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4000 Cases Involving Health and Human Services Commission (HHSC) or Other Settings

4100 Allegations Involving HHSC Health Care Facilities

APS January 2022

Texas law requires certain types of health care facilities to be licensed to provide services. HHSC is required to regulate these facilities to protect consumers’ and patients’ health and safety by ensuring compliance with state laws and rules. HHSC establishes the following:

  • Rules and standards for facilities’ general operations, patient services, and physical plans.
  • Procedural rules for license applications and issuance, complaints, violations, and enforcement.

Health care facilities licensed and regulated by HHSC include the following:

  • Medical hospitals.
  • Private psychiatric hospitals and crisis stabilization facilities.
  • Dialysis facilities.
  • End-stage renal disease facilities.
  • Narcotic treatment clinics.
  • Substance abuse treatment facilities.
  • Comprehensive outpatient rehabilitation facilities.
  • Rural health clinics.
  • Special care facilities.
  • Outpatient occupational and physical therapy facilities.
  • Ambulatory surgical centers.
  • Birthing centers.
  • Abortion facilities.

HHSC is responsible for investigating allegations of abuse and neglect in these facilities, as well as complaints of substandard care. APS refers such allegations or complaints to the HHSC Complaints Health Facility mailbox.

For concerns about hospital discharge planning, see 4110 Allegations in Hospitals.

See Appendix I: Facilities and Jurisdictions.

4110 Allegations in Hospitals

APS September 2022

APS does not investigate allegations of abuse or neglect that occurs in hospitals. APS refers allegations of abuse, neglect, or financial exploitation of people age 65 or older or adults with disabilities to HHSC, if the allegation has both of the following characteristics:

  • Does not meet APS eligibility criteria.
  • Occurs in a hospital while the client is receiving services, including while admitted, under observation, or in the emergency room.

APS investigates allegations of abuse, neglect, or financial exploitation involving people in hospitals as outlined below.

Allegation

When Does APS Investigate?

An alleged perpetrator abused or neglected a person who is currently in the hospital and is age 65 or older or an adult with a disability.

All of the following criteria are present:

  • The client was not on the premises of the hospital when the alleged abuse or neglect occurred.
  • The client was not under the supervision or service delivery of the hospital when the alleged abuse or neglect occurred.
  • The alleged perpetrator is not affiliated with the hospital.

An alleged perpetrator abused a person in the hospital parking lot who is not receiving hospital services but is age 65 or older or an adult with a substantial impairment.

All of the following criteria are present:

  • The client was not under the supervision or service delivery of the hospital.
  • The alleged perpetrator is a caretaker, family member, or other person with whom the client has an ongoing relationship.

An alleged perpetrator financially exploited a person who is currently in the hospital and is age 65 or older or an adult with a disability.

Both of the following criteria apply:

  • The alleged perpetrator is a caretaker, family member, or other person with whom the client has an ongoing relationship.
  • The alleged perpetrator is not affiliated with the hospital.

Self-neglect of a person who is currently in the hospital and is age 65 or older or an adult with a disability.

All of the following criteria are present:

  • The client was not on the premises of the hospital when the alleged self-neglect occurred.
  • The client was not under the supervision or service delivery of the hospital when the alleged self-neglect occurred.
  • The client will have an ongoing need for protective services upon release from the hospital, after the hospital makes appropriate community referrals for assistance, placement, and care.

If the client dies in the hospital after APS receives the intake, see:

11100 Client’s Death Is Related to Natural Causes, Accident, or Self-Neglect

11200 Client’s Death May Involve a Perpetrator

Hospital Discharge Planning

When an individual is admitted to the hospital, the law requires hospitals to address a patient’s known ongoing needs before discharge. Such needs include appropriate discharge planning and community referrals.

APS may participate in discharge planning as part of its efforts to stabilize the client’s situation if either of the following applies:

  • APS invoked Texas Human Resources Code §48.208 to obtain an Emergency Order for Protective Services (EOPS) to hospitalize the client.
  • APS was involved in persuading the client to seek treatment at the hospital instead of seeking an EOPS.

Hospitals must follow certain guidelines about examination, treatment, and stabilization of the patient. See the Emergency Medical Treatment and Labor Act.

Concerns with Hospital Discharge Planning

When the APS specialist has concerns about a hospital’s discharge planning practices, he or she does as follows:

  • Consults with the APS program administrator or designee.
  • Notifies APS State Office about the concerns by emailing the APS Policy mailbox, if appropriate.

APS district management may speak with hospital staff or management but does not file a formal complaint with HHSC. The APS State Office policy team consults with the director of field operations about the complaint and follows up with HHSC to address any concerns, as appropriate.

Examples of Hospital Discharge with a Need for Ongoing Protective Services

Examples of allegations involving clients that meet the criteria for protective services include, but are not limited to, the following:

  • The client is leaving the hospital against medical advice and lacks capacity to consent.
  • The condition of the client’s home prevents appropriate discharge planning by the hospital. For example, the person cannot return home unless a ramp is installed.
  • The person is returning to a situation where there is ongoing abuse, neglect, or financial exploitation.

Examples of Hospital Discharge Without a Need for Ongoing Protective Services

Examples of allegations involving clients that do not meet the criteria for protective services include, but are not limited to, the following:

  • The person is unable to pay for long-term care or is ineligible for Medicaid funding.
  • The person exhibits inappropriate behaviors that make placement difficult.
  • The person has capacity to consent and refuses the discharge plan, but this does not place him or her in a state of abuse, neglect, or financial exploitation.
  • The hospital is for any reason unable to easily locate a placement.

4200 Allegations Involving HHSC Long-Term Care Regulatory Services

APS January 2022

HHSC Long-Term Care Regulatory Services investigates allegations of abuse, neglect, or financial exploitation in facilities it regulates, including nursing homes.

APS refers allegations of abuse, neglect, or financial exploitation of people age 65 or older or adults with disabilities to HHSC Long-Term Care Regulatory Services if the allegation has both of the following characteristics:

  • Does not meet the criteria for APS involvement.
  • Occurred in a facility regulated by HHSC Long-Term Care Regulatory Services.

To make a referral to HHSC (excluding Provider Investigations), the APS specialist does the following:

  • Calls 1-800-458-9858 or emails the HHSC Complaint and Incident Intake mailbox.
  • Identifies himself or herself as a collateral.
  • Identifies the APS reporter as the actual reporter.
  • Provides the following:
    • APS reporter’s contact information.
    • All available collateral names and contact information.
    • All relevant case information.

The APS specialist may provide additional information if contacted by HHSC but does not release a copy of the case record. To request APS case records, HHSC contacts the DFPS Records Management Group by phone at 512-929-6764 or by email at the Records Management mailbox.

See 4231.1 Allegations in Settings Investigated by HHSC Provider Investigations.

Long-Term Care Ombudsman Program

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

Federal and state authority mandates ombudsmen to do the following:

  • Identify, investigate, and resolve complaints made by, or on behalf of, residents.
  • Provide services to help in protecting health, safety, welfare, and rights.

4210 HHSC Facility-Based Programs

APS January 2022

APS investigates abuse and neglect involving a person living in a facility licensed or operated by HHSC when all the following apply:

  • The abuse or neglect is alleged to have occurred outside the facility.
  • The facility was not responsible for supervision or service delivery for the client at the time the alleged abuse or neglect occurred.
  • The alleged perpetrator is both of the following:
    • A family member, caretaker, or person with an ongoing relationship with the client.
    • Not affiliated with the facility.

APS investigates financial exploitation involving a person living in a facility licensed or operated by HHSC when the alleged perpetrator is both of the following:

  • A family member, caretaker, or person with an ongoing relationship with the client.
  • Not affiliated with the facility.
Examples of When APS Investigates Abuse, Neglect, and Financial Exploitation

Scenario

Does APS Investigate?

A facility resident goes home on a weekend pass with her son. The son slaps her because she refuses to eat dinner.

Yes. The facility resident was not on facility grounds or under the care or supervision of the facility when the incident occurred.

A facility resident’s daughter strikes him while at the facility.

No. Although the alleged perpetrator is not a facility staff member, the client is on the premises of the facility, and the facility is responsible for providing services to him at the time of the alleged incident. As appropriate, APS refers the situation to law enforcement and HHSC for investigation of possible neglectful supervision by facility staff.

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

No. The facility resident is under the care and supervision of the facility at the time of the alleged act, and the alleged perpetrator is a facility staff member. APS refers the situation to HHSC for investigation of the alleged abuse.

A facility resident’s grandson has stopped paying her bill at the facility, causing the resident to be at risk of eviction.

Yes. The alleged perpetrator is a family member who is not affiliated with the facility.

Temporary Safe Environment

APS conducts an investigation if a client is temporarily in an HHSC facility, such as a nursing home or other temporary residence, but will return to a situation of abuse, neglect, or financial exploitation.

See Appendix I: Facilities and Jurisdictions.

4211 Allegations in Nursing Homes

APS January 2022

APS investigates allegations of abuse, neglect, and financial exploitation as outlined in 4210 HHSC Facility-Based Programs.

APS investigates allegations of self-neglect involving a nursing home resident only when all of the following apply:

  • The client was not on the premises of the nursing home when the alleged self-neglect occurred.
  • The client was not under the supervision or service delivery of the nursing home when the alleged self-neglect occurred.
  • The client has an ongoing need for protective services upon release from the nursing home after the nursing home has made appropriate community referrals for assistance and placement.

If the client dies in the nursing home after APS has received an intake, see:

11100 Client’s Death Is Related to Natural Causes, Accident, or Self-Neglect

11200 Client’s Death May Involve a Perpetrator

Examples of Situations Appropriate for APS Investigation

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

  • The person is at risk of eviction because of alleged financial exploitation.
  • The person lacks capacity to consent and is leaving the nursing home against medical advice.
  • The condition of the person’s home prevents appropriate discharge planning by the nursing home. For example, the person cannot return home unless a ramp is installed.
  • The person is returning to a situation where there is ongoing abuse, neglect, or financial exploitation.

Examples of Situations Not Appropriate for APS Investigation

Examples of situations involving people 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 person is being evicted because he or she has chosen to pay other expenses rather than the nursing home bill, but he or she is still eligible for placement at another nursing home or other safe environment.
  • The person has capacity to consent and refuses to participate in the discharge plan, but this decision does not place the person in a state of abuse, neglect, or financial exploitation.
  • The nursing home is having difficulty locating an alternate placement.
4211.1 Financial Exploitation of a Resident of a Nursing Home

APS January 2022

APS may receive an intake when non-payment of bills or imminent eviction have led to concerns of financial exploitation of a nursing home resident. The APS specialist must determine the reason for non-payment of bills, imminent eviction, or both.

APS does not validate (confirm) an allegation of financial exploitation if the alleged perpetrator did not use, or try to use, the client’s resources for the alleged perpetrator’s monetary or personal benefit, profit, or gain.

The APS specialist validates caretaker neglect if the caretaker mismanaged the client’s money but did not commit financial exploitation. For example, this would occur if the caretaker chooses to pay the client’s rent and utilities at home, instead of the nursing home bill, because the client may return home eventually.

APS is not responsible for paying a client’s unpaid nursing home bill that has resulted from financial exploitation or neglect. Instead, the APS specialist intervenes to prevent further financial exploitation or neglect.

See:

8623 Financial Exploitation Allegations

8620 Determination of the Validity of the Allegation

4211.2 Nursing Home Discharge Planning

APS January 2022

Nursing homes must give the resident, resident’s guardian, family representative, or responsible party written notice of discharge at least 30 calendar days before discharge, including eviction, unless danger to the health or safety of the resident or others in the facility requires a more immediate discharge.

The discharge notice must include specific information, including the following:

  • 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 or discharged.
  • Information about the resident’s right to appeal the transfer or discharge.

26 Texas Administrative Code §554.505

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, a family member, or a responsible party to help the resident adjust to his or her new environment after discharge.

26 Texas Administrative Code §554.502

APS may participate in discharge planning as part of its efforts to stabilize the client’s situation if either of the following applies:

  • APS invoked Human Resources Code §48.208 to obtain an Emergency Order for Protective Services (EOPS) to place the client in the facility.
  • APS was involved in persuading the client to move into the facility instead of seeking an EOPS.

See:

4211 Allegations in Nursing Homes

4211.1 Financial Exploitation of 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.

A client is not in a state of self-neglect if he or she meets both of the following criteria:

  • The client is in a safe environment, such as a nursing home.
  • The client has 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 his or her needs.

Concerns with Nursing Home Discharge Planning

When there are concerns with a nursing home’s discharge planning practices, the APS specialist does the following:

  • Consults with the APS program administrator or designee.
  • Notifies APS State Office about the concerns by emailing the APS Policy mailbox, as appropriate.

District management may speak with nursing home staff or management but does not file a formal complaint with HHSC. The policy team in State Office consults with the director of field operations about the complaint and follows up with HHSC to address any concerns.

See Appendix I: Facilities and Jurisdictions.

4212 Allegations in Assisted Living Facilities

APS January 2022

APS investigates allegations of abuse, neglect, and financial exploitation in facility-based programs as outlined in 4210 HHSC Facility-Based Programs.

APS investigates allegations of self-neglect involving an assisted living resident only when the client is unable to provide for himself or herself the protection, food, shelter, or care necessary to avoid emotional harm or physical injury.

If the client dies in an assisted living facility after APS has received an intake, see:

11100 Client’s Death Is Related to Natural Causes, Accident, or Self-Neglect

11200 Client’s Death May Involve a Perpetrator

See also Appendix I: Facilities and Jurisdictions.

Facilities Exempt From Licensure

APS investigates allegations of abuse, neglect, and financial exploitation of clients in boarding home facilities and adult foster care facilities that are exempt from HHSC Long-Term Care Regulatory Services licensure requirements. HHSC Long-Term Care Regulatory Services does not investigate in these facilities.

See 4310 Allegations in Boarding Home Facilities.

Determining Licensure Status

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

Texas Health and Safety Code Chapter 247 requires licensure by HHSC Long-Term Care Regulatory Services for any establishment that furnishes, in one or more facilities, all of the following:

  • Food and shelter.
  • Care for four or more people who are not related to the landlord or owner (proprietor) of the establishment.
  • Personal care services or administration of medication by a person licensed or otherwise authorized in Texas to administer the medication.

When a Facility’s Licensure Status Is Unknown

The APS specialist does the following:

  • Uses the HHSC Licensing, Credentialing & Regulation webpage to determine whether the facility is currently licensed.
  • Determines the number of people not related to the landlord or owner (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. Facilities are considered to be part of the same establishment and subject to licensure based on the following:
    • Common ownership.
    • Physical proximity.
    • Shared services, personnel, or equipment in any part of the facility’s operations.
    • Any public appearance of joint operations or of a relationship between facilities.
  • Determines whether the facility provides personal care. Personal care includes the following:
    • Assistance with eating or feeding, dressing, moving, bathing, personal needs, or personal maintenance.
    • 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 care for three or fewer people who are not related to the landlord or owner (proprietor) of the home.
  • Adult foster homes that are contracted to provide care for three or fewer people who are not related to the landlord or owner (proprietor) of the home.
  • Veterans Affairs medical foster homes in which a trained caregiver is on duty at all times to help people complete activities of daily living.
  • Boarding home facilities, which do not provide personal care, but can 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 I: Facilities and Jurisdictions

4310 Allegations in Boarding Home Facilities

4221 Home and Community Support Services Agencies (HCSSAs)

4222 Adult Foster Care

8500 Allegations Involving Paid Caretakers

4212.1 Allegations in Facilities Requiring an Assisted Living Facility License

APS January 2022

APS investigates abuse, neglect, and financial exploitation involving residents of assisted living facilities (ALFs) requiring a license from HHSC Long-Term Care Regulatory Services, as outlined in 4210 HHSC Facility-Based Programs.

For policy about self-neglect in ALFs, see 4212 Allegations in Assisted Living Facilities.

Discharge Planning and Alternate Placement

Assisted living facilities must give the resident, resident’s legal representative, or member of the resident’s family written notice of discharge at least 30 calendar days before discharge, including eviction, unless danger to the health or safety of the resident or others in the facility requires a more immediate discharge.

The discharge notice must include the following information:

  • 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.
  • Information about the resident’s right to appeal the transfer or discharge.

DADS Rules, 26 TAC §553.125

Unlike nursing homes, assisted living facilities are not required to develop a post-discharge plan of care or ensure 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. See 4212 Allegations in Assisted Living Facilities.

Emergency Situations Involving Facilities Requiring Licensure

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

  • An emergency is discovered after business hours.
  • HHSC Long-Term Care Regulatory Services staff cannot be reached.

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

  • Takes the necessary steps to provide emergency intervention.
  • Emails a detailed summary of the situation to the HHSC CII-DFPS Referrals mailbox.
  • Contacts HHSC Long-Term Care Regulatory Services the next business day to explain the intervention.
  • Verifies that HHSC Long-Term Care Regulatory Services will assume jurisdiction of the case.
  • Closes the case once HHSC Long-Term Care Regulatory Services confirms that it will assume jurisdiction of the case.

Closure of Facilities Requiring Licensure

HHSC can close a facility requiring an ALF license 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.

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

Health and Safety Code §142.011

Health and Safety Code §242.062

Health and Safety Code §247.042

Upon request and according to the memorandum of understanding (MOU) between APS and HHSC, APS helps HHSC find suitable placements for incapacitated people who have no family willing to assist.

Human Resources Code §48.303

4220 HHSC Community-Based Programs

APS January 2022

HHSC licenses home and community support services agencies (HCSSAs) that provide home health, hospice, or personal care assistance services in a person’s home, an independent-living environment, or another appropriate location.

4221 Home and Community Support Services Agencies (HCSSAs)

APS January 2022

Home and community support services agencies (HCSSAs) provide services to people in a residence or independent-living environment. Services offered may include the following:

  • Nursing.
  • Physical, occupational, speech, respiratory, or intravenous therapy.
  • Social services.
  • Dialysis.
  • Personal assistance services.
  • Nutritional counseling.
  • Terminal and palliative care (through hospice agencies).

APS investigates the actions of a HCSSA employee providing non-Medicaid services (caretaker) when an allegation meets both of the following criteria:

  • Involves the abuse, neglect, or financial exploitation of a person age 65 or older or an adult with a disability.
  • Does not occur in a facility that is regulated by another agency.

If the allegation meets these criteria, APS conducts an investigation regardless of whether the employee was in the role of caretaker when the alleged act occurred.

When a family member or other person with an ongoing relationship is also a Medicaid-paid provider with a HCSSA, see 8500 Allegations Involving Paid Caretakers.

If a HCSSA employee is aware of issues that affect a client’s health or safety and fails to report the issues to HCSSA staff responsible for the client’s plan of care, APS investigates the situation as caretaker neglect.

Hospice

Hospice is a program of palliative care consisting of medical, social, and support services to terminally ill patients, when curative treatment is no longer possible. Hospice also provides support services for patients’ families.

Hospice providers must be licensed as a HCSSA and have a contract with HHSC to provide Medicaid hospice services.

Outpatient Hospice

APS investigates allegations of abuse, neglect, and financial exploitation when the client is receiving non-Medicaid hospice services in his or her own home.

Inpatient Hospice

HHSC Long-Term Care Regulatory Services investigates allegations of abuse, neglect, or financial exploitation that happen at inpatient hospice facilities.

APS investigates allegations of abuse, neglect, or financial exploitation of people receiving inpatient hospice services as outlined in 4210 HHSC Facility-Based Programs.

Clinical Issues

Clinical issues are complaints involving HCSSA employees, including direct care aides and licensed professionals (such as licensed vocational nurses and registered nurses), that are directly related to the quality of care provided as part of the employee’s professional responsibilities.

Clinical issues do not meet the criteria for APS investigation.

The APS specialist refers clinical issues and any other allegations involving HCSSA employees, including hospice, that do not meet criteria for APS involvement to the HHSC Complaint and Incident Intake mailbox.

See 8500 Allegations Involving Paid Caretakers.

4222 Adult Foster Care

APS January 2022

Adult foster care homes care for people not related to the owner. The homes are one of the following:

  • Licensed by HHSC as an assisted living facility (four or more beds).
  • Contracted with HHSC as an adult foster care provider (three or fewer beds).
  • Neither licensed nor contracted (three or fewer beds).

This includes Veterans Affairs (VA) medical foster homes.

APS investigates allegations of abuse, neglect, and financial exploitation of people living in adult foster care homes that are either of the following:

  • Contracted through HHSC.
  • Neither licensed nor contracted.

HHSC is responsible for investigating when the facility’s capacity (number of beds) is four or more, even if the facility does not currently have four residents.

See:

4210 HHSC Facility-based Programs

4212 Allegations in Assisted Living Facilities

14300 Due Process for Non-EMR (Employee Misconduct Registry) Cases

Appendix I: Facilities and Jurisdictions

4230 HHSC Protective Service Providers

APS January 2022

There are two programs that investigate allegations of abuse, neglect, and exploitation of vulnerable adults and children in certain settings:

  • HHSC Provider Investigations.
  • DFPS Child Care Investigations (CCI).

4231 HHSC Provider Investigations (PI)

APS January 2022

HHSC PI investigates allegations of abuse, neglect, and exploitation by certain providers, including but not limited to the following:

  • State-operated facilities, such as state supported living centers (SSLCs).
  • Intermediate care facilities for individuals with intellectual disabilities (ICF-IID).
  • Local authorities or community centers.
  • 1915(c) Medicaid-waiver programs, such as Home and Community-based Services (HCS) and Texas Home Living (TxHmL).

HHSC PI also investigates allegations involving people living in an HCS group home, even if they do not get services under the waiver program from the provider.

See:

4221 Home and Community Support Services Agencies (HCSSAs)

4231.11 Allegations Involving the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs

4231.1 Allegations in Settings Investigated by HHSC Provider Investigations

APS January 2022

APS investigates allegations of abuse, neglect, and financial exploitation of clients receiving services from certain providers for mental health or intellectual disabilities when the alleged perpetrator is both of the following:

The client is automatically eligible for APS services when he or she has been determined to qualify for a 1915(c) Medicaid waiver (see 3120 Substantial Impairment).

HHSC Provider Investigations (PI) 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(9).

The following chart describes the type of investigation conducted when a client is receiving services from certain providers for mental health or intellectual disabilities, such as a state supported living center (SSLC) or a local mental health authority.

Where the Alleged Incident Occurred

The Alleged Perpetrator

Who Investigates

Anywhere outside the facility when the facility or community center was not responsible for supervision.

A family member or a person with an ongoing relationship who is not a staff member.

APS

Anywhere inside or outside the facility when the facility or community center was responsible for supervision.

A family member or a person with an ongoing relationship who is not a staff member.

APS investigates the family member or person with an ongoing relationship.

HHSC PI investigates staff members for possible neglect.

Actions Taken by APS

After receiving a report about a client who is receiving services for mental health or intellectual disabilities, the APS specialist does the following:

  • Completes a thorough investigation.
  • If appropriate, contacts the administrator of the facility or provider agency to gain access to employees who may have witnessed an incident that took place on the grounds of the facility.
  • Consults with the supervisor to determine whether a release of information to the facility or provider agency is needed.

If a release of case information, including findings, to the facility or provider is necessary, the APS specialist follows policy in 14300 Due Process for Non-EMR (Employee Misconduct Registry) Cases.

For allegations that do not meet criteria for an APS investigation but fall in the jurisdiction of HHSC Provider Investigations, see 15111.2 Release of Case Records to HHSC Provider Investigations.

4231.11 Allegations Involving the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Programs

APS January 2022

HHSC Provider Investigations (PI) investigates allegations of abuse, neglect, and exploitation of adults and children who receive services from HCS and TxHmL providers.

APS investigates allegations of abuse, neglect, and financial exploitation as outlined in 4231.1 Allegations in Settings Investigated by HHSC Provider Investigations.

When the client is an adult who has a guardian, investigations are conducted as follows:

  • APS investigates the guardian.
  • HHSC PI investigates the HCS or TxHmL provider.

If the provider is also the adult’s guardian, both APS and HHSC PI investigate.

Emergency Protective Services During an HHSC PI Investigation in an HCS Program

During an investigation, an HHSC PI investigator may determine that an adult receiving services from an HCS provider, either through a waiver or through another payment method, is unsafe and requires immediate intervention. In this situation, the HHSC PI investigator contacts Statewide Intake (SWI) to make a referral for assistance from APS.

Some people who require emergency protective services participate in the HCS waiver service program and automatically meet criteria for substantial impairment. Others may not be enrolled in the HCS waiver program and need to be assessed for substantial impairment.

APS provides emergency protective services to the person, and the HHSC PI investigator continues the investigation involving the HCS provider.

When the APS specialist receives the intake, he or she immediately contacts the HHSC PI investigator to do the following:

  • Make the case initiation contact, as required by policy.
  • Determine the nature and extent of the emergency and what emergency protective services are necessary.

If it appears an emergency does exist, the APS specialist does the following:

  • Attempts to make a face-to-face contact within the time frame for the priority, including completing the Safety Assessment and marking the appropriate danger factor.
  • Authorizes purchased client services, if appropriate, only until the HCS administrator, HHSC Long-Term Care Regulatory Services, or another resource provides the required services.
  • Works jointly with the HHSC PI investigator to resolve the emergency situation.
  • Validates self-neglect, unless the client has a guardian.
  • Completes the Risk of Recidivism Assessment.
  • Closes the case once the required services are in place through another source or the situation has been stabilized.

See 15127 Release of Case Information to Entities Responsible for Protecting Clients.

4231.2 Allegations in Settings Regulated by HHSC Child Care Regulation (CCR)

APS January 2022

Regulation

HHSC Child Care Regulation (CCR) regulates child care institutions that provide any of the following for all or part of the day for children who are not related by blood, marriage, or adoption to the owner or operator:

  • Assessment
  • Care
  • Training
  • Education
  • Custody
  • Treatment
  • Supervision

These institutions include emergency shelters, residential treatment centers, halfway houses, maternity homes, therapeutic camps, foster family homes, and foster group homes.

Investigation of Allegations and Complaints

DFPS Child Care Investigations (CCI) investigates allegations of abuse and neglect of children in licensed day care and residential child care facilities.

APS investigates allegations of abuse, neglect, or financial exploitation in facilities licensed by HHSC CCR when all of the following apply:

  • The client is an adult with a disability who is a resident of a residential child care facility.
  • A facility employee, contractor, or volunteer is the alleged perpetrator.
  • The alleged acts occurred when the facility had responsibility for care and supervision of the client.

The APS specialist refers allegations and complaints as follows:

  • Allegations of abuse and neglect of a resident under age 18 are referred to DFPS CCI, as appropriate.
  • Concerns or complaints about violations of minimum standards in a residential child care facility are referred to HHSC CCR, as appropriate.

Before releasing information about the investigation to the administrator of the residential child care facility, the APS specialist must follow due process procedures.

See Appendix I: Facilities and Jurisdictions.

4300 Allegations in Other Settings

4310 Allegations in Boarding Home Facilities

APS January 2022

APS investigates allegations of abuse, neglect, and financial exploitation in boarding home facilities as outlined below.

When a boarding home facility is operating as an unlicensed assisted living facility, APS refers allegations to HHSC Long-Term Care Regulatory Services, as outlined in 4212 Allegations in Assisted Living Facilities.

What Is a Boarding Home Facility?

A boarding home facility is an establishment that meets all of the following criteria:

  • Furnishes housing in one or more buildings to three or more people who are unrelated to the owner by blood, marriage, or adoption and who are adults with disabilities or people age 65 or older.
  • Provides community meals, light housework, meal preparation, transportation, grocery shopping, money management, laundry services, or help with self-administration of medication (as defined in HSC Section 260.001) but does not provide personal care services as defined by HSC Section 247.002.

Health and Safety Code Chapter 260

If a home is providing personal care services or has four or more residents, refer to 4212 Allegations in Assisted Living Facilities to determine investigative jurisdiction.

See:

Appendix I: Facilities and Jurisdictions

When a Facility’s Licensure Status Is Unknown under Determining Licensure Status in 4212 Allegations in Assisted Living Facilities

Determining the Perpetrator Role

The relationship between a resident and staff (including the owner) of a boarding home facility is often only that of a tenant and staff or landlord. APS does not investigate allegations when this is the only relationship between the client and perpetrator.

APS investigates abuse, neglect, or financial exploitation by a boarding home’s staff or owner only when one of the following applies:

  • The person has an ongoing relationship with the client.
  • The person is the client’s representative payee.

Some allegations concerning a boarding home’s staff or owner may be subject to law enforcement investigation only.

Investigations Involving Boarding Home Facilities

When allegations involve a resident of a boarding home facility, the APS specialist does the following:

  • Determines whether the alleged act meets the APS definition of abuse, neglect, or financial exploitation.
  • Determines whether the alleged perpetrator is subject to APS investigation.
  • Determines whether the home meets the definition of a boarding home facility, and does one of the following:
    • Investigates the allegations if the home meets the definition.
    • Refers the allegations to the HHSC CII-DFPS Referrals mailbox if the home does not meet the definition of a boarding home facility.

See:

When a Facility’s Licensure Status Is Unknown under Determining Licensure Status in 4212 Allegations in Assisted Living Facilities

4212.1 Allegations in Facilities Requiring an Assisted Living Facility License

Appendix I: Facilities and Jurisdictions

4320 Allegations Involving Schools

APS January 2022                                                                                                           

APS investigates allegations of abuse, neglect, and financial exploitation involving schools when all of the following apply:

  • The client is an adult with a disability who is a student at the school.
  • A school employee, contractor, or volunteer is the alleged perpetrator.
  • The alleged act occurred when the school had responsibility for care and supervision of the client.

APS cooperates with school officials when investigating allegations of abuse, neglect, and financial exploitation of adults with disabilities by school personnel.

The APS specialist refers allegations of abuse and neglect of a student younger than 18 years old to Child Protective Investigations as appropriate.

See 14500 Cases Involving School Personnel.

Notifications at Initiation of Investigation

Before the initial face-to-face contact with the client, the APS specialist notifies the following people that a report has been assigned for investigation:

  • The school principal (or the school superintendent if the school principal is an alleged perpetrator).
  • The client’s caretaker.

These notifications help ensure the immediate safety of the client.

The APS specialist requests that the school principal (or the school superintendent) not alert the alleged perpetrator or possible collaterals about the report until the APS specialist has interviewed them.

The APS specialist has the discretion to allow school personnel or others who ordinarily support the client to be present during the interview or examination of the client if both of the following criteria are met:

  • It will not compromise the integrity of the investigation.
  • The person is not a principal or collateral in the current investigation.

See:

14500 Cases Involving School Personnel

14530 Notification of Final Findings for School Personnel

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