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10000 Providing and Arranging for Services

APS February 2021

APS may provide protective services to a person who meets both the following criteria:

  • Is age 65 or older or is an adult with a disability, or both.
  • Is in a state of abuse, neglect, or financial exploitation, as validated during an APS investigation.

Providing Services Regardless of Financial Resources

APS provides protective services without regard to the client’s income or resources. However, the APS specialist assesses whether the client has resources to pay for services without the use of purchased client services (PCS) funds. APS uses PCS funds for the protection of the client’s life and safety in compliance with state and federal law.

Texas Human Resources Code §48.205

Providing Services to a Family Member or Caretaker

APS may also provide protective services to a family member or a caretaker if APS determines that such services are necessary to alleviate abuse, neglect or financial exploitation or to prevent the client from returning to a state of abuse, neglect or financial exploitation.

These services may include the following:

  • Social casework.
  • Case management.
  • Arrangement of the following:
    • Psychiatric and health evaluation.
    • Home care.
    • Day care.
    • Social services.
    • Health care.
    • Respite services (to give the caretaker a break from caretaking).
    • Other services.

The term protective services does not include conducting an investigation of alleged abuse, neglect, or financial exploitation of an alleged victim.

An APS specialist provides or arranges protective services. The APS specialist works with the client and the family member or caretaker to make sure that the services will alleviate the abuse, neglect, or financial exploitation of the client. Services provided to a caretaker or family member do not require a review of the financial circumstances of the client or recipient. However, it is important for everyone involved to understand that APS will provide the services only for a limited time.

Examples

The table below provides examples of situations in which APS may use PCS to provide services to a client’s family member or caretaker.

Situation

Use of PCS

The client is a man age 65 or older who is unable to perform any of his activities of daily living (ADLs) and has mild dementia.

His four adult children constantly argue about what is best for their father. The siblings disagree whether the client should either:

  • Participate in a senior day care program.
  • Live in a nursing home.

The siblings also disagree about who has the authority to make decisions on their father’s behalf.

The siblings try to prevent each other from seeing their father. This has caused the father to become upset and depressed.

The APS specialist may use PCS funds to pay a family counselor or a professional mediator to work with the family to develop a plan that best serves the client’s needs.

The client is a young woman with a physical disability that prevents her from performing any of her ADLs. Her only caretaker is her mother.

The client’s physical therapist is concerned that the mother is experiencing caretaker burnout based on observations of the mother when she brings her daughter for treatments. He has noticed the following:

  • The client isn’t as clean and well-dressed as she used to be.
  • The mother speaks in a sharp tone to her daughter. He has never observed this behavior until lately.

The APS specialist may use PCS funds to arrange for the mother to receive temporary help (for example, respite care) and individual counseling.

Providing Services during the Case

APS may deliver protective services in every stage of a case, including the following:

  • The Investigation stage, to address short-term needs.
  • The Maintenance stage, to stabilize a low-risk situation.
  • The Intensive Case Services stage, to address the more complex root causes of a client’s abuse, neglect, or financial exploitation.

APS may provide protective services to a person who is age 65 or older or is an adult with a disability when either of the following apply:

  • The person gives his or her consent to receive protective services.
  • The person lacks the capacity to consent and meets conditions in Human Resources Code §48.208.

See also:

3100 Alleged Victim Eligibility

3120 Substantial Impairment

8210 Alleged Victim Refuses to Cooperate With APS Investigation

10910 Assessing the Need for Purchased Client Services

Human Resources Code §48.002(a)(5); §48.204

10100 Service Delivery Goals

APS February 2021

The goal of service delivery is to alleviate current and future risk of abuse, neglect, or financial exploitation. The APS specialist completes the Safety Assessment, Risk of Recidivism Assessment, and Strengths and Needs Assessment to do the following:

  • Promote client safety.
  • Identify the client’s strengths and needs.
  • Reduce current harm and future risk of harm to the client.

Steps the APS specialist may take to achieve these goals include, but are not limited to, the following:

  • Offering actions or services, or both, to resolve identified problems.
  • Finding and coordinating community resources.
  • Evaluating the effectiveness of provided services.
  • Modifying services as the client’s situation changes.
  • Pursuing necessary legal intervention.
  • Providing temporary emergency services.
  • Deciding when APS has provided all necessary protective services and the client’s case is stable enough for closure.

See 14200 Service Stage Closure.

Cultural Competency in Service Delivery

The APS specialist develops service plans in a culturally competent manner by doing the following:

  • Adapting the planning process to meet the client’s needs within his or her cultural context.
  • Accepting differences and using positive cultural strengths in the service planning process.

See also 1210 Cultural Sensitivity.

10200 APS Service Plan

APS February 2021

The APS specialist works with the client to develop a service plan in accordance with Human Resources Code §48.203, Voluntary Protective Services. The client may choose to do any or all of the following:

  • Receive voluntary protective services, if the client requests or consents to receive those services.
  • Participate in all decisions about his or her welfare, if able to do so.
  • Withdraw or refuse consent, in which case the APS specialist may not provide services, except in situations described in Human Resources Code §48.208.

When to Develop the APS Service Plan

The APS specialist develops a service plan when any of the following apply:

  • APS or others conduct immediate interventions as part of the Safety Assessment.
  • There is harm to be addressed related to a validated allegation.
  • The APS specialist has completed a Strengths and Needs Assessment or reassessment.

Developing a service plan begins in the Investigation stage and continues throughout the service delivery stages as APS identifies the client’s needs.

Example

During the initial face-to-face contact with the alleged victim, the APS specialist finds that the alleged victim is without life-sustaining medications (Immediate Intervention). During the investigation, APS learns that the alleged victim is also without food on a regular basis (Services Related to Valid ANE) as a result of the alleged victim’s grandson having access to the checking account. The specialist takes steps to remedy the financial exploitation to alleviate further maltreatment (Intensive Case Services).

How to Develop the APS Service Plan

When developing a service plan, the APS specialist considers all of the following:

  • The client’s and APS specialist’s perceptions of the problem, including the conditions that contributed to current dangers or that appear to be the underlying cause of abuse, neglect, or financial exploitation.
  • The client’s and caretaker’s areas of strength and areas of need.
  • The client’s motivation and capacity to address the problem.
  • The resources available.

The APS specialist does the following when developing a service plan:

  • Works cooperatively with the client to develop the service plan.
  • Counsels the client to make sure that the client understands the limitations and intent of PCS, including appropriate financial management, when the APS specialist is using PCS.
  • Develops a long-term plan for addressing the root problem.
  • Uses available government, community, or private resources before PCS.

Client’s Participation in Service Planning

If the client is able to participate, the APS specialist involves him or her in developing the service plan. The APS specialist does the following:

  • Makes all reasonable efforts to resolve each problem.
  • Respects the right of a client to consent to or refuse protective services, if the client has the capacity to do so, except in cases that are covered in Human Resources Code §48.208.

The APS specialist documents the client’s participation in developing the service plan by marking the Client participated in service delivery checkbox on the APS Investigation Conclusion page in IMPACT.

A specific statement about the client’s participation is not required in the narrative. However, the APS specialist does not mark the checkbox in a way that contradicts information in the narrative.

How to Document the APS Service Plan

The Service Plan page in IMPACT is for the APS specialist to do the following:

  • List all problems that APS identified.
  • Document a description of each problem identified during the investigation or in the Strengths and Needs Assessment.
  • Document a description of each action that APS or others will take.
  • Choose the appropriate Action Category to identify who took each action to alleviate identified problems. See 10241 Action Categories.
  • Indicate the results of each action taken (or that services were not available). See 10242 Action Results.
  • Indicate the final outcome for each problem. See 10243 Outcomes.
  • Document (in the Contact Standards section) the frequency and types of contacts necessary to monitor the progress of the service plan.

Each problem listed on the service plan can have multiple actions, and individual actions can address multiple problems.

See:

8140 Current Danger Factors and Immediate Interventions

9520 Service Contacts

10240 Entering Action Categories, Action Results, and Outcomes in the Service Plan

11210 Strengths and Needs Assessment

10210 Offering the Least Restrictive Alternative

APS February 2021

A primary goal of APS is to help clients stay safe in the least restrictive environment.

Example

A client has difficulty managing money to make the client’s income last through the month. The APS specialist recommends financial counseling as a first step toward solving the problem, provided that this has not been offered and proven ineffective in the past. A representative payee service (in which someone else manages the client’s money on the client’s behalf) is a more restrictive option, so APS only offers it after less restrictive options have proven ineffective.

See also:

9520 Service Contacts

10200 APS Service Plan

10230 Making a Reasonable Effort

10220 Using Legal Alternatives (Court Actions)

APS February 2021

If the service plan includes legal alternatives, the APS specialist refers to 13000 Legal Actions, Legal Documents, and Other Non-Legal Remedies and its subitems.

The APS specialist gets supervisory approval before encouraging, helping with, or advocating for any legal actions.

Exception: The supervisor’s approval is not required if someone other than DFPS is applying to get a protective order.

The APS specialist consults with the regional attorney before taking action on behalf of DFPS to do either of the following:

Documenting Legal Actions in the Service Plan

The APS specialist documents any legal actions taken by doing as follows:

  1. Choosing Legal Action in the Action Category section of the APS Service Plan page.
  2. Documenting a description of the legal action taken in the Action Description section of the APS Service Plan page.
  3. Completing the Legal Action page.
  4. Completing the Guardianship Detail page, if appropriate.

See also:

Documentation Requirements under How to Help Someone Apply for Guardianship in 7221 Relative or Other Person as Guardian

10200 APS Service Plan

13140 Required Documentation of Legal Actions

10230 Making a Reasonable Effort

APS February 2021

The APS specialist makes all reasonable efforts to resolve problems, including root causes, and to stabilize the client’s condition. The APS specialist determines on a case-by-case basis what qualifies as reasonable effort and what is stabilized.

Full resolution of a client’s problems is always the goal of APS casework, but it is not always achievable. In some cases, full resolution is not a practical goal because of inadequate resources, client resistance, or some other obstacle. In such cases, the APS specialist closes the case when the client’s situation is as close to stable as possible.

The phrase reasonable effort implicitly recognizes the following:

  • The client’s personal choices may limit the effectiveness of APS intervention.
  • Resources available to APS for helping clients are limited.
  • APS cannot remedy all situations.

Reasonable efforts include the following:

  • Searching for a solution among available regional resources, if resources are unavailable locally.
  • Searching for a solution in other parts of the state, if those services meet the client’s needs.
  • Using purchased client services (PCS), when appropriate, if other resources are unavailable and PCS can meet the client’s needs.
  • Changing the service plan if an action fails to solve the problem, and a different action is likely to be more effective.
  • Evaluating services continually to make sure they are effective.
  • Recognizing that some problems cannot be solved if the resources are not available in the region or in other parts of the state.
  • Recognizing that some clients are not willing to change their circumstances.

Reasonable efforts do not include the following:

  • Keeping a case open indefinitely because a resource might eventually become available.
  • Making a positive outcome a requirement to close the case.
  • Doing more for one client than DFPS would do for another in the same situation.

See also:

14120 Supervisory Review of Investigation Stage Closure

14220 Supervisory Review of Service Stage Closure

10240 Entering Action Categories, Action Results, and Outcomes in the Service Plan

APS February 2021

Each problem identified on the service plan requires at least one action (identified in Action Description). Each action requires at least one Action Category and Action Result. Each problem requires one overall Outcome. The tables in the subitems of this section provide guidance to help the APS specialist choose the appropriate action categories, action results, and outcomes to complete the service plan.

See:

8100 Safety Assessment

10200 APS Service Plan

10243 Outcomes

Action Results and Outcomes

Once the actions to complete the service plan occur, the APS specialist monitors these actions to determine their results and the problem’s final outcome.

The APS specialist chooses an Action Result on the APS Service Plan page in IMPACT for each completed action.

Once APS determines an overall outcome for the problem, the APS specialist chooses an Outcome on the APS Service Plan page for each problem that best describes the disposition of the problem.

See:

9510 Safety Contacts

9520 Service Contacts

10240 Entering Action Categories, Action Results, and Outcomes in the Service Plan

10241 Action Categories

APS February 2021

The table below shows the options for Action Category and describes each category.

Action Category

Description

Action by Family Members, Neighbors, or Friends

This refers to applying the family’s own strengths as resources and using extended family members, neighbors, or others to alleviate safety concerns or identified problems.

Examples include, but are not limited to, engaging a family member, neighbor, or friend to give the client temporary help, shelter, or care.

Action by Community or Governmental Agencies or Services (not purchased client services)

This includes involving a community- or faith-based organization, tribal council, or other agency in activities to address safety concerns or identified problems.

Examples of services that fall under this category to address safety concerns include, but are not limited to, the following:

  • Immediate psychological or medical evaluation.
  • Emergency home health care services.
  • Access to emergency food, shelter, and medication.
  • Utility assistance.
  • Major cleanup and repair services.
  • Services from any of the following:
    • Public health authority
    • Housing inspectors
    • 911
    • Animal control

Examples of services that fall under this category to address a problem related to a valid allegation of abuse, neglect, or financial exploitation or to needs identified during the Intensive Case Services (ICS) stage include, but are not limited to, the following:

  • Long-term therapy.
  • Treatment.
  • Referrals.
  • A waiting list for services.

APS-Direct Provision of Services (not including the investigation or assessment itself)

This refers to actions that the APS specialist or other APS staff members take that specifically address one or more current danger factors or other identified problems.

Examples include, but are not limited to, delivering materials from APS resource rooms or delivering medication or food.

Legal Action

This includes actions that law enforcement, APS, or another agency takes to make sure the client is safe.

Placement

This refers to removing a client from the home and placing him or her in a hospital, nursing home, or other alternate care facility.

Purchased Client Services

This includes any goods or services purchased (or pledged to be purchased) using purchased client services (PCS) funds.

Other Safety Intervention

This refers to unique interventions that the client, family, or APS specialist identifies to address a specific safety concern or problem and that do not fit within the other categories of actions.

10242 Action Results

APS February 2021

The table below lists the options for Action Result and describes each of them.

Action Result

Description

Action Successful

The action was successful in addressing and alleviating a specific safety concern or identified problem.

Action Unsuccessful

The action was not successful in addressing or alleviating a specific safety concern or identified problem.

Client Refused Services or Withdrew

APS offered the client services to address a specific safety concern or identified problem, but the client did one of the following:

  • Refused services.
  • Initially agreed to services, but withdrew before completing services or using them to their fullest intended extent.

Caretaker Refused Services or Withdrew

The caretaker did one of the following:

  • Refused services.
  • Initially agreed to services, but withdrew before completing services or using them to their fullest intended extent.

Examples of caretaker refusal or withdrawal from services include the following:

  • APS offers services to help him or her alleviate the client’s safety concerns or identified problems, but the caretaker refuses to accept these services.
  • APS offers services to address the role he or she may have had in creating the safety concerns or identified problems, including as an alleged perpetrator. The caretaker accepts services but then withdraws from the service plan.

This Action Result also applies when the caretaker refuses to participate in protective actions that APS is offering to the client.

No Services Available

The APS specialist has made reasonable efforts to address all identified problems but is still unable to secure a long-term solution, or the client does not qualify for necessary services.

10243 Outcomes

APS February 2021

The table below lists the options for Outcome and explains appropriate reasons for choosing each of them.

Outcome

Reason

Yes – Problem Resolved

The actions resolved the safety concern or problem.

No – Moved/Unable to Locate

Client has moved to another state, or despite reasonable efforts, APS has been unable to find the client.

No – Efforts or Services Exhausted or Insufficient

The actions did not resolve the safety concern or problem because available services were insufficient to alleviate it.

The APS specialist marks this Outcome if either of the following happens:

  • The caretaker refused services (or withdrew), and APS has exhausted all other efforts to address the safety concern or problem.
  • The client engaged in services, but these services were not successful in addressing the safety concern or problem, and there are no more services that APS could provide to (or arrange for) the client.

No – Client Has Refused All Actions/Withdrawn

Either of the following applies:

  • The client originally accepted, but has since withdrawn from all actions and services.
  • The client refused all services that APS offered.

N/A – Client Died

The client died during the open APS case.

10250 Monitoring the Service Plan

APS February 2021

The goals of monitoring the service plan are to ensure the following:

  • The client is safe.
  • The actions that APS and others are taking are appropriate and effective.
  • The client is not at risk of further abuse, neglect, or financial exploitation.

The APS specialist accomplishes this by making contacts with the client and collaterals throughout the case.

The APS specialist reviews the service plan at least every 30 calendar days to determine whether issues have been resolved. If they have not been resolved, the APS specialist does the following:

  • Determines what revisions, if any, the service plan needs.
  • Continues to review and monitor the service plan until all identified problems have an outcome.

See 10200 APS Service Plan.

10300 Possible Lack of Capacity to Consent When a Client Refuses or Withdraws from Services

APS February 2021

When a client refuses or withdraws from services, this may indicate a lack of capacity to consent. A client may lack the capacity to consent if physical or mental impairments make the client unable to understand the nature of protective services offered and also unable to understand the consequences of agreeing to or refusing protective services.

APS considers the following factors:

  • Danger factors identified on the Safety Assessment or Safety Reassessment.
  • Any other indicators (signs) of a possible lack of capacity, such as difficulty recognizing problems and making or carrying out plans to address them.

The APS specialist’s opinion about a client’s decision-making capacity is never the sole basis for not providing services to a client whom APS has determined to be unsafe. APS seeks an evaluation from a medical or mental health professional to determine whether the client is physically or mentally capable of making informed decisions about the need for protective services.

APS acts quickly when a client is at risk of harm. APS seeks legal action when both of the following apply:

  • The client is at high risk of harm.
  • A medical or mental health professional has determined that the client lacks the ability to make informed decisions.

In emergency situations, APS may provide emergency protective services before obtaining a medical or mental health assessment.

See also:

10000 Providing and Arranging for Services

13500 Original Petition for Emergency Order for Protective Services (EOPS)

10310 Assessing Indicators (Signs) of a Lack of Capacity to Consent

APS February 2021

When a client is reluctant to accept APS involvement, it is important for the APS specialist to evaluate the client’s ability to make informed decisions about his or her need for services.

In these cases, the APS specialist reviews the Safety Assessment or Safety Reassessment to determine whether any of the identified danger factors indicate a possible lack of capacity.

Certain conditions may not be evident during the initial interview with the client. Examples of these conditions include:

  • Dementia.
  • Severe depression.
  • Suicidal ideation (thoughts of suicide).
  • Undue influence of someone else on the client.
  • Delirium.

The APS specialist conducts more visits as necessary to determine whether there are signs that a client lacks capacity to consent to services.

See also 8210 Alleged Victim Refuses to Cooperate With APS Investigation.

10320 Client Refusing or Withdrawing from Services

APS February 2021

Client Refuses Protective Services

The APS specialist consults with the supervisor or subject matter expert (SME) when a client refuses services and APS has determined the client to be unsafe, conditionally safe, or high risk because of a mandatory override. The reasons for this consultation are as follows:

  • To discuss additional case actions to try to gain the client’s cooperation.
  • To determine whether a medical or mental health assessment is necessary.

The APS specialist may try to gain the client’s cooperation before closing the case if the client refuses services but APS has determined the client to be safe.

The APS specialist must complete the Risk of Recidivism Assessment whenever a client refuses services, regardless of the safety decision or risk level.

See also:

8210 Alleged Victim Refuses to Cooperate With APS Investigation

8700 Risk of Recidivism Assessment (RORA)

9700 Subject Matter Expert (SME) Consultations

10330 Seeking Medical or Mental Health Evaluations

Client Withdraws from Services

If a client initially accepts services and then withdraws from services (after a valid finding), the APS specialist does the following:

  • Attempts additional home visits to gain the client’s cooperation. This includes, at a minimum, one successful face-to-face visit and a second successful or attempted follow-up face-to-face visit.
  • Consults with the subject matter expert (SME), as needed.
  • Consults with the supervisor to determine whether there is enough reason to get a professional evaluation of the client’s capacity to consent.

The supervisor may waive the requirement for additional home visits. This applies especially if the client has indicated that he or she does not want APS services and the supervisor believes, based on the APS specialist’s observations, that the client may feel harassed by continued APS visits.

Documentation When a Client Refuses or Withdraws from Services

When a client with the capacity to consent refuses or withdraws from services, the APS specialist does the following:

  • Documents the services offered in the Action Description, Action Category, and Action Result fields of the APS Service Plan.
  • Chooses No – Client has refused all actions/withdrawn in the Outcome field of the APS Service Plan.
  • Chooses one of the following closure reasons:
    • Client Refused Services on the Investigation Conclusion page.
    • Client Withdrew from Services on the Stage Closure page in the Maintenance or Intensive Case Services (ICS) stage.

When a client with questionable capacity refuses or withdraws from services, the APS specialist documents the following:

  • The services offered and the client’s refusal or withdrawal, in the APS Service Plan.
  • The consultation with the supervisor or subject matter expert about additional case actions, if the specialist will take any.

See:

8700 Risk of Recidivism Assessment (RORA)

9600 Supervisor Consultations

9700 Subject Matter Expert (SME) Consultations

14110 Investigation Stage Closure Codes

10330 Seeking Medical or Mental Health Evaluations

APS February 2021

During a case, the APS specialist may determine that both of the following apply:

  • The client is in a state of ongoing abuse, neglect, or financial exploitation.
  • The client is refusing or withdrawing from services.

The actions that the APS specialist takes, along with the supervisor or subject matter expert (SME), depend on the client’s level of safety. Seeking a medical or mental health evaluation is not always necessary but may be appropriate in some situations, as described below.

When the Client Is Unsafe

If APS determines that the client is unsafe, the APS specialist consults with the supervisor or SME to determine whether a medical or mental health evaluation is necessary.

If an evaluation is necessary, the APS specialist does the following:

  1. Arranges to have one of the following professionals evaluate the client:
    • Physician
    • Registered nurse
    • Physician assistant
    • Advanced practice nurse
    • Licensed psychologist
    • Licensed professional counselor
    • Master social worker
  2. Obtains from the professional a written statement of the following:
    • The client’s capacity (or lack thereof) to consent to services.
    • The client’s physical and mental condition, if the client is at serious risk of harm.
  3. Uses the written statement to determine whether an emergency order for protective services (EOPS) is necessary.

When the Client Is Safe or Conditionally Safe

In some cases when APS determines that the client is safe or conditionally safe, the APS specialist may have concerns about one or more of the following:

  • The client’s capacity.
  • Actions or services the client agreed to, which may fail or not take place at all if the client withdraws.

The APS specialist consults with the supervisor or SME to determine whether a medical or mental health evaluation is necessary or a referral to the Health and Human Services Commission (HHSC) Office of Guardianship Services (OGS) is appropriate.

If an evaluation is necessary, the APS specialist does the following:

  • Arranges to have a physician evaluate the client.
  • Obtains from the physician a verbal or written statement of the client’s capacity (or lack thereof) to consent.
  • Refers the client to the HHSC OGS program, if appropriate.

Documentation for Seeking Medical or Mental Health Evaluations

The APS specialist does the following:

  • Documents the supervisory or SME consultation about the possible need for a medical or mental health evaluation. The APS specialist completes a Contact Detail page with the appropriate Contact/Summary Type and records the consultation in the Narrative section of the page.
  • Files any written statements in the paper case file.
  • Enters any written statements or medical records or assessments that APS has obtained on the External Documentation page.
  • Documents related legal actions on the Legal Action/Outcome page.

See:

7300 Referrals to HHSC Office of Guardianship Services (OGS)

8100 Safety Assessment

9000 Case Contacts

9600 Supervisor Consultations

9700 Subject Matter Expert (SME) Consultations

10320 Client Refusing or Withdrawing from Services

13140 Required Documentation of Legal Actions

13500 Original Petition for Emergency Order for Protective Services (EOPS)

14110 Investigation Stage Closure Codes

16220 Maintenance of External Case Files

Human Resources Code §48.208

10400 Community-Based Long-Term Care

APS February 2021

The Texas Health and Human Services Commission (HHSC) operates programs that provide community-based long-term care in the client’s own home, neighborhood, or community. These programs are an alternative to institutional care.

See the HHSC website for more information.

10410 Service Planning and Community-Based Long-Term Care

APS February 2021

When developing a service plan with the client, the APS specialist considers services offered by HHSC’s Long-Term Care Regulatory Services division when all of the following are true:

  • The allegations are valid, and the client is in a state of abuse, neglect, or financial exploitation.
  • The services will alleviate the abuse, neglect, or financial exploitation.
  • The client has the capacity to consent.
  • The client has accepted services that APS has offered.

10420 Access to HHSC Long-Term Care Services

APS February 2021

The APS specialist helps the client get community-based long-term care by doing the following:

  • Contacting the local long-term care ombudsman to request services.
  • Communicating with the HHSC community care worker about the level of urgency of the client’s health condition.
  • Cooperating with the HHSC community care worker to help the client get and complete applications.
  • Cooperating with the HHSC community care worker to help the client get any necessary verification documents.
  • Attending the initial assessment appointment, if needed.
  • Verifying with the HHSC community care worker which services the client is eligible for.
  • Verifying with the HHSC community care worker whether services are immediately available.

10430 HHSC Long-Term Care Services Not Available

APS February 2021

This section applies if a client is eligible for HHSC long-term care services but services are not immediately available.

In this situation, the APS specialist addresses the abuse, neglect, or financial exploitation before closing the case. The specialist does this by working with the client and the HHSC community care worker to determine whether the client meets the criteria to bypass the interest list.

If the client meets the criteria, the HHSC community care worker follows the HHSC procedures for bypassing the interest list.

If the client does not meet the criteria to bypass the interest list, the APS specialist does the following:

  • Makes sure HHSC adds the client’s name to the interest list.
  • Makes sure the client has access to other available community services, working jointly with the HHSC community care worker.
  • Consults with the APS subject matter expert (SME) in the district or another part of the state to identify comparable services to offer the client.
  • Offers more restrictive alternatives until community-based care services become available.
  • Helps the client access community resources that may provide necessary community-based care until HHSC services become available.

For information on using purchased client services (PCS) funds for personal attendant care, refer to the PCS Guide on the APS Resources page of the DFPS intranet.

See also 10230 Making a Reasonable Effort.

When a Client Refuses Alternative Services

The APS specialist makes sure that the client is on the appropriate interest list, and the specialist closes the case, if both of the following apply:

  • Community-based care is not available.
  • The client has the capacity to consent and refuses more restrictive alternatives.

See also 10230 Making a Reasonable Effort.

10500 Clients with Intellectual Disabilities or Mental Health Diagnoses Receiving Services from HHSC

APS February 2021

The Health and Human Services Commission (HHSC) provides case management services to people in the community who need those services. See the HHSC webpage about services for people with disabilities. The local area authorities for intellectual disabilities and mental health services provide information on who is eligible for or is receiving those services.

APS Intakes Involving Clients with HHSC Case Management

When APS receives an intake involving a client who is receiving HHSC case management services, the APS specialist does the following:

  • Accepts the intake if there are allegations of abuse, neglect, or financial exploitation.
  • Begins an investigation of the allegations, including a discussion with the HHSC case manager about the allegations.
  • Assesses the client.
  • Determines the validity of each allegation.
  • Identifies the client’s needs, working with the HHSC case manager, if possible.

Procedures for Valid APS Cases

The APS specialist does the following if any of the allegations are Valid:

  • Meets with the HHSC case manager about the case, to get information about the case manager’s treatment plan for the client.
  • Assesses the roles and responsibilities of APS and HHSC with regard to meeting the client’s needs.
  • Documents in the APS Service Plan in IMPACT the actions that the HHSC case manager will complete and the actions that APS will complete.

Avoiding Duplication of Services

DFPS provides services to remedy abuse, neglect, and financial exploitation, but its staff also avoids duplication of services between agencies. This prevents two agencies from doing either of the following:

  • Using federal funds for the same purpose.
  • Providing services that are unnecessary because the other agency is already meeting the client’s needs.

See also:

4100 Allegations Involving HHSC Health Care Facilities

4200 Allegations Involving HHSC Long-Term Care Regulatory Services

10600 Financial Exploitation and Service Delivery

10610 Financial Exploitation by a Fiduciary

APS February 2021

A fiduciary is a person acting in a formal position of trust, often in a financial capacity.

If APS determines that financial exploitation by a fiduciary has occurred, the APS specialist discusses available remedies with the client. The remedies listed in the table below are provided for information purposes only. To pursue these legal options, the client hires a private attorney. APS cannot provide legal representation or help in such a matter.

If there is misconduct by a …

then remedies may include …

representative payee for the Social Security Administration (SSA), Department of Veterans Affairs (VA), or other federal benefits, …

  • changing representative payee.
  • notifying the agency that issues the payments. Its fraud and abuse division can investigate.

agent or attorney-in-fact (one who acts for another under a power of attorney (POA)), …

  • revoking the POA. POAs can be revoked at any time and in any manner.
  • hiring a private attorney, through whom the client may demand an accounting from the agent or attorney-in-fact. State law (Estates Code §751.103) identifies POA agents as fiduciaries and requires them to keep detailed records of all transactions they make with the principal’s (client’s) assets. They must also provide an accounting to the principal within 60 days of it being demanded. If the agent fails to provide the accounting, the principal may go to court to have it ordered.

trustee, …

going to court. Trusts are not overseen by any outside authority. A civil suit or criminal prosecution may be necessary to address trustee misconduct.

10620 Medicaid Eligibility and Financial Exploitation of Income or Resources

APS February 2021

Financial exploitation may affect whether a client is eligible for Medicaid for long-term care or Medicaid waiver programs. APS may help the client with the Medicaid process.

Income

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

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

  • Rent for property that the client owns.
  • Royalties from the client’s property, such as mineral rights and intellectual property.
  • Payments from promissory notes (when someone owes money to the client).

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

  • What authority the designated perpetrator had, in order to collect the income on the client’s behalf.
  • That the income is not and will not be available to the client, and why.

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

See 8620 Determination of the Validity of the Allegation.

Resources

Resources That Are in the Client’s Name

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

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

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

A client or his or her authorized representative may claim undue hardship (which may allow the client to avoid the penalty period) when imposing a penalty would do either of the following:

  • Threaten the health or life of the client.
  • Deprive the client of food, clothing, shelter, or other necessities of life.

An undue hardship may exist when the client has no place to go in the community or no place to receive care that meets the client’s needs, and also any of the following conditions are present:

  • The client, family members, and other people involved do not know where the person who received the resource is.
  • The client can show that physical harm may result from trying to get the resource returned.
  • The person who received the resource is unwilling to cooperate with the client and HHSC. For example, this may happen in an APS financial exploitation case or a case of potential fraud.

See 8620 Determination of the Validity of the Allegation.

10700 Hospital and Nursing Home Admissions

10710 Voluntary Admission to Hospital or Nursing Home

APS February 2021

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

  • His or her medical coverage, including Medicaid and Medicare identification numbers.
  • His or her ability to pay deductibles.

10720 Involuntary Admission to Hospital or Nursing Home

APS February 2021

With Court Order

The APS specialist may ask the court to order involuntary hospitalization, medical treatment, or nursing home placement if all of the following apply:

  • The client suffers from abuse or neglect that presents a threat to life.
  • The client lacks the capacity to consent.
  • APS cannot obtain consent from anyone else on the client’s behalf.

See 13500 Original Petition for Emergency Order for Protective Services (EOPS).

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

Without Court Order

The APS specialist may authorize hospitalization, medical treatment, or nursing home placement without a court order if both of the following apply:

See also 13150 Legal Forms Completed by the APS Specialist.

10730 APS Role in Completing Hospital and Nursing Home Admission Forms

APS February 2021

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

  • The client is being admitted to a hospital or nursing home (either voluntarily or involuntarily).
  • The client is not able to sign the admission forms, such as the Preadmission Screening and Resident Review (PASRR).
  • The facility refuses to admit the client without a signature.

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

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

10800 Management of Clients’ Affairs and Assets

APS February 2021

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

Clients in this situation are often ill, frightened, and very vulnerable. Their overriding concerns are usually the protection of their homes, their belongings, and, if applicable, their pets.

It is important that the APS specialist try to keep the client’s situation stable until one of the following occurs:

  • APS finds a designee to manage the client’s affairs.
  • The client is able to manage his or her own affairs.
  • APS refers the client for guardianship.

Procedures for APS Specialists

The APS specialist gets supervisory approval before managing a client’s affairs, unless the situation is an emergency. In an emergency, the specialist notifies the supervisor as soon as possible.

The supervisor and the district director or designee jointly determine the extent of the management of personal affairs that APS will offer to the client.

When temporarily managing a client’s affairs or assets, the APS specialist does the following:

  • Has a witness (a co-worker, supervisor, law enforcement officer, or regional attorney) present when acting on the client’s behalf regarding finances or property.
  • Makes sure all financial transactions are well documented. This includes placing copies of all money orders, receipts, deposit slips, and so on, in the paper case folder (external documentation folder).
  • Gives the client the originals of all the papers mentioned above.
  • Gets witnessed receipts for any cash that APS receives from or gives to the client, regardless of the amount.
  • Tells the supervisor about all matters, including actions that the client requests that could be perceived as inappropriate.
  • Tells the supervisor about any accusations that the client or others make of actual or perceived wrongdoing by the APS specialist.

When temporarily managing a client’s affairs or assets, the APS specialist never takes the following actions:

  • Being named or becoming the client’s attorney of fact, as under a power of attorney.
  • Being named as the representative payee for the client.
  • Moving the client’s money into the APS specialist’s bank account.
  • Storing the client’s personal items on or in the APS specialist’s property (such as in the specialist’s home, car, purse, and so forth).

Procedures for Supervisors

The APS supervisor does the following:

  • Tells the district director or designee if an APS specialist is handling the financial or personal assets of a client.
  • Goes with the APS specialist as often as possible to serve as the witness.
  • Staffs the case with the APS specialist regularly to discuss the case and to determine the level of APS involvement.
  • Considers whether an evaluation of the client for guardianship is needed.

10900 Purchased Client Services (PCS)

APS February 2021

APS purchases goods and services to meet clients’ short-term needs. APS categorizes these services by type of assistance: medical, residential, environmental, services, legal, and other.

The PCS Guide defines allowable services. The APS associate commissioner has the authority to approve the purchase of services that are not listed in the PCS Guide.

APS purchases goods and services when they meet any of the following criteria:

  • Necessary to remedy abuse, neglect, or financial exploitation.
  • Unavailable free of charge through other government, community, or private resources.
  • Expected to remedy the problem, and no further purchased goods or services will be necessary.
  • Needed for a short time, until other available resources can take effect.

APS limits the type, amount, and duration of purchased services that clients can receive based on the following:

  • Individual service plans.
  • Availability of specific goods and services in each geographical area of the state.
  • Availability of funds.

See:

Providing Services Regardless of Financial Resources in 10000 Providing and Arranging for Services

10620 Medicaid Eligibility and Financial Exploitation of Income or Resources

Methods of Purchased Client Services

APS uses a variety of methods to pay for goods and services to help alleviate abuse, neglect, or financial exploitation. These methods include the following:

  • State term contract procurement card – a state-issued credit card that APS staff members use to pay for items such as groceries, medications, home repair supplies, furniture, and emergency shelter.
  • Purchase order for placement services (POPS) – an abbreviated contract document that APS uses to secure a client’s placement in a residential care facility.
  • Contract – an agreement between the DFPS contract staff and a contractor to provide goods or services to an APS client.
  • Claims processing – an arrangement in which DFPS pays contracted providers, who in turn pay vendors for the goods or services.

APS specialists consult with APS management and contract managers to choose the best method for each purchase.

Restrictions on Purchased Client Services

The APS specialist gets approval from the DFPS contract staff before making a purchase from a non-contracted vendor for goods or services with a cost greater than $5,000.

The APS specialist does not use purchased client services for any of the following:

  • State of Texas sales tax.
  • The specialist’s personal use or benefit, such as to get rebates or coupons.
  • Any instrument, such as a gift card or money order, that someone else can use to purchase items or get cash.
  • Prepayment for goods or services.
  • Any attorney services, bonding, or court fees.

Human Resources Code, §48.202; §48.205; §48.206

See 10330 Seeking Medical or Mental Health Evaluations.

10910 Assessing the Need for Purchased Client Services

APS February 2021

To assess the need for purchased client services (PCS), the APS specialist does the following:

  • Completes the Safety Assessment before authorizing services during the investigation, unless there is an immediate need for services.
  • Explores how the client met his or her needs before APS involvement and how the client will continue to meet his or her needs after APS involvement ends.
  • Explores the client’s financial resources to determine whether the client has the means to pay for all or a portion of the needed goods or services.
  • Compares the client’s income and expenses to determine whether expenses are appropriate and necessary.
  • Determines the status of applications that the client has filed or that others have filed on his or her behalf (such as applications for public assistance, Social Security benefits, Medicaid waiver services, and so on).

The APS specialist may identify an immediate need for PCS while conducting a case initiation by phone. If this happens, the APS specialist does the following:

  • Authorizes PCS as appropriate, without assessing the client’s financial situation or determining whether other resources exist.
  • Gets the client’s income and budget information during the initial face-to-face interview to determine whether other resources are available to meet the client’s needs.

If the APS specialist completes the case initiation at the same time as the initial face-to-face interview, he or she gets income and budget information at that time.

See:

9200 Case Initiation

10911 Client’s Budget and Financial Resources

10911 Client’s Budget and Financial Resources

APS February 2021

The APS specialist documents in IMPACT the client’s income and average monthly expenses when the specialist authorizes purchased client services. If the client refuses to provide this information, the specialist documents the client’s refusal in IMPACT.

A more extensive analysis may be necessary in special situations, including the following:

  • The client is recidivist. See 2331 Recidivistic Cases.
  • The case requires extensive use of purchased client services.
  • The case involves excessive unexplained expenses.

In these instances, the APS specialist uses his or her judgment to determine whether it is necessary to get copies of the client’s bank statements or other financial information to gain a more accurate understanding of the client’s resources.

The APS specialist is not required to address the client’s budget, average monthly expenses, or other resources if the only service authorized is one of the following:

  • A medical or mental health assessment.
  • Ongoing support services.
  • Transportation, if the contractor is providing it directly.

See 10910 Assessing the Need for Purchased Client Services.

10920 Obtaining Approval for Purchased Client Services

APS February 2021

APS staff members are not allowed to approve purchased client services (PCS) funds for their own cases. This applies to all APS staff members, including all levels of management. For example, a supervisor who is assigned a case may not approve PCS funds for that case.

All approvals for PCS funds are required to come from someone higher on the management chain than the requester, not a staff member at the same level. For example, a supervisor may not approve PCS funds for a case assigned to another supervisor; this approval is required to come from a program administrator or higher.

The following people may not approve PCS funds, even while they are in the role of acting supervisor or acting program administrator:

  • An APS specialist.
  • A subject matter expert (SME).

10921 Cost and Required Approval

APS February 2021

$750.00 or Less for a Single Purchase

Approval from the requester’s first-level manager is required before the requester commits to a PCS purchase of $750.00 or less. This approval can be verbal or written. If the requester’s first-level manager is not available, the requester obtains approval from another first-level manager or higher in the same district.

The requester submits the Service Authorization form in IMPACT to the manager who gave approval.

$750.01–$5,000.00 for a Single Purchase

Approval from the requester’s second-level manager is required before the requester commits to a PCS purchase that costs at least $750.01 but not more than $5,000.00. This approval can be verbal or written. If the requester’s second-level manager is not available, the requester obtains approval from another second-level manager or higher in the same district.

The requester submits the Service Authorization form in IMPACT to the manager who gave approval.

$5,000.01 or More for a Single Purchase

A purchase that is likely to cost $5,000.01 or more requires coordination with a DFPS contract manager before the purchase. The requester consults contract staff to coordinate the purchase and documents this consultation in a contact Narrative.

10922 Additional Requirements for PCS

APS February 2021

Splitting Purchases Prohibited

Splitting purchases occurs when a DFPS staff member breaks up a large purchase into smaller purchases to get around any of the following:

  • State or federal laws or regulations.
  • Policies that place limits on purchases.
  • APS requirements for management approval.

Splitting purchases to get around any of the regulations listed above is not allowed. Splitting purchases to get around management approval is not allowed, whether or not the staff member knows that the purchase is being split or knows the reason for the split.

Sometimes a purchase requires a credit increase to a procurement credit card (state term contract procurement card). In this situation, a DFPS staff member contacts the regional contract manager to complete a form to increase a line of credit.

Service Lasting 60 Calendar Days or More

The APS specialist obtains verbal or written approval from the second-level manager before authorizing a service that is expected to be necessary for 60 calendar days or more within a 12-month period.

Sometimes the client continues to need the service for longer than the second-level manager initially approved. In this situation, the APS specialist continues to obtain verbal or written approval from the second-level manager for each additional time period of service, regardless of the number of calendar days in each time period.

Documentation of Approvals

The approver gives verbal or written approval for any PCS purchase before an APS specialist commits to that purchase.

The APS specialist saves the Service Authorization form in IMPACT and submits it to the manager who gave approval. The manager documents the approval by electronically signing the Service Authorization form in IMPACT.

If the approver gives verbal or written approval before the APS specialist completes the Service Authorization form, the approver changes the date and time listed on the Approval Status-Approve Service Authorization page in IMPACT to the actual date and time that approval occurred.

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