COMMENT DUE DATE:
January 2, 2008
DATE:
December 14, 2007
Laura Brown FSSD (405) 521-4396
Dena Thayer PMU Manager (405) 521-4326
Pat McCracken PMU Specialist (405) 522-1017
RE:
APA WF 07-30
The proposed policy is Permanent . This proposal will go to the Commission meeting on
CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 1. General Provisions
OAC 340:5-1-4 [AMENDED]
OAC 340:5-1-6 [AMENDED]
Subchapter 3. Reports of Maltreatment of Vulnerable Adults
OAC 340:5-3-1 [AMENDED]
OAC 340:5-3-3 [AMENDED]
Subchapter 5. Investigation of Adult Protective Services Referrals
OAC 340:5-5-3 through 340:5-5-4 [AMENDED]
OAC 340:5-5-6 [AMENDED]
SUMMARY:The proposed revisions to Subchapters 1, 3, and 5 of Chapter 5 amend the rules to ensure compliance with Sections 10-101 through 10-110 of Title 43A of the Oklahoma Statutes.The revisions: (1) amend and add new Adult Protective Services (APS) definitions; (2) change the APS specialist's responsibility for submitting an accounting report for temporary guardianship from quarterly to annually; (3) clarify the time frames for initiating investigations and completion of investigation reports; and (4) includes rules for redirecting or stopping the flow of assets into an alleged perpetrator's account as a type of protective services.
340:5-1-4 is revised to add additional ethical considerations for actions of APS specialists when referring clients for professional services.
340:5-1-6 supersedes the emergency rule, and is revised to:(1) add definitions to terms commonly used in the practice by Adult Protective Services specialists; and (2) provide common understanding of terms.
340:5-3-1 supersedes the emergency rule, and is revised to:(1) remove reference to a form; and (2) add clarifying language.
340:5-3-3 is revised to ensure that APS reports are taken by each local HSC office with county directors responsible for compliance.
340:5-5-2 is revised to state that time frames for initiating investigations begin with the receipt of the report by any OKDHS staff.
340:5-5-3 is revised to: (1) change the time frames for completion of investigation reports; (2) add clarifying language; and (3) remove internal procedures from rules.
340:5-5-4 is revised to add: (1) redirecting or stopping the flow of assets into an alleged perpetrators account as a type of protective services that may be provided in exploitation investigations; and (2) clarifying language.
340:5-5-6 supersedes the emergency rule, and is revised to:(1) change the required annual reporting from quarterly to annually as stated in state statute; (2) add a responsibility of an APS specialist to apply for all benefits that a client in guardianship is potentially eligible; (3) remove internal procedures from rules; and (4) add clarifying information.
PERMANENT RULEMAKING APPROVAL IS REQUESTED.
LEGAL AUTHORITY:Commission for Human Services, Article XXV, Sections 2, 3, and 4 of the Oklahoma Constitution; and Sections 10-101 through 10-110 of Title 43A of the Oklahoma Statutes.
State of Oklahoma
DEPARTMENT OF HUMAN SERVICES
TO:Programs Manager
Policy Management Unit
FROM:Mary Stalnaker, Family Support Services Division Director
DATE:11/07/2007
RE:CHAPTER 5. ADULT PROTECTIVE SERVICES
OAC 340:5-1-4 [AMENDED]
OAC 340:5-1-5[AMENDED]
OAC 340:5-1-6 [AMENDED]
OAC 340:5-3-1 [AMENDED]
OAC 340:5-3-3 [AMENDED]
OAC 340:5-5-2 [AMENDED]
OAC 340:5-5-3 [AMENDED]
OAC 340:5-5-4 [AMENDED]
OAC 340:5-5-6 [AMENDED]
APA WF # 07-30
CONTACT:Laura Brown 405-521-4396
A.Brief description of the purpose of the proposed rule.
PURPOSE:The purpose of the proposed revisions to Subchapter 1 of Chapter 5 add:(1) an ethical consideration for actions of Adult Protective Services (APS) specialists when referring clients for professional services; (2) definitions to terms commonly used in the practice by APS specialists and to provide common understanding of terms; and (3) add clarifying language.
The purpose of the proposed revisions to Subchapter 3 of Chapter 5 include: (1) ensuring that APS reports are to be taken by each local HSC office with county directors responsible for compliance; and (2) adding clarifying language.
The purpose of the proposed revisions to Subchapter 5 of Chapter 5:(1) state that time frames for initiating investigations begin with the receipt of the report by any OKDHS staff; (2) change the time frames for completion of investigation reports; (3) add clarifying language; (4) remove internal procedures from rules; (5) add redirecting or stopping the flow of assets into an alleged perpetrators account as a type of protective services that may be provided in exploitation; (6) change the required annual reporting from quarterly to annually; and (7) add a responsibility of an APS Specialist to apply for all benefits that a client in guardianship is potentially eligible.
STRATEGIC PLAN IMPACT:The proposed rule change supports the Oklahoma Department of Human Services (OKDHS) goals of protecting vulnerable adults from abuse, neglect and exploitation.
SUBSTANTIVE CHANGES:
OAC 340:5-1-4 is revised to add additional ethical considerations for actions of APS specialists when referring clients for professional services.
OAC 340:5-1-5 is revised for language clarification.
OAC 340:5-1-6 supersedes the emergency rule, and is revised to:(1) add definitions to terms commonly used in the practice by Adult Protective Services specialists; and (2) provide common understanding of terms.
OAC 340:5-3-1 supersedes the emergency rule, and is revised to:(1) remove reference to a form; and (2) add clarifying language.
OAC 340:5-3-3 is revised to ensure that APS reports are taken by each local HSC office with county directors responsible for compliance.
OAC 340:5-5-2 is revised to state that time frames for initiating investigations begin with the receipt of the report by any OKDHS staff.
OAC 340:5-5-3 is revised to: (1) change the time frames for completion of investigation reports; (2) add clarifying language; (3) remove internal procedures from rules.
OAC 340:5-5-4 is revised to add: (1) redirecting or stopping the flow of assets into an alleged perpetrators account as a type of protective services that may be provided in exploitation investigations and (2) clarifying language.
OAC 340:5-5-6 supersedes the emergency rule, and is revised to:(1) change the required annual reporting from quarterly to annually as stated in state statute; (2) add a responsibility of an APS Specialist to apply for all benefits that a client in guardianship is potentially eligible; (3) remove internal procedures from rules; and (4) add clarifying information.
REASONS:The reasons are to improve the APS specialist’s ability to provide timely and appropriate protective services to vulnerable adults. The APS Program is able to reduce the risk of harm by providing improved structure and details to the processes by which the APS specialists meet the safety needs of clients.
REPERCUSSIONS:If the proposed revisions are not implemented, it may affect the delivery of services as the rules will not reflect current APS practices.
LEGAL AUTHORITY:Commission for Human Services, Article XXV, Sections 2, 3, and 4 of the Oklahoma Constitution and Sections 10-101 through 10-110 of Title 43A of the Oklahoma Statutes.
Permanent rulemaking approval is requested:
B.A description of the classes of persons who most likely will be affected by the proposed rule, including classes that will bear the costs of the proposed rule, and any information on cost impacts received by the Agency from any private or public entities:Vulnerable adults will be affected by this proposed change.
C.A description of the classes of persons who will benefit from the proposed rule:Vulnerable adults will benefit from this rule change.
D.A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each:No economic impact will result from the proposed rule change on the vulnerable adults.
E.The probable costs and benefits to the Agency and to any other agency of the implementation and enforcement of the proposed rule, the source of revenue to be used for implementation and enforcement of the proposed rule and any anticipated effect on state revenues, including a projected net loss or gain in such revenues if it can be projected by the Agency:The costs of implementing and enforcing the proposed rule are limited to printing and distributing the rule material.This cost is estimated to be less than $20 and is within the current budget. No additional funding is required.
F.A determination of whether implementation of the proposed rule will have an economic impact on any political subdivisions or require their cooperation in implementing or enforcing the rule:This proposed rule change will not have any economic impact on any political subdivisions or require their cooperation in implementing or enforcing the rules.
G.A determination of whether implementation of the proposed rule may have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act: There will not be any adverse effect on small businesses as a result of the proposed rule.
H.An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or non‑regulatory methods or less intrusive methods for achieving the purpose of the proposed rule:There is not a less intrusive or less costly method of achieving the purpose of the proposed rule.
I.A determination of the effect of the proposed rule on the public health, safety, and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety, and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk:The proposed rule will assist vulnerable adults to secure and preserve economic and personal independence in the least restrictive environment of a comprehensive and coordinated delivery system of needed services.
J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented: There will be no effect on public health, safety and environment if the proposed rule is not implemented.
K.The date the rule impact statement was prepared and if modified, the date modified: Prepared 11/7/07.
CHANGES FROM THE EMERGENCY RULES EFFECTIVE 11-1-07 (WF 07-19) ARE HIGHLIGHTED IN AQUA
SUBCHAPTER 1. GENERAL PROVISIONS
340:5-1-4. Ethical considerations
Issued 6-1-03 Revised 6-1-08
The Adult Protective Services (APS) specialist has ethical responsibilities according to Section 10-109a of Title 43A of the Oklahoma Statutes.The APS specialist maintains professional objectivity when providing or arranging services for vulnerable adults, whether services are paid for by the vulnerable adult or from private or public funds.
(1) The APS specialist must not:
(A) handle the client's personal resources, such as bank accounts, cash, checks, notes, mortgages, trusts, deeds, sales contracts, stocks, bonds, certificates, or other liquid assets without prior approval of the supervisor;
(B) obtain or initiate repairs, personal services, and other necessary actions to provide health care, food, or shelter to or on behalf of a vulnerable adult without prior supervisory approval.Prior written approval is not required in emergency situations where immediate action is required to protect the vulnerable adult from imminent harm or significant loss of property but all plans of this nature, along with approval, must be documented in writing in the case record as soon as possible after approval;
(C) solicit, charge, request, or accept a fee, gift, reward, or payment of any kind from individuals or staff for services rendered as a volunteer, intern, or employee;
(D) use contact with the client or any member of the client's support system for personal gain or personal relationships;
(E) after termination of any assignment, make personal contact with a former client or any member of the client's support system or use former contact with a client for personal gain;
(F) buy items from a client;
(G) engage in any employment or business interest that would constitute a conflict of interest or impair the APS specialist's ability to carry out duties in an impartial manner;
(H) give diagnostic medical or legal opinions;
(I) refer the client to just one physician, attorney, counselor, or other professional for services.The client is presented options whenever possible;¢ 1
(IJ) have sexual contact with clients, their relatives, next of kin, or members of their support system; and
(JK) make after hours home visits, other than those specifically approved by the supervisor.
(2) The APS specialist contacts the supervisor immediately when the client or the APS specialist is threatened or injured in the course of the investigation.
INSTRUCTIONS TO STAFF 340:5-1-4
Issued 6-1-08
1.The APS Computer System Notes Section must document the reason there was only one referral for professional services.Supervisory approval of exceptions is also documented in writing in the Notes Section of the APS Computer System.
340:5-1-5. Confidentiality¢ 1
Issued 6-1-03 Revised 6-1-08
(a) All records, working papers, and reports related to an Adult Protective Services (APS) investigation are confidential under Section 10-110 of Title 43A of the Oklahoma Statutes, and may be disclosed only by order of the court except under the circumstances described in (b) through (e) of this Section.Representatives of the general public, news media, or agencies not meeting one of the exceptions in (c) of this Section who request details on a specific case may be referred to the county director, area director, Family Support Services Division (FSSD), APS Unit staff, or the Oklahoma Department of Human Services (OKDHS) Public Information Office of Communications for a detailed explanation of OKDHS confidentiality rules.¢ 1
(b) When consulting persons knowledgeable of the circumstances of an alleged victim of abuse, neglect, or exploitation, or when making other contacts as part of the investigation or service planning process, the APS specialist may disclose information necessary to ensure that the client is protected and the client's needs are met.
(c) Certain persons acting in an official capacity with regard to the APS client may review or receive information from the entire case record, including:
(1) a district attorney or employees of the district attorney's office;
(2) the attorney representing the person who is the subject of an involuntary services action;
(3) the attorney for the Oklahoma Disability Law Center, when involved in representing an APS client;
(4) staff of an Oklahoma law enforcement agency or a law enforcement agency of another state, including a state or local Medical Examiner's Office;
(5) staff of another state's APS program;
(6) physical or mental health care professionals involved in the evaluation or treatment of the vulnerable adult; and
(7) OKDHS staff who use the information in carrying out their own responsibilities.¢ 2
(d) Any agency or person authorized by OKDHS to provide services to a vulnerable adult client may receive a summary of information necessary to secure or provide appropriate care for the client.
(e) The client's caretaker, legal guardian, and next of kin may receive summaries of information from an APS case record.The information provided is that which is needed based on the purpose for the request for information.
(f) Some information from APS records may be released to employees or contractors of the State for research purposes, upon application to and approval by OKDHS, the FSSD, APS Unit.While local OKDHS offices may release statistical information, no specific case information is released for research purposes unless approval is received from the FSSD, APS Unit.
INSTRUCTIONS TO STAFF 340:5-1-5
Issued 6-1-03 Revised 6-1-08
1.To maintain the highest degree of confidentiality, Adult Protective Services (APS) records are kept in locked files at both the local and state office levels.
2.Oklahoma Department of Human Services staff who may be granted access to APS records include staff of Field Operations Division, Division of Children and Family Services, Developmental Disabilities Services Division, Office of the Inspector General, Office of Client Advocacy, and any others who request records in order to evaluate eligibility or complete an investigation.
340:5-1-6. Definitions
Revised 11-1-07 6-1-08
The following words and terms, when used in this Subchapter shall have the following meaning, unless the context clearly indicates otherwise.
"Abandonment" means the withdrawal of support or the act of deserting a vulnerable adult by a caretaker or other person responsible for the vulnerable adult's care.
"Abuse" means causing or permitting the:
(A) infliction of physical pain, injury, sexual abuse, sexual exploitation, unreasonable restraint or confinement, or mental anguish; or
(B) deprivation of nutrition, clothing, shelter, health care, or other care or services without which serious physical or mental injury is likely to occur to a vulnerable adult by a caretaker or other person providing services to a vulnerable adult.
"Activities of daily living (ADLs)" means basic self-care activities such as toileting, transfer, feeding, bathing, and dressing.
"Adult" means a person 18 years of age or older.
"APS specialist" means an Oklahoma Department of Human Services (OKDHS) worker who has successfully completed Adult Protective Services (APS) New Worker Academy or is working under the oversight of a more experienced APS specialist.
"Caretaker" means a person who is responsible for the care of or financial management for a vulnerable adult as a result of family relationship or has assumed responsibility for care of a vulnerable adult voluntarily, by contract, or by friendship; or who serves as a legally appointed guardian, limited guardian, or conservator.
"Emergency" means a situation in which a vulnerable adult is likely to suffer death or serious physical harm without immediate intervention.
"Evidence" means all documentation, photographs, interviews, observations, objects, and other information collected, observed, or otherwise obtained during the course of an investigation.
"Executive Function" means the brain's ability to absorb information, interpret this information, and make decisions based upon this information.
"Exploitation" means unjust or improper use of the person or resources of a vulnerable adult for the profit or advantage of another person through undue influence, coercion, harassment, duress, deception, false representation, or false pretense.
"Financial neglect" means repeated instances by a caretaker or other person who has assumed the role of financial management of failure to use the resources available to restore or maintain the health and physical well-being of a vulnerable adult, including but not limited to:
(A) squandering or negligently mismanaging the money, property, or accounts of a vulnerable adult;
(B) refusing to pay for necessities or utilities in a timely manner; or
(C) providing substandard care to a vulnerable adult despite the availability of adequate financial resources.
"Guardian" means one of the types of guardianship specified in the Oklahoma Guardianship and Conservatorship Act, Title 30 of the Oklahoma Statutes.
(A) General guardian.A general guardian is a person appointed by the court to serve as the guardian of an incapacitated person to ensure that the essential requirements for the health and safety of the person are met, to manage the estate of the person, or both.
(B) Limited guardian.A limited guardian is a person appointed by the court to serve as the guardian of a partially incapacitated person and is authorized by the court to exercise only certain powers of a guardian over the person, or estate or financial resources of the person, or both.
(C) Special guardian.A special guardian is a person appointed by the court to exercise certain specified powers to alleviate a situation in which there is a threat of serious impairment to the health or safety of an incapacitated or partially incapacitated person, or a situation in which the financial resources of the person will be seriously damaged or dissipated unless immediate action is taken.
"Incapacitated adult" means a vulnerable adult whose ability to receive and evaluate information effectively or to make and to communicate responsible decisions is impaired to such an extent that the person lacks the capacity to manage his or her financial resources or to meet essential requirements for the person's mental or physical health or safety without assistance.
"Indecent exposure" means forcing or requiring a vulnerable adult to:
(A) look upon the body or private parts of another person or upon sexual acts performed in the presence of the vulnerable adult; or
(B) touch or feel the body or private parts of another person.
"Instrumental activities of daily living (IADLs)" means abilities necessary for an adult to function independently in the community, such as preparing meals, using the telephone, driving or arranging for transportation, shopping, and handling finances.
"Mandatory reporter" means any person who has reasonable cause to believe someone is suffering from abuse, neglect, or exploitation.
"Maltreatment" means abuse, neglect, self-neglect, exploitation, sexual exploitation, or verbal abuse.
"Neglect" means:
(A) failure to provide protection for a vulnerable adult who is unable to protect his or her own interest;
(B) failure to provide adequate shelter, nutrition, health care, or clothing for a vulnerable adult; or
(C) negligent acts or omissions that result in harm or unreasonable risk of harm to a vulnerable adult through action or inaction, or lack of supervision by a caretaker providing direct services.
"Power of attorney" means authority granted by a legal document authorizing a person or other entity to act for the principal, subject to the extent of the power authorized.The affidavit may be durable. If it is durable, the power of attorney has been filed at the county court house and becomes effective when the principal loses decision making abilities as defined by the document and instructions of the principal.The power is revoked upon:
(A) written revocation of the principal;
(B) incapacity of the principal unless it is a durable power of attorney;
(C) death of the principal;
(D) a termination date if specified in the document;
(E) order of the court; or
(F) the appointment of a guardian, in most cases.
"Self-neglect" means neglect brought about by a vulnerable adult's own actions or inactions which causes the vulnerable adult to fail to meet the essential requirements for physical or mental health and safety due to the vulnerable adult's lack of awareness, incompetence, or incapacity.
"Services which are necessary to aid an individual to meet essential requirements for mental or physical health and safety" means services which include, but are not limited to the:
(A) identification of adults in need of protective services;
(B) provision of medical care for physical or mental health needs; and
(C) provision of assistance in personal hygiene, food, clothing, adequately heated and ventilated shelter, protection from health and safety hazards, protection from physical maltreatment, guardianship referral, outreach, and transportation necessary to secure any of such needs.This excludes taking the adult into physical custody without the adult's consent except through proper procedures for the provision of involuntary services.
"Sexual abuse" means:
(A) oral, anal, or vaginal penetration of a vulnerable adult by or through the union with the sexual organ of a caretaker or other person providing services to the vulnerable adult, or the anal or vaginal penetration of a vulnerable adult with any other object by a caretaker or other person providing services to the vulnerable adult;
(B) for the purpose of sexual gratification, the touching, feeling, or observation of the body or private parts of a vulnerable adult by a caretaker or other person providing services to the vulnerable adult; or
(C) indecent exposure by a caretaker or other person providing services to the vulnerable adult.
"Sexual exploitation" means and includes, but is not limited to, a caretaker causing, allowing, permitting, or encouraging a vulnerable adult to engage in prostitution or in lewd, obscene, or pornographic photographing, filming, or depiction of the vulnerable adult as those acts are defined by Oklahoma law.
"Substantiated" means more than 50% of the evidence collected during an APS investigation determines that maltreatment occurred and the alleged victim meets the definition a vulnerable adult.
"Temporary guardian" means a person or other entity appointed by the court under Title 43A of the Oklahoma Statutes with authority only to consent on behalf of an incapacitated adult to the provision of protective services determined necessary to remove conditions creating an emergency need and other services approved by the court.A temporary guardian serves in that capacity only until the expiration of the order appointing him or her.
"Undue Influence" means the substitution of one person's will for the true desires of another.
"Unsubstantiated" means evidence found during an APS investigation was insufficient to determine maltreatment occurred.
"Verbal abuse" means the use of words, sounds, or other communication including, but not limited to, gestures, actions, or behaviors, by a caretaker or other person providing services to a vulnerable adult that are likely to cause a reasonable person to experience humiliation, intimidation, fear, shame, or degradation.
"Vulnerable adult" means an adult who, because of physical or mental disability or other impairment, may be subject to maltreatment and is substantially impaired in his or her ability to independently:
(A) provide adequately for his or her own care or custody;
(B) manage his or her property and financial affairs effectively;
(C) meet essential requirements for mental or physical health or safety; or
(D) protect himself or herself from maltreatment without assistance.This determination is not made based on a person's eligibility for disability benefits from any source or on the impairment being permanent, but solely on the adult's reported physical or mental condition at the time an APS referral is made and the APS specialist's assessment of that condition during investigation.
SUBCHAPTER 3. REPORTS OF MALTREATMENT OF VULNERABLE ADULTS
340:5-3-1. Reporting a need for protective services
Revised 11-1-07 6-1-08
(a) Mandatory requirement to report.Any person having reasonable cause to believe that a vulnerable adult is suffering from abuse, neglect, or exploitation is mandated by law [Section 10-104.A of Title 43A of Oklahoma Statutes] to make a report to the Oklahoma Department of Human Services (OKDHS), the office of the district attorney in the county in which the suspected incident occurred, or local law enforcement.
(1) State law provides that any person who knowingly and willfully fails to promptly report any abuse, neglect, or exploitation is, upon conviction, guilty of a misdemeanor.
(2) Any person who willfully or recklessly makes a false report or a report without a reasonable basis is liable in a civil suit for any actual damages suffered by any person named in the report and any punitive damages set by the court or jury.
(3) Any person exercising good faith and due care in making a report of alleged abuse, neglect, or exploitation has immunity from any civil or criminal liability that might otherwise be incurred.
(4) Every person in Oklahoma is a mandatory reporter, and select groups who routinely have contact with vulnerable adults are specifically named in Oklahoma statutes, including:
(A) social workers,;
(B) physicians;
(C) operators of emergency response vehicles,;
(D) mental health professionals,;
(E) law enforcement,;
(F) staff of domestic violence programs,;
(G) long-term care facility personnel, including staff of:
(i) nursing facilities;
(ii) intermediate care facilities for persons with mental retardation;
(iii) assisted living facilities; and
(iv) residential care facilities;
(H) persons entering into transactions with a caretaker or other person who has assumed the role of financial management for a vulnerable adult;
(I) staff of:
(i) residential care facilities;
(ii) group homes; and
(iii) employment settings for individuals with developmental disabilities;
(J) job coaches;
(K) community service workers;
(L) personal care assistants; and
(M) other medical professionals.
(b) Content of the report.The law requires that the report of alleged abuse, neglect, or exploitation of vulnerable adults include the information in (1) through (3) of this subsection.Additional information which is useful in investigating a report is included on Form APS-1, Adult Protective Services Referral.The minimum information required by law is:¢ 1
(1) the name, and address, or location of the vulnerable adult;
(2) the name and or address of the caretaker, if any; and
(3) a description of the situation of the vulnerable adult.
(c) Obtaining the name of the reporter.Although the person making the report is not required by law to provide a name, address, or telephone number, such information is helpful in the event the APS specialist has further questions or needs to clarify any points of the complaint.¢ 12
INSTRUCTIONS TO STAFF 340:5-3-1
Revised 11-1-07 6-1-08
1.Additional information which is useful in investigating a report is included in the Intake Section of the Adult Protective Services (APS) Computer System.
12.(a) The person accepting the report explains to the reporter that:
(1) the Oklahoma Department of Human Services (OKDHS) may need to contact the reporter for additional information, and stresses the importance of the reporter's testimony if legal intervention is necessary;
(2) the reporter's name is not revealed during the course of the investigation;
(3) if the caller specifically requests anonymity or refuses to provide a name and contact information, OKDHS Adult Protective Services (APS) records are confidential, but may be disclosed upon order of the court; and
(4) according to state law, [Section 10-104 of Title 43A of Oklahoma Statutes] an employer may not retaliate against an employee for making an APS referral.
(b) If the reporter continues to decline to provide his or her name and contact information, the report is accepted and given to an APS supervisor for screening.
340:5-3-3.Reports received by the county office local human services center (HSC)
Issued 6-1-03 Revised 6-1-08
The local Oklahoma Department of Human Services HSC office is required to accept all reports alleging maltreatment of a vulnerable adult, including anonymous reports and reports made about an adult residing in a different county. County directors are responsible for ensuring compliance.¢ 1
INSTRUCTIONS TO STAFF 340:5-3-3
Issued 6-1-03 Revised 6-1-08
1.Local staff receiving reports record information on Form APS-1, Adult Protective Services Referral, or its electronic equivalent in the Intake Section of the Adult Protective Services (APS) Computer System.In the case of a report on an adult residing in another county, the local office receiving the report takes all required information.The information recorded is also sent by electronic mail or fax to the appropriate Adult Protective Services (APS) specialist IV or designee.The report is automatically submitted to the APS Specialist IV for screening by the APS Computer System.In situations which require immediate response, the appropriate APS staff is telephoned immediately.
(1) The local Oklahoma Department of Human Services (OKDHS) staff person accepting the report explains to the caller that OKDHS is not able to release or discuss specific information about the investigation unless the reporter is responsible for provision of some kind of protective services to the client.
(2) Any report received is considered a request for protective services and is submitted to the appropriate APS supervisor for screening.If a report is not accepted for APS investigation, the reporter is referred to any other agencies which might be able to provide help for the situation, and the.The contact is documented as an Information and Referral. (I & R) by the APS supervisor or their designee, stating the reasons the report did not meet the criteria for investigation.This is documented in the APS Computer System I & R Notes Section.
SUBCHAPTER 5. INVESTIGATION OF ADULT PROTECTIVE SERVICES
REFERRALS
340:5-5-2. Initiating investigations
Revised 6-7-04 6-1-08
An Adult Protective Services (APS) investigation is initiated by a visit to the vulnerable adult who is the alleged victim (AV) at the adult's home or other place of residence.¢ 1 through 4
(1) Time frame for initiating investigations.
(A) Investigations of referrals of maltreatment are initiated as soon as possible within three working days of the receipt in the Oklahoma Department of Human Services (OKDHS), excluding weekends and official OKDHS holidays, of receipt of the referral by the assigned APS unit.
(B) In the case of an emergency situation when immediate action may be required, the investigation is initiated as soon as possible within four hours of receipt.¢ 5 & 6 2
(2) Denial of access to the AV.If the APS specialist is denied entry into the residence of the AV, or is denied a private interview with the AV, the Oklahoma Department of Human Services OKDHS staff may petition the court for an order allowing entry or access.
INSTRUCTIONS TO STAFF 340:5-5-2
Revised 3-1-06 6-1-08
1.(a) Prior to the Adult Protective Services (APS) specialist making the initial visit to the vulnerable adult, the supervisor discusses with the APS specialist any safety issues identified in the acceptance and screening of the report, and together they make arrangements for safety concerns to be addressed both before and during the visit.The APS specialist:
(1) and the APS supervisor staff the report and case record information and determine whether there are any risk factors associated with the family, their the home, or their the neighborhood.If the APS specialist believes the home visit cannot be made safely, then the APS supervisor is consulted to determine whether a home visit is appropriate due to the safety concerns.If not, law enforcement is contacted for assistance;
(2) prior to petitioning the court for an order of entry, staffs the situation with the supervisor and documents the situation in the Notes Section of the APS Computer System;
(23) prepares either a paper day sheet or schedule in Microsoft Outlook Calendar, listing the planned visits for the day and maintains that schedule as much as possible.
(A) A copy of the day sheet is left in plain sight on the APS specialist's desk or left with the supervisor.
(B) If there are major changes in the schedule, the APS specialist informs the human services center (HSC) staff or the APS supervisor of the changes;
(34) arranges the work schedule in order to make new or questionable visits early in the day;
(45) notifies human services center HSC staff when he or she leaves and returns.If the APS specialist plans to go home after the last field visit, he or she notifies the APS supervisor after the last visit is finished even if it is an after hours visit; and
(56) is aware of the areas in the neighborhood where help could be obtained if an emergency occurred.
(b) Human services centers HSCs keep supplies of basic safety equipment items for the APS specialist to keep in the car when making home visits.
(1) The APS specialist carries:
(A) a cellular phone, whenever possible;
(B) one change of clothing;
(C) clean towels for clean-up or decontamination;
(D) surgical gloves for handling adults that may be injured or exposed to methamphetamine;
(E) disinfectant hand wipes;
(F) plastic trash bags for covering car seats and floorboards, and carrying clothes that may need decontamination; and
(G) dust masks to limit breathing of chemical or other fumes.
(2) When preparing to park and leave the vehicle used for making the home visit, the APS specialist:
(A) parks in an open area and near a light source that offers the safest walking route to the home;
(B) locates the client's building before exiting the car when the client's residence is in an apartment complex, whenever possible;
(C) parks on the street rather than in a driveway, and in the direction in which the APS specialist plans to leave; and
(D) takes only the items necessary to complete the home visit.Purses or wallets are concealed if left in a parked and locked car.
(3) When approaching the residence, the APS specialist:
(A) looks and listens for signs of someone in the residence and assesses whether there is any indication of danger involving the occupants of the residence;
(B) is aware of any smells associated with substance abuse;
(C) observes the outside of the residence, the surrounding homes, any animals or unfamiliar vehicles; and
(D) if carrying a cellular phone, programs the phone so that a 911 call can be made easily in an emergency.
(4) In order to make a safe entrance into the residence, the APS specialist:
(A) goes only to the door that is in plain sight of the street and stands to the side of the door when knocking;
(B) as the door is opened, looks quickly inside to determine if there are any threats to safety;
(C) does not enter the home if an unseen person calls for the APS specialist to come in;
(D) quickly evaluates the client's attitude and demeanor to determine if there are warning signs of aggression, violence, substance use, or suspicious behavior;
(E) secures an entry order from the court if needed to obtain permission for law enforcement to enter the home; and
(F) does not enter the home when law enforcement accompanies the APS specialist for the home visit.If law enforcement:
(i) makes the decision to enter, the APS specialist remains outside the residence in order to ensure the APS specialist's physical safety; or
(ii) requests the assistance of the APS specialist in the residence due to an emergency with the adult, the APS specialist does not enter the residence until it has been secured by law enforcement and is determined safe to enter;
(G) does not attempt to aggressively persuade the client if he or she refuses to allow access to the home.If denied, the APS specialist leaves the residence and consults with a supervisor; and
(H) leaves the residence if the APS specialist does not feel safe entering the home, and consults with a supervisor.
(5) When in the client's residence, the APS specialist is particularly aware of any signs of risk to safety.The APS specialist once inside the client's residence:
(A) stays near an exit and remains alert and observant;
(B) pays attention to any unusual sights or smells, particularly those associated with the manufacture or use of drugs;
(C) remains aware of the possibility of any other persons in the residence and inquires about anyone that may appear to be in another room; and
(D) leaves immediately if there is risk to safety.
(6) When leaving the client's residence, the APS specialist remains alert to safety risks by:
(A) observing any activity or persons near the residence or in the neighborhood;
(B) having car keys in hand when walking to the parked car; and
(C) not lingering to make phone calls or notes, but instead leaves the neighborhood immediately.
(7) If an APS specialist has an ongoing APS case in which there have been or are new allegations of methamphetamine use or manufacture, the same precautions are taken as in an investigation.
(c) APS staff maintain regular contact with law enforcement to stay informed about the most current indicators of methamphetamine production.The Oklahoma Bureau of Narcotics and Dangerous Drugs Control (OBNDDC) information flyers are kept in supply in each human services center.
(1) Outbuildings, hotel and motel rooms, apartments, storage sheds, garages, and vacant buildings are all common places where methamphetamine is produced.Some of the indicators of methamphetamine use and production identified by the OBNDDC are:
(A) strong odor that resembles urine or unusual chemicals such as ether, ammonia, or acetone;
(B) little or no traffic around the home during the day, but significant activity during very late hours;
(C) extra efforts made to cover windows or to reinforce doors;
(D) trash not put out for collection;
(E) significant accumulation of items such as cooking dishes, coffee filters, or bottles that do not appear to be for regular household use;
(F) presence of unusual quantities of chemicals; and
(G) vehicles loaded with laboratory materials or chemicals.
(2) The APS specialist, in initiating an investigation alleging use or production of methamphetamine:
(A) requests law enforcement to accompany him or her;
(B) remains in the car until law enforcement has determined that the residence is safe to enter; and
(C) does not enter the residence under any circumstances when there is evidence of a methamphetamine laboratory.
(3) When evidence of a methamphetamine laboratory either outside or inside the residence is encountered, the APS specialist:
(A) does not enter any residence where there is any evidence of methamphetamine laboratory materials or chemicals on the property;
(B) discreetly, but immediately leaves the residence if he or she unknowingly enters a home in which there is evidence of a methamphetamine laboratory, and drives to a safe location to contact law enforcement; and
(C) follows decontamination procedures as described in paragraph (4) of this Instruction.
(4) If there is any exposure to a methamphetamine laboratory, decontamination procedures are followed.The APS specialist:
(A) covers car seats and floorboards with plastic covering and wipes hands with disinfectant wipes before touching the steering wheel;
(B) goes to a safe location to change clothes and place the dirty clothes in a plastic trash sack.All exposed skin surfaces are cleaned with disinfectant wipes.Wash any items carried into the home with soap and water; and
(C) makes every effort not to touch any surface until the skin has been wiped with disinfectant wipes or items washed with soap and water.
(d) The APS specialist coordinates with law enforcement to handle decontamination procedures and ensure the safety of any vulnerable adult who has likely been exposed to a methamphetamine laboratory.
(1) Transportation of the vulnerable adult is arranged by the APS specialist in cooperation and coordination with law enforcement.
(2) Whenever possible, the vulnerable adult is taken immediately for a medical examination.If it is not possible to obtain a medical examination the same day, arrangements for a medical examination are made as soon as possible.
(3) Whenever possible, the adult is taken immediately for a medical examination.If it is not possible to obtain a medical examination the same day, arrangements for a medical examination are made as soon as possible.
2.(e) If the vulnerable adult is in the hospital or other temporary residence at the time of the referral, the initial visit is made to that location.
3.(f) The initial home visit is not preceded by a telephone call or appointment and is made unannounced.
4.(g) If the alleged victim (AV) cannot be located, efforts to locate the AV are documented in the case record Interview Section of the APS Computer System.
52.(a) An emergency situation is determined by the APS supervisor at the time of screening and immediately communicated to the assigned APS specialist.
6.(b) If an investigation is not initiated in a timely manner, reasons for the lack of timeliness are documented in the case Notes Section of the APS Computer System.
340:5-5-3. Elements of an investigation
Revised 8-1-06 6-1-08
Although the investigation process may vary depending on the initial allegations and other factors, all Adult Protective Services (APS) investigations include paragraphs (1) through (10).
(1) Notification of local law enforcement.Local law enforcement is provided notification of all APS referrals assigned for investigation.¢ 1
(2) Efforts to locate and notify others.APS specialists must make every reasonable effort to locate and notify the vulnerable adult's caretaker, guardian, and next of kin.¢ 2
(3) Visits to and interviews with the vulnerable adult.Each APS investigation includes at least one visit and private interview with the vulnerable adult, and may include as many as are necessary to reach a conclusion and determine what, if any, protective services are needed.¢ 3
(4) Consultation with others.Other people who have or can reasonably be expected to have pertinent knowledge about the alleged victim's (AV's) circumstances are interviewed during the investigation, including any alleged perpetrator of maltreatment.
(A) This consultation includes medical, psychiatric, or other evaluations as necessary to assist in the determination of a vulnerable adult's decision-making capacity and need for services.
(B) The AV's permission is not required for these contacts.¢ 4
(5) Photographs.The APS specialist may take still photographs or video recordings to document injuries to the vulnerable adult, or conditions in the adult's residential environment which have resulted or may result in an injury or serious harm to the adult.
(6) Other relevant data.The APS specialist collects any data relevant to the situation being investigated, including records, to arrive at a finding on the referral.If the APS specialist is denied access to pertinent records, documentation, or other information relevant to the investigation, the Oklahoma Department of Human Services (OKDHS) may petition the court for an order allowing access.
(7) Determining the adult's decision-making capacity.OKDHS is mandated by Section 10-106.C of Title 43A of the Oklahoma Statutes to determine a vulnerable adult's risk and needs along with the client's capacity to consent to receive services, especially with regard to the need for involuntary services.Each investigation includes an evaluation of the vulnerable adult's decision-making capacity.
(A) Information is obtained from medical or psychiatric sources, if available, to assist in the determination.In making this determination, the APS specialist assesses and considers:
(i) the client's short and long term memory;
(ii) the client's executive functioning by their ability to plan and execute a plan;
(iii) the client's ability to recognize risk factors;
(iv) denial of problems by client or caretaker;
(v) the client's executive functioning by their ability to understand and follow directions;
(vi) indicators of affective disorders such as depression or bipolar disorder; and
(vii) indicators of substance abuse, dementia, delirium, psychosis, traumatic brain injury, uncharacteristic socially inappropriate behaviors, impaired decision-making, and other factors.
(B) The APS specialist's assessment of a client's mental capacity to consent to protective services takes into account the client's awareness of:
(i) the limitations and deficiencies in the physical environment;
(ii) the client's own physical or mental limitations;
(iii) resources available to assist in meeting the client's needs; and
(iv) the consequences to the client if nothing is done to improve the situation.
(C) If a client is deficient in all or most of the areas in (B) of this paragraph, he or she may lack the capacity to consent to protective services and it may be appropriate to petition the district court for an order authorizing the provision of needed services.
(D) If a client expresses awareness of all four areas in (B) of this paragraph, it is likely that the present circumstances are the client's choice, though in some cases a client might express awareness in these areas and still lack the capacity to consent to provision of services.
(E) If a client appears unaware of the consequences of the present situation, and an emergency exists, legal intervention is appropriate.
(8) Evaluation to determine the need for protective services.The evaluation consists of the APS specialist's analysis and consultation with the supervisor of all evidence gathered during the initial phases of the investigation.The evaluation includes consideration of whether:
(A) the vulnerable adult needs protective services.If so, the need for protective services is documented in a statement that includes the least restrictive services that will meet the person's needs;
(B) services that are identified as needed are available through OKDHS or in the community, and the sources and manner in which they can be provided.Options are explored with the vulnerable adult;¢ 5
(C) the vulnerable adult is capable and willing to obtain services for himself or herself;
(D) the vulnerable adult can pay for needed services or is eligible for public assistance programs;
(E) a caretaker or guardian is willing to provide or agree to the provision of needed services; and
(F) the vulnerable adult desires the services.¢ 65
(9) Completion of investigative report.The APS specialist, within:
(A) 30 60 calendar days of the date the report is received,:
(A) completes necessary interviews and assessments including identification of any immediate service needs; and
(B) 30 calendar days of the date the report is received when the allegation involves self-neglect:
(i)(B) completes all final documentation;
(ii)(C) submits a report to the local district attorney; and
(iii)(D) makes a determination of substantiated or unsubstantiated based on the definitions of terms in OAC 340:5-1-6; or¢ 6,7, & 8
(C) 60 calendar days of the date the report is received when the allegation involves a third party perpetrator:
(i) completes all final documentation;
(ii) submits a report to the local district attorney; and
(iii) makes a determination of substantiated or unsubstantiated based on the definitions of terms in OAC 340:5-1-6.¢ 6,7, & 8
(10) Follow-up.The APS specialist, in consultation with the APS supervisor, is responsible for determining what follow-up is needed in each case investigated.
(A) On cases not requiring court-ordered involuntary services, follow-up needs are determined on a case-by-case basis.¢ 7
(i) If the supervisor and APS specialist determine no follow-up is necessary, that decision and the reasons for it are documented in the case record.
(ii) If the supervisor and APS specialist determine follow-up is necessary, that decision and the reasons for it are documented in the case record, along with the plan for completing follow-up, the findings of the follow-up, and any action necessary in response to those findings.
(B) When the contact is made by phone or other means than face-to-face visit, supervisory approval of the means of contact is documented in the case record, along with the reasons justifying contact other than face-to-face.
(CB) For referrals that resulted in a client receiving involuntary services, OKDHS is responsible for assuring ensuring basic needs for safety and security are met as required by the court.The APS specialist monitors the delivery of court-ordered protective services and continues to assess the need for additional services determined by the changing needs of the client.At least one follow‑up visit is made at 30 days regardless of whether OKDHS continues to hold temporary guardianship.
(i) If the client's situation is stable or improving after 30 days and OKDHS no longer holds guardianship, the case is closed.
(ii) If OKDHS continues to hold guardianship after 30 days, a follow-up visit to the client is required at least once each 30 days for the duration of the temporary guardianship.
(iii) If the client's situation is deteriorating at any time during the follow-up period, the service plan is reassessed and changed as needed with the concurrence of the court.
(iv) Follow-up visits to clients receiving involuntary services are made at least every 30 days, but may be made as often as needed to comply with APS specialist guardianship responsibilities and to monitor the client's situation.
(v) If an out-of-home placement is used as a temporary or long term solution to identified needs, the APS specialist has regular contact with the client for the duration of the court ordered temporary guardianship.The frequency of this contact is determined by the APS specialist and supervisor's determination of the specific client situation and the availability of an independent objective third party to provide follow-up and notification to the APS specialist.Visits to the client are made at least once every 30 calendar days while the client is under APS guardianship.Information from follow-up visits is documented in the case record and made available to the court on review of the guardianship.Follow-up visits may be made as frequently as the APS specialist and supervisor determine they are needed, based on an individual client's situation.¢ 8For clients placed:
(I) in medical facilities such as geriatric psychiatric units or medical hospital for care, the worker follows-up with the client's assigned social worker;
(II) in group homes, residential care facilities, and assisted living centers, the APS specialist may contact other professionals not associated with the facility who provide treatment or services to the client for follow‑up information every 30 calendar days or more often as indicated;
(III) at any facility owned or operated by OKDHS, face-to face-visits are made every 30 calendar days with interim contacts with the social work staff or more often as indicated; and
(IV) at any type of nursing home, the APS specialist visits the client, at least once every two weeks during the first month of placement to check for changes in the client's condition, such as injuries, signs of over‑medication, and cognitive state.Concerns are discussed with the nursing home administrator or director of nursing, and the APS supervisor.After the first month, the APS specialist visits the client at least once every 30 calendar days, reviews the nursing home charts and incident reports, and discusses care needs with the staff and client's family, if available.
(DC) The APS specialist may determine as a result of follow-up contacts that further placement options need exploring.This may be the result of inappropriate action on the part of the provider, current information about the facility's ability to provide care for the client, or the facility's request to relocate the client.Placement alternatives are determined in accordance with this Section and approved by the supervisor, county director, and the area APS field liaison.The court appointed attorney for the client and the family is notified of the problems and alternatives that have been developed.A written report of the change of placement is submitted to the court, with a copy of the motion to the client's family and attorney of record.
(ED) Follow-up contact with clients remaining at home in temporary guardianship is made frequently with a minimum of every 30 calendar days to assure that client safety and needs are being met by the established service plan.Modifications are made as needed to the service plan as well as provision of services by providers.The quality of care and the method of contact are evaluated on a case-by-case basis depending on the individual needs of the specific client including a face‑to‑face visit every 30 calendar days.Reports are submitted at the request of the court or a minimum of every 30 calendar days.
(FE) In the event the client is placed in a facility out-of-county, the APS supervisor or designee immediately contacts the APS supervisor in the county of placement to notify the receiving county of the placement and that follow-up activities pursuant to this paragraph must be provided by the receiving county.
(i) The APS specialist in the county where the client is residing is the worker designated to provide follow-up services for temporary guardianship cases.That APS specialist documents contacts and required information as set forth in this subparagraph and sends it to the county of jurisdiction once a month.¢ 9
(ii) The resident county APS specialist is responsible for all issues that require written consent and other problems or concerns and acts in coordination with the APS specialist in the county of court jurisdiction for reporting to the court as required by the court order with a minimum of every 30 calendar days. ¢ 9 All actions are discussed with APS specialist in the county of court jurisdiction.
(iii) The APS specialists and supervisors from both counties discuss and determine the best course of action for renewals of temporary guardianships.
(I) The decision takes into account, the client's specific situation, the family and their desires, the availability of the courts in the two counties, and the advice of the client's court appointed attorney, and the attorney(s) representing OKDHS in the matter.
(II) The area APS field liaison, State Office APS Family Support Services Division (FSSD) APS Unit, and attorneys for the OKDHS Legal Division are consulted as needed for assistance in determining the best course of action.
INSTRUCTIONS TO STAFF 340:5-5-3
Revised 8-1-06 6-1-08
1.Each Adult Protective Services (APS) supervisor is responsible for determining, in conjunction with each county director and local law enforcement agencies, the method and frequency of notifying the law enforcement agencies of APS referrals within their jurisdictions.
2.(a) To accomplish this mandate, existing Oklahoma Department of Human Services (OKDHS) records are reviewed by the APS specialist.The reporter, if known, other professionals involved with the vulnerable adult, and involved friends, neighbors, or service providers may provide information to identify the client's caretaker, guardian, and next of kin.For purposes of this requirement:
(1) "caretaker" is the vulnerable adult's primary caretaker;
(2) "guardian" is a guardian, limited guardian, or conservator appointed under Title 30 of the Oklahoma Statutes.Persons holding power of attorney or similar surrogate decision-making documents are not guardians; and
(3) "next of kin" of the vulnerable adult is the adult's spouse, closest adult child, closest sibling, or closest adult grandchild, or, in the case of younger vulnerable adults, the adult's parent.
(b) If the vulnerable adult retains the capacity to consent to voluntary services, and does not wish for a caretaker or next of kin to receive notification of the investigation, OKDHS abides by the wishes of the vulnerable adult.
(c) When the caretaker, guardian, and next of kin are identified, a copy of "APS Questions and Answers," OKDHS Publication Number 99‑07, is provided to each of them and to the vulnerable adult.
3.This requirement includes the initial visit, a follow-up visit to the home if the alleged victim (AV) is in the hospital or other place at the time of the referral, and any other visits and interviews with the vulnerable adult.
(1) During each visit with the AV, the adult's circumstances are observed and documented in writing in the case record Interview Section of the APS Computer System.
(2) The law requires at least one private interview with the AV.
(3) All interviews are documented in the Interview Section of the APS Computer System.
4.These consultations, known as collateral contacts, are of extreme importance in determining the AV's current circumstances, expressed desires, habitual practices, and recent changes.All interviews with collaterals, alleged perpetrators, family members, next of kin, caretakers, legal guardians, or service providers are documented in the Interview Section of the APS Computer System.
(1) The AV's caretaker, guardian, and next of kin are considered collateral contacts if they are identified.
(2) Any collateral contacts about which the APS specialist is unsure are staffed with the specialist's supervisor before proceeding.
(3) The alleged perpetrator (AP) is interviewed in all referrals in which a perpetrator is identified.The AP is interviewed after other contacts have been interviewed.
(4) The APS specialist coordinates with appropriate law enforcement officials regarding interviewing APs who are also or may be the subject of a criminal investigation.
(5) An investigation is considered complete when a finding is reached, the Form APS-2 08AP002E, Adult Protective Services Report of Investigation, is submitted to the district attorney (DA), and the computer documentation of the finding is done.
(6) At any time it appears that criminal wrongdoing may have occurred, the APS specialist discusses the case with local law enforcement, the DA, or both before interviewing the AP.
(7) All collateral contacts and attempts at contact are documented in the case record.
5.APS specialists in each local office develop a coordinated working relationship with the local Oklahoma State Department of Health, mental health facilities, DA's office, law enforcement agencies, and other public or private agencies which may be helpful in facilitating the investigation process or in providing needed services to clients.
6.(a) This evaluation is the basis for determining a referral substantiated or unsubstantiated, and for developing an individualized service plan for the client.
(1) The APS specialist reviews all evidence gathered during the investigation, including all collateral contacts made and all records reviewed to assess their usefulness in making a finding on the referral.
(2) If more than half of the evidence indicates maltreatment of the vulnerable adult is likely to have occurred and that the alleged victim is a vulnerable adult, a finding of substantiated is entered in the Findings Section of the APS Computer System.
(3) If less than half of the evidence indicates maltreatment is likely to have occurred, a finding of unsubstantiated is entered in the Findings Section of the APS Computer System.
(4) Although intuition and instinct play a large part in the investigative process, they play no part in the case finding.Even a very strong feeling that maltreatment occurred, if not supported by sufficient evidence, must result in a finding of unsubstantiated.
(5) A service plan is developed with the client and involved family and caretakers in all cases where service needs are indicated.
7.(b) The county director is responsible for monitoring timely completion of APS investigations within 60 calendar days and regularly discussing with the APS supervisor referrals with investigations pending over 90 calendar days.
8.(c) Service provision and follow-up activities often extend beyond the 60 calendar days based on the individual client's needs and service plan.These ongoing activities are not considered in determining whether the investigation was timely, as long as a substantiation decision has been reached and the Form APS-2 08AP002E submitted to the DA's office.
7.Follow-up activities are documented in the APS Computer System by the completion of a new risk assessment in the Risk Assessment Section, documentation in the Interview section, and updating the Service Plan Monitoring Section.
(1) If the supervisor and APS specialist determine no follow-up is necessary, that decision and the reasons for it are documented in the Service Plan Section of the APS Computer System.
(2) If the supervisor and APS specialist determine follow-up is necessary, that decision and the reasons for it are documented in the Notes section.The plan for completing follow-up is documented in the Service Plan Section of the APS Computer System.
(3) When the contact is made by phone, it must be done with a third party.The third party must not be the vulnerable adult or the alleged perpetrator.Supervisory approval of the means of contact is documented in the Notes Section of the APS Computer System, along with the reasons justifying contact other than face-to-face.
8.The worker documents information from follow-up visits in the Interview Section, the Risk Assessment Section, and the Service Plan Section of the APS Computer System.
9.In the event the client is placed in a facility out-of-county the APS specialist in the placement county is added to the APS Computer System as a back-up worker and documents all contacts, interviews, and risk assessments on the APS Computer System as soon as the contacts are made. All actions are discussed with the APS specialist in the county of jurisdiction and documented in the Notes, Interview, and Service Plan Sections of the APS Computer System.
340:5-5-4. Special considerations during investigations
Revised 7-1-07 6-1-08
(a) Referrals regarding members of Indian tribes.Referrals are accepted for an alleged victim (AV) who is a tribal member according to the Protective Services for Vulnerable Adults Act as set forth in Sections 10-101 through 10-110 of Title 43A of the Oklahoma Statutes.The Adult Protective Services (APS) specialist provides or arranges voluntary or involuntary services as indicated for a vulnerable adult regardless of whether the adult resides on tribal land.¢ 1
(b) Referrals involving two or more counties.If a referral involves two or more counties, as when the AV lives in one county and the alleged perpetrator (AP) in another, local APS staff from both human services centers (HSCs) are involved in the investigation.¢ 2
(c) Referrals involving Soonercare (Medicaid) fraud.When an APS investigation indicates fraud by a provider receiving Medicaid funds, APS staff immediately notifies the Medicaid Fraud Control Unit (MFCU) in the Office of the Oklahoma Attorney General.APS cooperates with any investigation by MFCU.If MFCU declines to investigate, APS staff completes the investigation and sends a summary report to MFCU upon completion of the investigation.
(d) Referrals involving persons and provider agency employees.APS investigations of maltreatment of vulnerable adults may include all persons in a relationship of caretaker, regardless of organizational affiliation, except those noted in Subchapter 3 of this Chapter.Care providers who may be subject to APS investigation include, but are not limited to, home health providers, community services workers for persons with developmental disabilities, personal care assistants, adult foster homes, adult day care centers, independent living centers, residential care facilities, and assisted living centers.
(1) These agency investigations include all the elements of an APS investigation, with special emphasis placed on:
(A) interviewing agency staff and other residents or participants who may have knowledge of the reported incident;
(B) obtaining copies of applicable charts and records;
(C) reviewing medication lists and schedules;
(D) taking photographs;
(E) examining habilitation or other care plans;
(F) examining financial records and other money management documentation;
(G) reviewing time schedules and time sheets; and
(H) requesting any other information needed to complete the investigation.
(2) If assistance is needed in assessing medical issues in these cases, involvement of the OKDHS long-term care nurse may be requested.¢ 3
(3) APS staff submits findings of substantiated referrals of maltreatment by persons who are personal care assistants, Medicaid personal care attendants (MPCA), and community services workers subject to the requirements of the Community Services Worker (CSW) Registry maintained by Developmental Disabilities Services Division (DDSD) pursuant to Section 1025.3 of Title 56 of the Oklahoma Statutes within three working days to the OKDHS Office of Client Advocacy for consideration of placement of the worker's name on the statewide CSW Registry.Persons whose names are on the CSW Registry must not be employed by providers for direct care services to persons with developmental disabilities or as personal care attendants (PCA) paid through the Medicaid ADvantage Waiver.¢ 4
(4) For agency employees who are not subject to the CSW Registry requirements, the agency director or board is notified of any substantiated elements of the investigation.Any corrective action plan on the part of the agency becomes a part of the APS case record.If the agency fails to cooperate in addressing the substantiated elements of the investigation, APS staff notifies the licensing agency, any appropriate governing board, and the district attorney's (DA's) office of the failure to cooperate.
(e) Referrals involving other licensed or certified persons.APS staff sends findings to any state agency with concurrent jurisdiction over persons or issues identified in the investigation, including, where appropriate, the Oklahoma State Department of Health (OSDH), the Oklahoma Board of Nursing, and any other appropriate state licensure or certification board, agency, or registry.¢ 5
(f) Referrals alleging exploitation.Referrals involving exploitation are complex.To assist in handling some of these referrals, the OKDHS Office of the Inspector General (OIG) may accept for investigation referrals of exploitation involving large amounts of funds or the need to access complex records regarding financial transactions.¢ 6If OIG declines to investigate, the APS specialist completes the investigation.Protective services that may be provided in cases of exploitation include:
(1) changing the representative payee; ¢ 67
(2) freezing all assets of the client; and
(3) petitioning the court for an order allowing access to records; and ¢ 7
(4) redirecting or stopping the flow of client assets into the alleged perpetrators accounts or access to the accounts.
(g) Persons referred to OKDHS by the courts.Courts are not authorized to remand criminal defendants to OKDHS based on a finding of lack of competency. Courts are authorized to refer the alleged incompetent defendant to OKDHS for consideration of voluntary assistance according to Section 1175.6b(B) of Title 22 of the Oklahoma Statutes.In order to qualify for such findings, the court must make findings described in (1) or (2) of this subsection.
(1) Referral for voluntary services occurs when the court finds that the person is incompetent for reasons other than the AV is a person requiring treatment under Title 43A of the Oklahoma Statutes and is found not to be dangerous.
(2) When a court, the DA, or the attorney for a criminal defendant notifies the APS specialist that a referral for voluntary APS services has been made, the APS specialist obtains a copy of the order from the person making the referral.If, after evaluation, it appears to the APS specialist the AV may also be developmentally disabled, the APS specialist immediately contacts the DDSD Area Intake office and requests their involvement in the process of determining what voluntary services are available.This is a joint effort between the APS specialist and the DDSD case manager.¢ 8
(h) AV receiving services from DDSD.When an AV is receiving or may be eligible for services from DDSD, the APS specialist contacts the appropriate DDSD Area Intake office to coordinate activities to enhance the AV's safety.Section 1175.3(D)(1)(b) of Title 22 of the Oklahoma Statutes authorizes a court to call for DDSD to conduct a competency evaluation to determine whether mental retardation or other developmental disability may be involved.¢ 9
(i) Referrals involving residents of residential care facilities, assisted living facilities, and continuum of care facilities.A copy of the final investigative report is sent to OSDH.¢ 10
INSTRUCTIONS TO STAFF 340:5-5-4
Revised 7-1-07 6-1-08
1.Adult Protective Services (APS) staff is encouraged to continue the established working relationships with tribal social services to provide services for Native American clients, but are not required to contact tribal APS prior to initiating and completing an APS investigation.APS staff may contact the United States Marshal for assistance on restricted land, as appropriate.
2.APS staff in the county of residence of the alleged victim (AV) has primary responsibility for maintaining the case record of the investigation.APS specialists in other counties involved cooperate fully and as quickly as possible in attempting to obtain information needed for the investigation.All requested information is forwarded to the human services center (HSC) in the AV's county of residence for completion of the case.
(1) Staff in the HSC of the county of residence may request staff in the HSC of the county in which the alleged perpetrator (AP) lives to conduct the interview with the AP.All efforts to involve the AP with the APS staff in the county of residence are exhausted before this option is exercised.The same APS specialist interviews the AV and the AP if possible.
(2) When problems with coordination between APS staff in different HSCs occur, they contact the area APS field liaison(s) for resolution.
3.(a) The APS specialist may request the involvement of an Oklahoma Department of Human Services (OKDHS) long-term care (LTC) nurse in investigations involving agency providers or when a nursing assessment is needed.The role of the nurse in APS cases is to:
(1) act as a resource in the interpretation of physical observations made by the APS specialist;
(2) accompany the APS specialist to visit the client if approved by the area nurse;
(3) assist the APS specialist in determining a course of action on the client's behalf; and
(4) assist in the follow-up of the client in the home, as appropriate.
(b) In order to involve the OKDHS LTC nurse in an APS investigation, the APS specialist must determine that the need exists for an in-home medical assessment.This conclusion may be reached after discussion with the APS specialist IV and the OKDHS LTC nurse, or both.
(1) If the OKDHS LTC nurse is not available, the specialist may call the area nurse.
(2) If a nurse cannot be reached or is geographically unavailable for immediate response, the APS specialist determines whether other nursing resources are available.Examples of other nursing resources include the Developmental Disabilities Services Division (DDSD) nurse or nurse at the local Oklahoma State Department of Health (OSDH).
(3) If the situation demands immediate attention and no nursing resource is available, the APS specialist initiates the home visit immediately.
(c) If assistance from the OKDHS LTC nurse is appropriate either at the initial home visit or follow-up visits, the APS specialist accompanies the nurse to visit the client.If the OKDHS LTC nurse accompanies the APS specialist on the initial home visit, the specialist and OKDHS LTC nurse together assess the need for further action.After a visit to the client, the OKDHS nurse completes all items on Form 08AP003E, Adult Protective Services Nursing Assessment, and submits the original to the APS specialist for scanning and inclusion in the case record Nursing Assessment Section of the APS Computer System.
4.(a) The APS specialist submits Form 08AP001E, Adult Protective Services Referral to the Office of Client Advocacy (OCA) by fax to 405-525-4855 or e‑mail to *OCA.Intake@okdhs.org:
(1) Form 08AP015E, Transmittal to Client Advocacy;
(2) copies of the Intake Section and any pertinent sections from the APS Computer System;
(3) Form 08AP002E, Adult Protective Services Report of Investigation,; and
(4) relevant documentation to the Office of Client Advocacy (OCA), along with Form 08AP015E, Transmittal to Client Advocacy, by fax to 405-525-4855 or e‑mail to *OCA.Intake@okdhs.org.
(b) If any supporting documentation is not available in electronic format, the APS specialist sends it to OCA Intake by interagency mail, with the APS case number clearly identified on the forms.
(bc) For substantiated findings against a community services worker (CSW), the:
(1) finding substantiates physical, sexual, or verbal abuse, neglect, or financial exploitation by a caretaker.Self neglect is not included;
(2) vulnerable adult named as a victim is a person with developmental disabilities; and
(3) maltreatment was committed by a caretaker employed as a habitation training specialist (HTS) by a vocational, residential, or in-home supports provider.
(cd) For substantiated findings against a personal care attendant (PCA), the:
(1) finding substantiates physical, sexual, or verbal abuse, neglect, or financial exploitation of a vulnerable adult by a caretaker.Self neglect is not included; and
(2) maltreatment was committed by a caretaker employed as a Medicaid PCA (MPCA) through the ADvantage Waiver program.
(de) OCA screens APS reports to ensure they involve a matter subject to the CSW Registry.Within two working days of receiving a report, OCA decides whether to open an investigation. OCA Intake Unit notifies the APS specialist and or supervisor by e-mail of the decision.If OCA does not open an investigation, that does not change the APS substantiated finding.
(ef) The process established for consideration of placement of a person's name on the Abuse Registry must be followed.
(1) APS uses a preponderance of the evidence standard to substantiate maltreatment of a vulnerable adult.The Abuse Registry process requires clear and convincing evidence which is a higher standard of proof.Some APS substantiated findings do not meet this higher burden of proof.OCA reviews APS findings to determine whether the cases merit further review.
(2) If the case appears to merit further review, OCA completes an independent investigation. If the OCA investigation results in a substantiated finding on a CSW or MPCA, OCA submits its report to OKDHS Legal Division for review.If the Legal Division determines that placement of the person's name on the Abuse Registry may be warranted, the CSW or MPCA is notified of due process rights, including the right to an administrative hearing.
(fg) When the APS specialist has any question about whether to send a particular report to OCA, the APS specialist contacts OCA Intake for guidance at 405-525-4850 or 800-522-8014.
5.(a) Contact information for OSDH includes:
(1) mailing address, 1000 N.E. 10th Street, Oklahoma City (OKC), Oklahoma (OK)73111;
(2) local telephone number, 405-271-6868; toll-free number, 1‑800‑747-8419; fax number, 405-271-4172; and toll-free fax, 1‑866-239-7553; or
(3) e-mail address, LTCComplaints@health.state.ok.us.
(b) Contact information for the Oklahoma State Board of Nursing includes:
(1) mailing address, 2915 N. Classen Blvd., OKC, OK73106; and
(2) telephone number, 405-962-1800.
6.A vulnerable adult's benefits may be suspended pending appointment of a payee or change of payee.
76.A referral to OKDHS Office of Inspector General (OIG) is made on Form 19MP001E, Referral Form, or electronic equivalent.An e-mail referral is made or is sent to oigfraud@okdhs.org.
7.A vulnerable adult's benefits may be suspended pending appointment of a payee or change of payee.
8.When an AV in a criminal defendant case is referred to OKDHS, the assigned APS specialist makes periodic reports to the court regarding the status, activities, and well-being of the AV in accordance with Section 1175.6b of Title 22 of the Oklahoma Statutes.Periodic reports are made at least yearly, or more often if ordered by the court.
(1) Original case records on clients previously remanded to OKDHS under Title 22 of the Oklahoma Statutes are maintained in the HSC of the client's residence.Copies of all reports and evaluations are kept in the original case record. New reports are entered in the Intake Section of the APS Computer System with references to existing paper files.
(2) If the county of the client's residence is different from the county of court jurisdiction, the HSC in the county of court jurisdiction maintains a "dummy" case containing copies of all court orders, evaluations, and reports submitted to the court.At least two weeks prior to the date a report is due to the court, the APS specialist in the county of court jurisdiction notifies the APS specialist in the county of residence that the report to the court is due.The APS specialist in the county of residence is responsible for completing the report and any necessary evaluations and forwarding the originals to the court, with copies made for both HSCs an APS specialist is assigned as back-up for the purpose of seeing the client, documenting the contact, and preparing reports as needed.These are maintained in the specified W drive and may be printed as needed by with specialist.
(3) If, in the opinion of the APS specialist or the DDSD case manager, the AV appears to have achieved competency, the APS specialist reports this opinion in writing to the court.The court is then authorized to set another hearing for the purpose of determining competency.
9.(a) APS staff provides information to DDSD staff to assist in evaluation of a client known or suspected to have a developmental disability.The case manager for a client receiving DDSD services facilitates and cooperates with the APS investigation by providing requested information and accompanying the APS specialist on home visits when needed.
(1) When APS is assisted by DDSD on a case, a copy of Form 08AP002E is routed to the appropriate DDSD case manager upon completion of the investigation.
(2) An example of a situation when APS and DDSD staff coordinate activities is when the AV has developmental disabilities and is facing criminal charges.
(b) When a client receiving APS services appears to have developmental disabilities but does not receive DDSD services, DDSD Intake staff or other appropriate staff may accompany the APS specialist, only when absolutely necessary, on home visits and assist in making application for DDSD services.When APS is assisted by DDSD on a case, a copy of Form 08AP002E is routed to the appropriate DDSD case manager upon completion of the investigation.
(c) If the APS specialist suspects the AV has developmental disabilities, the APS specialist calls the DDSD Area Intake office to determine whether the client receives DDSD waiver services or is on the waiting list.To make a referral for DDSD waiver services or DDSD state funded services, the APS specialist contacts the appropriate DDSD Area Intake office.
(1) DDSD has three Area Intake offices.
(A) Area I includes Oklahoma City and Enid.The toll-free number is 1-800-522-1064.
(B) Area II includes Tulsa.The toll-free number is 1-800-522-1075.
(C) Area III includes Pauls Valley.The toll-free number is 1-800-522-1086.
(2) The APS specialist describes the situation and gives details to the DDSD intake worker regarding the person who may be in need of DDSD services.Details include the AV's:
(A) name;
(B) Social Security number;
(C) date of birth;
(D) address;
(E) phone number;
(F) diagnosis;
(G) medical information;
(H) name of responsible party or legal guardian; and
(I) any other pertinent information.
(3) The DDSD intake worker explains to the APS specialist the DDSD services available, if any, and how to access services and/or make application for DDSD services.
(d) If, after consultation with DDSD staff, it appears the AV may be eligible for DDSD waiver services but is not yet receiving them, the APS specialist informs the AV and/or the AV's responsible party or legal guardian that the AV may be eligible for DDSD waiver services.The APS specialist advises how to apply for services and offers to assist in completing and signing the DDSD waiver application and obtaining all required documents, such as physical and psychological reports.
(1) If the family does not want or need the APS specialist's help in applying for DDSD waiver services, the APS specialist may provide the family the appropriate DDSD Area Intake number so they can make their own application.In this case the APS specialist informs the local DDSD staff that the family was referred to the DDSD Area Intake office and may need services.If there is no family, responsible party or legal guardian or these persons are the alleged perpetrator, the APS specialist may assist the DDSD intake worker with the application.
(2) DDSD maintains a waiting list of clients when resources are unavailable for persons to be added to services funded through the Home and Community-Based Services Waiver. The waiting list is maintained in chronological order based on the date of receipt of a written request for services.For emergency situations, exceptions to the chronological order may be made, in accordance with OAC 317:40-1-1(g).
(e) A referral is made by the APS specialist to DDSD Quality Assurance on all waiver services or state funded services clients.A copy of Form 08AP002E is routed to DDSD Quality Assurance upon completion of the APS investigation.
(f) When a complaint alleges abuse, neglect, or exploitation of a person with developmental disabilities by an OKDHS employee, refer to OAC 340:5-3-6 (c).
(g) If, in the course of an investigation, the APS specialist discovers the vulnerable adult is a Hissom class member, the report is immediately communicated to OCA.OCA may return the report to APS for investigation since OCA has the right of first refusal on investigations involving former residents of the Hissom Memorial Center.
10.Final investigative findings are faxed, mailed, or e-mailed in summary form to OSDH.See Instruction 5 for OSDH contact information.
340:5-5-6. Provision of protective services to clients receiving APS services
Revised 11-1-07 6-1-08
(a) Voluntary protective services.Protective services may be provided on a voluntary basis when a vulnerable adult consents to provision of services, requests services, and is willing to allow the Adult Protective Services (APS) specialist to provide or arrange for services as authorized by Section 10-106 of Title 43A of the Oklahoma Statutes (43A O.S. § 10-106).
(b) Payment for protective services.The cost of providing voluntary or involuntary protective services is borne by the client if the APS specialist determines that the person is financially able to make payment or by any private or public programs for which the vulnerable adult is eligible.If a caretaker controls the person's funds and refuses to pay for necessary services, this may be construed as caretaker interference and is handled as described in OAC 340:5-6(b)(3) (3) of this subsection.¢1
(1) Payment for voluntary services.If voluntary services are required to meet an emergency need and no other payment source is available, procedures described in OAC 340:5-5-6(b)(3) (3) of this subsection are followed.In cases where the services are not to meet an emergency need, the APS specialist arranges for voluntary services if:
(A) services can be provided free of charge;
(B) the client has funds and agrees to pay for the services; or
(C) there is a public or private assistance program available to pay for the services.
(2) Payment for involuntary services.Payment for involuntary protective services is made from the client's funds only upon order of the court.If payment is required for involuntary services, procedures described in OAC 340:5-5-6(b)(3) (3) of this subsection are followed if:
(A) no funds are available from the client's assets; and
(B) no private or public payment source is available.
(3) Payment for emergency protective services.The Oklahoma Department of Human Services (OKDHS) maintains a limited APS Emergency Fund that may be accessed only when specific criteria are met.This fund is used as a short-term measure for crisis situations until other arrangements are made.¢2
(c) Court-related services.All petitions or motions filed with the court regarding a vulnerable adult require the signature of the district attorney (DA), assistant district attorney (ADA), or OKDHS Legal Division attorney.
(d) Non-cooperation of caretaker.When a vulnerable adult consents to receive protective services but the caretaker refuses to allow the provision of services, OKDHS may petition the court for an injunction prohibiting the caretaker from interfering with the provision of protective services in accordance with OAC 340:5-5-6(e) subsection (e).¢3
(e) Petitioning the court - order enjoining caretaker.When the client's caretaker refuses to allow the provision of protective services to which the client has consented or otherwise interferes in the provision of services, OKDHS may petition the court for an Order to Enjoin Caretaker.¢ 4
(f) Refusal to consent to protective services.If a vulnerable adult does not consent to the provision of needed services, or withdraws consent after it is given, the APS specialist documents the client's refusal in the case narrative or on Form APS-2 08AP002E, Adult Protective Services Report of Investigation.Services are terminated unless OKDHS determines that the person lacks capacity to consent.In that case, the APS specialist considers action as outlined in OAC 340:5-1-4.
(g) Involuntary protective services.Involuntary protective services are authorized by 43A O.S. § 10-107 of Title 43A of the Oklahoma Statutes.If a vulnerable adult is suffering from abuse, neglect, or exploitation that presents a substantial risk of death or immediate and serious physical harm to self, or significant and unexplained depletion of the adult's estate, but lacks the capacity to consent to receive protective services and no consent can be obtained from anyone acting as caretaker, the services may be ordered by the court on an involuntary basis.The court authorizes provision of specific services that the court finds least restrictive of the rights and liberty of the person involved.
(h) Petitioning the court - emergency order for involuntary protective services.OKDHS may petition the court for an order to provide emergency protective services.The petition is made in the county of the client's residence or in a county where any of the protective services are provided.¢5
(1) If an emergency order to provide protective services is issued by the court, the order includes the appointment of a temporary guardian for the person in need of services.The temporary guardian may be either OKDHS or an interested person.The order gives the temporary guardian authority only to consent to the specified protective services on behalf of the person.¢6
(2) The vulnerable adult, temporary guardian, or any other interested person may at any time petition the court to have the emergency order set aside or modified.
(i) Notice to recipient.The court sets a date to hear the case.The hearing is scheduled within five days of the date the judge signs the notice to the recipient of protective services.The vulnerable adult must receive notice 48 hours in advance of the hearing.Notice may be waived by the court in emergency cases, as described in OAC 340:5-5-6(i)(2) (2) of this subsection.
(1) A court order is issued showing OKDHS has petitioned the court for an order to provide protective services, and giving the date, time, and place of the hearing.The order specifies who serves the notice to the client.¢7
(2) When petitioning the court for an order for emergency protective services, OKDHS may file a motion to waive notice if there is a risk that immediate and reasonably foreseeable death or serious physical harm to the person will result from a delay.This action is authorized by Section 43A O.S. § 10-108.D of Title 43A of the Oklahoma Statutes.In response, the court may enter a 72-hour verbal order if not during regular court hours or issue a limited order during regular hours and order written notice be served on the client and attorney, if known, of a hearing to be held within that 72-hour period. ¢8
(3) If the hearing is declined, the court may either terminate the emergency temporary guardianship or enter a temporary 30-day order to provide involuntary protective services.
(j) Emergency services responsibilities for out-of-home placements.As a result of a substantiated investigation, determination of capacity to consent, needs, and risk assessment, the APS specialist develops a service plan to address the identified needs and safety issues.¢ 9All out-of-home placements, including any change of placement, of clients under APS guardianship, are reported to and subject to approval of the court.Only protective services that are necessary to remove the conditions immediately threatening the life and well-being of the person are ordered.Protective services that may be authorized by an emergency court order include a change of residence only if the court gives specific approval for such action and names the facility in its order.Emergency placements may be made to nursing homes, personal medical institutions, other home placements, or other appropriate facilities.Emergency placement is not made to facilities for the acutely mentally ill.
(1) When the service plan recommends out-of-home placement for safety, health, and care needs, the APS specialist discusses this plan with the client.The client is provided with all the information necessary to make an informed decision.This may include visits to a variety of placement options arranged or facilitated by the APS specialist.The client's family, if appropriate and approved by the client, are is included in the planning stages.The client or family is provided with all the information available to the APS specialist regarding the quality of care provided by the identified and selected placement.
(2) Information on current quality issues of specific nursing facilities are obtained from a variety of sources to determine the appropriateness of a facility for a client receiving APS services.Placements are determined by the local APS specialist and supervisor, with approval from the county director and area APS field liaison.If a facility has any Oklahoma State Department of Health (OSDH) deficiencies at or above the actual harm level, or has had more than three substantiated Long Term Care Investigations (LTCI) reports in the past year, the placement must be approved by the APS state program office.¢ 10
(k) Time limits for providing involuntary emergency protective services.Protective services under an emergency court order other than a 72-hour order may be provided for 30 days.If the APS specialist determines protective services are required past this 30-day period, a petition is filed for continuation of involuntary protective services in accordance with (I) of this Section.
(l) Continuation of services.Continuation of services is authorized by Section 43A O.S. § 10-108.L of Title 43A of the Oklahoma Statutes.
(1) If, upon expiration of the original 30-day order, the vulnerable adult continues to require protective services, OKDHS immediately files a motion for the court to order either or both:
(A) appointment of a guardian; and
(B) commitment of the vulnerable adult to a nursing home, personal medical institution, home placement, or other appropriate facility other than a facility for the acutely mentally ill.
(2) Before the court enters a six-month order for continued protective services, the court directs that a comprehensive evaluation of the vulnerable adult is conducted and submitted to the court within 30 days at a review hearing.The evaluation includes at least:
(A) the address where the person resides and the name of any persons or agencies presently providing care, treatment, or services;
(B) a summary of the professional treatment and services provided the person by OKDHS or other agency, if any, in connection with the problem creating the need for protective services; and
(C) a medical, psychological or psychiatric, and social evaluation and review, including recommendations for or against maintenance of partial legal rights and recommendations for placement consistent with the least restrictive environment required.
(3) The original order continues in effect until the evaluation is submitted and the hearing is held on the motion.
(4) Notice of this hearing is served as described in OAC 340:5-5-6(i) subsection (i).
(5) The APS specialist is responsible for assembling the required information and submitting it to the court of jurisdiction.
(6) When an investigation indicates that the vulnerable adult is likely to need assistance with his or her affairs for an extended period of time, consideration is given to identifying a relative, friend, or other person interested in the well-being of the client to serve as permanent guardian.Any person interested in the welfare of a person believed incapacitated or partially incapacitated may file a guardianship petition with the court.Procedures for filing the petition are given in Section 30 O.S. § 3-101 of Title 30 of the Oklahoma Statutes, the Oklahoma Guardianship and Conservatorship Act.Interested persons are referred to the office of the district court clerk for further information and assistance.
(m) Continuation of services for an additional period.If after the hearing the vulnerable adult is found in need of continued protective services, the court issues an order to continue the temporary guardianship to provide specified protective services for an additional period not to exceed six months 180 calendar days, as authorized by Section 10 108.L of Title 43A of the Oklahoma Statutes 43A O.S. § 10‑108.If after the 180 calendar days the vulnerable adult is still found in need of protective services, the court may renew the order every six months as needed.
(n) Sale of real property.In the event that temporary guardianship extends for more than one year or the client owns real property that must be sold in order to qualify for SoonerCare (Medicaid), OKDHS may as temporary guardian sell the real property of the vulnerable adult pursuant to the provisions of the Oklahoma Guardianship and Conservatorship Act and as directed by the OKDHS Legal Division.The fact that the vulnerable adult would be in jeopardy for receipt of SoonerCare (Medicaid) if the property was not sold shall be stated in the court order directing the sale of the real property.
(o) Sale of personal property.The court may issue an order authorizing OKDHS to sell personal property of a vulnerable adult when additional resources are required to pay for necessary care for the vulnerable adult.
(np) Responsibilities of the temporary guardian of the person or estate.The APS specialist as temporary guardian is responsible for ensuring, to the extent possible, protection of the client residence, resources, and belongings.This includes:
(1) securing the residence, checking and gathering the mail, and feeding or arranging for care for the client's domestic animals or livestock;
(2) inventorying the client's home and personal property, using a video camera where available.
(A) For enhanced accountability a minimum of two people must be present during the inventory, one of whom is a law enforcement representative or non-OKDHS employee. ¢ 11
(B) All persons present during the inventory must sign a document attesting to the authenticity of the inventory and/or the video recording noting the date and their professional affiliation;
(3) establishing an account at a local financial institution and depositing any cash and uncashed checks; and¢ 1112
(4) securing other valuables located during the inventory.The APS specialist:
(A) arranges to have the locks changed or padlocks the residence to secure it from intrusion, if necessary; and
(B) advises all parties that no one is allowed to enter the residence unless accompanied by a representative of OKDHS, for as long as the temporary guardianship is in effect.
(oq) Additional responsibilities of temporary guardian of the estate.The APS specialist responsible for the temporary guardianship of the estate:
(1) opens a guardianship account in a local financial institution and regularly collects and deposits monies due to the client;
(2) submits an accounting to the court as ordered by the court, no less than quarterly annually;
(3) works with the court, the client's attorney, the DA, and the OKDHS Legal Division to obtain a professional accountant to manage the estate; and
(4) absent the availability of professional financial management, is responsible for regular financial activities as dictated by the client's circumstances, which include, but are not limited to, the timely:
(A) payment and documentation of the client's expenses, and other bills as they occur. ¢ 13 Cash transactions require documentation of APS supervisory approval and a signed and witnessed receipt from the recipient of the cash;
(B) deposit of funds received;
(C) redirection of incoming funds to the new account; and
(D) protection of existing accounts.
(pr) Responsibility of APS specialist - involuntary protective services.In cases where temporary guardianship of the person has been granted to OKDHS, the APS specialist provides, arranges, or facilitates the protective services ordered by the court.This may include, but is not limited to:
(1) hiring of in-home caregivers to provide in-home care and protection for the client;
(2) placement in a medical facility for treatment of health related problems;
(3) placement in a safe and anonymous location;
(4) placement in a facility for either short or long term care needs.Long term care facilities include:
(A) residential care facilities;
(B) group homes;
(C) nursing homes;
(D) intermediate care facilities for persons with mental retardation;
(E) assisted living centers;
(F) skilled nursing facilities; or
(G) or any other type of facility licensed to provide 24-hour care and/or services for vulnerable adults.¢ 1214
(5) The APS Specialist applies for any state or federal programs on behalf of the vulnerable adult or makes arrangements for facilities to be paid from the client's funds or resources.
(qs) Responsibility of APS specialist - emergency out-of-home placement - ex-parte hearing.When an emergency situation requires immediate placement, the APS specialist places the client in a licensed facility that, to the best of the APS specialist's knowledge, provides the required services needed to ameliorate the current emergency situation.Reasons for this choice are documented in the case record and provided to the court at the 72-hour hearing.
(t) Enforcement of involuntary court orders.In order to enforce the involuntary order of protective services, the court may order:
(1) forcible entry of the premises of the vulnerable adult to be protected;
(2) transportation of the vulnerable adult to another location; or
(3) the eviction of a person from any property owned, leased, or rented by the vulnerable adult and restricting that person from further access to any property of the vulnerable adult.
INSTRUCTIONS TO STAFF 340:5-5-6
Revised 11-1-07 6-1-08
1.The Adult Protective Services (APS) specialist may assist a client in making application for public or private assistance programs by:
(1) completing application forms; and
(2) gathering documentation necessary to determine eligibility.
2.(a) Form 08AP017E, APS Emergency Request, is completed if If the APS specialist determines a client needs emergency services for which no payment source is available an APS Emergency Request, is completed and submitted in the Emergency Fund Section of the APS Computer System.Authorization to utilize the APS Emergency Fund is approved when:
(1) obtained from an APS programs field representative the client is a vulnerable adult with an open referral and has an emergency as defined by policy OAC:5-1-6;
(2) approved on a case-by-case basis the APS specialists has verified the client has no funds to pay for the services and family members and local or area resources are unwilling or unable to assist;
(3) specific to each item or service needed all Oklahoma Department of Human Services (OKDHS) programs that the client may be eligible for have been applied for;
(4) requested only after personal, family, and community resources have been requested and denied or exhausted.all federal programs have been explored and or applied for;
(5) the Service Plan Section is completed on the APS Computer System describing how the emergency fund expenditures will reduce risk, address needs, and prevent the need for future Emergency Fund expenditures;
(6) the Emergency Fund Section of the APS Computer System is completed and submitted; and
(7) the supervisor and field liaison's reviews of these circumstances and approvals are documented in the Notes Section of the APS Computer System.
(b) The APS reports containing the Emergency Fund Requests are to remain open until the human services center (HSC) has been notified of the payment of all pending claims.
(c) Forms 23C0135E, Vendor Information, and 02AD001E, Aging Services Division Claim, are completed as needed for each vendor and the originals are sent to Family Support Services Division (FSSD) Adult Protective Services Unit (APS) within 10 working days of the approved request.
(d) When claims have been paid in the Emergency Fund Section of the APS Computer System, FSSD APS Unit staff;
(1) approves or denies the request(s);
(2) documents the approval or denial in the Emergency Fund Section of the APS Computer System;
(3) processes all claims upon receipt;
(4) documents tracking of claims; and
(5) notifies HSC staff when claims have been paid in the Emergency Fund Section of the APS Computer System.
3.The date, time, and circumstances of the client's consent are documented in the case record narrative or Capacity to Consent Section of the APS Computer System and on Form 08AP002E, Adult Protective Services Report of Investigation.
4.(a) The APS specialist explains to the caretaker the legal responsibility of the Oklahoma Department of Human Services (OKDHS) to provide the needed services and authority to obtain an injunction if necessary.Family members and other interested parties may be involved in the attempt to persuade the caretaker to allow provision of services.If, after reasonable attempts have been made to persuade the caretaker to allow the needed services to be provided, the caretaker still refuses to allow service provision, OKDHS may petition the court for an injunction prohibiting the caretaker from interfering with the provision of protective services.The petition alleges specific facts sufficient to show that the:
(1) vulnerable adult is in need of protective services;
(2) vulnerable adult consents to receive the needed services; and
(3) caretaker refuses to allow the provision of such services.
(b) The APS specialist documents the date, time, and circumstances under which consent was obtained from the person in need of protective services, as well as the circumstances surrounding the caretaker's refusal to allow service provision.
(c) If the court finds that the person is in need of and consents to protective services and that the caretaker refuses to allow provision of those services, the court may enter an order enjoining the caretaker from interfering with provision of services.
(d) If a caretaker continues to refuse to allow provision of protective services after an injunction has been issued by the court, OKDHS requests assistance from law enforcement officials to implement the court order.
5.(a) The APS specialist must have a face-to-face interview with the client within 24 hours prior to the filing of a petition for involuntary services.
(b) The petition must have "approved as to form" by the district attorney, assistant district attorney, or the OKDHS Legal Division and must include:
(1) the name, age, and address of the vulnerable adult determined in need of services;
(2) the nature of the abuse, neglect, or exploitation;
(3) the specific services needed; and
(4) information relating to the capacity of the vulnerable adult to consent to services and OKDHS attempts to obtain consent.
(c) Whether a petition for involuntary services is filed in the county of residence or the county where services are provided, the county of residence is the lead county and remains primarily responsible for the case, including documentation of the case record and coordination of service planning for the client.When two or more counties are involved with a client receiving involuntary services, close communication and coordination is required to ensure the client's needs are met.
(d) If a client's residence later changes to the county where services are provided, the case is transferred to the new county of residence.If the former county of residence still has an active court case on the client, the county of court jurisdiction informs the county of residence of any and all information requested by the court with as much lead time as possible, until the court order expires.If continued court action is needed, it is initiated in the new county of residence.
6.The services to be provided must be specifically listed in the court order, including the names of any facilities or agencies which will be service providers for the client.
7.The APS specialist usually serves the notice on the person who is the subject of the petition unless the situation is potentially dangerous, in which case the APS specialist may request assistance from a law enforcement officer.If the client has retained or been appointed an attorney, notice is served on the attorney, which constitutes service on the client.
8.If the APS specialist is uncertain whether the circumstances warrant a waiver of notice, the APS specialist staffs the situation with the APS specialist IV or area APS field liaison before presenting the petition and evidence to the court for a decision.
9.See OAC 340:5-5-3, Instructions to Staff 5 and 6 for additional information.
10.These include, but are not limited to, reviewing Oklahoma State Department of Health (OSDH) survey reports, Long Term Care Investigations (LTCI) records, and information available from the Long Term Care Ombudsman at the local Area Agency on Aging office.The APS state program office in the Family Support Services Division (FSSD) provides periodic updates on what information is available and how to access it.Names of facilities that have had their license suspended or revoked or been decertified for SoonerCare (Medicaid) within the past year or have a current restriction on new admissions imposed by OSDH are placed on a list maintained by FSSD.Clients are not placed in those facilities without thorough documentation of other placements attempted and the reason those would not work.Preferences expressed and decisions made by clients receiving APS services and their guardian, caretaker, or next of kin are also thoroughly documented in the case record.
11.Exceptions to this must be approved by the county director and documented in the Notes Section of the APS Computer System.
1112.(a)The account must be established using the name of the APS specialist and one other OKDHS employee.
(b)The account information is documented in the Estate Management Section of the APS Computer System.Financial institutions that require Social Security numbers are given the OKDHS federal identification number (FEI).In no instance does the APS specialist provide their personal Social Security number for a client's financial account.
13.Cash transactions require documentation of APS supervisory approval and a signed and witnessed receipt from the recipient of the cash.
1214.Involvement of the client and his or her family is desirable in all cases to the extent they are able to be safely involved.
(1) Any time an out-of-home placement is considered, the APS specialist assesses the:
(A) client's preferences and desires;
(B) family preferences and desires;
(C) client's medical condition, needs, and recommendation of physician;
(D) unique circumstances of the client's situation in order to provide appropriate and safe level of care;
(E) availability of facilities to meet clients needs;
(F) acceptance of client by facility; and
(G) payment arrangements, availability, and affordability.
(2) This assessment criteria is documented in the case record and made available at the request of the court in the form of a written report.
