Adult Protective Services in Facilities

1. Adult Protective Services in Facilities Division of Aging and Adult Services

2. Learning Objectives • Understand the role of APS in facilities. • Understand how APS collaborates with others to protect disabled adults. • Understand the difference between protection of individuals and regulation of facilities. • Be knowledgeable of the variety of records pertaining to the adult’s care. • Gain skills and knowledge in use of resources in a facility evaluation. • Be knowledgeable of the diverse methods of protecting adults in facilities.

3. Role of APS Focus on the Victim – Not the Facility This is the primary mission of APS in facilities Protection Vs. Regulation APS protects the victim. Other agencies regulate and/or enforce Facility Vs. domestic Setting Cannot hold facilities to a higher standard than other settings Keep Perspective on the Total APS Workload APS Reports on Adults in Facilities comprise 20% of all reports

4. Separating Regulatory from Protective Issues at Intake • Reports may be: • Specific to APS, • Involve APS and regulatory issues, • Or may be specific to regulatory issues.

5. APS vs. Regulatory • What are examples of APS only situations • What are examples of Both APS & Regulatory Issues

6. Licensure Issues vs. Protective Services • If the complaint relates only to general conditions, the report is referred to the appropriate licensing authority

7. Adult Care Homes • Adult care homes are residences for aged and disabled adults who may require 24-hour supervision and assistance with personal care needs. • Vary in size from family care homes of two to six residents to adult care homes of more than 100 residents. The smaller homes, with 2 to 6 residents, are still referred to as family care homes. • Adult care homes are different from nursing homes in the level of care and qualifications of staff. They are licensed by the state Division of Health Service Regulation (Group Care Section) under State regulations and are monitored by Adult Home Specialists within DSS.

8. Nursing Homes • Nursing Homes are facilities that provide nursing or convalescent care for three or more persons. A nursing home provides long term care of chronic conditions or short term convalescent or rehabilitative care of remedial ailments, for which medical and nursing care are indicated. • All nursing homes must be licensed in accordance with North Carolina State law by the North Carolina Division of Health Service Regulation Licensure Section (919) 733-1610.

9. Who is a Caretaker? • The level of responsibility that a facility has for an individual resident will vary • There may be activities or time frames when the facility is NOT acting as a caretaker • APS Manual III-48

10. The Complainant and Confidentiality The complainant’s name will not be released except to: • DHSR • The DA • Law Enforcement, or • By Court Order APS Manual III-47

11. Returning to a Facility from a Hospital • When a referral comes from the hospital, the referral should be considered an APS report if the APS criteria are alleged • Refer to AHS for licensure issues.

12. The Initial Visit APS Manual III-51 • Be professional and in control • Notify the person in charge when you arrive at the facility • Go directly to see the disabled adult. • State that you will need all the records • pertaining to the adult • Give the staff a description of what will be needed for the evaluation • Always carry a copy of 108A – 103 a & b

13. The Assessment APS Manual III-51 • The same process as in domestic settings • Visit with the adult • Collateral Contacts • Obtain medical records as needed • Interview the adult alone • Interview the adult before discussing the allegations with administrator or contacting collaterals

14. The Assessment cont….. • Don’t be intimidated by Medical or Other Professional Terms • Be Inquisitive (ask questions) • Familiarize yourself with medical terminology & common medications • Find and use local resources • Focus on facts

15. Working with the Facility Staff Establish a relationship with a staff person Make multiple visits and interview multiple sources •Roles and Conflicts • Maintaining rapport • Stall tactics used by facilities

16. Working with Family Members •Include family members as collaterals • Contact family members early in the evaluation.

17. Interviewing • Know who to interview • Use good interviewing techniques • Know when is it appropriate to interview

18. FacilityRecords • Review ALL records that pertain to the disabled adult • Look for specific changes indicated in these records

19. APS and the AHS • How the roles overlap • • Patient/Resident rights • • Regulation versus protection • Best Practice • • APS and AHS visit a facility together • • APS and AHS coordinate efforts

20. Other Regulation or Enforcement Entities DHSR Complaint Investigation Mental Health Section The AHS Health Care Personnel/Nurse Aide Registry (internal process within DHSR) Area Mental Health Authority/LME The DA and Law Enforcement

21. Other Disciplines and Agencies • GACPD • Case Managers ACH/MH • Hospitals and Physicians • Ombudsman • Day Programs • Home Health • PT and OT • Facility Psychologist or Social Worker • EMS/Rescue • Dietician

22. NCDHSR Complaint Sectionhttp://www.ncdhhs.gov/dhsr/ciu/complaintintake.html • Division Contact: Rita Horton • Complaint Hotline: 1-800-624-3004 (within N.C.) or 919-855-4500 • Complaint Hotline Hours: 8:30 a.m. - 4:00 p.m. weekdays, except holidays. • Fax: 919-715-7724 • Mail: 2711 Mail Service Center, Raleigh, NC 27699-2711 • Adult Care Homes-Adult Homes Specialist • APS Manual III-48

23. Common Issues Handled by Other Agencies and Contact Information • Physicians and Urgent Care Centers - N.C. Medical Board (1-800-253-9653) • Labor/Personnel Issues - N.C. Department of Labor (1-800-625-2267) • Health Insurance Portability and Accountability Act (HIPAA) Complaints - U.S. Office of Civil Rights (1-800-368-1019) • Discrimination Complaints - U.S. Office of Civil Rights (1-800-368-1019) • Medicaid Fraud - N.C. Division of Medical Assistance (919-647-8000) • Medicare Fraud - U.S. Office of Inspector General (1-800-447-8477)

24. Health Care Personnel Registryhttps://www.ncnar.org/index1.jsp • The Division of Health Service Regulation also maintains the North Carolina Nurse Aide I and Health Care Personnel Registry. • This site is designed to assist individuals and facilities who wish to access the Nurse Aide I and Health Care Personnel Registry databases for pre-employment verification of an applicant's credentials

25. Keep and Use CurrentResources • Medical Abbreviations List • Medications Guide • Chart of Decubitus Ulcers • Possible Indicators of Mistreatment • Consult with Experts

26. Medical Information Websites • Medline Plus www.nlm.nih.gov/medlineplus/ • Rx List www.rxlist.com • Health Square www.healthsquare.com

27. Case Decision •The same process as domestic settings • Look for facts. Be specific.

28. Notices and Written Reports The focus is on factual information The written report should be tailored to meet the needs of the agency or the person receiving it: • DHSR • DMA • DA • Other agencies

29. The written summary to the administrator shall be limited to: • Acknowledgement that a protective services report was received on a specified patient or resident of the facility • The allegations in the report (the reporter shall NOT be named) • Whether or not mistreatment was found • Whether the need for protective services was substantiated A general statement as to how the conclusion was reached (collaterals shall not be named) APS Manual III-47

30. Notice to Administrator cont…. Can be used for the written summary to the administrator A copy shall be sent to DHSR within 30 days of completion of the evaluation APS Manual III-47

31. Planning Services This is your opportunity to fix the problem Plan with: • the disabled adult • the Family, • the Facility, and the other agencies • Corrective action is NOT an APS plan

32. Thank You!