdictions.

For policy regarding nursing homes, see 1542 Allegations in Nursing Homes.

For policy regarding homes and state facilities for persons with intellectual disabilities, see 1430 Assessing Allegations in Settings Investigated by APS Facilities Investigations.

Long-Term Care Ombudsman Program

The DADS Long-Term Care Ombudsman program advocates for the quality of life and care for residents in long-term care facilities.

Federal and state authority mandates ombudsmen to:

  •  identify, investigate, and resolve complaints made by, or on behalf of, residents; and

  •  provide services to help in protecting health, safety, welfare, and rights.

See 3431 Roles and Responsibilities of APS.

1541 Allegations in Facilities Requiring Licensure by DADS Regulatory Services

APS IH / February 2013

APS investigates abuse, neglect, and financial exploitation involving residents of facilities requiring licensure by DADS, as outlined in 1500 Allegations in Facilities Investigated by Texas State Agencies Other Than DFPS, except for nursing homes.

For policy regarding nursing homes, see 1542 Allegations in Nursing Homes.

See also Appendix II: Facilities and Jurisdictions.

Facilities Exempt From Licensure

DADS Regulatory Services does not investigate allegations of abuse, neglect, and financial exploitation of persons age 65 or older or adults with disabilities in boarding home facilities and adult foster care facilities that are exempt from DADS Regulatory Services licensure requirements. APS investigates in these facilities.

See:

2682 Investigations in Boarding Home Facilities

1541.2 Procedure for Determining Whether an Assisted Living Facility Is Licensed or Should Be Licensed by DADS Regulatory Services

Emergencies Involving Facilities Requiring Licensure

APS provides emergency protective services to prevent or remedy abuse, neglect, or financial exploitation in facilities that require licensure, when:

  •   an emergency is discovered after business hours; and

  •   DADS Regulatory staff cannot be reached.

Closure of Facilities Requiring Licensure

DADS is allowed to close facilities requiring licensure if the facility operates in violation of licensing standards in a manner that creates an immediate threat to the health and safety of the residents.

DADS is also required to help families find new placements for displaced relatives when facilities licensed or subject to licensure by DADS are closed because they fail to meet regulatory standards.

Health and Safety Code §§142.011, 242.062, 247.042

Upon request and according to the Memorandum of Understanding (MOU) between APS and DADS, APS assists DADS in finding suitable placements for incapacitated persons who have no family willing to assist.

Human Resources Code §48.303

See Appendix II: Facilities and Jurisdictions.

In the DFPS Statewide Intake Handbook, see 2712.2 DADS Consumer Rights and Services Complaint Intake Unit.

1541.1 Procedure for Assessing Allegations in Facilities Requiring Licensure by DADS Regulatory Services

APS IH / December 2011

The APS specialist:

  •   investigates allegations of abuse, neglect, or financial exploitation of persons age 65 or older and adults with disabilities in situations specified by policy in facilities that are licensed or unlicensed but subject to licensure by DADS Regulatory Services; and

  •   refers allegations in facilities that are licensed or unlicensed but subject to licensure by DADS Regulatory Services that do not meet specific criteria for APS involvement to the DADS Complaint Intake.

See:

Appendix II: Facilities and Jurisdictions

1541 Allegations in Facilities Requiring Licensure by DADS Regulatory Services

1541.2 Procedure for Determining Whether an Assisted Living Facility Is Licensed or Should Be Licensed by DADS Regulatory Services

APS IH / April 2016

The APS specialist determines if an assisted living facility is licensed or subject to licensure in order to determine jurisdiction.

Texas Health and Safety Code Chapter 247 requires licensure by DADS Regulatory Services for any establishment that furnishes, in one or more facilities:

  •  food and shelter;

  •  care for four or more persons who are unrelated to the proprietor of the establishment; and

  •  personal care services or administration of medication by a person licensed or otherwise authorized in this state to administer the medication.

1541.21 Procedure for When a Facility’s Licensure Status Is Unknown

APS IH / April 2016

The APS specialist:

  •  uses the DADS website to determine if a facility is currently licensed;

  •  determines the number of people not related to the proprietor who are receiving care in the same establishment;

  •  determines whether the facility is considered part of the same establishment as other assisted living facilities. One or more facilities are considered to be part of the same establishment, and subject to licensure based on:

  •  common ownership,

  •  physical proximity,

  •  shared services, personnel, or equipment in any part of the facility’s operations, and

  •  any public appearance of joint operations or of a relationship between facilities;

  •  determines whether the facility provides personal care. Personal care includes:

  •  assistance with feeding, dressing, movement, bathing, personal needs, or maintenance, and

  •  general supervision or oversight of the physical and mental well-being of a person who needs assistance to maintain a private and independent residence in the facility or who needs assistance to manage his or her personal life, regardless of whether a guardian has been appointed for the person;

  •  determines whether the facility is exempt from licensure.

Facilities that are exempt from licensure include the following:

  •  Unlicensed personal care homes that furnish care to three or fewer persons who are unrelated to the proprietor of the establishment

  •  Adult foster homes that are contracted to furnish care to three or fewer persons who are unrelated to the proprietor of the establishment

  •  VA Medical Foster Care Homes are private homes in which a trained caregiver is on duty 24/7 to assist individuals with completing activities of daily living

  •  Boarding home facilities – facilities that do not provide personal care, but are allowed to provide the following without a license:

  •  Shelter

  •  Community meals

  •  Light housework

  •  Meal preparation

  •  Transportation

  •  Grocery shopping

  •  Money management, other than acting as representative payee

  •  Laundry services

  •  Assistance with self-administration of medication

See:

Appendix II: Facilities and Jurisdictions

2672 Investigations in Boarding Home Facilities

2680 Allegations Involving Paid Caretakers

1541.3 Procedure for Emergency Situations Involving Facilities Requiring Licensure by DADS Regulatory Services

APS IH / February 2013

When an APS specialist discovers an emergency after business hours in a facility (licensed or unlicensed) that is subject to licensure by DADS, the APS specialist:

  •   takes the necessary steps to provide emergency intervention;

  •   leaves a detailed message at DADS Complaint Intake Unit (Consumer Rights and Services);

  •   contacts DADS Regulatory Services the next business day to explain the intervention;

  •   verifies that DADS Regulatory Services will assume jurisdiction of the case;

  •   closes the case once DADS Regulatory Services acknowledges that it will assume jurisdiction of the case; and

  •   consults the supervisor to determine what further action is needed, if DADS Regulatory Services does not assume jurisdiction of the case by the next business day.

In the DFPS Statewide Intake Handbook, see 2712.2 DADS Consumer Rights and Services Complaint Intake Unit.

1541.4 Procedure for Closure of Facilities Requiring Licensure by DADS Regulatory Services

APS IH / December 2011

Upon request, the APS specialist assists the DADS Regulatory Services worker to find suitable placement for a person age 65 or older or an adult with a disability when the alleged victim:

  •   is displaced because of the closure of a DADS-regulated facility as a result of a violation of licensing standards that created an immediate threat to the health and safety of the residents;

  •   is incapacitated; and

  •   has no family willing to assist.

1542 Allegations in Nursing Homes

APS IH / December 2011

The Texas Department of Aging and Disability Services (DADS) is responsible for investigating allegations of abuse, neglect, or financial exploitation in facilities licensed by DADS, including nursing homes.

APS refers allegations of abuse, neglect, or financial exploitation of persons 65 or older or adults with disabilities that do not meet the criteria for APS involvement to DADS as appropriate.

APS does not investigate abuse or neglect that occurs in nursing homes.

See

Appendix II: Facilities and Jurisdictions

Health and Safety Code Chapter 242

Abuse, Neglect, and Financial Exploitation Allegations Involving Nursing Homes

APS investigates alleged acts of ...

only when ...

abuse and neglect by an alleged perpetrator of persons age 65 or older or adults with disabilities who are currently in a nursing home...

all of the following criteria are present:

  •   Alleged victims were not on the premises of the nursing home when the alleged acts occurred.

  •   Alleged victims were not under the supervision or service delivery of the nursing home when the alleged acts occurred.

  •   Alleged perpetrators are not affiliated with the nursing home.

self-neglect of persons age 65 or older or adults with disabilities who are currently in a nursing home…

all of the following criteria are present:

  •   Alleged victims were not on the premises of the nursing home when the alleged acts occurred.

  •  Alleged victims were not under the supervision or service delivery of the nursing home when the alleged acts occurred.

  •   Alleged victims have an ongoing need for protective services upon release from the nursing home after appropriate community referrals for assistance, placement, and care by the nursing home.

financial exploitation of persons age 65 or older or adults with disabilities who are currently in a nursing home...

if the alleged perpetrators are:

  •   caretakers, family members, or other persons with whom the individual has an ongoing relationship; and

  •   not affiliated with the nursing home.

If the alleged victim dies in the nursing home after APS has received an intake, see 2640 Client Dies During the Investigation.

Nursing Home Discharge Planning

Nursing homes must provide the resident, resident’s guardian, family representative, or responsible party with a written notice of discharge at least 30 calendar days before discharge, including eviction, unless the health or safety of the resident or other individuals in the facility are endangered and more immediate discharge is necessary.

The discharge notice must include specific information, including:

  •   reasons for discharge;

  •   effective date of the discharge;

  •   the location to which the resident will be discharged; and

  •   information regarding the resident’s right to appeal the discharge.

DADS Rules, 40 TAC §19.502(e),(f)

As part of the discharge process, the nursing home must also develop a post-discharge plan of care with the participation of the resident, resident’s guardian, family member, or responsible party to assist the resident in adjusting to his or her new environment after discharge.

DADS Rules, 40 TAC §19.803(a)(3)

APS efforts to ensure stabilization of alleged victims’ situations may include participation in discharge planning if APS either:

  •   invoked Human Resources Code §48.208 to obtain an Emergency Order for Protective Services (EOPS) to place the alleged victim in the facility; or

  •   was involved in persuading the alleged victim to move into the facility in lieu of seeking an EOPS.

See:  

1542.2 Examples of Situations Appropriate for APS Investigation

1542.3 Examples of Situations Not Appropriate for APS Investigation

2673.1 Procedure for Investigations Involving Allegations of Financial Exploitation Against a Resident of a Nursing Home

Need for Alternate Placement at Discharge

APS does not investigate self-neglect allegations from nursing homes, including eviction because of non-payment, when the only need is alternate placement. Locating alternate placement is part of appropriate discharge planning and the legal responsibility of the nursing home.

Persons age 65 or older and adults with disabilities are not in a state of self-neglect if they:

  •   are in a safe environment, such as the nursing home; and

  •   have a discharge plan that includes transfer to another safe environment, such as another nursing home, assisted living facility, or private residence with sufficient safeguards to meet the individual’s needs.

1542.1 Procedure for Allegations in Nursing Homes

APS IH / December 2011

The APS specialist investigates allegations of abuse, neglect, or financial exploitation of persons age 65 or older and adults with disabilities in nursing homes in situations specified by policy.

The APS specialist refers allegations that do not meet the criteria in 1542 Allegations in Nursing Homes for an APS investigation to the Texas Department of Aging and Disability Services (DADS).

When the regional office has concerns with a nursing home’s discharge planning practices, the APS specialist consults the APS program administrator or designee and, as appropriate, notifies APS state office through the DFPS APS IN HOME mailbox with any concerns. The regional office may speak with nursing home staff or management, but does not file a formal complaint with DADS. The policy team in state office consults with the director of field operations regarding the complaint and follows up with DADS Regulatory Services program to address any concerns.

See:

1542 Allegations in Nursing Homes

Appendix II: Facilities and Jurisdictions

1542.2 Examples of Situations Appropriate for APS Investigation

APS IH / December 2011

Some examples of situations involving persons age 65 or older or adults with disabilities that meet the criteria for protective services include, but are not limited to, the following:

  •   The individual is at risk of eviction because of alleged financial exploitation.

  •   The individual lacks capacity to consent and is leaving the nursing home against medical advice.

  •   The condition of the individual’s home prevents appropriate discharge planning by the nursing home. For example, the person cannot return home unless a ramp is installed.

  •   The individual is returning to a situation where there is ongoing abuse, neglect, or financial exploitation.

1542.3 Examples of Situations Not Appropriate for APS Investigation

APS IH / December 2011

Some examples of situations involving persons age 65 or older or adults with disabilities that do not meet the criteria for protective services include, but are not limited to, the following:

  •   The individual is being evicted because he or she has chosen to pay other expenses rather than the nursing home, but is still eligible for placement at another nursing home or other safe environment.

  •   The individual has capacity and refuses to participate in the discharge plan, but this decision does not place the individual in a state of abuse, neglect, or financial exploitation.

  •   The nursing home is having difficulty locating an alternate placement.

1543 Allegations in Assisted Living Facilities

APS IH / April 2015

The Texas Department of Aging and Disability Services (DADS) is responsible for investigating allegations of abuse, neglect, or financial exploitation by an alleged perpetrator in facilities licensed by DADS, including assisted living facilities.

APS refers allegations of abuse, neglect, or financial exploitation of persons 65 or older or adults with disabilities that do not meet the criteria for APS involvement to DADS as appropriate.

APS does not investigate abuse or neglect by an alleged perpetrator that occurs in assisted living facilities.

See

Appendix II: Facilities and Jurisdictions

Health and Safety Code Chapter 247

Abuse, Neglect, and Financial Exploitation Allegations Involving Assisted Living Facilities

APS investigates alleged acts of ...

only when ...

Abuse or neglect by an alleged perpetrator of persons age 65 or older or adults with disabilities who are currently in an assisted living facility...

all of the following criteria are present:

  •  Alleged victims were not on the premises of the assisted living facility when the alleged acts occurred.

  •  Alleged victims were not under the supervision or service delivery of the assisted living facility when the alleged acts occurred.

  •  Alleged perpetrators are not affiliated with the assisted living facility.

self-neglect of persons age 65 or older or adults with disabilities who are currently in an assisted living facility…

an alleged victim is unable to provide for himself or herself the protection, food, shelter, or care necessary to avoid emotional harm or physical injury.

financial exploitation of persons age 65 or older or adults with disabilities who are currently in an assisted living facility...

if the alleged perpetrators are:

  •  caretakers, family members, or other persons with whom the individual has an ongoing relationship; and

  •  not affiliated with the assisted living facility.

If the alleged victim dies in an assisted living facility after APS has received an intake, see 2640 Client Dies During the Investigation.

Assisted Living Facility Discharge Planning and Alternate Placement

Assisted living facilities must provide the resident, resident’s legal representative, or a member of the resident’s family with a written notice of discharge at least 30 calendar days before discharge, including eviction, unless the health or safety of the resident or other individuals in the facility are endangered and more immediate discharge is necessary.

The discharge notice must include specific information, including:

  •  the intent of the facility to transfer or discharge the resident

  •  the reasons for transfer or discharge;

  •  the effective date of the transfer or discharge;

  •  the location to which the resident will be transferred, if the resident is being transferred; and

  •  information regarding the resident’s right to appeal the transfer or discharge.

DADS Rules, 40 TAC §92.125(Y)(i),(v)

Unlike nursing homes, assisted living facilities are not required to develop a post-discharge plan of care or insure a safe discharge.

APS investigates self-neglect allegations from assisted living facilities, including eviction because of non-payment. Locating alternate placement is not the legal responsibility of the assisted living facility.

1543.1 Procedure for Allegations in Assisted Living Facilities

APS IH / April 2015

The APS specialist investigates allegations of abuse, neglect, or financial exploitation of persons age 65 or older and adults with disabilities in assisted living facilities in situations specified by policy.

The APS specialist refers allegations that do not meet the criteria for an APS investigation as outlined in 1543 Allegations in Assisted Living Facilities to the Texas Department of Aging and Disability Services (DADS).

See:

1543 Allegations in Assisted Living Facilities

Appendix II: Facilities and Jurisdictions

1550 Allegations Involving Schools

APS IH / October 2013

APS investigates allegations of abuse, neglect, and financial exploitation involving schools when:

  •   the alleged victims are adults with disabilities who are students at the school;

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

  •   the alleged acts occurred when the school had responsibility for care and control of the alleged victim.

The APS specialist refers allegations of abuse and neglect of a student less than 18 years of age to Child Protective Services as appropriate.

See also:

2671 Procedure for Investigations Involving Schools

5440 Releasing Findings Involving School Personnel

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

APS IH / September 2011

The DSHS Health Facility program surveys health care facilities that participate in the federal certification program or are regulated under state licensing statutes, or both. The Health Facility program’s overall goal is to monitor health care delivery by regulated health care facilities to assure high quality care to the people of Texas.

Health care facilities served through the program include:

  •   medical hospitals;

  •   private psychiatric hospitals and crisis stabilization;

  •   dialysis facilities;

  •   end-stage renal disease facilities;

  •   narcotic treatment clinics;

   • substance abuse treatment facilities;

  •   comprehensive out-patient rehabilitation facilities;

  •   rural health clinics;

  •   special care facilities;

  •   outpatient occupational and physical therapy facilities;

  •   ambulatory surgical centers;

  •   birthing centers; and

  •   abortion facilities.

The Joint Commission (TJC)

The Joint Commission evaluates and accredits health care organizations and programs in the United States. The Joint Commission is an independent not-for-profit organization that maintains standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission’s comprehensive accreditation process evaluates an organizations compliance with these standards and other accreditation requirements.

The Joint Commission:

  •   investigates complaints about the quality of care at a TJC-accredited health care organization; and

  •   addresses all complaints that relate to quality of care issues within the scope of their standards, including:

  •   patient rights,

  •   care of patients,

  •   safety,

  •   infection control,

  •   medication use, and

  •   security.

The Joint Commission does not:

  •   address individual billing issues and payment disputes; or

  •   review complaints of any kind in unaccredited organizations.

See:

3431 Roles and Responsibilities of APS

Appendix II: Facilities and Jurisdictions

1561 Allegations in Hospitals and Hospices

APS-IH / November 2016

The Texas Department of State Health Services (DSHS) is responsible for investigating allegations of abuse, neglect, or financial exploitation in medical facilities that are under the purview of The Joint Commission (TJC). Hospitals and Hospices are among the medical facilities in which DSHS conducts investigations.

APS refers allegations of abuse, neglect, or financial exploitation of persons age 65 or older or adults with disabilities that do not meet APS eligibility to DSHS and The Joint Commission as appropriate.

APS does not investigate abuse or neglect that occurs in hospitals or in hospices.

Abuse, Neglect, and Financial Exploitation Allegations Involving Hospitals or Hospices

APS investigates alleged acts of ...

only when ...

abuse and neglect by an alleged perpetrator of persons age 65 or older or adults with disabilities who are currently in the hospital or in a hospice ...

all of the following criteria are present:

  •  Alleged victims were not on the premises of medical facilities when the alleged acts occurred.

  •  Alleged victims were not under the supervision or service delivery of a medical facility when the alleged acts occurred.

  •  Alleged perpetrators are not affiliated with the facility.

financial exploitation of persons age 65 or older or adults with disabilities who are currently in the hospital or in a hospice...

the alleged perpetrators are:

  •  caretakers, family members, or other persons with whom the individual has an ongoing relationship; and

  •  not affiliated with the medical facility.

self-neglect of persons age 65 or older or adults with disabilities who are currently in the hospital or in a hospice …

all of the following criteria are present:

  •  Alleged victims were not on the premises of medical facilities when the alleged acts occurred.

  •  Alleged victims were not under the supervision or service delivery of a medical facility when the alleged acts occurred.

  •  Alleged victims have an ongoing need for protective services upon release from medical facilities after appropriate community referrals for assistance, placement, and care are made by the medical facility.

If the alleged victim dies in the hospital or hospice after APS has received an intake, see 2640 Alleged Victim Dies During the Investigation.

Hospital and Hospice Discharge Planning

Hospitals and hospices are required by law to address any known ongoing needs patients have before discharge. Such needs include appropriate:

  •  discharge planning; and

  •  community referrals.

APS efforts to ensure stabilization of alleged victims’ situations may include participation in discharge planning if APS either:

  •  invoked Human Resources Code §48.203 to obtain an Emergency Order for Protective Services (EOPS) to hospitalize the alleged victim; or

  •  was involved in persuading the alleged victim to seek treatment at the hospital in lieu of seeking an EOPS.

1561.1 Procedure for Allegations in Hospitals

APS IH / May 2011

The APS specialist investigates allegations of abuse, neglect, or financial exploitation of persons age 65 or older and adults with disabilities in medical facilities in situations specified by policy.

The APS specialist refers allegations that do not meet the criteria for an APS investigation as outlined in 1561 Allegations in Hospitals and Hospices to the appropriate entity. Allegations of abuse, neglect, and financial exploitation that occur in medical facilities regulated by Texas Department of State Health Services (DSHS) are referred to the DSHS Health Facility program.

Allegations of abuse, neglect, and financial exploitation that occur in accredited medical facilities are referred to the Joint Commission.

When the regional office has concerns with a hospital’s discharge planning practices, the APS specialist consults the APS program administrator or designee and, as appropriate, notifies APS state office via the APS In-Home Mailbox with their concerns. The regional office may speak with hospital staff or management, but does not file a formal complaint with DSHS or the Joint Commission. State office policy team consults with the Director of Field Operations regarding the complaint and follows up with the appropriate entity to address any concerns.

See 1561 Allegations in Hospitals and Hospices.

1561.2 Examples of Ongoing Protective Services Following Hospital Discharge

APS IH / May 2011

Some examples of allegations involving persons age 65 or older or adults with disabilities that meet the criteria for protective services include, but are not limited to, the following:

  •   The individual lacks capacity to consent and is leaving the hospital against medical advice.

  •   The condition of the alleged victim’s home prevents appropriate discharge planning by the hospital. For example, the person cannot return home unless a ramp is installed.

  •   The individual is returning to a situation where there is ongoing abuse, neglect, or financial exploitation.

1561.3 Examples of Hospital Discharge Without a Need for Ongoing Protective Services

APS IH / May 2011

Some examples of allegations involving persons age 65 or older or adults with disabilities that do not meet the criteria for protective services include, but are not limited to, the following:

  •  The individual is unable to pay for long-term care or is ineligible for Medicaid funding.

  •   The individual exhibits inappropriate behaviors that make placement more difficult.

  •   The individual has capacity and refuses the discharge plan, but this does not place the individual in a state of abuse, neglect, or financial exploitation.

  •   The hospital is for any reason unable to easily locate placement.

1570 Allegations Occurring on Indian Reservations

APS IH / May 2011

APS has no authority to conduct an investigation on Indian reservations without permission from reservation officials. When allegations are received that involve abuse, neglect, or financial exploitation of persons age 65 or older or adults with disabilities residing on Indian reservations, APS requests agreement or assistance from reservation officials.

1571 Procedure for Allegations Involving Indian Nations

APS IH / May 2011

The APS specialist immediately notifies the reservation’s social work department of the allegations and requests permission to conduct an investigation.

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