Adult Protective Services
Adult Protective Services
The purpose of this section is to provide statewide policy and general procedures for the Adult Protective Services (APS) program. Local procedures developed by each Region may supplement this chapter. APS staff must know and implement state and local policy and procedure.
Chapter 74.34 RCW authorizes the Department of Social and Health Services (DSHS) to investigate reports of abandonment, abuse, financial exploitation, neglect and self-neglect of vulnerable adults, and to provide protective services and legal remedies to protect vulnerable adults.
Table of Contents
Adult Protective Services 1
Ask an Expert 6
Definitions 7
Vulnerable Adults 7
Types of Abuse under RCW 74.34.020 7
Other Definitions Used by APS 10
Overview of the APS Program 14
Scope – Who performs investigations within ALTSA? 14
APS Reporting Requirements and Information 16
Mandated Reporting of Abuse of Vulnerable Adults 16
Failure of a Mandated Reporter to Make an APS Report 17
Permissive Reporting of Abuse of Vulnerable Adults 17
Reporter Confidentiality and Immunity 18
Interference with Reporting Requirements 18
APS Intake 19
APS Receipt of Reports 19
Summoning Emergency Response 20
As an APS Worker, Where do I enter information and what do I include in an APS Intake Report? 21
Sensitive, Critical or High Profile Cases – Restricted Case Designation 22
Intake and Coordination of Cross-Region APS Reports & Cases 23
APS Referrals to/from other Investigative Authorities 24
Reporting to Law Enforcement 24
Reporting Provider Fraud to Medicaid Fraud Control Unit (MFCU) and Reporting Client Fraud 25
Department of Health (DOH) 26
Licensing Authorities for Professions under Title 18 RCW (other than Health Professionals covered by DOH) 28
DSHS (RCS, CPS) 29
Indian Tribes in Washington 30
APS or Law Enforcement in another State 31
Part in WA, Part in another State: 31
Overview Chart: Sharing APS Intake Report Information with others 31
Screening Reports 33
APS Intake Report Screening Process 33
Reports Containing an Alleged Victim Age 18 or Older who has a Developmental Disability 34
Overview Chart of Intake Flow 35
Overview of Screening Decision Factors 36
Circumstances under which DSHS will Screen-Out an Intake Report (not assign for APS investigation) 37
Screen Out Decision Criteria Chart 37
Circumstances under which APS will investigate 39
The alleged victim is deceased at the time of intake 42
Investigation Response Priority Categories: “High,” “Medium” or “Low” 42
Investigation: Coordinating with Other Investigative Authorities 44
Coordinating with Law Enforcement 44
Coordinating Investigations with Medicaid Fraud Control Unit (MFCU) 45
If requested, APS shall provide MFCU an unredacted copy of the APS case record.Coordinating with RCS for Investigations Involving Residents in a DSHS Licensed or Certified Setting 45
Coordinating with CA for Investigations Involving Residents in a DSHS Licensed or Certified Setting 48
Coordinating with the Department of Health (DOH) 49
Coordinating with Tribes 49
Coordinating with the DDA and Long-Term Care Ombudsman Programs 49
Safe Field Work Practices 50
For additional information related to APS worker safety refer to 52
Investigation: Procedures for All APS Investigations 53
Searching Databases 53
Consent to Investigate 53
Obtaining Documentary Evidence 53
Interviewing the Reporter 54
Interviews - General Protocol for All APS Interviews 54
Interview Documentation 54
Interpreters 55
Interview Behavior 55
APS Worker Interview Safety 56
Interviewing the Alleged Victim 56
Timeframe to Conduct the Interview – Alleged Victim 57
Timeframe Exceptions: 57
Scheduled versus Unscheduled Interview - Alleged Victim 58
Third Party Presence in an Interview- Alleged Victim 59
Decision Making Screening 60
Giving Clients the “Your Rights”, DSHS 14-521 Form 62
Interviewing the Alleged Perpetrator 62
When a Face to Face Interview is Not Required 63
For AP interviews only when investigation is leading to a substantiated finding: 64
Interviews - Unique Circumstances 64
Person to be Interviewed is Incarcerated 64
Person to be Interviewed is a Minor Under Age 18 64
Person to be Interviewed Has a DPOA or Legal Guardian 65
A Person is Reported to be “Non-Interviewable” 65
Investigation: Unique Circumstances 66
Alleged Perpetrator is a DSHS Employee, AAA Employee, or AAA Subcontractor (including employees in RHCs and SOLAs) 66
APS Investigation of an Alleged Perpetrator Who May Have Also Committed a Crime 69
APS Investigation of a Personal Aide Providing Self-directed Care 70
APS Investigation of a Minor Alleged Perpetrator Under Age 18 71
APS Investigation Involving a Client of a DSHS/Aging Network Case Manager 71
APS Investigation Involving a Client Participating in New Freedom, Program of All-Inclusive Care for the Elderly (PACE) or Managed Care Plan 73
Alleged Victim Dies While the APS Case is Open 73
Alleged Perpetrator Dies During Open Case or Due Process 74
Self Neglect Specialist Protocol 74
Financial Exploitation Specialist Protocol 76
APS Tools 80
Legal Injunction 80
Photography to Document Evidence 80
Consent to Photograph 80
Photography Guidelines 81
Documentation and Tracking Photographs 81
APS Request for a Background Check through BCCU 81
How to Submit a Request for an APS Background Check through BCCU 81
Confidentiality of Background Check Information from BCCU 83
APS Use of Accurint to Search for Information 83
Purpose 83
Access to Accurint 83
Types of Searches 84
Confidentiality of Information Obtained through Accurint 84
Declaration Form 85
Investigation: Findings 86
Meaning of Recommended, Initial and Final Findings 86
Investigation Closure and Finding Options 87
Factors For Substantiation of Neglect or Abandonment 89
Factors For Substantiation of Abuse 90
Factors For Substantiation of Financial Exploitation 91
Factors for Substantiation of Self – Neglect 91
APS Investigation Staffing Protocol 92
Investigation Staffing Process: 92
Process for APS Program Managers or Field Service Administrators (FSAs): 93
Investigation Review of Recommended Substantiated Finding 94
Supervisor Approval 94
Regional Investigation Review Team (IRT): 94
Notification of APS Findings 96
Types of Outcome Reports 96
Outcome Report Form 96
Outcome Report – AP Form 96
Notification letters 96
Summary Chart of APS Notification: Who Gets What Investigation Outcome Information? 97
A Substantiated Initial Finding 103
Notifying the Alleged Victim/Legal Representative 103
Notifying the Alleged Perpetrator 103
Notifying the Agency/Program Employer of the Alleged Perpetrator 105
Notifying the DSHS (HCS, DDA, CA)/AAA/Aging Network Case Manager 106
Notifying the Home Care Referral Registry 106
Notifying Law Enforcement 106
Notifying the DSHS Facility Licensing Authority 106
Notifying the Facility in Which the Incident Occurred 107
An “Unsubstantiated,” Inconclusive,” or “Substantiated-Unknown Perpetrator” Finding 107
The Alleged Victim/Legal Representative 107
The Alleged Perpetrator 107
The Agency/Program Employer of the Perpetrator 107
Notifying the DSHS (HCS/DDA/CA)/AAA/Aging Network Case Manager 108
Notifying Law Enforcement 108
APS Due Process and ADS Abuse Registry 109
Administrative Hearing to Challenge an APS Initial Finding 109
Notifying the Alleged Perpetrator who is a Service Member on Active Duty or a Dependent of a Service Member on Active Duty 109
Discovery and Protective Order Procedure 111
Subpoenas 111
Dissemination of APS Case Record Information 112
When Discovery Has Been Requested 112
When Discovery Has Not Been Requested 112
Witness Payment 112
Change of Findings 113
Other Administrative Hearings that May Involve APS 113
DSHS Board of Appeals (BOA) 114
Judicial Review 114
Placing the Perpetrator on the ADS Registry 114
Nursing Assistant Employed in a Nursing Facility or Skilled Nursing Facility 115
Perpetrators other than Nursing Assistants in a Nursing Facility or Skilled Nursing Facility 115
Multiple Entries: Involving Alias Information, Multiple Cases or an Individual Previously Entered into the Abuse Registry 116
Changing an ADS Registry Entry 116
Sending Final Findings of Professionals under RCW 18.130 to DOH: 117
Sending Notice of a Final Finding against a Nursing Assistant employed in a Nursing Facility or Skilled Nursing Facility 117
Protective Services 119
Description of Protective Services 119
AAG involvement: 120
Authorization and Payment for APS Protective Services 121
Hierarchy of Protective Services Funding Sources 121
Intervention Services Funds 121
Authorization and Payment for Medicaid Services 122
Criteria for Use of State-Only-Funded Protective Services 122
Authorization and Payment for State-Only-Funded Protective Services 123
Legal Protective Services and Remedies 125
Protection Orders 125
Who may seek the protection order? 125
What “assistance” can an APS worker provide to the vulnerable adult who is seeking his/her own protection order? 126
Procedures 126
Guardianship 128
Petition under RCW 74.34.067(5) 128
Procedure to Remove or Modify a Guardianship 129
Power of Attorney 129
Coordination with Community Resources 131
Domestic Violence 131
Mental Health 131
APS Regional Resource Teams 131
APS Regional Resource Team Function 132
APS Regional Resource Team Membership and Appointments 132
APS Case Record and Documentation 134
The APS Case Record- Retention and Documentation Principles 134
APS Record Retention 135
Documentation Principles 135
Documenting Threatening Behavior 136
Tracking Incidents of Vulnerable Adults (TIVA) 137
Case Notes 137
Finding Template 137
Business Rules: 137
External Report: “APS Outcome Report” 138
HCS Adult Protective Services Intake Report 138
Criminal Investigation Request: APS Referral 138
Disclosure of APS Information 139
Within DSHS: Sharing APS Information 139
For Case Planning and Consultation 139
For Administration of DSHS Programs 139
Outside DSHS: Routine Sharing of APS Information under RCW 74.34 140
Public Disclosure of APS Information 140
Subpoena for APS Information 142
Discovery 142
Summary Chart of Guidelines for Release of Requested APS Case Record Information 142
After Event Review 146
Purpose 146
Policy 146
Scope 146
Process 147
Rules and Policy Governing the APS Program 149
APS List of Acronyms 150
Ask an Expert
· Jackie Heinselman at (360) 725-2616 or
· Carol Sloan at (360)725-2345 or
· Vicky Gawlik at (360)725-2615 or
Definitions
Chapter 74.34 RCW and WAC 388-71-0105 provide definitions that apply to the APS program.
Vulnerable Adults
A vulnerable adult is defined in Chapter 74.34 RCW as a person who is:
1. 60 years of age or older with the functional, mental, or physical inability to care for himself or herself;
Or
2. Over age 18 and:
o Has a guardian appointed through superior court as per Chapter 11.88 RCW; or
o Has a developmental disability as defined in RCW 71A.10.020, such as intellectual disability, cerebral palsy, epilepsy, autism, or a condition similar to intellectual disability which originated prior to age eighteen; or
o Lives in a facility licensed by DSHS (e.g., adult family home, assisted living facility, nursing home, soldier’s home, residential habilitation center, children’s foster home); or
o Receives services from an individual provider as defined in RCW 74.34.020; or
o Receives in-home services through a licensed home health, hospice, or home care agency; or
o Self-directs his or her own care by a personal care aide who performs that care for compensation.
Types of Abuse under RCW 74.34.020
1. “Abandonment” means action or inaction by a person or entity with a duty of care for a vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care.
2. “Abuse” means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult which have the following meanings:
Effective 7/24/2015: “Abuse” means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and personal exploitation of a vulnerable adult, and improper use of restraint against a vulnerable adult which have the following meanings:
a. “Sexual abuse” means any form of nonconsensual sexual contact including, but not limited to, unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under Chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under Chapter 71A.12 RCW, whether or not it is consensual.
Effective 7/24/2015: “Sexual abuse” means any form of nonconsensual sexual conduct including, but not limited to, unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual conduct between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under Chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under Chapter 71A.12 RCW, whether or not it is consensual.
b. “Physical abuse” means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to: striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately.
Effective 7/24/2015: “Physical abuse” means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to: striking with or without an object, slapping, pinching, choking, kicking, shoving, or prodding.
c. “Mental abuse” means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to: coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing.
Effective 7/24/2015: “Mental abuse” means a willful verbal or nonverbal action that threatens, humiliates, harasses, coerces, intimidates, isolates, unreasonably confines, or punishes a vulnerable adult. Mental abuse may include ridiculing, yelling, or swearing.